Rural emergency care expands as Medicare removes 35-mile distance rule

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 change applies only to Medicare; Medicaid and private insurance reimbursement policies remain unchanged, creating a two-tier incentive structure that may favor Medicare patients in newly accessible rural areas.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Rural and remote residents gain potential access to emergency care facilities that can now operate farther from main hospitals while retaining Medicare reimbursement eligibility, reducing travel burden for emergency services. The removal of an arbitrary geographic barrier expands healthcare access in underserved areas without imposing new costs on patients or restricting existing protections.

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

Named in the bill

Secretary of Health and Human Services, Medicare program, 42 CFR 413.65(e)(3)(i), off-campus facilities, critical access hospitals, provider-based status

Where it stands

• Jan 28, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jan 28, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

1 lobbying clients named this bill on 1 disclosure filings across 1 quarter, Mar 2026 to Mar 2026. Those filings disclosed $468,727 in lobbying spend. A filing names 47 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 0% of bills with at least one filing.

Mark Green, the sponsor, reported $29,535 in PAC receipts in the 2026 cycle.

• American College of Emergency Physicians — $468,727 on 1 filing

Lobbying Disclosure Act filings through May 5, 2026. A filing shows who paid to lobby on a bill it names, not what changed.