Rebuild America’s Health Care Schools Act of 2025
- Sponsor
- Rep. LaHood, Darin [R-IL-16]
- Committees
- Ways and Means Committee (primary)
- Last action
- Feb 27, 2025
Bottom line
The bill expands Medicare reimbursement for hospital-based nursing and allied health education costs, aiming to support healthcare workforce development and address past payment disputes with hospitals.
What it actually does
This bill amends Title XVIII of the Social Security Act to expand the definition of "reasonable costs" for Medicare reimbursement to hospitals for nursing and allied health education programs. It explicitly includes direct and indirect costs incurred by the hospital, costs allocated by a related entity, and costs associated with training at the hospital or a related entity. Furthermore, it prohibits the Secretary of Health and Human Services from recouping certain past payments and mandates refunds for amounts recouped in the last six years if those costs would be allowable under the new rules.
Proponents argue
Supporters argue this bill is crucial for strengthening the healthcare workforce by ensuring hospitals are fully reimbursed for the true costs of training nurses and allied health professionals. They contend it will incentivize more hospitals to host these vital programs, thereby increasing the supply of skilled healthcare workers and addressing critical shortages, especially in rural and underserved areas, ultimately improving patient care.
Opponents contend
Opponents might argue that expanding reimbursable costs could significantly increase Medicare expenditures without clear accountability for program outcomes, potentially shifting a greater financial burden onto taxpayers and beneficiaries. They may also raise concerns about the broad definition of "related entity" and the retroactive refund provision, which could lead to substantial, unbudgeted costs and undermine the integrity of past audit processes.
The bill is very short and focused, making it highly accessible for a quick and informed review.
Section 2(a) of the bill, amending Section 1861(v)(1) of the Social Security Act
Expansion of Medicare Reimbursement for Nursing and Allied Health Education Costs
This provision mandates that Medicare include all direct and indirect costs incurred by hospitals for nursing and allied health education programs when determining "reasonable costs" for reimbursement. This includes costs directly incurred by the hospital, costs allocated by a related entity holding the program's license or accreditation, and costs associated with training at the hospital or a related entity. This significantly broadens the scope of what Medicare will pay for in these educational programs, aiming to provide more comprehensive financial support to hospitals.
Supporters argue
Supporters argue this expansion is necessary to accurately reflect the true costs hospitals bear in training essential healthcare professionals, which are often underestimated under current regulations. They contend that full reimbursement will stabilize and grow these programs, directly addressing critical workforce shortages and improving patient care quality and access.
Critics contend
Critics might argue that expanding reimbursable costs without strict oversight could lead to inflated claims or inefficient spending, potentially increasing healthcare costs for beneficiaries and taxpayers. They may question the extent to which these 'related entity' costs are truly incremental and necessary for direct patient care or efficient education.
Tradeoffs
The provision balances the critical need to support healthcare workforce development and ensure fair reimbursement for hospitals against concerns about increasing Medicare spending and the potential for cost inefficiencies or lack of transparency in cost allocation.
Section 2(a)(ii) of the bill
Clarification of "Related Entity" for Cost Reimbursement
This subsection defines "related entity" broadly for the purpose of cost reimbursement. It includes any entity that is related by common ownership or control to the hospital itself, or an entity where the hospital is the sole corporate member (or vice versa), or entities that are part of the same legal entity as the hospital, or those that share a board with the hospital. This ensures that costs incurred by various parts of a larger health system or affiliated educational institutions can be included in the hospital's Medicare cost report.
Section 2(b) of the bill
Mandate for HHS Rulemaking
This section directs the Secretary of Health and Human Services (HHS) to issue all necessary rules to carry out the amendments made by subsection (a) within 120 days of the bill's enactment. This ensures that the new cost reimbursement policies are put into practice promptly and provides a clear timeline for the regulatory process.
Section 2(c) of the bill
Protection Against Past Payment Recoupment and Mandated Refunds
This provision prohibits HHS from recouping or reducing Medicare payments made to a hospital for nursing or allied health education costs if those costs would be allowable under the new rules, starting from the date of enactment. Crucially, it also requires HHS to refund any such payments that were recouped or reduced during the 6-year period prior to the bill's enactment. This retroactively protects hospitals from past audits or payment adjustments related to these specific education costs, providing significant financial relief.