The Centers for Medicare and Medicaid Services reduced funding to $10 million nationally for the 2026 Navigator Program for states using the federally facilitated marketplace, Healthcare.gov. A unanimous, bipartisan effort by the PA Legislature in 2019 moved Pennsylvania away from the federally facilitated marketplace, Healthcare.gov, to a state-based exchange, Pennie. This shields Pennsylvania from these cuts and from the ebbs and flows of federal funding fluctuations. It has allowed Pennsylvania to take control of operations and customer services at a significantly lower cost and use the financial savings to launch a reimbursement program to lower premiums. See the CMS Press Release.

Income, assets and household size determine eligibility for some Medicaid and Medicare programs. The Pennsylvania Health Law Project (PHLP) has a resource library with helpful guides to assist consumers with enrollment into the Medicare Savings Program, Part D Extra Help, Medical Assistance for Workers with Disabilities and other programs.

HHS recently released the HIPAA Security Rule to Strengthen Cybersecurity of Electronic Protected Health Information (PHI). The proposed rule attempts to address cybersecurity best practices, methodologies, and guidelines that would significantly impact Community Health Centers. Please view the recording and PowerPoint slides from NACHC’s February webinar on the proposed rule to learn more. We will circulate a comment letter template on Friday, Feb. 28, so FQHCs can tailor their feedback and ensure their voice is heard. The deadline for comments is Friday, March 7. To help us craft a strong comment letter, please send your thoughts and feedback on the proposed rule to regulatoryaffairs@nachc.org.

House Republicans released a budget blueprint that orders the primary healthcare committee to slash spending by $880 billion. The Budget Committee draft is the first step in an expedited process known as budget reconciliation that Republicans are using to extend tax cuts from Pres. Donald Trump’s first term, as well as to fund border security, energy and defense initiatives. The budget resolution does not spell out how the Energy and Commerce Committee must find $880 billion in spending cuts over the next decade. But Medicare and Medicaid are by far the largest programs under its jurisdiction, and Trump has repeatedly vowed not to touch Medicare as he seeks to renew tax cuts for corporations and wealthy households that are due to expire at the end of the year. Source: NBC News

Pennsylvania Govern Josh Shapiro filed a lawsuit challenging the Trump Administration’s unconstitutional freeze of federal funding. Even after multiple court orders to release the federal funds and Gov. Shapiro’s engagement with Pennsylvania’s federal representatives, state agencies still remain entirely unable to access $1.2 billion in federal funding, with an additional $900 million requiring an undefined review by federal agencies before it can be drawn down. To ensure the interests of the commonwealth and its residents are protected, Gov. Shapiro is taking legal action to restore access to this funding.

Click here to learn more.

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.