[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7727 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 7727
To amend title XVIII of the Social Security Act to ensure the continued
designation of certain critical access hospitals under the Medicare
program, and for other purposes.
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IN THE HOUSE OF REPRESENTATIVES
February 26, 2026
Mr. Alford (for himself, Mr. Thompson of Pennsylvania, Ms. Tokuda, and
Mr. Cuellar) introduced the following bill; which was referred to the
Committee on Ways and Means
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A BILL
To amend title XVIII of the Social Security Act to ensure the continued
designation of certain critical access hospitals under the Medicare
program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Sustaining Rural Healthcare Act''.
SEC. 2. ENSURING THE CONTINUED DESIGNATION OF CERTAIN CRITICAL ACCESS
HOSPITALS UNDER THE MEDICARE PROGRAM.
Section 1820(c)(2) of the Social Security Act (42 U.S.C. 1395i-
4(c)(2)) is amended by adding at the end the following new
subparagraph:
``(F) Ensuring continued designation of certain
critical access hospitals.--A facility that is
designated as a critical access hospital by a State
under subparagraph (B) that meets the criterion
specified in clause (i)(I) as of the date of such
designation and that would continue to be eligible for
such designation but for application of such criterion
shall be deemed to meet such criterion for a period
specified by the Secretary (not to exceed 3 years) if
the Secretary determines that loss of such designation
would reduce access to necessary health care items and
services for individuals residing in the service area
of such facility.''.
SEC. 3. DISCRETIONARY AUTHORITY FOR STABILIZATION PARITY.
(a) In General.--Notwithstanding any other provision of law, the
Secretary may designate a hospital as a Critical Access in Character
for purposes of Medicare reimbursement if the Secretary determines that
the hospital is critical to ensuring access to essential health
services in the community it serves.
(b) Eligibility Criteria.--A hospital may qualify for designation
under subsection (a) if the hospital--
(1) is located in a rural area, as defined under section
1886(d)(2)(D) of the Social Security Act or a rural census
tract of a metropolitan statistical area (as determined under
the most recent modification of the Goldsmith Modification,
originally published in the Federal Register on February 27,
1992 (57 Fed. Reg. 6725));
(2) is located in an area designated by the Secretary as a
health professional shortage area;
(3) serves medically underserved, persistent poverty,
Tribal, or frontier communities;
(4) serves a high proportion of Medicare beneficiaries, as
determined by the Secretary based on the percentage of
inpatient or outpatient encounters attributable to individuals
entitled to benefits under Medicare; and
(5) faces a significant risk of full or partial closure or
a material reduction in the scope of services furnished, as
determined by the Secretary using financial or operational
performance indicators.
(c) Payment Parity Authority.--A hospital receiving a designation
under this section shall, for the period of such designation, be
eligible to receive reimbursement for inpatient and outpatient services
under Medicare at payment rates equivalent to those applicable to a
Critical Access Hospital, subject to such limitations and conditions as
the Secretary may establish.
(d) Duration.--A designation under this section shall remain in
effect only until the hospital is financially and operationally
stabilized, as determined by the Secretary, but may not extend beyond a
period of 3 years unless renewed by the Secretary for good cause.
(e) Guidance and Implementation.--Not later than 12 months after
the date of enactment, the Secretary shall issue guidance describing
eligibility standards, documentation requirements, and renewal
conditions; establish monitoring and reporting requirements to ensure
performance, patient access, and financial stability improvements
during the stabilization period; and collaborate with the Department of
Agriculture to make available no-cost Technical Assistance through the
Community Facilities Program to designated hospitals to strengthen
their financial and operational status.
(f) No Adverse Precedent.--A designation under this section shall
not be construed as conferring Critical Access Hospital status for
purposes of any other provision of law.
(g) Financial Risk Standard.--In conducting a review under
subsection (a), the Secretary shall determine whether the hospital is
at significant financial risk of reduced access to essential health
services in the community it serves. Such determination shall be based
on evidence that the hospital's financial distress--
(1) results primarily from the unique operational
challenges of furnishing health care in a rural area, including
low patient volumes, workforce shortages, geographic isolation,
or payer mix characteristics typical of rural communities; and
(2) does not result primarily from improper financial
management, including but not limited to misallocation of
resources, avoidable administrative inefficiencies, or non
rural business decisions unrelated to the provision of rural
health services.
(h) Documentation.--The Secretary may require the hospital to
submit such financial statements, operational data, and other
documentation as the Secretary determines necessary to evaluate the
criteria described in subsection (b).
(i) Rule of Construction.--Nothing in this section shall be
construed to limit the Secretary's authority to impose additional
conditions or oversight necessary to ensure the integrity of the
Critical Access Hospital program.
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