Congress quietly expands physician self-referral rights in rural hospitals
H.R. 2191 — Physician Led and Rural Access to Quality Care Act · Filed by H. Griffith (R-VA) · 33 cosponsors · Introduced Mar 18, 2025 · Referred to committee
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What it does
This bill amends federal physician self-referral rules (the Stark Law) to create a new exemption for 'covered rural hospitals'—hospitals in rural areas more than 35 miles (or 15 miles in mountainous terrain) from another hospital. It allows physician-owned rural hospitals to accept referrals from their physician-owners without triggering self-referral penalties, and it removes a prior prohibition on expanding existing physician-owned hospitals, effective immediately upon enactment.
Why we flagged it
The bill's operative mechanism is a targeted exemption from anti-self-referral rules for a specific class of hospitals (rural, physician-owned). While framed as rural access, the primary beneficiary is the physician-owner class, not patients or the general public.
What the text implies
- Removes the expansion prohibition on physician-owned hospitals retroactively ('beginning on the date of enactment'), potentially allowing existing physician-owned hospitals to grow their footprint immediately without prior regulatory review.
- The 35-mile (or 15-mile mountainous) distance threshold is a bright-line rule that may not reflect actual healthcare access or competition in all rural markets; hospitals just outside the threshold remain subject to Stark restrictions.
The full analysis lists 5 implications of this text.
Who stands to gain
physician-owners of rural hospitals; existing physician-owned hospital operators; rural hospital management companies with physician ownership