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H.R. 5821House119th Congress (2025-2027)In Committee

Rural Hospital Fairness Act

Sponsored by Doug LaMalfaRep. Doug LaMalfa (R-CA)
Introduced October 24, 2025

AI-Generated Summary

Updated November 23, 2025 at 8:02 PM UTC

The Rural Hospital Fairness Act amends the Social Security Act to let certain rural hospitals keep their critical access hospital (CAH) status under Medicare, even if they no longer meet the standard location rule. It applies to hospitals that were CAHs before 2002, were still certified in 2024, and are the only hospital in their county. This helps ensure continued Medicare support for isolated rural hospitals.

Key Provisions

  • Adds a new paragraph to the definition of critical access hospitals, allowing a facility that loses its certification to keep that status if it meets specific conditions.
  • The facility must have been designated a critical access hospital before Jan. 1, 2002 and still be certified as of Dec. 31, 2024.
  • The facility must be located in a county (or equivalent) where no other hospital, critical access hospital, or rural emergency hospital exists.
  • If those conditions are met, the Secretary can deem the facility a critical access hospital even if it no longer meets the usual location requirement.

Legislative Activity

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HouseIntro Referral Latest Action

Referred to the House Committee on Ways and Means.

Ways and Means Committee

October 24, 2025

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HouseIntro Referral

Introduced in House

October 24, 2025

HouseIntro Referral

Referred to the House Committee on Ways and Means.

Ways and Means Committee

October 24, 2025

Bill Text

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Introduced in HouseIssued October 24, 2025

I

119th CONGRESS

1st Session

H. R. 5821

IN THE HOUSE OF REPRESENTATIVES

October 24, 2025

Mr. LaMalfa introduced the following bill; which was referred to the Committee on Ways and Means

A BILL

To amend title XVIII of the Social Security Act to provide for the treatment of certain hospitals as critical access hospitals under the Medicare program.

1.

Short title

This Act may be cited as the Rural Hospital Fairness Act.

2.

Providing for the treatment of certain hospitals as critical access hospitals under the Medicare program

Section 1820(h) of the Social Security Act (42 U.S.C. 1395i–4(h)) is amended by adding at the end the following new paragraph:

(4)

Continuation of CAH status for certain facilities

(A)

In general

A facility described in subparagraph (B) that does not meet the location requirement under subsection (c)(2)(B)(i)(I) (and was not certified by the State as being a necessary provider of health care services to residents in the area under subsection (c)(2)(B)(i)(II)) shall be deemed to have been certified by the Secretary under subsection (e) as a critical access hospital so long as such facility is otherwise eligible to be designated by the State as a critical access hospital under subsection (c) and meets any other criteria required by the Secretary under subsection (e)(3).

(B)

Facility described

For purposes of subparagraph (A), a facility described in this subparagraph is a facility that—

(i)

was designated as a critical access hospital before January 1, 2002;

(ii)

as of December 31, 2024, was certified by the Secretary under subsection (e) as a critical access hospital; and

(iii)

as of the date on which the facility was officially notified by the Secretary that it was no longer so certified, was located in a county (or equivalent unit of local government) in which no other hospital, critical access hospital, or rural emergency hospital was located.

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