Lawmakers Proposed Five-Year Rural Health Program Extension
The legislation allows rural hospitals in North Dakota to maintain flexible Medicare reimbursement models for five additional years.
Updated on Sept. 24, 2026 in Healthcare
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Senator John Hoeven and Representative Julie Fedorchak introduced legislation to extend the Frontier Community Health Integration Project by five years. The program enables rural healthcare providers to test alternative Medicare reimbursement methods to ensure long-term sustainability.
Why it matters
The proposal aims to bolster the financial stability of rural medical facilities and reduce overall Medicare costs by maintaining flexible service models. Providing certainty for these reimbursement structures is intended to help hospitals remain open in underserved areas.
The proposed bill would extend the Frontier Community Health Integration Project for 5 years. Currently, 3 of the 5 participating hospitals nationwide are located in North Dakota.
The players
John Hoeven
A United States Senator representing North Dakota with a focus on rural infrastructure and agricultural policy.
Julie Fedorchak
A member of the United States House of Representatives from North Dakota.
Jacobson Memorial Hospital Care Center
A rural healthcare facility currently testing alternative Medicare reimbursement models.
McKenzie County Healthcare Systems
A North Dakota-based hospital provider participating in federal rural health integration initiatives.
Southwest Healthcare Services
A critical access hospital participating in the federal testing of alternative health reimbursement methods.
The details
The Frontier Community Health Integration Project provides Critical Access Hospitals with regulatory flexibility to expand service lines beyond traditional mandates. Participating facilities, including Jacobson Memorial Hospital Care Center, McKenzie County Healthcare Systems, and Southwest Healthcare Services, use this authority to operate skilled nursing beds and fund integrated telehealth and ambulance services. The legislation would formally codify these reimbursements as companion measures in the House and Senate.
Timeline
September 23, 2026: Senator John Hoeven and Representative Julie Fedorchak introduced the legislation.
Market Landscape
The proposed legislation extends the Frontier Community Health Integration Project, following the pattern of previous pilot programs designed to test alternative rural reimbursement models. It reflects a broader federal strategy to preserve rural hospital access by moving away from traditional, volume-based payment schedules.
Rural operators should monitor the legislative calendar for the bill's advancement, as the extension directly impacts the ability to bill Medicare for non-traditional services like telehealth and skilled nursing. Facilities currently using these reimbursement models should prepare for potential continuity planning if the five-year extension is enacted.
The takeaway
The program extension underscores the federal government's pivot toward supporting rural hospital viability through specific, alternative Medicare reimbursement flexibilities. Hospital administrators should evaluate their reliance on these specific billing codes for telehealth and ambulance services in their current budget models.
Further reading
For more context on how regional policy shifts impact local providers, see Healthcare.
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Should the government provide extra Medicare flexibility to help sustain rural hospitals?
