To amend title XVIII of the Social Security Act to provide for the treatment of certain hospitals as critical access hospitals under the Medicare program.
Sponsors
Legislative Progress
IntroducedMr. LaMalfa introduced the following bill; which was referred to …
Summary
What This Bill Does
This bill allows certain rural hospitals to keep their "Critical Access Hospital" (CAH) status under Medicare, even if they don't meet the usual requirement of being located more than 35 miles from other hospitals. It specifically helps hospitals that were originally designated as CAHs before 2002, were still certified as of December 31, 2024, and are the only hospital in their county.
Who Benefits and How
Rural hospitals that lost their CAH certification due to location technicalities are the primary beneficiaries. These hospitals receive higher Medicare reimbursements under CAH status—Medicare pays 101% of their actual costs instead of using a fixed payment schedule. This extra revenue helps them stay financially viable. Rural communities also benefit by preserving access to local healthcare, avoiding the need to travel long distances for medical care.
Who Bears the Burden and How
Federal taxpayers and the Medicare program bear the costs. Cost-based reimbursement for CAHs is more expensive than the standard Medicare payment system, so this bill increases Medicare spending. The Centers for Medicare & Medicaid Services (CMS) also faces additional administrative work to track and verify which hospitals qualify for this exemption.
Key Provisions
- Exempts qualifying rural hospitals from the 35-mile distance requirement for CAH status
- Only applies to hospitals that were designated as CAHs before January 1, 2002
- Hospitals must have been certified as of December 31, 2024
- Only applies if the hospital was the sole healthcare provider in its county when it lost certification
- Provides "deemed certification" so hospitals don't need to reapply
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Allows certain rural hospitals that lost Critical Access Hospital (CAH) status to regain it by exempting them from location requirements under Medicare.
Policy Domains
Legislative Strategy
"Grandfather in specific rural hospitals that lost CAH status due to location technicalities, protecting their Medicare reimbursement rates and preventing closure"
Likely Beneficiaries
- Rural hospitals designated as CAH before 2002 that recently lost certification due to location requirements
- Rural communities served by these sole-provider hospitals
- Hospital operators and staff who would otherwise face closure or reduced reimbursement
Likely Burden Bearers
- Medicare program (increased costs from cost-based reimbursement vs. prospective payment)
- Federal taxpayers (funding Medicare)
- CMS administrators (additional certification and oversight complexity)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_state"
- → State government health agencies responsible for CAH designation
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
A rural hospital designation under Medicare that provides special reimbursement and regulatory flexibility, originally established under Section 1820 of the Social Security Act (42 U.S.C. 1395i-4)
A facility that: (i) was designated as a critical access hospital before January 1, 2002; (ii) as of December 31, 2024, was certified by the Secretary as a critical access hospital; and (iii) as of the date notified of loss of certification, was located in a county with no other hospital, critical access hospital, or rural emergency hospital
The statutory requirement that critical access hospitals must be located more than 35 miles from another hospital (or be certified by the State as a necessary provider)
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology