The Halliday Brief — March 30, 2026
- ◆ S. 1868 clears committee — VA care at your local CAH moves closer
- ◆ RHTP technical assistance meeting — today at 3 p.m. CT, Teams link on RHTP page
- ◆ Dakota Conference early bird closes — tomorrow, March 31
- ◆ Round 1 workforce grants: 31 days remaining
This week's Brief expands its lens from Bismarck to Washington. Senator Cramer's Critical Access for Veterans Care Act cleared the Senate Veterans' Affairs Committee earlier this month — and for North Dakota's rural hospitals, the implications are worth understanding carefully before the bill reaches the floor.
We also have two events on the calendar that deserve your attention before the week is out: an ND HHS technical assistance call on RHTP this afternoon, and the NDHA Leadership Conference in Bismarck starting Wednesday. Details on both below.
DosonFounder, Von Halliday Consulting · MinotCramer's Critical Access Bill Clears Committee — ND's CAHs Could Become VA Care Sites
The Critical Access for Veterans Care Act passed the Senate Veterans' Affairs Committee overwhelmingly this month, opening a potential new patient pipeline for rural hospitals already under financial pressure.
North Dakota has one VA Medical Center — in Fargo — and eight Community-Based Outpatient Clinics spread across the state. Only five of the towns that host those clinics also have a Critical Access Hospital, leaving veterans in the remaining 32 communities caught between a VA system too far away and a local Critical Access Hospital they cannot yet use for VA-covered care.
Senator Kevin Cramer's Critical Access for Veterans Care Act (S. 1868), co-sponsored by Senator Tim Sheehy of Montana, aims to change that. The Senate Veterans' Affairs Committee advanced the bill overwhelmingly on March 18, sending it toward a full Senate floor vote. The legislation establishes a pilot program to improve care coordination for eligible veterans who receive care from a critical access hospital or an affiliated provider-based rural health clinic.
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ND · SD · MT · WY · NV · AK
How It Works
The pilot is open to critical access hospitals in any state designated by CMS as a frontier state — a category that includes North Dakota, South Dakota, Montana, Wyoming, Nevada, and Alaska.1 Veterans eligible to participate are those enrolled in VA health care who live within 35 miles of a participating CAH and who qualify for the VA Community Care Program through existing pathways: drive time, wait time, or lack of a particular service at a VA facility.2,3
Once a veteran opts into the pilot, VA shall provide a one-year authorization to receive outpatient services at the participating CAH.4 Critically, the Secretary of Veterans Affairs may not require a covered veteran to receive prior authorization or a referral before receiving care under this provision.4
On reimbursement — the question most hospital administrators will ask first — the committee print directs VA to establish criteria ensuring appropriate reimbursement rates, including through the consideration of cost-based reimbursements.5 This is a directive to consider cost-based rates, not a mandate; the original bill would have required them outright, but that provision was removed during committee markup.6
VA is required to conduct annual outreach to eligible veterans in pilot areas and to participating CAHs directly.7,8 The bill also requires VA to submit annual reports to Congress covering the facilities that opted into the pilot, the number of veterans participating at each site, the types of care delivered, and the Secretary's recommendation on continuation or expansion.9
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Pilot Program Directives
What S. 1868 Requires of VA
Key VA obligations under the committee print · Five-Year Pilot · Frontier States Only
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| ◆ | Conduct annual outreach to eligible veterans in pilot areas to notify them of their ability to participate |
| ◆ | Conduct direct outreach to CAHs in pilot areas on their ability to join |
| ◆ | Issue one-year authorization upon opt-in for outpatient services at participating CAH |
| ◆ | Consider cost-based reimbursement rates — directed, not mandated |
| ◆ | Submit action plan within one year to identify and eliminate rural veteran care barriers |
| ◆ | Report annually on participating facilities, veterans enrolled by site, and types of care received |
| Source: S. 1868 (Committee Print), Secs. 2–3 · March 18, 2026 Committee Advance | |
Rural Veterans Action Plan
A separate provision requires VA to develop a comprehensive action plan — within one year of enactment — to identify, address, and eliminate barriers to care for veterans in rural, highly rural, and frontier areas.10 The plan must include consultation with rural health providers, tribal health authorities, and state partners; a barrier assessment covering network adequacy, transportation, provider participation, and infrastructure; and measurable strategies to address each.11 Implementation must begin within 90 days of the plan's submission.12
North Dakota's Stake
The state's critical access hospitals are already navigating RHTP grant deadlines, Medicaid uncertainty, and workforce shortages. For those facilities, the pre-authorization waiver and the directive to consider cost-based VA reimbursement represent two concrete operational improvements — a potential new covered patient population and a simpler path to getting paid for serving them.
The committee print was the result of a lengthy negotiation with committee Democrats.6 Senators Sanders and Hirono voted against the bill even in its scaled-back form, signaling how far apart the committee's two wings remain on rural health financing.6 Still, the pre-authorization removal, the outreach mandates, and the action plan requirement are real wins for rural providers.4,7,8,10
The committee print reflects the friction that exists in Washington, both broadly around rural health reimbursement and more specifically around the ongoing debate over VA Community Care. Following bipartisan negotiations ahead of the markup, the bill was narrowed from its introduced form — but the version that emerged is still among the more innovative rural access models the Senate Veterans' Affairs Committee has advanced in recent years, with its effort to better integrate Critical Access Hospitals into the VA care delivery network representing a genuine shift in how the federal government thinks about rural veteran access.
For CAH administrators, two provisions warrant close attention. The pre-authorization waiver is operationally significant — it removes the single biggest administrative friction point between CAHs and VA patients. The reimbursement question is less settled: VA is directed to consider cost-based rates, not required to adopt them, and the practical viability of participating in the pilot will hinge on how VA exercises that discretion in rulemaking. Organizations in frontier states should begin scenario-planning around both outcomes now.
ND HHS Technical Assistance Call Is at 3 p.m. CT — Teams Link on RHTP Page
ND HHS is hosting a technical assistance meeting this afternoon specifically for critical access hospital staff to ask questions about the Round 1 workforce retention funding opportunity. This is the most direct line to the people running the program before the April 30 deadline.
RHTP Workforce Retention Grant — Q&A for CAH Staff
Time: 3:00 p.m. CT, Monday, March 30, 2026
Format: Microsoft Teams — link and call-in number posted on the RHTP page
Who it's for: Critical access hospital staff interested in the Round 1 workforce retention funding opportunity
Purpose: Open Q&A — bring your questions about eligible uses, application requirements, and the grant process
This is a targeted technical assistance session — not a broad stakeholder briefing — so the format will be question-driven. Organizations still evaluating whether to apply have a direct opportunity to get answers from ND HHS before the window closes. Eligible uses for the workforce retention grants include retention bonuses, tuition reimbursement, child care partnerships, professional development, and mentorship programs. The application deadline is April 30 at 5:00 p.m. CT.
ND HHS will require a W-9 form to set up each organization in their contract system. If your organization wants to receive payment via electronic funds transfer, you will need to submit the substitute IRS Form W-9 ahead of award. A grant agreement template is available on the RHTP funding page for review — note that it is illustrative only, and actual terms may vary.
Come prepared with specific questions about the scoring criteria and sustainability rubric. ND HHS has emphasized it wants this process to be easy and seamless — if it isn't, they want to know. That posture makes this call worth your time even if your application is already underway. The W-9 requirement is easy to overlook; confirm your organization has it ready before submission.
Dakota Conference on Rural Health Returns June 3–4 in Grand Forks — Early Bird Closes Tomorrow
The region's premier rural health gathering is reimagined for 2026 with a tighter format and a sharper focus on leadership, workforce, and innovation. Early bird registration and exhibitor spaces both expire March 31.
Early Bird Registration & Exhibitor Space
Both participant early bird registration and exhibitor space close March 31, 2026. Exhibitor spaces are first-come, first-served and may close before the deadline if capacity is reached.
The 2026 Dakota Conference on Rural Health takes place June 3–4 at the Alerus Center in Grand Forks, organized by the UND Center for Rural Health in partnership with the UND College of Nursing and Professional Disciplines, the North Dakota Rural Health Association, and Altru Health System. This year's conference has been deliberately restructured — condensed to one and a half days — in direct response to feedback from past participants and exhibitors.
The agenda includes three keynotes, 21 breakout sessions, poster presentations, an exhibitor floor, a legislative panel, and an awards program. The 2026 theme centers on leadership, workforce, and innovation in rural North Dakota communities. For hospital administrators and health system leaders who track rural policy, the legislative panel is a standing draw.
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The abstract submission window for presentations closed January 9, 2026. Accepted poster presenters must submit handouts and slides by April 30, 2026 for online posting ahead of the conference. Registration fee scholarships are available through the UND Center for Rural Health for those with financial barriers to attendance.
For organizations navigating the RHTP, Medicaid uncertainty, and workforce pressures simultaneously, the Dakota Conference is one of the few venues where state agency staff, legislators, tribal health leaders, and CAH administrators are all in the same room. The legislative panel in particular is worth the trip. If you haven't registered, the early bird deadline is tomorrow — the rate difference is material. Exhibitor spaces are first-come, first-served and may already be limited.
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1RHTP TA Call Today · 3 p.m. CT ND HHS technical assistance for CAH staff on the Round 1 workforce retention grant. Teams link at hhs.nd.gov/rural-health-transformation. If you missed it, check the same page for a recording or follow-up summary.
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2NDHA Leadership Conference Apr 1–2 · Bismarck The North Dakota Hospital Association's annual leadership gathering convenes Wednesday and Thursday at the Bismarck Event Center. Thursday's agenda includes an AHA federal update, an NDHA state legislative update covering 2027 priorities and RHTP project proposals, and a panel with Senators Cleary and Roers and Representative Stemen. Registration at ndha.org/events/leadership2026.
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3RHTP Round 1 Deadline 31 Days April 30 at 5:00 p.m. CT. A strong application needs a clear theory of change, quantifiable retention metrics, and alignment with CMS's sustainability scoring rubric. Confirm your W-9 is ready before you submit — ND HHS requires it to set up your organization in the contract system.
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4RHTP Rounds 2–3 Grant Windows Access expansion, telehealth, healthy lifestyles, and technology grants open in rapid succession after April 30. Two ND HHS workforce and infrastructure surveys launching soon will shape how those awards are structured — completing them is a direct line to influencing how the remaining $189M gets designed.
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5Medicaid Work Requirements — June 1 Rulemaking Ahead CMS must issue an interim final rule by June 1, 2026 establishing the binding implementation framework for Medicaid work requirements. States must implement by January 1, 2027. North Dakota's roughly 23,000 expansion enrollees are subject to the new rules. Full analysis in next week's Brief.
1 S. 1868 (Committee Print), Sec. 2(c): frontier state designation by CMS.
2 S. 1868 (Committee Print), Sec. 2(i)(2)(C): 35-mile proximity threshold.
3 S. 1868 (Committee Print), Sec. 2(i)(2)(D) and Sec. 2(i)(2)(A): Community Care Program eligibility, 38 U.S.C. § 1703(d)(1); enrollment under 38 U.S.C. § 1705(a).
4 S. 1868 (Committee Print), Sec. 2(d): one-year authorization. Sec. 2 (amending 38 U.S.C. § 1703(d)(5)): no prior authorization required.
5 S. 1868 (Committee Print), Sec. 2(b)(2)(D): consideration of cost-based reimbursements.
6 Colleague briefing notes, legislative assistant to Sen. Cramer, provided to Von Halliday Consulting, March 2026.
7 S. 1868 (Committee Print), Sec. 2(e)(1): annual veteran outreach.
8 S. 1868 (Committee Print), Sec. 2(e)(2): CAH outreach.
9 S. 1868 (Committee Print), Sec. 2(h): annual congressional report requirements.
10 S. 1868 (Committee Print), Sec. 3(a): rural veterans action plan, one-year deadline.
11 S. 1868 (Committee Print), Sec. 3(b)(2): barrier assessment scope.
12 S. 1868 (Committee Print), Sec. 3(c): 90-day implementation start.
The Halliday Brief is published weekly by Von Halliday Consulting. It synthesizes federal and North Dakota state rural health policy developments for administrators, clinicians, tribal health leaders, foundation officers, and state-level decision-makers who need accurate, actionable intelligence — without wading through agency websites and legislative reports themselves.
If a colleague should be reading this, forward it. If you have a policy question, a funding opportunity your organization is navigating, or a challenge that deserves a closer look — reach out.
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