Rural Advocacy and Policy

America’s rural hospitals are committed to serving their communities and ensuring local access to high-quality, affordable health care. The AHA is working to ensure federal policies and regulations are updated for 21st century innovation and care delivery, and new resources are invested in rural communities to protect access.

On this page, you can find our most up to date rural advocacy agenda, our rural report, the latest AHA regulatory advisories, comment letters, fact sheets and more.


Featured Resources 

Image of the Rural Health Special BulletinCMS Clarifies Guidance on Hospital Co-Location for CAHs
According to CMS hospital co-location guidance is not applicable to CAHs due to the regulatory requirements that they be at least 35 miles or 15 miles by secondary roads or mountainous terrain from another acute care hospital. Specifically, since most CAHs have to meet the distance requirements, co-locating with another hospital would not be an option for them because doing so would mean they no longer meet the distance requirement. However, while this guidance is not applicable to most CAHs, CMS clearly provides that they are allowed to co-locate with other health care facilities, such as physician offices, visiting specialists, rural health clinics or federally qualified health centers. Read the AHA Special Bulletin here.


  • CMS Funding 1,000 New Residency Slots for Hospitals Serving Rural & Underserved Communities. On December 17, CMS issued a final rule that will enhance the health care workforce and fund additional medical residency positions in hospitals serving rural and underserved communities phasing in 200 slots per year over five years. Also, CMS finalized its proposed policies to implement the Promoting Rural Hospital GME Funding Opportunity, which will provide an adjustment to IME and direct GME FTE resident caps each time an urban and rural hospital establish a Rural Training Track (RTT) program. 
  • OSHA withdraws ETS for occupation exposure to COVID-19. The Department of Labor’s Occupational Safety and Health Administration Dec. 27 announced it is withdrawing its health care emergency temporary standard (ETS), originally issued June 21. Read the AHA Special Bulletin with more details on this withdrawal. 

  • CMS issues interpretive guidance for vaccine mandate rule. The Centers for Medicare & Medicaid Services Dec. 28 released interpretive guidance, as well as updated its Frequently Asked Questions for its Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule. Read AHA’s Dec. 29 Special Bulletin for more details. 

  • USCIS issues guidance on expedited work permit renewals for health care workers. The U.S. Citizenship and Immigration Services Dec. 28 released guidance on how health care workers can receive expedited renewal of their Employment Authorization Document. Health care workers whose permits are expiring in 30 days or less can find out if they qualify for expedited processing using pages 7-9 of this DHS advisory memorandum

Learn More About the Rural Advisory Groups


2022 Rural Advocacy Agenda

2022 Rural Advocacy Agenda Cover

View and download the 2022 Rural Advocacy Agenda here.

AHA-Supported Bill Would Fix Medicare ACO Benchmarking Flaw, June 15, 2021

A coalition of 13 health care organizations, including the AHA, today voiced support for the Accountable Care in Rural America Act, bipartisan legislation that would revise the benchmarking formula for the Medicare Shared Savings Program to ensure participating accountable care organizations have an equal opportunity to share in savings regardless of their geographic location. This legislation fixes an important flaw in the current MSSP benchmarking methodology – a flaw that systematically disadvantages many ACOs, including a high proportion in rural areas, and makes it harder for them to achieve savings even when they improve quality and reduce costs,” the groups said in a letter of support for the bill. View the entire letter here.

Rural Health Special Message: HHS Announces Funding for Rural COVID-19 Response, June 9, 2021

Rural Health Special Message: HHS Announces Funding for Rural COVID-19 Response

Rural Health Special Message: HHS Announces Funding for Rural COVID-19 Response, June 8, 2021 here.

Final Recommendations: Future of Rural Health Care Task Force, May 2021

Final Recommendations Future Of Rural Health Care Task Force, May 2021

View and download the Final Recommendations Future Of Rural Health Care Task Force, May 2021 here.

Rural Health Special Bulletin; March 11, 2021

Rural Health Special Bulletin; March 11, 2021

View and download the Rural Health Special Bulletin here.

Coronavirus Aid, Relief, and Economic Security (CARES) Act: Provisions to Help Rural Hospitals

Provisions to Help Rural Hospitals

View and download the CARES Fact Sheet here.



Additional Resources

                        Rural Voices Video