Critical Access Hospitals

Current understanding

Critical Access Hospitals (CAHs) are a Medicare designation for small rural hospitals that receive cost-based reimbursement in exchange for meeting size and service limits (e.g., 25 or fewer inpatient beds, 24/7 emergency services). Legislation affecting CAH payment, conditions of participation, or program status flows through Ways and Means (Medicare) and Energy and Commerce.

Evidence log

• 2026-05-21 — Rural Community Hospital Demonstration Program Reauthorization: 2026 — Rural Community Hospital Demonstration Program Reauthorization (introduced): targets small rural hospitals that exceed the 25-bed CAH cap but still need cost-based Medicare payment, extending a parallel payment pathway for facilities just outside CAH eligibility. (novelty: 2) (novelty: 2)
• 2026-07-29 — A bill to amend titles XVIII and XIX of the Social Security Act to make improvements relating to the designation of rural emergency hospitals.: 2025 — S5164 (introduced): would amend Medicare (Title XVIII) and Medicaid (Title XIX) of the Social Security Act to improve the rural emergency hospital designation, refining the REH category that serves overlapping rural markets with CAHs. (novelty: 2)
• 2026-07-28 — Rural Obstetrics Readiness Act: 2026 — Rural Obstetrics Readiness Act (introduced): CAHs and other rural or shortage-area hospitals would be eligible for HRSA grants covering obstetric emergency training, workforce, equipment, AIM capacity training for facilities without dedicated OB units, and a rural urgent maternal telehealth pilot — targeting the OB-service gap in facilities that have closed or never operated labor and delivery units. (novelty: 3) (novelty: 3)
• 2025-04-02 — EASE Act: 2025 — EASE Act (S1248, introduced): CAHs would be eligible members of nonprofit rural provider networks delivering telehealth specialty care under a proposed CMMI demonstration for Medicare/Medicaid/CHIP beneficiaries. (novelty: 3)
• 2025-04-01 — EASE Act of 2025: 2025 — EASE Act of 2025 (introduced): CAHs would be among the eligible participating sites in a proposed CMMI nonprofit-network model delivering telehealth specialty care to rural Medicare/Medicaid/CHIP beneficiaries. (novelty: 3)
• 2026-07-23 — To require the development of a comprehensive rural hospital cybersecurity workforce development strategy, and for other purposes.: 2026 — HR9908 (introduced): would require a federal strategy for rural hospital cybersecurity workforce development, targeting a workforce gap that disproportionately affects CAHs and other rural facilities with limited IT security staffing. (novelty: 3)
• 2025-09-08 — Rural Behavioral Health Improvement Act of 2025: 2025-09-08 — Rural Behavioral Health Improvement Act of 2025 (HR5217, introduced): rural behavioral health improvement bill referred to Energy and Commerce and Ways and Means; CAHs are among the primary rural care sites potentially affected by any resulting behavioral health service expansion. (novelty: 3) (novelty: 3)
• 2026-03-26 — Save Struggling Hospitals Act: Save Struggling Hospitals Act (S4233) introduced in the Senate and referred to Finance to support financially distressed hospitals; CAHs — which already receive cost-based Medicare reimbursement — are a likely population of interest as the bill develops. (novelty: 2)
• 2026-04-14 — ICU Bed Act of 2026: cross-connection with icu-bed-act-2026: ICU capacity policy interacts with critical access hospital transfer patterns and rural surge capacity. (novelty: 2)
• 2025-01-03 — Rural 340B Access Act of 2025: cross-connection with rural-340b-access-act: Critical access hospitals are already 340B-eligible; the bill extends similar drug discount access to the newer rural emergency hospital category, which serves overlapping rural markets. (novelty: 2)
• 2025-06-13 — Community Paramedicine Act of 2025: cross-connection with community-paramedicine-program: Community paramedicine is often positioned as a rural care access strategy that complements critical access hospital models. (novelty: 2)
• 2026-03-20 — Rural Health Care Facilities Revitalization Act: HR7514 (Rural Health Care Facilities Revitalization Act) introduced in the 119th Congress and referred to the House Agriculture Subcommittee on Commodity Markets, Digital Assets, and Rural Development; potential adjacency to CAH facility financing though the bill sits on the USDA Rural Development track rather than the Medicare payment track. (novelty: 2)

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