Investing in childcare services creates jobs, allows caregivers to participate in the labor market, and provides opportunities for young families to remain in their rural communities — all of which contribute to a thriving regional economy. Research has shown that accessible, reliable childcare can help address local labor shortages and strengthen economic mobility for families.

Event: Rural Community Action Assembly: Childcare Demands and Workforce Needs
When: Thursday, March 27, from 10:00 a.m. to 11:30 a.m. ET
Where: Virtual

At this event, you will hear from experts and practitioners about strategies and best practices for supporting the local workforce through sustainable childcare services.

This event is for rural economic or workforce development organizations, policymakers and community leaders in rural regions, rural chambers of commerce, and current and potential childcare providers.

Participation is free, but registration is required. A video recording and event materials will be shared publicly after the session. Participants will have opportunities to engage with their peers, and all attendees will be encouraged to contribute to the conversation. Click here to register

For questions about this series, please contact Philip Jones at philip.jones@phil.frb.org.

This virtual meeting is a continuation of the Rural Community Action Assembly.

Update: On February 25, the White House issued an Executive Order to empower patients with clear, accurate, and actionable healthcare pricing information. Read the fact sheet for more information, which indicates the Departments of the Treasury, Labor, and Health and Human Services will:

• Ensure hospitals and insurers disclose actual prices, not estimates, and take action to make prices comparable across hospitals and insurers, including prescription drug prices
• Update their enforcement policies to ensure hospitals and insurers are in compliance with requirements to make prices transparent

Existing CMS guidance: Hospital Price Transparency regulations require each hospital operating in the U.S. to provide 1) a comprehensive machine-readable file with the standard charges for all items and services the hospital provides and 2) a display of shoppable services in a consumer-friendly format.

Additional resources available:

• Hospital Price Transparency Tools: CMS offers a suite of tools to aid hospitals in implementing hospital price transparency. These tools are designed to help facilitate compliance with regulations and enhance the accessibility of pricing information. The Online Validator ensures machine-readable files meet CMS template layouts and data specifications, enabling hospitals to identify and fix errors before publication. The HPT TXT Generator helps hospitals create the required cms-hpt.txt file, which contains information about the hospital and a direct link to the machine-readable file.
• Data Dictionary GitHub Repository: Here hospitals can access the CMS templates and data dictionary with technical instructions for encoding required standard charge information and get technical support.
• For any questions related to hospital price transparency, email PriceTransparencyHospitalCharges@cms.hhs.gov.

Compliance: CMS is planning a more systematic monitoring and enforcement approach, per the Executive Order. Consistent with standing CMS policies, non-compliance will be addressed with swift enforcement. See a list of enforcement actions to date and see a list, updated quarterly, of enforcement activities and their outcomes undertaken by CMS since the January 1, 2021, effective date.

CMS will host a series of public engagement events this spring as part of the Medicare Drug Price Negotiation Program. The virtual public engagement events will provide an opportunity for patients, beneficiaries, caregivers, consumer and patient organizations, and other interested parties, such as clinicians and researchers, to share input relevant to the drugs selected for the second cycle of negotiations.

CMS is interested in input relevant to the selected drugs, the condition(s) that the selected drug may be used to treat, and other medications that may be used to manage those conditions. This includes information related to the clinical benefits of the selected drugs compared to therapeutic alternatives, how the selected drugs address unmet need, and how the selected drugs impact specific populations.

CMS will use the information shared during the roundtable events to better understand patients’ experiences with the conditions and diseases treated by the selected drugs and patients’ experiences with the selected drugs themselves. CMS will use the information shared during the town hall meeting to better understand clinicians’ experiences prescribing and/or managing treatment with the selected drugs or therapeutic alternatives and clinicians’ considerations that drive treatment choice between the selected drugs and therapeutic alternatives. The information shared during both the town hall meeting and the roundtable events will also inform CMS’ identification of therapeutic alternatives, key outcomes, and adjustment of the starting point to develop the initial offer in negotiating with manufacturers of selected drugs. CMS will release redacted transcripts for the town hall meeting and each of the roundtable events, omitting participant names and other identifying information after all the events have ended.

Dates: The public engagement events will be held April 16 – April 30, 2025. Participant registration will be open until March 12, 2025.

Attendance: Anyone from the public may attend the town hall meeting livestream as a listener. Registration is not required, and the link to the livestream will be available here on April 30, 2025. Accommodation for people with disabilities and language assistance (e.g., interpretation) may be available.

Public Input Opportunities: There are two ways the public can share feedback and input with CMS:

• Public Engagement Events:
  • CMS will host one livestreamed town hall meeting for all selected drugs, focused on the clinical considerations related to the selected drugs. CMS encourages practicing clinicians and researchers, as well as other interested parties, to register to speak.
  • CMS will host 15 private (i.e., not livestreamed or open to press or general public) patient-focused roundtable events, one for each selected drug, which will be open to patients, patient advocacy organizations, and caregivers selected to speak at the events, and will allow for discussion among speakers.

Those who wish to make a public statement in the town hall meeting or to participate in a private roundtable event should register for the opportunity to speak at the public engagement events. Additional information to register for the events can be found here. For more information about the public engagement events, please see the Frequently Asked Questions document linked here.

If you are selected to speak at the event for which you registered, you will have 4 days after receiving the confirmation email to confirm your availability to participate at the selected event date and time, and any language interpretation services you need.

• Submitted Statement: CMS encourages the public to submit written input, if interested, in response to the CMS request for information about selected drugs and evidence about alternative treatments. Information can be submitted here by 11:59 PM PT March 1, 2025.

The public engagement events are subject to change, including postponement and/or cancellation.

Additional information on the public engagement events can be found here. Additional information about the Medicare Drug Price Negotiation Program can be found here.

The NRHA CEO Certification Program is celebrating five years of helping rural health Executives achieve their hospital and career goals. Since its first cohort launched in February 2020, the program has trained, tested and certified over 500 rural healthcare leaders, strengthening hospitals, clinics, and communities through certified rural health leadership.

“This program is essential for CAH or Rural CEOs, whether experienced, new, or aspiring. It absolutely builds assurance, confidence, knowledge, and a collegial trusted network,” – A recent CEO Certification Program graduate.

Introducing New Leadership Development Offerings

Witnessing the impact the programs have on individuals and their teams as they more confidently lead with increased knowledge and a new network of motivated successful peers CRHL is launching Cultural Transformation, a program designed to enhance leadership effectiveness and increase employee engagement. By fostering a thriving workplace culture, this initiative helps organizations, and their teams succeed while better serving their communities.

In addition to Cultural Transformation, CRHL is expanding its leadership development programs to include:

• Leadership Coaching: Personalized, one-on-one coaching to help leaders refine their strategies and drive meaningful change within their organizations.
• Executive Coaching: Specialized coaching for senior leaders to address challenges unique to rural health executives.
• Group Coaching:A cost-effective coaching alternative where diverse members collaborate in structured sessions to enhance leadership effectiveness.
• Rural Health Management Academy: A program designed to assist new and first-time rural health managers in strengthening leadership skills to ensure the long-term viability of rural hospitals, clinics, and communities.
• Rural Health Leadership Academy: A combination of self-guided and group learning, helping rural health leaders develop new leadership skills and improve the sustainability of rural healthcare delivery.

 “These expanded services represent the next chapter for CRHL,” said Sydney Grant, Chief Learning Officer at CRHL. “As we celebrate five years of empowering rural health leaders, we are excited to bring forward new opportunities for leadership growth and organizational success.”

 Looking Ahead

CRHL remains dedicated to improving rural healthcare by stabilizing hospitals through leadership education and engagement. By working alongside rural health executives and industry experts, CRHL continues to develop specialized programs that elevate leadership excellence, ensuring sustainable healthcare for rural communities.

Rural healthcare leaders and organizations interested in exploring these expanded offerings should reach out Kodi Smith, kodis@nrhasc.com or (309) 233-4228.

About the Center for Rural Health Leadership

The Center for Rural Health Leadership (CRHL) equips rural healthcare leaders with the knowledge and tools needed to create stronger, more sustainable healthcare organizations. Through specialized programs and expert-driven education, CRHL is committed to developing the next generation of rural healthcare leaders and strengthening healthcare in rural America.

From Becker’s Financial Management

Rural hospitals face mounting financial and operational challenges that threaten their long-term viability, with Medicare Advantage emerging as a growing pain point, according to a Feb. 20 report published by the American Hospital Association.

Many rural facilities continue to operate at a loss after years of turbulence, and the AHA warns that the rapid expansion of MA — along with the program’s ubiquitous challenges, including low reimbursement rates, payment delays and excessive prior authorizations — is straining rural providers and jeopardizing access to care.

“With MA plans accounting for more than half of total Medicare enrollment and growing, it’s more important than ever that the program works for patients and the providers who care for them,” AHA President and CEO Rick Pollack said. “It is critical for policymakers to address the harmful impact of Medicare Advantage’s low reimbursements and excessive administrative burdens to help ensure rural hospitals can continue to provide care to their patients and communities.”

Twelve things to know:

1. Rural hospitals receive about 90.6% of traditional Medicare rates on a cost basis from MA plans, according to the report. Quality of care is also affected, with 81% of rural clinicians reporting declines due to insurer requirements.
2. Rural MA patients also face longer hospital stays, spending 9.6% more time in the hospital before transitioning to post-acute care compared to similar traditional Medicare patients, according to the AHA.
3. Administrative burdens have also grown, with nearly four in five rural clinicians reporting an increase in administrative tasks over the past five years, and 86% saying these demands have negatively affected patient outcomes.
4. A survey cited in the AHA report found that nearly 80% of rural clinicians have experienced a rise in administrative tasks over the past five years, with 86% reporting negative effects on patient outcomes. Delays in MA plan approvals lead to longer hospital stays for patients awaiting post-acute care — 9.6% longer than traditional Medicare beneficiaries — further driving up costs for already struggling rural hospitals.
5. MA has grown rapidly in recent years, with about 32.8 million people (54% of the eligible Medicare population) now enrolled in an MA plan. In rural areas, the growth rate has been even steeper, with MA enrollment quadrupling since 2010, according to the AHA. At its current trajectory, MA is expected to cover most rural Medicare beneficiaries in the near future.
6. Many seniors opt for MA plans due to supplemental benefits, such as vision and dental coverage, as well as cost-sharing protections. However, for rural hospitals, this shift has led to significant financial and operational challenges.
7. Historically, traditional Medicare has reimbursed hospitals at rates below the cost of care, according to the AHA report, which found that MA plans pay even less, reimbursing rural hospitals at just 90.6% of traditional Medicare rates on average. For Medicare-dependent and low-volume hospitals, this rate drops to 85%, while critical access hospitals receive only 95% of their costs under MA plans.
8. This payment disparity cost rural hospitals an estimated $1 billion in 2023 alone. Given that Medicare accounts for a larger share of rural hospital revenue than urban hospitals — 43% versus 37% — these lower rates have an outsized impact on rural providers.
9. The AHA argues that the financial instability caused by MA policies is accelerating the closure and downsizing of rural hospitals. Over the past decade, more than 100 rural hospitals have closed or converted to other provider types. Additionally, 432 rural hospitals are at risk of closing, according to a Feb. 11 report from Chartis, a healthcare advisory services firm.
10. A conflicting study published in November 2023 by the American Journal of Managed Care found that increasing MA enrollment did not increase rural hospitals’ financial distress or risk of closing. Researchers studied rural hospitals in 14 states and found that MA enrollment in rural hospital counties grew from 14.3% of Medicare beneficiaries in 2008 to 28.4% in 2019. Additionally, the percentage of Medicare inpatient stays paid for by MA plans increased from 6.5% in 2008 to 20.6% in 2019.
11. When MA penetration increased by 1% in a county, hospitals’ financial stability increased slightly, and they experienced a 5% reduction in risk of closing, according to the AJMC study. One in 5 of the hospitals studied treated no MA patients during the study period. The findings challenge concerns that MA plans harm rural hospitals through lower payments or added administrative burdens.
12. With MA enrollment expected to continue to grow, the AHA has urged policymakers to ensure that rural hospitals can sustain operations while providing high-quality care. The report suggests several key reforms, including:

• • Streamlining prior authorization processes to protect timely access to medical care and drugs covered under the medical benefit.
  • Cost-based reimbursement for critical access hospitals from MA plans.
  • Ensuring prompt payment from insurers for medically necessary, covered healthcare services provided to patients.
  • Requiring MA plan clinicians who review coverage denials to share their name and credentials and ensure they meet CMS rules and have relevant training and expertise.
  • Improving data collection, reporting and transparency with a focus on metrics that are meaningful indicators of patient access, including appeals, grievances and denials.
  • Expanding network adequacy requirements for post-acute care sites.

Click here for more details on the AHA report.