April 24, 2026

The President’s Message is published in the MHA Weekly News Report, a member-only publication of the Montana Hospital Association. To subscribe, click here.

This week, the Montana Hospital Association joined hospital leaders from across the country in Washington, D.C. for the AHA Annual Meeting and coordinated visits with Montana’s congressional delegation. Special thanks to Nick Dirkes (Frances Mahon Deaconess Hospital), Dr. Heidi Duncan and JJ Carmody (Billings Clinic), Dr. Kevin Harada (Northern Montana Hospital), Donna Neste (Vista Plains Health), and Dr. Kathryn Bertany (Bozeman Health) for sharing firsthand perspectives from their communities.

We emphasized the critical importance of protecting the 340B Drug Pricing Program, which 48 of our 63 hospitals rely on to sustain essential services—from emergency care to behavioral health, pharmacy support, and access programs for vulnerable patients. Proposed rebate models could effectively eliminate access to certain drugs for rural communities. Nick Dirkes shared how the program has both expanded options for prescription medications in his community, and how dismantling it will drive up healthcare costs and could close local pharmacies.

In addition, Donna Neste highlighted the growing challenges posed by commercial insurance practices and Medicare Advantage plans. The tactics of insurers are particularly burdensome for Critical Access Hospitals like her hospital in Harlowton, which have fewer resources to handle the growing number of prior authorization requests, denials, and delayed payments. While not the perfect or final solution, we urged support for policies like the Medicare Advantage Prompt Pay Act to bring greater accountability and timeliness to insurer payments.

Workforce remains a top concern. New caps on student loans for health professionals, CNA training in nursing homes and access to highly-trained foreign healthcare workers were on the agenda.

Dr. Harada led the discussion on the potential impact of proposed federal student loan caps on health professionals, which could limit the pipeline of nurses, nurse practitioners, and other critical providers that Montana’s rural facilities depend on. He also advocated for changes to the CNA lockout provision, a counterproductive feature of the Civil Monetary Penalty program that prohibits nursing homes with recent survey findings from training new CNAs—even if those survey findings are non-clinical in nature (such as an expired fire extinguisher inspection). JJ Carmody and Dr. Duncan explained how the new $100,000 fee added to J-1 Visa applicants has cut off access to foreign physicians and healthcare professionals, worsening our already severe workforce shortage.

Dr. Bertany and I led discussion on the RHTP program, emphasizing the need for flexibility in how funding can be utilized to provide the most benefit to healthcare facilities in Montana. Current CMS guidance does not provide for flexibility based on a state’s unique infrastructure, IT, and other needs.

These meetings are not just an opportunity to bring our messages to our delegation—they’re also a chance to listen. Sen. Tim Sheehy expressed the opportunity to re-train retired and discharged members of the military into civilian healthcare roles. It’s a topic we took up quickly with the Montana Department of Labor as it continues work on licensure reform and apprenticeships.

Thank you to the members for your continued advocacy and leadership on these issues.