FAIR Residency Data Act

Summary#

The FAIR Act would require hospitals that run Medicare-approved medical residency programs to report counts of applicants and accepted candidates by medical-school type (osteopathic or allopathic). Hospitals must also affirm that they consider both types of graduates and, if they require an exam score, that they accept either the osteopathic (COMLEX) or allopathic (USMLE) exam at the applicant’s choice. If a hospital does not submit the required data for a fiscal year, its Medicare payment rate for inpatient discharges would be reduced by 2% for each year of non‑submission, starting for discharges on or after October 1, 2026. The Department of Health and Human Services (HHS) must publish the submitted data on a public website.

• Main change: Hospitals with approved residency programs must report applicant and acceptance counts separated by osteopathic (DO) and allopathic (MD) schools and provide an affirmation about consideration and exam‑score acceptance.
• Enforcement: Medicare inpatient payment rates for a hospital are reduced by 2% for each fiscal year the hospital fails to submit the required info.
• Public reporting: HHS must post the data and the hospital affirmations online for each fiscal year beginning with FY2025.
• Limitation: The bill says it does not force programs to accept any particular number of applicants or federalize medical education.

What it means for you#

• Hospitals / Residency programs

  • Must collect and submit, each fiscal year, the number of applicants and number accepted into each approved residency program, split by graduates of osteopathic and allopathic medical schools.
  • Must affirm their policy to consider both DO and MD applicants and, if an exam score is required, that they accept COMLEX or USMLE at the applicant’s choice.
  • Face a 2% Medicare payment reduction for inpatient discharges for each fiscal year they fail to submit the required data (reductions begin for discharges on/after Oct 1, 2026).

• Medical students and residency applicants (DO and MD)

  • The bill does not change application rules or create guaranteed spots.
  • The published data could make it easier to see how many DO and MD applicants apply and are accepted at specific hospitals.

• Department of Health and Human Services (HHS) / CMS

  • Must collect hospital submissions and publish the aggregate counts and affirmations on a public website.
  • Must apply payment reductions to hospitals that do not report.

• General public / researchers

  • Will have access to yearly, hospital-level counts of applicants and acceptances by school type and hospitals’ stated exam acceptance policy.

Expenses#

No direct public cost estimate is included in the bill text or the supplied material.

• No fiscal note or budget estimate is provided in the material supplied.
• Possible government costs (not estimated in the bill): setting up a data collection system, staff time to review submissions, and maintaining a public website.
• Possible hospital costs (not estimated): time and systems to collect, certify, and submit the required counts and written affirmations; potential loss of Medicare revenue if submissions are missed (2% per missed fiscal year).
• It is unclear whether HHS will provide templates, deadlines, or technical support to reduce compliance costs.

Proponents' View#

• The bill appears intended to encourage more equal treatment of osteopathic (DO) and allopathic (MD) applicants to residency programs.
• Supporters may argue that public reporting increases transparency about how many DO and MD applicants are considered and accepted at each hospital.
• Requiring programs to state that they accept COMLEX or USMLE at the applicant’s choice could reduce exam‑score barriers that some applicants face.
• The payment reduction is a financial incentive to ensure hospitals report the required information.

Opponents' View#

• One concern is that the bill does not provide a fiscal estimate or detail on administrative steps, so the actual cost to hospitals and HHS is unclear.
• The payment penalty (2% per fiscal year missed) could reduce hospital Medicare revenue; it is unclear whether the penalty can accumulate without limit and how large the total reduction could become.
• The bill does not explain reporting deadlines, data formats, or checks for accuracy. This could create uncertainty about compliance.
• The published data are counts only; they may not explain the reasons for differences in acceptance rates (for example, program size, specialty competitiveness, or applicant qualifications). This could lead to misleading conclusions.
• The bill does not say how HHS will protect small counts that might risk identifying individuals in small programs; privacy or re‑identification risks are not addressed.

What is unclear:

• The exact submission schedule, deadlines, and format HHS will require.
• Whether there is a cap on accumulated payment reductions.
• Any requirements HHS may set to prevent small‑cell disclosure that could identify applicants.