HAP Resource Center

Fact Sheet: HAP’s Rural Health Agenda

Rural hospitals are bedrocks of their communities and anchors of the health care continuum.

They are struggling and need help to survive. Working together, the commonwealth’s leaders can protect rural Pennsylvanians’ health and hospital care.

Pennsylvania's rural hospitals support 69,500 jobs and drive $14 billion in annual economic impact.Regulatory Reform

Pennsylvania’s outdated hospital regulations hinder modern care delivery and are out of sync with rural needs. Rural hospitals should be relieved from certain requirements without having to maneuver a burdensome exceptions process.

  • Provide flexibility to support small hospital staffing for inpatient units.
  • Exempt rural hospitals from maintaining 24/7/365 access to post-surgical care.
  • Expand duties that can be safely performed by well-qualified advanced practice providers.
  • Eliminate administrative mandates that have no bearing on patient care or safety.


Workforce shortages threaten access to care. On average, Pennsylvania’s rural hospitals are trying to fill 28% of nursing support and 26% of registered nurse positions.

  • Offer grants and set requirements to encourage current providers to teach and supervise emerging practitioners in Federally Qualified Health Centers and other rural locations.
  • Bolster student loan repayment programs for nurses and primary care providers, with incentives for those who work in underserved areas.
  • Remove the collaboration agreement mandate for experienced nurse practitioners.
  • Increase the number of J1 visas to empower hospitals to recruit more international professionals.

5 rural Pennsylvania hospitals have closed in the last four years.Sustainable Operations

Rural hospitals care for fewer patients than their urban and suburban peers. They also rely heavily on below-cost payments from Medicare and Medicaid, despite the high fixed expenses of running a hospital.

  • Provide interim funds to stabilize hospitals when the Pennsylvania rural health model ends in 2024.
  • Develop and implement the next-generation payment model to sustain rural hospitals.
  • Provide low interest loans to support rural hospitals’ aging infrastructure.
  • Expand the options available for rural facilities by codifying the federal ‘Rural Emergency Hospital’ definition in state law.

Accessing Care

A shortage of rural emergency medical services (EMS) and other transportation providers makes it hard for patients to get to and from hospitals and move between different care settings.

  • Increase funding and maximum grants for Pennsylvania’s Fire and EMS Grant Program.
  • Help pay tuition for the next generation of EMS providers.
  • Legislate that payment cannot be denied simply because care is provided via telehealth.
  • Expand and improve Pennsylvania’s broadband infrastructure to support virtual care.

Behavioral Health

Without timely access to behavioral health care, patients’ symptoms can escalate to crisis. Too many patients face long waits in hospital emergency departments because it’s hard to find care for complex behavioral health needs.

  • Invest in community-based, peer support, and crisis programs and professionals.
  • Integrate mental health screening and treatment into primary care settings.
  • Enable timely patient transfers from hospitals to appropriate behavioral health care settings.

Big-Picture Challenges

Many health care challenges are amplified in rural communities.

Maternal Health Deserts

A 2023 March of Dimes report found 17 rural Pennsylvania counties have only moderate access to obstetric services or are maternity care deserts and nearly half of women in the commonwealth’s rural counties live more than 30 minutes from a birthing hospital. Hospitals need help to sustain high-quality maternal health care in rural communities.

Medical Liability

“Venue shopping” in medical liability cases stresses rural hospitals already on the brink. The looming threat of out-of-county lawsuits and higher insurance costs jeopardize care, particularly in critical areas like obstetrics. Elected leaders and the courts must work together to restore the effective, stabilizing measures they implemented two decades ago.

Continuum of Care

Especially in rural communities where services are already limited, it is essential to support every aspect of the continuum of care. When there aren’t enough home-based, community-based, post- acute, specialty, mental health, and other services, some patients come to the hospital sooner than may be necessary or stay longer despite being ready for discharge. Other patients must wait in the emergency department or to schedule non-emergent procedures when acute care beds are full.




Topics: Access to Care, Behavioral Health, Health Care Reform, Medical Liability, Public Health, Regulatory Advocacy, Rural Health Care, State Advocacy, Telehealth, Workforce

Revision Date: 5/15/2024

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