Repeals the existing federal Horseracing Integrity and Safety Act and replaces it with a State-led system that lets State racing commissions form an interstate compact to create a Racehorse Health and Safety Organization (RHSO). The RHSO — governed by a nine-member board and supported by breed-specific and racetrack-safety committees — would set uniform rules on medication control, racetrack safety, laboratory accreditation, discipline, and appeals, and would be funded by fees, assessments, and limited borrowing.

States can enforce RHSO rules themselves or allow the RHSO to enforce them; the law limits industry loans to the RHSO, requires accredited testing labs, establishes due-process protections for discipline and results management, and phases in most provisions on the later of two years after enactment or when two or more States join the compact (with certain parts effective sooner).