US HB7409

Restricts geographic reclassification to rural status under Medicare to hospitals located in urban areas that meet specific qualifying criteria, effective for applications submitted on or after October 1, 2026

Terminates all rural reclassification status for subsection (d) hospitals on October 1, 2029, unless hospitals demonstrate they meet qualifying criteria to the Secretary of Health and Human Services

Prohibits the Medicare Geographic Classification Review Board from approving reclassification applications for fiscal years beginning October 1, 2026 or later if the hospital is already treated as rural under separate reclassification provisions

Prevents hospitals from holding dual geographic reclassifications simultaneously, blocking Board-approved reclassifications during any period a hospital is treated as rural under the alternative pathway

Requires that rural designations referenced for reclassification purposes must have been in effect as of January 1, 2026