Congress removes guardrails on rural hospital designations—states now have blank check
H.R. 771 — Rural Health Care Access Act of 2025 · Filed by Mark Green (R-TN) · 4 cosponsors · Introduced Jan 28, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
What it does
This bill amends the Medicare Rural Hospital Flexibility Program to remove mileage-distance restrictions that currently limit which rural facilities can be designated as critical access hospitals (CAHs). States will be able to designate rural hospitals as CAHs without regard to how far they are from other hospitals, potentially allowing more rural facilities to access CAH status and its associated Medicare reimbursement benefits.
Why we flagged it
The bill removes a specific regulatory constraint (mileage limits) on state authority to designate rural hospitals as critical access hospitals under Medicare. It is a targeted deregulatory amendment that expands state discretion within an existing federal program.
What the text implies
- Removal of mileage safeguards may enable states to designate multiple hospitals in close proximity as CAHs, potentially creating redundant facilities and fragmenting rural healthcare networks rather than strengthening them.
- CAH designation carries enhanced Medicare reimbursement (cost-based reimbursement vs. DRG-based), so expanded eligibility could increase federal Medicare spending without corresponding quality or access metrics.
The full analysis lists 4 implications of this text.
Who stands to gain
rural hospitals and health systems; hospital networks in rural areas; rural healthcare providers