The ARCH Act (Assistance for Rural Community Hospitals Act) would extend two key Medicare payment programs that support rural hospitals—the Medicare-dependent hospital (MDH) payments and the Medicare low-volume hospital (LVH) payments—until later dates (primarily through October 1, 2031 for MDH and through 2031/2032 for LVH). It also requires the Comptroller General to complete a GAO report within 180 days of enactment evaluating Medicare rural hospital classifications (such as critical access, rural emergency, sole community, etc.), including overlaps among criteria and recommendations to simplify classifications and improve financial sustainability and access in rural areas. Additionally, the bill invites analysis of allowing certain hospitals (sole community hospitals and medicare-dependent small rural hospitals) to use an earlier cost reporting period (began in FY 2021) for calculating adjusted payments under MDH provisions. In short, the bill aims to provide longer-term financial support for rural hospitals and to examine, streamline, and potentially reform how rural hospital classifications are defined for payment purposes.
Key Points
- 1Extends MDH payments: Replaces the current deadline (April 1, 2025) with October 1, 2031 for the MDH payment methodology, and extends the associated target amount timing to align with 2031.
- 2Extends LVH payments: Extends the LVH payment provisions and related timing through 2031 (with certain subparagraphs updated to reference through 2031 or 2032 as appropriate).
- 3Hospitals may decline reclassification: Amends provisions allowing hospitals to decline certain reclassifications, updating the applicable fiscal year reference to 2031.
- 4GAO rural hospital classifications report: Requires the Comptroller General to deliver a report within 180 days of enactment detailing (a) the total number of hospitals with any of several rural classifications in the prior five fiscal years, (b) overlaps among classifications, (c) recommendations to simplify classifications and adjust criteria to improve financial sustainability and rural access, and (d) projections related to allowing certain hospitals to use an earlier cost reporting period (FY2021) for calculating adjusted MDH payments.
- 5Short title and scope: The act is titled the “Assistance for Rural Community Hospitals Act” or “ARCH Act,” signaling a focus on rural hospital support and classification reform.