On January 30, 2026, the Medicare-Dependent Hospital designation, Low-Volume Hospital payment adjustment, rural ground ambulance add-on payments, and Medicare telehealth flexibilities will expire. NRHA urges Congress to permanently extend or enact at least a 5-year extension. A series of short-term extenders put rural hospitals in an uncertain position that makes long-term financial planning more difficult and undermines the benefit of the programs. It is critical that Congress continues to extend these critical programs that support the rural health infrastructure. 

Medicare Telehealth Flexibilities Extenders: Medicare telehealth flexibilities that rural providers have relied on since 2020, including extending distant site status to RHCs and FQHCs, must be made permanent. These flexibilities are set to expire on January 30, 2026. NRHA supports the Telehealth Modernization Act of 2025 (H.R. 5081), which extends Medicare telehealth services until FY27 and also creates payment parity for RHCs and FQHCs furnishing telehealth care, a needed reform to ensure our rural clinics can provide telehealth services.

Medicare Dependent Hospitals (MDHs) and Low-Volume Hospital (LVH) Designations: Congress must extend MDH designation and LVH payment adjustment or at least 5 years in recognition of rural hospitals’ low volumes and significant Medicare patient population. Hospitals need predictability and certainty around Medicare reimbursement for budgeting and planning purposes. These designations will expire after January 30, 2026. NRHA supported the Rural Hospital Support Act (S. 1110) and the Assistance for Community Hospitals Act (H.R. 6430), in the 118th Congress.  NRHA urges Congress to pass S. 335/H.R. 1805 to extend these hospital designations past January 30, 2026.  

Rural Ground Ambulance Payments Extenders: Additional Medicare reimbursement for ground ambulance services in rural areas is critical and must be extended for at least 5 years. Rural ambulance providers are lifelines for timely emergency care but face financial challenges due to low call volumes and high operational costs. These extenders are set to expire on January 30, 2026. NRHA supported the Protecting Access to Ground Ambulance Medical Services Act (S. 1643/H.R. 2232) in the 118th Congress.

Section 131 Reset:  Section 131 of the Consolidated Appropriations Act of 2021 (CAA, 2021) provides eligible hospitals with a one-time opportunity to reset their low or zero Per Resident Amounts (PRAs) and Medicare full-time equivalent (FTE) resident caps. However, this reset opportunity sunsets on December 26, 2025, and many rural hospitals have not been able to take advantage of it. NRHA asks Congress to swiftly enact another 5-year extension of the PRA and cap resetting period first established in Section 131 to grow the number of residents training in rural areas.

Please find NRHA’s expiring rural health Medicare extenders leave behind here.