National Rural Health Association

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Policy Positions

After seven years of the approval of an issue paper or policy brief, that paper automatically undergoes a two-part review process. If the Rural Health Congress does not make a decision on the paper or brief within eight years of approval or if the congress votes to archive a paper, it is no longer considered an official position of NRHA. All policies will be kept on file but separate from current, active policies.

If you have any questions about any of these papers or if you are an NRHA member and would like to revisit/update any of these papers, please contact NRHA's Government Affairs office at 202-639-0550 or

The positions listed below are in the chronological order that they were originally adopted by the Rural Health Congress (formerly the Rural Health Policy Board).

Access To Automatic External Defibrillation
— February 2003

Access to Health Care for the Uninsured in Rural and Frontier America
May 1999

Antitrust and Rural Health
— May 1996

Community Health Advisor Programs

November 2000

Emergency Medical Services, Paper #13 to the "The Rural Health Careers Pipeline" series

 -- November 2005

Facilitating the Use of National Surveys in Rural Health Research
— May 1998

Federal Medicaid Reform: A Rural Perspective
— May 2003 (Updated May 2007)

Federal Medicaid Reform: A Rural Perspective
— April 2004 (Updated May 2007)

Funding of Graduate Medical Education Updated
— February 1998

HIV/AIDS in Rural America: Disproportionate Impact on Minority and Multicultural Populations

— July 2004 (This is an update of the HIV/AIDS in Rural America policy paper from November 1997)

Health Insurance Access in Rural America

-- March 2004

Impact of Entitlement Programs on Rural Health
— May 1995

Long-Term Care in Rural America

May 2001

Meeting Oral Health Care Needs in Rural America

-- April 2005 

Mental Health in Rural America
May 1999

National Agenda for Rural Minority Health
— May 1999

National Agenda for Rural Minority Health: Recruitment and Training of Health Professionals 

April 2001

National Agenda for Rural Minority Health: The Need For Responsive Rural Health Delivery Systems

July 2001

National Agenda for Rural Minority Health: The Need for Standardized Data and Information Systems

— April 2001

National Health Policy Reform: The Rural Perspective
— September 1992

Niche (Limited-Service) Hospital Providers

-- May 2005

Nursing, Paper #2, to the "The Rural Health Careers Pipeline" series

-- December 2005 

Pharmacist's Right to Refuse Service, Policy Statement, August 2005

While NRHA respects a pharmacist's right to refuse to fill some prescriptions, these refusals cannot obstruct both a prescribing clinician's authority and the ability of rural patients to access prescribed medications. NRHA supports the American Medical Association resolution of June 20, 2005 and encourages state laws that would allow prescribing clinicians to dispense medication directly to patients when no willing pharmacist is located within 30 miles. AMA Resolution

Quality of Rural Health Care

-- December 2003 

Reforming the Universal Service Fund

— May 2003

Role of Telemedicine in Rural Health Care
— February 1998

Rural America's Health Care Safety Net Providers

— March 2002

Rural and Frontier Emergency Medical Services Toward the Year 2000
— May 1997

Rural Graduate Medical Education

— June 2003

Rural Health Clinics in Rural America
— February 1997 (updated November 2006)

Rural Health Professions

— January 2004

Rural Physician Recruitment and Retention
November 1998 

Rural Veterans: A Special Concern for Rural Health Advocates
— May 2004 (Updated February 2007)

Strengthening the Role of International Medical Graduates in Providing Access to Health Care for Rural America

— March 2003

Vision for Health Reform Models for America's Rural Communities
— February 1998


Letters of support for legislation

NRHA endorses legislation that aligns with its legislative and regulatory agenda and will benefit the health of rural America.  Here is a selection of support letters sent by NRHA.

HR 3458 Pilot Program on Brain Injury - Aug. 12, 2008

HR 6557 Veterans Critical Access Act - July 22, 2008

HR 6163 Medicare Telehealth Enhancement Act - July 9, 2008

HR 6331 Medicare Improvements for Patients and Providers Act - June 25, 2008

Defecit Reduction Act Letter to Speaker Pelosi - Apr. 14, 2008

Defecit Reduction Act Letter to Majority Leader Reid - Apr. 14, 2008

S 2786 Medicare Rural Health Access - March 24, 2008

Presidential Budget Letter to President Bush - Feb. 1, 2008

HR 2419 Farm Bill - July 17, 2007

HR 2606 340B Program Improvement and Integrity Act - July 6, 2007

HR 1651 Rural Health Quality Advisory Commission Act - March 23, 2007 


2013 OIG report 

NRHA's Response to the Office of Inspector General's Report on Critical Access Hospitals 

The Office of Inspector General at the Department of Health and Human Services released a report that, if fully implemented, could close hundreds of rural hospitals across the nation, reducing access to health care for millions of rural patients while costing taxpayers more money.

The 34-page report on critical access hospitals (CAHs) asks Congress to allow CMS to strip CAH status from any facility that came into the program under state "necessary provider" designations.

For some states this could mean that as many as 70% of CAHs could lose the status. Read the full report here

In response, NRHA has sent a letter to House and Senate leadership about the vital importance of CAHs.

Your elected officials need to hear from you about the work your CAH does for your rural community. 

Contact your senators and representatives today to let them know how important critical access hospitals are in your state.

NRHA has put together a number of talking points about the vital importance of these facilities.

NRHA hosted a webinar to layout the concerns we have about this report and the challenges that CAHs may face on Capitol Hill in the near future.

The slides used on the webinar are available here. A recording of the webinar is available here 


Past appropriations 

In an effort to ensure full funding of essential federal rural health programs, NRHA is constantly monitoring the federal appropriations process. Here you will find the latest news, updates and supporting materials on the funding of federal rural health programs.

Please note, the federal fiscal year (FY) begins Oct. 1 and ends Sept. 30. FY 2013 is from Oct. 1, 2012, to Sept. 30, 2013.

National Rural Health Association Fiscal Year 2013 Appropriations Chart

Descriptions of Rural Safety Net Programs

 Fiscal Year 2013 Resources

 Fiscal Year 2012 Resources 

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