Bennet, Collins, Colleagues Press CMS to Grant Greater Flexibility to Rural Health Transformation Program Implementation

Jun 18, 2026 | Press Releases

Denver- Colorado U.S. Senator Michael Bennet, co-chair of the Senate Rural Health Caucus, and Maine Senator Susan Collins (R-Maine) led a bipartisan group of their colleagues to ask Dr. Mehmet Oz, Administrator for the Centers for Medicare and Medicaid Services (CMS) to grant greater flexibility to ensure the successful implementation of the Rural Health Transformation Program (RHTP). The Senators stressed that RHTP provides a unique opportunity to address long-standing challenges. Senators Alex Padilla (D-Calif.) and John Hickenlooper also signed this letter.

"In rural communities across the country, hospitals and clinics serve as the backbone of local health care systems delivering emergency care, supporting maternal health, treating chronic illness, and standing ready to respond when lives are on the line. Its implementation is an important opportunity to strengthen care for the millions of Americans who rely on rural hospitals, clinics, and providers every day," began the senators.

For many rural communities, local hospitals and clinics are the front line for health care due to proximity. These institutions serve farmers and fishermen injured during harvest season, seniors managing chronic illness, families seeking maternity care close to home, and patients facing medical emergencies where every minute matters. Due to this, when rural hospitals struggle financially, the effects are felt far beyond the health care system. Communities lose jobs, families lose access to lifesaving care, and patients are forced to travel even further for care.

Rural health care systems across the country are facing enormous challenges. Over 200 rural hospitals have closed or cut inpatient services since 2010, and more than 45 percent of remaining facilities are operating in the red. Now that the $50 billion in funds is being distributed, RHTP is officially underway and all 50 states have their initial funding. As currently structured, the guidance for implementing the RHTP places many of our rural hospitals and clinics at a disadvantage unintentionally, even though they are the frontline providers that need this funding the most.

"Rural Americans deserve reliable access to high-quality care close to home. Our recommendations aim to strengthen the hospitals and providers that communities rely upon in moments of crisis and every day in between. Low reimbursement rates from public payers paired with low volumes are a major contributor to rural hospital financial instability. RHTP provides a unique opportunity to address these long-standing challenges and set rural hospitals up for success on their road to transformation," continued the senators.

This letter is endorsed by the Colorado Hospital Association, Colorado Rural Health Center, Eastern Plains Healthcare Consortium, Federation of American Hospitals, National Association of Rural Health Clinics, and National Rural Health Association.

"The National Rural Health Association supports Senators Bennet and Collins' bipartisan letter to CMS addressing methods to strengthen the Rural Health Transformation Program (RHTP). In order to protect the integrity of this historic investment, it is critical that CMS ensure funds reach the rural health facilities they were intended for. Providing greater flexibility for provider payments, workforce investments, and health information technology, while ensuring smaller and independent rural providers can meaningfully access funding opportunities, will help RHTP fulfill its purpose of strengthening rural health care systems and improving access to care in rural communities," said Alan Morgan, CEO of the National Rural Health Association.

"For this unique investment to be truly transformational, it is imperative that these dollars flow to rural providers, including the 5,800+ CMS-certified Rural Health Clinics across the country. "We greatly appreciate the leadership of Senators Bennet and Collins to ensure necessary flexibilities in implementation to ensure these funds go where they are needed most," said Sarah Hohman, Director of Government Affairs for the National Association of Rural Health Clinics.

"The Colorado Hospital Association appreciates Senators Bennet and Collins for their bipartisan leadership in advocating for a Rural Health Transformation Program that reflects the realities facing rural providers. Rural hospitals are the backbone of their communities, delivering essential care while navigating significant financial, workforce, and operational challenges. The recommendations outlined in this letter would help ensure RHTP funding reaches the providers serving patients on the front lines and provide the flexibility states need to address the unique needs of their rural communities. We encourage CMS to work closely with rural providers and state partners to ensure these dollars achieve their intended purpose of strengthening rural access to care," said Jeff Tieman, President & CEO of the Colorado Hospital Association.

"RHTP is an opportunity to advance rural healthcare nationwide. However, it must be implemented in a way that does not leave out the smallest rural healthcare providers who are often at the very forefront of the rural safety net care delivery system. The Colorado Rural Health Center enthusiastically supports the bipartisan reforms and adjustments laid out in this letter and in particular would like to ask your consideration of requests to ensure that funds are flexible to meet local needs and improve sustainability of facilities and providers," said Michelle Mills, CEO of the Colorado Rural Health Center.

Bennet remains committed to ensuring Coloradans in rural areas have access to the best health care available. In May 2026, Bennet and U.S. Senator Chuck Grassley (R-Iowa) led the unanimous Senate passage of the Rural Community Hospital Demonstration Reauthorization Act to extend a lifeline to rural hospitals across the country, including four in Colorado. In March, Bennet joined U.S. Senator Jerry Moran (R-Kan.) to introduce the Rural Hospital Revitalization Act, which would provide zero-interest loans through the U.S. Department of Agriculture (USDA)'s Community Facilities Program to qualifying hospitals for new construction or renovation of existing hospital facilities. In February, Bennet celebrated the passage of six of his health care bills: the Accelerating Kids Access to Care Act, REAL Health Providers Act, Medicare Multi-Cancer Early Detection Screening Coverage Act, Give Kids a Chance Act, PREEMIE Act Reauthorization, and Prescription Drug Supply Chain Pricing Transparency Act.

In November 2025, Bennet joined Senators John Barrasso (R-Wyo.), Tina Smith (D-Minn.), and Marsha Blackburn (R-Tenn.) in designating November 20, 2025, as National Rural Health Day. In July 2025, Bennet and Barrasso introduced the Accelerating the Development of Advanced Psychology Trainees Act, bipartisan legislation to increase access and coverage to behavioral, psychological, and mental health services in rural areas. In April 2025, Bennet and Representative Jeff Hurd (R-Colo.) held a roundtable discussion with rural health providers on the Western Slope to discuss challenges to providing high-quality care in Colorado's rural communities.

The text of the letter is available HERE and below.

Dear Administrator Oz:

We are writing to express our bipartisan support for successful implementation of the Rural Health Transformation Program (RHTP) and to respectfully request your consideration of targeted adjustments.

In rural communities across the country, hospitals and clinics serve as the backbone of local health care systems delivering emergency care, supporting maternal health, treating chronic illness, and standing ready to respond when lives are on the line. Its implementation is an important opportunity to strengthen care for the millions of Americans who rely on rural hospitals, clinics, and providers every day.

For rural communities throughout the country, local hospitals are far more than health care facilities. They are often the only emergency room within hundreds of miles, the only labor and delivery provider in a region, the primary source of behavioral health services, and the front line for primary and preventive care. Rural hospitals care for farmers injured during harvest season, seniors managing chronic illness, families seeking maternity care close to home, and patients facing medical emergencies where every minute matters.

These providers are also economic anchors and trusted institutions within their communities. When a rural hospital struggles financially, reduces services, or closes altogether, the effects are felt far beyond the health care system. Families lose access to lifesaving care, communities lose jobs and stability, and patients are forced to travel long distances for services that should be available close to home or move away from these health care deserts altogether.

At a time when many rural hospitals continue to face workforce shortages, rising operational costs, declining reimbursement, and persistent financial instability, it is essential that implementation of the RHTP reflects the realities facing rural providers on the ground. Congress created this program in recognition of the fact that rural providers require meaningful support to continue serving their communities and to build long-term sustainability for the future.

We are concerned, however, that the current structure and guidance for implementing the RHTP may unintentionally disadvantage many of the rural hospitals and clinics the program was intended to support. Larger systems and organizations often have substantially greater administrative capacity and resources to compete for and manage grant funding, while smaller rural providers - providers that need this funding the most - may lack the staffing, infrastructure, or technical support necessary to fully participate. In many instances, rural providers gain institutional support from larger systems to which they belong but still face the challenging economic realities of serving a rural population. In other instances, rural providers are completely independent and must face these challenges on their own. It is crucial that the RHTP be implemented to support providers caring for rural populations regardless of setting. Without clear protection and targeted support, there is a real risk that funding may not reach the frontline rural providers that communities depend upon most.

CMS's recent clarification that states may use provider payment funding for workforce recruitment and retention, infrastructure investments, technical assistance, systems development for alternative payment model participation, and support for non-clinical roles is a step in the right direction. These flexibilities recognize many of the practical challenges rural providers face and are important steps toward helping hospitals and clinics remain viable.

We believe that implementation can be improved further by lifting the cap on infrastructure and capital improvements for rural facilities, as many need significant improvement and equipment upgrades. We also believe that clarifying the permissibility of direct payments to providers is crucial.

At the same time, we ask for action to further strengthen the program to ensure it fully supports the needs of rural communities and providers by:

• Prioritizing direct support for rural hospitals, rural health clinics, and other essential rural providers that serve as primary access points for care in medically underserved communities;
• Allowing greater flexibility for states to use RHTP funds to enhance reimbursement for already billable services and help offset uncompensated care costs, recognizing that low reimbursement rates and low patient volumes continue to threaten the stability of rural providers;
• Revisiting the current limitations on electronic health record and health information technology investments, so rural hospitals can maintain and modernize the systems necessary to coordinate care, improve quality, and participate in value-based care arrangements; and
• Ensuring smaller and independent rural providers can meaningfully access funding opportunities and are not placed at a disadvantage.

Rural Americans deserve reliable access to high-quality care close to home. Our recommendations aim to strengthen the hospitals and providers that communities rely upon in moments of crisis and every day in between. Low reimbursement rates from public payers paired with low volumes are a major contributor to rural hospital financial instability. RHTP provides a unique opportunity to address these long-standing challenges and set rural hospitals up for success on their road to transformation.

Thank you for your continued work to support rural health care providers and the patients they serve. We appreciate your consideration of the adjustments we have requested and look forward to further engagement with you and your team to ensure RHTP fulfills its promise for rural communities across the country.

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