To amend title XVIII of the Social Security Act to expand the definition of critical access hospital under the Medicare program to include certain hospitals on Indian reservations.
- Bill Number
- H.R. 4258
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Native Americans
- Status
- Introduced
- Latest Action
- 2025-06-30: Referred to the House Committee on Ways and Means.
- Last Updated
- 2025-07-31T16:22:13Z
AI-Generated Summary
Purpose The legislation amends the Medicare program under title XVIII of the Social Security Act to allow certain hospitals located on Indian reservations to qualify as critical access hospitals, which receive special Medicare reimbursement rates for providing essential services in rural or underserved areas.
Key Provisions
- Beginning August 1, 2025, a state may designate a facility as a critical access hospital if it is located on a reservation (as defined in the Indian Health Care Improvement Act) and meets a modified distance requirement: it must be more than 35 miles (or 15 miles in mountainous terrain or areas with only secondary roads) from another hospital or similar facility that is also on a reservation or operated by the Indian Health Service, an Indian tribe, tribal organization, or urban Indian organization.
- Such facilities may establish distinct part units for psychiatric or rehabilitation services without being subject to the standard bed-number limits that apply to other critical access hospitals.
- The bill makes targeted adjustments to existing distance and bed rules in Section 1820(c)(2) of the Social Security Act to accommodate these reservation-based facilities.
Significant Changes to Existing Law
- Current law generally requires critical access hospitals to be located more than 35 miles from any other hospital. This bill creates an exception for reservation facilities by measuring distance only against other reservation-based or Indian Health Service-operated facilities.
- It removes the bed limitation for psychiatric and rehabilitation units in these specific facilities, expanding their operational flexibility compared to standard critical access hospitals.
Potential Impacts
- May increase Medicare reimbursement eligibility for hospitals on Indian reservations, potentially improving financial stability for these facilities.
- Could enhance healthcare access for residents of Indian reservations by supporting more local critical access hospitals.
- Affects Medicare program administration through the Centers for Medicare & Medicaid Services and state designation processes.
- Limited direct effects on international relations, though it touches on federal-tribal healthcare responsibilities.
Main Stakeholders Affected
- Hospitals and facilities on Indian reservations.
- Indian Health Service, Indian tribes, tribal organizations, and urban Indian organizations.
- Medicare beneficiaries living on or near reservations.
- State health agencies responsible for critical access hospital designations.
- The Centers for Medicare & Medicaid Services.
Notable Legal, Constitutional, or Political Implications
- Builds on existing federal authority in Indian health policy under the Indian Health Care Improvement Act without altering broader constitutional frameworks for tribal sovereignty or federal trust responsibilities.
- Introduces a targeted exception within Medicare rules that applies only to reservation-based facilities, maintaining the overall structure of the critical access hospital program.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2025-06-30: Referred to the House Committee on Ways and Means.
- 2025-06-30: Introduced in House
- 2025-06-30: Introduced in House
Bill Versions
- To amend title XVIII of the Social Security Act to expand the definition of critical access hospital under the Medicare program to include certain hospitals on Indian reservations. — issued 2025-06-30 — PDF (3 pages)