FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

Rural Hospitals | FAH Policy Blog Team

Protecting Rural Hospitals: Five Ways Policymakers Can Make A Difference

While National Rural Hospital Week, November 18-22, is a time to celebrate all of the things that make rural America unique, it is also a time to address the ways policymakers can support access to quality health care for the 60 million Americans who reside in rural communities.

There are five policy areas that lawmakers can champion to protect health care in rural America – the Rural ACO Improvement Act, Medicaid Disproportionate Share Hospital (DSH) payments, Telehealth, Broadband and the Medicare Dependent Hospital (MDH) and Low Volume Hospital (LVH) programs.

Rural ACO Improvement Act

Recently, the FAH, along with 14 other health care organizations, sent a letter in support of a Senate bill that would revise the benchmarking formula for the Medicare Shared Savings Program.

Senators Catherine Cortez Masto (D-NV) and Pat Roberts (R-KS)’s legislation, the Rural ACO Improvement Act (S. 2648), would help ensure accountable care organizations (ACOs) in smaller communities have an equal opportunity to share in the program’s savings. Currently, not all ACOs are treated equally. This flaw in the system hurts programs in rural areas solely because of their geographic location and scope of care.

The FAH letter states, “This legislation fixes an important flaw in the current MSSP benchmarking methodology – a flaw that systematically disadvantages ACOs in rural areas and makes it harder for them to achieve savings even when they improve quality and reduce costs on par with their counterparts in urban areas.”

This bipartisan bill would fix this issue and level the playing field to further incentivize health care coordination in rural areas. FAH encourages Congress to enacts this legislation.

Medicaid Disproportionate Share Hospital (DSH) Payments

Safety-net hospitals throughout the United States are dependent upon Medicaid DSH payments that help offset the costs of care hospitals incur treating Medicaid and low-income patients, and further preserves access to care in rural America.

In FY 2020, hospitals are scheduled to endure Medicaid DSH cuts of $4 billion that would be detrimental to health care in rural America.  We urge Congress to enact legislation that will eliminate, or at a minimum delay, these cuts.


Telehealth is pivotal to bringing personalized care to rural America. New technological advancements can increase timely access to patient-centered care, enhance patient choice and, through early intervention, can help prevent long-term, costly health events for many of the folks who call rural America home.

Specialty care is becoming harder and harder to find in rural communities, the use of telehealth reduces geographic challenges and provides patients convenient and more timely access to providers.

As the utilization of telehealth continues to grow, FAH believes that it should be reimbursed by Medicare, Medicaid, private insurance and other payers at the same level as when those services are delivered in person. Reimbursements should not discriminate based on the technology used. The use of telehealth should be encouraged by federal policies, especially those with a focus on access to care in rural America.


Using telehealth in rural areas expands access to and improves the quality of health care millions of Americans receive. However, there is often a lack of infrastructure in place to achieve the expansion of telehealth – namely, a lack of broadband internet.

And while broadband is used in everything from agriculture to education, expanding rural America’s access to reliable internet service is pivotal to increasing access to quality health care for rural communities. Policymakers everywhere – at the federal, state and local level – should work to promote the deployment and availability of broadband nationwide, especially in rural areas. Americans should have access to quality health care, and broadband is an important step to achieve that goal in rural areas.

Medicare Dependent Hospital (MDH) & Low Volume Hospital (LVH) Programs

The Medicare Dependent Hospital (MDH) and the Low Volume Hospital (LVH) payment programs should be made permanent to ensure patient access to hospitals in rural America. These programs, which currently sunset in 2022, help relieve some of the financial pressure on rural providers.

FAH is committed to the permanent extension of the MDH and LDH programs that are essential for rural hospitals to continue to serve their communities. We urge policymakers to permanently extend these vital programs.

FAH will continue to work with policymakers to achieve the above goals in order to increase access to quality health care for the 60 million people who call rural America home.