Health Care Access and Rural Equity Act of 2003

Health Care Access and Rural Equity Act of 2003 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to make a variety of changes with regard to rural health care and such matters as: (1) urban and rural standardized payment amounts under the Medicare inpatient hospital prospective payment system (PPS); (2) disproportionate share hospital (DSH) adjustment for rural hospitals; (3) payment adjustment for low-volume hospitals; (4) adjustment to the Medicare inpatient hospital PPS wage index to revise the labor-related share of such index; (5) treatment of certain sole community hospitals to limit the decline in payment under the PPS for hospital outpatient department services; (6) the critical access hospital program; and (7) permanent treatment of certain physician pathology services under Medicare.

Directs the Secretary of Health and Human Services to publish and use alternative guidelines for geographic reclassification of certain hospitals located in sparsely populated States.

Amends the Public Health Service Act to give the Secretary the authority to make and guarantee loans from the loan fund to any rural entity for projects for capital improvements.

Amends SSA title XVIII to provide for a five-year extension of the authorization for appropriations for certain Medicare rural grants.