Over the past several years, Congress has passed short-term extenders for critical rural health programs and designations. To ensure rural patient and provider stability, NRHA urges Congress to permanently extend or enact at least a 5-year extension for these programs. A series of short-term extenders put rural hospitals in an uncertain position that makes long-term financial planning more difficult and ultimately undermines the benefit of the programs.  

Medicare Telehealth Flexibilities: Medicare telehealth flexibilities that rural providers have relied on since 2020 must be made permanent in order to incentivize rural provider investment in telehealth and expand rural access to care. These flexibilities are set to expire on December 31, 2027. NRHA supports the CONNECT for Health Act (S. 1261/H.R. 4206), which would make permanent the Medicare telehealth flexibilities that have been in place since 2020 and for the first time enact payment parity for rural health clinics (RHCs) and federally qualified health centers (FQHCs). These flexibilities include removing geographic restrictions, allowing the home as an originating site, authorizing audio-only telehealth, and expanding the types of practitioners eligible to furnish telehealth services. 

Medicare Dependent Hospitals (MDHs) and Low-Volume Hospital (LVH) Designations: Congress must extend MDH designation and LVH payment adjustment for at least 5 years in recognition of these 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 December 31, 2026. NRHA supports the Rural Hospital Support Act (S. 335) and the Assistance for Community Hospitals Act (H.R. 1805) and urges Congress to pass these bills to extend these hospital designations past January 30, 2026.   

Rural Ground Ambulance Payment Add-ons: 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 payment add-ons are set to expire on December 31, 2027, and must be extended. NRHA supports and urges Congress to pass the Protecting Access to Ground Ambulance Medical Services Act (S. 1643/H.R. 2232). 

Section 131 Reset Opportunity:  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 for Graduate Medical Education. However, this reset opportunity lapsed 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.