Rural emergency care expands as Medicare removes 35-mile distance rule
H.R. 772 — Rural ER Access Act · Filed by Mark Green (R-TN) · Introduced Jan 28, 2025 · Referred to committee
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What it does
This bill directs the Secretary of Health and Human Services to remove a Medicare regulation that requires off-campus emergency facilities to be located within 35 miles of a hospital or critical access hospital. The change would allow emergency departments and urgent care facilities to operate farther from main hospitals while still qualifying for Medicare provider-based status, potentially expanding emergency care access in rural areas.
Why we flagged it
The bill's operative mechanism is straightforward: it removes a geographic restriction on Medicare-eligible off-campus emergency facilities. This is a deregulatory measure aimed at expanding emergency care access in rural areas by eliminating an arbitrary distance requirement.
What the text implies
- Off-campus facilities located 35+ miles from a main hospital may now qualify for provider-based status, which carries higher Medicare reimbursement rates than independent facility rates—potentially shifting revenue from independent rural providers to hospital systems operating satellite facilities.
- Removal of the distance requirement may incentivize hospital systems to establish off-campus emergency departments in rural areas previously considered too remote, but also creates risk that such facilities could be located in areas with insufficient patient volume or clinical support.
The full analysis lists 3 implications of this text.
Who stands to gain
hospital systems and health systems operating off-campus emergency facilities; rural healthcare providers seeking Medicare provider-based status; critical access hospitals expanding service areas