This bill, called the "Rural ER Access Act," removes the requirement that off-campus medical facilities must be within 35 miles of a hospital to receive Medicare benefits, tasking the Secretary of Health and Human Services to enact this change within 60 days.
Mark Green
Representative
TN-7
The Rural Emergency Hospital Access Act removes the requirement that off-campus facilities must be within a 35-mile radius of a hospital to receive Medicare benefits. This change aims to improve access to emergency care in rural areas by allowing facilities to qualify for provider-based status regardless of their proximity to a main hospital. The Secretary of Health and Human Services is required to implement this change within 60 days.
Rural ER Access Act Eliminates 35-Mile Rule for Medicare Payments to Off-Campus Facilities
The Rural ER Access Act is straightforward: it scraps the Medicare rule that says off-campus medical facilities have to be within 35 miles of a main hospital to get provider-based payments. The Secretary of Health and Human Services has 60 days from enactment to make it happen (SEC. 2).
Unpacking the Change
This bill directly removes the 35-mile radius limit for off-campus facilities seeking "provider-based" status under Medicare. This status affects how facilities get paid, and being "provider-based" often means higher reimbursement rates. Before this, if you were, say, a clinic 40 miles from the nearest hospital, you were out of luck for this type of Medicare funding. Now, that distance restriction is gone.
Real-World Rollout
Imagine a small town where the nearest full-service hospital is 50 miles away. Under the old rules, a new clinic in that town couldn't qualify for the enhanced Medicare payments that come with provider-based status. This bill changes that. Now, that clinic can potentially qualify, which could make it financially viable to operate. This could mean the difference between having local healthcare access and having to drive an hour or more for routine care or emergencies. For a construction worker with a job-related injury or a family needing quick access to urgent care, that change could be significant.
Potential Pitfalls
While the intent is to boost rural healthcare, there are some practical things to consider. Without the geographic limit, it's possible that hospitals could set up more facilities in slightly more affluent rural areas, rather than the most underserved ones. There's also the question of whether this leads to a bunch of new facilities popping up just to grab those higher Medicare payments, without actually increasing useful access to care. It's important to track how this plays out – are we getting more care where it's truly needed, or are we just shifting resources around?
Connection to Existing Laws
This Act is a direct change to the Medicare payment rules, specifically targeting the regulations around provider-based status for off-campus facilities. It is a targeted change, not a comprehensive reform. This act focuses on the location requirement.