S. 521 — Supporting Access to Rural Community Hospitals Act of 2025

This section expands exceptions to the 35-mile distance requirement for Critical Access Hospital (CAH) designation to include rural community hospitals—as defined under the Rural Community Hospital demonstration program (established under section 410A(f) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003)—that were participating in that demonstration as of enactment, for designations occurring during the one-year period beginning six months after enactment. (As background, the CAH program reimburses small rural hospitals with no more than 25 acute care beds on a reasonable cost basis under Medicare Part A rather than the inpatient prospective payment system; the demonstration provided similar cost-based reimbursement to up to 20 qualifying small rural hospitals without a distance requirement.) It also makes a conforming amendment to the demonstration program's definition of rural community hospital to specify that such a hospital is not a CAH (as defined in SSA section 1861(mm)(1)).