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.

This bill, H.R. 4345, would update the Medicare program to expand the definition of a critical access hospital (CAH) to include hospitals located on Indian reservations. Introduced by Representative Newhouse, the measure amends the Social Security Act to allow a state to designate an on-reservation facility as a CAH beginning August 1, 2025, without regard to the usual distance-from-other-hospitals requirement. It also lets such facilities establish psychiatric or rehabilitation distinct part units (if applicable) without being constrained by CAH bed limits, and prevents those units from counting toward the facility’s classification when determining whether it primarily provides services covered under 1861(e)(1). The overall aim is to improve access to Medicare-participating, small, rural-like hospital services for populations living on Indian reservations by broadening eligibility for CAH status and related service options.