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Congress·In Committee·3 months ago

House Bill Would Let Struggling Rural Hospitals Bypass Medicare's 35-Mile Rule for Critical Access Status

Also known as: Rural Hospital Closure Relief Act of 2025

Legislative Progress

✓ Filed
Review
House
Senate
President

Impacts

Positive Impacts(2)
Medicare
Helps
Chronic Illness
Helps

State Impacts

GuamGU
Positive

Lets HHS set an island-appropriate inpatient bed limit for critical access hospitals in Guam instead of the standard 25-bed cap used in states. This could make it easier for Guam’s small hospitals to keep or qualify for critical access status while meeting local needs.

American SamoaAS
Positive

Lets HHS set an island-appropriate inpatient bed limit for critical access hospitals in American Samoa instead of the standard 25-bed cap used in states. This may help maintain inpatient capacity without risking critical access status.

Northern Mariana IslandsMP
Positive

Lets HHS set an island-appropriate inpatient bed limit for critical access hospitals in the Northern Mariana Islands instead of the standard 25-bed cap. This may better fit remote-island hospital realities and help keep inpatient care available.

United States Virgin IslandsVI
Positive

Lets HHS set an island-appropriate inpatient bed limit for critical access hospitals in the U.S. Virgin Islands instead of the standard 25-bed cap. This can help preserve inpatient services while aligning rules to local capacity needs.

Key Points

  • Lets States ask Medicare to waive the usual 35-mile distance rule so certain struggling rural hospitals can qualify as “critical access” hospitals.
  • Only certain hospitals can use this path, and they must be in rural or near-rural areas and show financial trouble (including 2 straight years of losses).
  • Hospitals must file a plan to stay financially stable and agree to add or expand a high-need service in the community, like maternity care or mental health care.
  • Caps the program at 120 hospitals nationwide and no more than 5 per State, and it stops creating new designations after 9 years.
  • Health and Human Services must set the rules within 1 year; government watchdogs will study costs, access to care, and future rural hospital payment options.
HealthcareMedicare Medicaid

Milestones

2 milestones2 actions
Nov 20, 2025House

Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Nov 20, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

After HHS guidance is released and states set their process

States start selecting and certifying “necessary provider” hospitals for the new critical access pathway (within the national and per-state caps).

Some communities may see their local hospital get a financial lifeline; others may not if the state uses up its allowed slots.

After state certification pathways open

Eligible hospitals submit applications and attestations, including a plan to add or expand a high-need service line.

Hospitals may add services like maternity care or behavioral health, or expand capacity (for example, more clinic hours or staff).

Likely annually after certification

Some newly designated critical access hospitals begin regular reporting on their new/expanded service line; noncompliance can risk losing the designation.

Hospitals that don’t keep up with reporting or fail to follow through on service commitments could lose the payment boost, which could affect local access.

Related News

1 article
SFGATE·4 months ago

Calif. senator makes last-ditch effort to save rural hospital

Reports on a separate effort to address the Medicare 35-mile Critical Access Hospital rule after a rural hospital lost CAH status. Not specifically about the Rural Hospital Closure Relief Act of 2025, but closely related policy terrain.

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Source Information

Document Type

Congressional Bill

Official Title

Rural Hospital Closure Relief Act of 2025

Bill NumberHR 6240
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(2)
R: 2

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.