The Fair Access In Residency (FAIR) Act amends Medicare’s inpatient hospital payment statute to require hospitals that run approved residency programs to report, for each fiscal year, program‑level counts of applicants and accepted candidates separated by osteopathic (DO) and allopathic (MD) medical schools, plus a short institutional affirmation about consideration and examination‑score policies. If a hospital fails to submit the required data, Medicare inpatient payments to that hospital will be reduced by 2 percent for each prior fiscal year (starting with FY2025) in which the data were not provided, with reductions applying to discharges on or after October 1, 2026.
By combining a reporting mandate, public disclosure, and a financial penalty, the bill aims to create transparent metrics about how DO and MD graduates fare in residency selection. That transparency matters for medical schools, residency programs, applicants, and health systems that rely on Medicare GME funding — and it raises practical questions about data definitions, administrative burden, and how narrowly targeted a reporting rule can be without affecting program autonomy.
At a Glance
What It Does
The bill amends section 1886(d)(5)(B) of the Social Security Act to require hospitals with approved residency programs to submit annual, program‑level counts of applicants and accepted applicants from osteopathic and allopathic schools and an affirmation on whether the hospital considers both applicant types and accepts COMLEX or USMLE scores at applicant choice. HHS must publish those submissions online for each fiscal year beginning with FY2025.
Who It Affects
All hospitals receiving Medicare inpatient prospective payment rates that sponsor accredited residency programs; hospital GME administrators and program directors will collect and report the data. HHS/CMS will need to intake, validate, and publish the filings.
Why It Matters
The bill uses Medicare payment leverage to force reporting rather than to mandate admissions, producing public data that could reshape debates over DO/MD parity in GME. It creates a new compliance obligation tied directly to hospital reimbursements and introduces potential operational and legal questions about measurement, enforcement, and program autonomy.
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What This Bill Actually Does
The FAIR Act creates an annual reporting duty for hospitals that run approved medical residency training programs. For each fiscal year beginning with FY2025, hospitals must report, at the program level, how many applicants each residency program received from osteopathic versus allopathic medical schools and how many applicants from each school type the program accepted that year.
Hospitals must also submit a one‑paragraph affirmation stating that they consider applicants from both DO and MD schools and, if the program requires an exam score, that they accept either COMLEX or USMLE at the applicant’s election.
The statute attaches a monetary consequence to noncompliance: Medicare inpatient payments to a hospital will be reduced by 2 percent for each prior fiscal year (starting with FY2025) in which the hospital failed to submit the required information, and that reduction applies to discharges on or after October 1, 2026. HHS must publish the reported counts and affirmations on a public website by fiscal year, making the data available to applicants, schools, advocacy groups, and researchers.Operationally, hospitals will need to adapt internal application tracking and acceptance records to produce program‑level counts aligned to fiscal years; program directors will likely need to coordinate with GME offices and central HR/IT systems.
CMS will have to decide how it receives filings (portal, format, data validation rules), how it defines key terms (what counts as an applicant or an accepted slot), and how it displays the publicly posted data while protecting personally identifiable information. The bill includes a rule of construction saying it does not federalize medical education or force programs to accept a given number of DO or MD students, but it uses Medicare payment adjustments to incentivize reporting rather than admissions decisions.
The Five Things You Need to Know
The bill adds a 2% Medicare inpatient payment reduction for each prior fiscal year (beginning FY2025) that a hospital does not submit the required residency reporting; reductions apply to discharges on or after October 1, 2026.
Hospitals must report program‑level counts for each approved residency program of applicants and of accepted applicants, separately for osteopathic (DO) and allopathic (MD) medical schools.
Hospitals must include an institutional affirmation that the program considers both DO and MD applicants and, if an exam score is required, that the hospital accepts either COMLEX or USMLE at the applicant’s election.
HHS must publish the submitted counts and affirmations on a public website for each fiscal year beginning with FY2025, creating a searchable public record tied to individual hospitals and programs.
The bill expressly states it does not require programs to accept any particular applicants or to federalize medical education — it conditions only reporting and disclosure; admissions decisions remain with the programs.
Section-by-Section Breakdown
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Short title
Names the statute the 'Fair Access In Residency Act of 2025' (FAIR Act of 2025). This is purely stylistic, but it signals the legislative intent to frame the measure as a transparency/equity effort rather than a direct admissions mandate.
Medicare payment reduction for failure to report
This amendment inserts a new sentence into the existing Medicare hospital inpatient payment provision creating a financial penalty: starting October 1, 2026, hospitals that have not submitted the required information for prior fiscal years (beginning with FY2025) will face a 2% reduction in the amount determined under clause (i) for each such prior fiscal year. Practically, this ties compliance to Medicare reimbursement calculations and means hospitals may see cumulative reductions if they missed multiple years of reporting.
Required program‑level data elements: applicants and accepted applicants
The bill specifies two discrete numeric elements hospitals must report for each approved residency program and fiscal year: (I) number of applicants from osteopathic schools and number from allopathic schools who applied to the program beginning in that fiscal year; and (II) number of applicants from each school type accepted into the program beginning in that fiscal year. Because the requirement is program‑level and tied to fiscal years, hospitals will need to map academic cycle application and match data to CMS fiscal reporting periods and to decide how to treat multi‑institution or consortium programs.
Institutional affirmation on consideration and exam‑score acceptance
Hospitals must submit an affirmation that their policy is to consider applicants from both DO and MD schools and to accept either the COMLEX or USMLE score at the election of the applicant if an exam score is required. That element is not numeric but functionally compels hospitals to declare selection and testing policies publicly. It also creates a discrete compliance checkpoint that can be compared against reported acceptance counts.
Public posting and rule of construction
Section 2(b) requires the Secretary of HHS to publish the reported counts and affirmations on a public website for each fiscal year beginning FY2025. Section 2(c) clarifies that nothing in the Act should be construed to federalize medical education or to force programs to admit a specific number of applicants. Together, these clauses create a transparency regime while preserving formal admissions autonomy, although the payment penalty functionally incentivizes compliance with reporting.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Osteopathic medical students and recent graduates — They gain public data that can reveal program‑level acceptance patterns and support advocacy for equitable consideration against allopathic peers.
- Residency applicants generally — Increased transparency helps applicants compare program behavior across DO/MD cohorts and make informed application choices.
- Researchers and policy analysts studying GME and workforce diversity — Program‑level, published counts provide a new dataset for studying parity, pipeline, and distribution of residency slots.
- Medical schools (particularly DO schools) — Schools can use the data to evaluate their graduates’ match outcomes and to press for changes where disparities appear.
Who Bears the Cost
- Hospitals that sponsor residency programs — They must build or reconfigure tracking, reporting, and attestations at the program level and face potential Medicare payment reductions for noncompliance, which creates both administrative expenses and financial risk.
- Hospital GME offices and program directors — Responsible for collecting accurate counts, mapping academic application cycles to fiscal reporting, and ensuring the institutional affirmation aligns with written policies.
- HHS/CMS — Must create intake, validation, publication systems and bear the operational costs of processing and hosting program‑level data while handling disputes or corrections.
- Smaller or resource‑constrained training hospitals — These institutions may disproportionately feel the administrative and financial burden, which could influence their ability to maintain or expand residency slots.
Key Issues
The Core Tension
The central dilemma is between promoting transparency and parity in residency selection and preserving program autonomy and practical feasibility: the bill uses Medicare financial leverage to force reporting and public disclosure (which can reveal disparities and pressure change), but it stops short of ordering admissions; that creates a policy trade‑off where the incentive to report may indirectly reshape program behavior, raise administrative burdens, and invite disputes over definitions and enforcement.
The bill raises immediate implementation questions that the text does not resolve. First, it omits precise definitions for key terms: what constitutes an 'applicant' (did they submit materials, rank the program, or enter the National Resident Matching Program for that program?), how to count 'accepted' positions (offer letters, match results, filled positions, categorical vs preliminary slots), and how to treat programs that span institutions or academic years that do not align with federal fiscal years.
Those definitional gaps will determine whether reported counts are comparable across hospitals or easily gamed.
Second, the penalty structure trades on Medicare leverage but is blunt: a 2% reduction per missed year can compound and hit hospitals that failed to report early while doing nothing to directly change admissions behavior. The statutory rule of construction says the law does not force admissions, but payment penalties for nonreporting could create indirect pressure on program practices (for example, hospitals might change reporting practices, alter program structure, or reduce participation in Medicare‑funded programs to avoid scrutiny).
Finally, data quality and privacy issues loom: program‑level counts are less sensitive than individual records, but small programs or specialty tracks could risk reidentification or misleading rates if denominators are small. HHS will need to balance transparency with consistency and privacy protections while also deciding enforcement mechanics and appeal processes.
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