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Version 00 · Introduced in House · Mar 3, 2025
Assistance for Rural Community Hospitals Act or the ARCH Act
This bill extends through FY2031 (1) the Medicare-Dependent Hospital Program, which provides additional payments to certain small rural hospitals that have a high proportion of Medicare patients; and (2) certain increased payment adjustments for low-volume hospitals under Medicare's inpatient prospective payment system.
It also requires the Government Accountability Office to report on the number of hospitals that received certain classifications for purposes of payment under Medicare, including low-volume hospitals and Medicare-dependent hospitals.
People & committees
Rep. Miller, Carol D. [R-WV-1] · R–WV
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Referred to the House Committee on Ways and Means.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Jan 22, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-03-03 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal would extend specified Medicare payment rules for hospitals classified as Medicare-dependent or low-volume through fiscal year 2031. It would also require a report to Congress examining rural hospital classifications, overlapping eligibility rules, and possible changes. These are proposed extensions and study requirements; the supplied record does not establish that they became law.
Extension of payment methodology Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— (A) in clause (i), by striking April 1, 2025 and inserting October 1, 2031; and (B) in clause (ii)(II), by striking April 1, 2025 and inserting October 1, 2031.
(b) LVH extension Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is amended— (1) in subparagraph (C)(i)— (A) in the matter preceding subclause (I), by striking through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting through 2031;
the Comptroller General of the United States shall submit to Congress a report on Medicare rural hospital classifications
(2) An analysis of the extent to which there is overlap between the criteria for any two or more of the classifications described in paragraph (1). (3) Recommendations for— (A) simplification with respect to such classifications and any such overlap;
Source snapshot updated 2026-01-22T22:34:48Z. 2025-03-03: Referred to the House Committee on Ways and Means. 2025-03-03: Introduced in House
Section 1 would name the bill the Assistance for Rural Community Hospitals Act, or ARCH Act.
This Act may be cited as the Assistance for Rural Community Hospitals Act or the ARCH Act.
Section 2(a) would extend the Medicare-dependent hospital payment methodology by replacing April 1, 2025, with October 1, 2031, in two statutory clauses. It would make corresponding changes to the payment calculation's target amount provisions, including replacing a reference to fiscal year 2024 and part of fiscal year 2025 with fiscal year 2031. The underlying calculation is not reproduced.
(1) Extension of payment methodology Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— (A) in clause (i), by striking April 1, 2025 and inserting October 1, 2031; and (B) in clause (ii)(II), by striking April 1, 2025 and inserting October 1, 2031.
(A) Extension of target amount Section 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended— (i) in the matter preceding clause (i), by striking April 1, 2025 and inserting October 1, 2031 ; and (ii) in clause (iv), by striking fiscal year 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2031.
Section 2(a) would also update the provision permitting hospitals to decline reclassification—a change in their classification—by replacing its reference to fiscal year 2024 or October 1, 2024, through March 31, 2025, with fiscal year 2031. The bill does not reproduce the underlying conditions for declining.
(B) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww note) is amended by striking fiscal year 2024, or the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2031.
Section 2(b) would extend specified low-volume hospital provisions by replacing references ending in 2024 and the first part of fiscal year 2025 with references running through 2031. A separate clause's reference to April 1–September 30, 2025, and fiscal year 2026 would become fiscal year 2032. The underlying eligibility rules and payment calculations are not reproduced.
(b) LVH extension Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is amended— (1) in subparagraph (C)(i)— (A) in the matter preceding subclause (I), by striking through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting through 2031; (B) in subclause (III), by striking through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting through 2031; and (C) in subclause (IV), by striking the portion of fiscal year 2025 beginning on April 1, 2025, and ending on September 30, 2025, and fiscal year 2026 and inserting fiscal year 2032;
(2) in subparagraph (D)— (A) in the matter preceding clause (i), by striking through 2024 or during the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting through 2031; and (B) in clause (ii), by striking through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting through 2031.
Section 3 would require the Comptroller General to report to Congress within 180 days after enactment. The report would count hospitals that held any of six Medicare classifications during any of the five fiscal years preceding enactment: critical access hospitals, rural emergency hospitals, rural referral centers, sole community hospitals, Medicare-dependent small rural hospitals, and low-volume hospitals. These are statutory categories whose eligibility definitions are referenced but not reproduced.
Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on Medicare rural hospital classifications that includes the following information: (1) The total number of hospitals that, with respect to any of the 5 fiscal years preceding such date of enactment, had any of the following classifications:
(A) Classification as a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act (42 U.S.C. 1395x(mm)(1))). (B) Classification as a rural emergency hospital (as defined in section 1861(kkk)(2) of such Act (42 U.S.C. 1395x(kkk)(2))). (C) Classification as a rural referral center (as described in section 1886(d)(5)(C) of such Act (42 U.S.C. 1395ww(d)(5)(C)). (D) Classification as a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))). (E) Classification as a medicare-dependent, small rural hospital (as defined in section 1886(d)(5)(G)(iv) of such Act (42 U.S.C. 1395ww(d)(5)(G)(iv))). (F) Classification as a low-volume hospital (as defined in section 1886(d)(12)(C)(i) of such Act (42 U.S.C. 1395ww(d)(12)(C)(i))).
The report would examine overlap among the classifications' eligibility rules and recommend simplifications. It would also recommend eligibility changes intended to support rural hospitals' financial sustainability and rural residents' access to care. These are requested recommendations and goals, not established results.
(2) An analysis of the extent to which there is overlap between the criteria for any two or more of the classifications described in paragraph (1). (3) Recommendations for— (A) simplification with respect to such classifications and any such overlap; and (B) changes with respect to the criteria for such classifications that would promote financial sustainability for rural hospitals and improve access to health care for individuals in rural areas.
The report would project the effects of allowing sole community hospitals and Medicare-dependent small rural hospitals to calculate adjusted payments using a cost reporting period beginning in fiscal year 2021—a period for reporting hospital costs. This provision requests a study of that option; it does not itself grant the option.
(4) The projected effects of allowing sole community hospitals (as described in paragraph (1)(D)) and medicare-dependent, small rural hospitals (as described in paragraph (1)(E)) to use a cost reporting period beginning during fiscal year 2021 for the purpose of calculating adjusted payments under section 1886(d)(5) of the Social Security Act (42 U.S.C. 1395ww(d)(5)).
The supplied action snapshot, updated January 22, 2026, records introduction in the House and referral to the House Committee on Ways and Means on March 3, 2025. It supplies no later action and does not establish the bill's subsequent status.
Source snapshot updated 2026-01-22T22:34:48Z. 2025-03-03: Referred to the House Committee on Ways and Means. 2025-03-03: Introduced in House 2025-03-03: Introduced in House
A closer look
Reviewed version: Introduced in House · 2025-03-03. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion does not extend to other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This text-only conclusion does not establish the absence of earmarks in other versions or accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow carve-out, special exemption, or preferential exception beyond the programs' intended beneficiaries was identified in the complete supplied introduced text. This conclusion is limited to that version and does not extend to other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Jan 22, 2026. How PlainBill uses AI