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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.

H.R. 4258 · 119th Congress · Jun 30, 2025 · Lineage

A BILL

Section 1 Expanding the definition of critical access hospital under the Medicare program to include certain hospitals on Indian reservations

Section 1820(c)(2) of the Social Security Act (42 U.S.C. 1395i–4(c)(2)) is amended—
(1)
in subparagraph (B)(i)(I), by inserting “subject to subparagraph (F),” before “is located”;
(2)
in subparagraph (E)(ii), by striking “The total” and inserting “Subject to subparagraph (F), the total”; and
(3)
by adding at the end the following new subparagraph:

“(F) Hospitals on Indian reservations

“(i) In general—Beginning August 1, 2025, a State may designate a facility as a critical access hospital if the facility—

“(I) is located on a reservation (as defined in section 4 of the Indian Health Care Improvement Act); and

“(II) is located more than a 35-mile drive (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) from a hospital, or another facility described in this subsection, that—

“(aa) is located on a reservation (as so defined); or

“(bb) is operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act).

“(ii) Psychiatric and rehabilitation distinct part units—A facility described in clause (i) may establish a distinct part unit under subparagraph (E) without regard to the limitation on number of beds under clause (ii) of such subparagraph.”