Healthcare (Medicaid · Rural Communities)

HR 44, the Rural 340B Access Act of 2025, would expand eligibility for the federal 340B drug discount program to include specific rural emergency hospitals. It directly affects rural emergency hospitals owned or operated by state/local governments, non-profits with governmental powers, or private non-profits with contracts to serve low-income patients. The bill amends the law to formally add these hospitals as "covered entities" under the 340B program, allowing them to purchase discounted drugs. This change would enable these facilities to access the same drug discounts previously available to other safety-net providers.

HR 772, the Rural ER Access Act, removes a Medicare rule requiring off-campus emergency departments to be within 35 miles of a main hospital campus. Specifically, it directs the Health and Human Services Secretary to revise Medicare regulations (42 CFR §413.65(e)(3)(i)) to eliminate this location requirement. This change directly affects rural hospitals and healthcare organizations seeking to establish or expand off-campus emergency departments. The key mechanism is updating the Medicare eligibility criteria, allowing such facilities to qualify for billing without the previous geographic restriction, potentially increasing access to emergency care in rural areas.

HR 1153, the Rural Physician Workforce Production Act of 2025, provides additional Medicare payments to hospitals training medical residents in rural areas to address physician shortages. Hospitals can receive payments equal to the difference between rural training costs (based on 2015 GAO data adjusted for inflation) and standard graduate medical education payments, for residents spending at least 8 weeks in rural settings. It specifically supports hospitals with residency programs where over 50% of training occurs in rural locations, regardless of specialty or training site. This bill directly affects eligible hospitals, including critical access and rural emergency hospitals, by incentivizing rural physician training through updated Medicare funding mechanisms.

HR 3108, the RPM Access Act, increases Medicare reimbursement for remote patient monitoring (RPM) in rural areas by setting a minimum reimbursement floor of 100% for practice expenses and malpractice costs starting in 2026. It requires that RPM services include real-time physician availability to address health issues, use data systems compatible with electronic health records, and mandates providers to report data on cost savings and adherence to medications. The bill directly affects rural Medicare beneficiaries with chronic conditions like heart failure and diabetes, as well as healthcare providers delivering RPM services in underserved rural communities. It also requires a 5-year report to Congress analyzing cost savings from RPM use, including reduced hospitalizations and medication adherence. The law aims to improve access to RPM in rural areas where healthcare shortages are most severe.

HR 2533, the EASE Act of 2025, requires Medicare and Medicaid to test a new telehealth model designed to improve specialty care access for rural and underserved Medicare/Medicaid beneficiaries. The bill mandates the Centers for Medicare & Medicaid Services (CMS) to partner with nonprofit provider networks - comprising at least 50 community health centers or rural clinics (half in rural areas) - to deliver specialty care via telehealth and coordinate with primary care providers. Eligible individuals must be enrolled in Medicare Part B, Medicaid, or CHIP and reside in designated rural or underserved areas. The model requires networks to collect and evaluate data on service delivery, with funding subject to existing program rules. This creates a structured pilot program focused on expanding remote specialty care access in underserved regions.

This bill establishes minimum annual funding levels for Medicaid Disproportionate Share Hospital (DSH) payments to states, directly affecting rural hospitals and state Medicaid programs. For fiscal years 2025 through 2029, it sets a minimum $20 million DSH allotment per state, and for 2030 onward, it requires states to maintain the prior year's minimum amount adjusted for inflation. The provision prevents states from reducing DSH funding below these specified floors, ensuring consistent support for hospitals serving high numbers of low-income patients. It applies to all states receiving Medicaid DSH payments under federal law.