Rural Hospital Closure Relief Act of 2025
Sponsored By: Representative Vindman
Introduced
Summary
temporary expansion of State authority to designate Critical Access Hospitals. This bill would let states certify certain struggling rural hospitals as CAHs by easing the 35-mile rule while adding caps, reporting, and a 9-year sunset.
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- Rural hospitals: Eligible hospitals would be able to apply for CAH status if they are a sole community hospital, a Medicare-dependent small rural hospital, a low-volume hospital, or a subsection (d) hospital and meet criteria including two consecutive years of negative operating margins and a solvency plan. They must commit to start or expand a high-demand service such as obstetrics or behavioral health.
- State allocations: New certifications would be capped at 120 nationwide and no more than 5 per state. The bill sets an initial one-per-state allocation then distributes remaining slots proportionally and ends new certifications after 9 years.
- Access, oversight, and transition: Certified hospitals would face periodic reporting and possible revocation for noncompliance. The Government Accountability Office and the Medicare Payment Advisory Commission would study impacts with reports due in about 6 and 8 years and facilities must transition within 1 year after the sunset to recommended payment models, their prior payment system, or Rural Emergency Hospital status.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 2 benefits, 0 costs, 1 mixed.
New path to keep rural hospitals open
This bill would let States certify certain rural hospitals as Critical Access Hospitals to help keep care local. Hospitals would need to be in rural areas, show two straight years of operating losses, and commit to add or expand a high‑need service like obstetrics or behavioral health. The Secretary could certify up to 120 hospitals nationwide, with no more than 5 per State, and must issue rules within 1 year. Certified hospitals would have reporting and notice duties, and could lose status for noncompliance. New certifications would end 9 years after enactment, and the Secretary would help these hospitals move to another payment model within 1 year after that.
National study of rural hospital payments
This bill would direct an independent Medicare advisory group to study rural hospital payment systems using 2018–2028 data. The report would be due to Congress within 8 years. It would include hospitals in the new State pathway, consider value‑based payment, and assess transition impacts if new systems are suggested. This would not change your benefits now, but it could shape future Medicare rules for rural care.
New bed and stay limits for rural hospitals
Starting October 1, 2025, this bill would cap rural Critical Access Hospitals at 25 acute care beds in the 50 States, DC, and Puerto Rico. In Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands, the Secretary would set the bed cap. All such hospitals would be limited to an annual average of 96 inpatient hours per patient. If you get inpatient care at a rural hospital, these limits could affect bed availability and typical length of stay.
Sponsors & CoSponsors
Sponsor
Vindman
VA • D
Cosponsors
Mann
KS • R
Sponsored 11/20/2025
Del. Moylan, James C. [R-GU-At Large]
GU • R
Sponsored 11/20/2025
Roll Call Votes
No roll call votes available for this bill.
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