FAIR Act
- Sponsor
- Rep. Harshbarger, Diana [R-TN-1]
- Committees
- Ways and Means Committee (primary)
- Last action
- Mar 25, 2025
Bottom line
The FAIR Act aims to increase transparency and ensure equitable consideration for osteopathic and allopathic medical school graduates in residency programs through reporting requirements and financial penalties for non-compliance.
What it actually does
This bill mandates that hospitals with medical residency programs report data on osteopathic and allopathic applicants and accepted candidates to the Secretary of Health and Human Services. It also requires hospitals to affirm that their policies consider both types of applicants and accept either the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) or the United States Medical Licensing Examination (USMLE) scores. Non-compliance will result in a 2% reduction in Medicare payments for indirect medical education for each prior fiscal year of non-submission, starting October 1, 2026. The collected data will be publicly published.
Proponents argue
Supporters argue that this bill addresses potential biases in residency applications, ensuring that qualified osteopathic medical graduates are not disadvantaged. By requiring hospitals to report data and affirm fair practices, it promotes transparency and accountability, ultimately strengthening the physician workforce by allowing all qualified candidates to pursue residency training. The acceptance of both major licensing exams removes an unnecessary barrier.
Opponents contend
Critics might argue that this bill imposes an additional administrative burden on hospitals, potentially diverting resources from patient care or training. Some might contend that residency programs already have robust, fair selection processes and that federal intervention in this area is unnecessary or could lead to unintended consequences in admissions criteria. Others might express concern about the federal government's role in dictating aspects of medical education without directly funding it.
The bill is short and clearly written, making it accessible for a quick and thorough review.
Section 2(a)(1)
Medicare Payment Reduction for Non-Compliance
This provision amends the Social Security Act to introduce a financial penalty for hospitals that fail to submit required information regarding residency candidates. For discharges occurring on or after October 1, 2026, a hospital's Medicare payments for indirect medical education (IME) adjustments will be reduced by 2 percent for each prior fiscal year (starting with fiscal year 2025) in which the hospital did not submit the mandated data. This creates a strong financial incentive for hospitals to comply with the new reporting requirements.
Supporters argue
Proponents argue that this penalty is necessary to ensure compliance and make the reporting requirements effective. Without a clear consequence for non-submission, the data collection efforts might be undermined, failing to achieve the bill's transparency goals.
Critics contend
Opponents might contend that financial penalties, especially those tied to Medicare payments, could disproportionately affect hospitals already facing financial strain, potentially impacting patient care or other essential hospital functions. They may also argue that the penalty is too severe for a reporting requirement.
Tradeoffs
The provision balances the need for robust enforcement of reporting requirements with the potential financial burden on hospitals. It aims to compel compliance but risks penalizing institutions that may struggle with new administrative demands.
Section 2(a)(2)
Mandatory Reporting of Residency Applicant Data and Policy Affirmation
This section requires hospitals with approved medical residency training programs to submit specific information to the Secretary of Health and Human Services for each fiscal year, starting with FY2025. The required data includes the number of applicants and accepted candidates for each residency program, disaggregated by whether they are from osteopathic or allopathic medical schools. Additionally, hospitals must affirm that their policy is to consider both types of applicants and that they accept scores from either the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) or the United States Medical Licensing Examination (USMLE) at the applicant's election.
Section 2(b)
Public Publication of Residency Data
This provision mandates that the Secretary of Health and Human Services (HHS) publish the collected data on residency applicants and acceptances, along with the hospitals' policy affirmations, on a public website. This ensures that the information gathered under the Act is accessible to the public, including prospective medical students, medical schools, and policymakers, for each fiscal year starting with FY2025.
Section 2(c)
Rule of Construction: No Federalization of Medical Education or Mandates on Acceptance Numbers
This section explicitly clarifies that nothing in the Act should be interpreted as federalizing medical education or as establishing a mandate for approved medical residency training programs to accept students (or a certain number of students) from osteopathic or allopathic medical schools. This provision aims to reassure stakeholders that the bill's intent is to promote transparency and fair consideration, not to dictate admissions outcomes or curriculum.