[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 5164 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 5164
To amend titles XVIII and XIX of the Social Security Act to make
improvements relating to the designation of rural emergency hospitals.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 29, 2026
Mr. Moran (for himself, Ms. Smith, Mr. Tuberville, Mrs. Britt, Mrs.
Capito, Mrs. Hyde-Smith, and Mr. Marshall) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to make
improvements relating to the designation of rural emergency hospitals.
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 ``Rural Emergency Hospital Designation
Improvement Act''.
SEC. 2. ELIGIBILITY CHANGES.
(a) In General.--Section 1861(kkk)(3) of the Social Security Act
(42 U.S.C. 1395x(kkk)(3)) is amended in the matter preceding
subparagraph (A), by striking ``as of'' and inserting ``at any point
during the period beginning on January 1, 2015, and ending on''.
(b) Waiver of Certain Requirements.--Section 1861(kkk)(3) of the
Social Security Act (42 U.S.C. 1395x(kkk)(3)), as amended by subsection
(a), is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively;
(2) by striking ``described.--A facility'' and inserting
``described.--
``(A) In general.--Subject to subparagraph (B), a
facility''; and
(3) by adding at the end the following new subparagraph:
``(B) Waiver.--Not later than 1 year after the date
of enactment of this subparagraph, the Secretary shall
promulgate regulations to waive the requirements under
subparagraph (A) with respect to facilities that
operate similarly to a rural emergency hospital in
order for such facilities to be eligible for conversion
to a rural emergency hospital under this subsection.''.
SEC. 3. DISTINCT PART UNITS.
Section 1861(kkk)(6) of the Social Security Act (42 U.S.C.
1395x(kkk)(6)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new subparagraphs:
``(C) maintain or include a unit of the facility
that is a distinct part licensed as an inpatient
psychiatric unit for behavioral health patients and
allows for inpatient care;
``(D) maintain or include a unit of the facility
that is a distinct part licensed as an inpatient
rehabilitation facility and allows for inpatient care;
and
``(E) maintain or include a unit of the facility
that is a distinct part licensed as an obstetric wing,
labor and delivery unit, or obstetric emergency
department.''.
SEC. 4. ADD-ON PAYMENT FOR DIAGNOSTIC LABORATORY TESTS.
Section 1834(x)(1) of the Social Security Act (42 U.S.C.
1395m(x)(1)) is amended--
(1) by striking ``hospitals.--'' and all that follows
through ``In the case'' and inserting ``hospitals.--
``(1) In general.--
``(A) Payment for rural emergency hospital
services.--In the case''; and
(2) by adding at the end the following new subparagraph:
``(B) Payment for diagnostic laboratory tests.--In
the case of clinical diagnostic laboratory tests and
other diagnostic laboratory tests that are not covered
OPD services (as defined in section 1833(t)(1)(B))
furnished by a rural emergency hospital (as defined in
section 1861(kkk)(2)) on or after January 1, 2027, the
amount of payment for such tests shall be equal to the
amount of payment that would otherwise apply under the
applicable fee schedule, increased by 5 percent to
reflect the higher costs incurred by such hospitals,
and shall include the application of any copayment
amount determined under this part as if such increase
had not occurred''.
SEC. 5. SWING BEDS.
Section 1861(kkk)(6) of the Social Security Act (42 U.S.C.
1395x(kkk)(6)), as amended by section 3, is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(F) may enter into an agreement with the
Secretary under which its facilities may be used for
the furnishing of services of the type which, if
furnished by a skilled nursing facility would
constitute extended care services. Payment to a rural
emergency hospital for services furnished under such an
agreement shall be based upon the reasonable cost of
the services as determined under section 1883(a)(2)(B)
(if such section were applied by submitting `rural
emergency hospital' for `hospital' and `inpatient
hospital' in clauses (ii) and (iii), respectively, of
such section).''.
SEC. 6. NECESSARY PROVIDER STATUS FOR FACILITIES THAT REVERT TO
CRITICAL ACCESS HOSPITAL DESIGNATION.
Not later than 1 year after the date of the enactment of this Act,
the Secretary of Health and Human Services shall promulgate regulations
to permit a rural emergency hospital (as defined in section
1861(kkk)(2) of the Social Security Act (42 U.S.C. 1395x(kkk)(2))) that
reverts back to its previous designation as a critical access hospital
(as defined in section 1861(mm)(1) of such Act (42 U.S.C. 1395x(m)(1)))
to regain its status as a necessary provider of health care services
pursuant to section 1820(c)(2)(B)(i)(II) of such Act (42 U.S.C. 1395i-
4(c)(2)(B)(i)(II)), but only if the facility was designated as a
necessary provider of health care services pursuant to such section
prior to converting to a rural emergency hospital.
SEC. 7. NATIONAL HEALTH SERVICE CORPS SITE ELIGIBILITY.
The Secretary of Health and Human Services, acting through the
Administrator of the Health Resources and Services Administration,
shall promulgate regulations to deem a rural emergency hospital (as
defined in section 1861(kkk)(2) of the Social Security Act (42 U.S.C.
1395x(kkk)(2))) to be a health professional shortage area in accordance
with section 332(a)(1)(C) of the Public Health Service Act (42 U.S.C.
254e(a)(1)(C)).
SEC. 8. SMALL RURAL HOSPITAL IMPROVEMENT PROGRAM GRANTS.
Section 1820(g) of the Social Security Act (42 U.S.C. 42 U.S.C.
1395i-4(g)) is amended--
(1) in paragraph (1)(D), by inserting ``or rural emergency
hospitals (as defined in section 1861(kkk)(2))'' after
``critical access hospitals''; and
(2) in paragraph (3)(A), by inserting ``or rural emergency
hospitals (as defined in section 1861(kkk)(2))'' after ``small
rural hospitals''.
SEC. 9. INCLUSION OF RURAL EMERGENCY HOSPITAL SERVICES UNDER MEDICAID.
(a) In General.--Section 1905(a) of the Social Security Act (42
U.S.C. 1396d(a)) is amended--
(1) in paragraph (2)(A), by inserting ``(including rural
emergency hospital services, as defined in section
1861(kkk)(1), which are licensed or otherwise approved by the
State)'' after ``services''; and
(2) in paragraph (4)(A), by inserting ``but including
services provided in a nursing facility that is a distinct part
unit of a rural emergency hospital, as defined in section
1861(kkk)(2)'' after ``diseases''.
(b) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this subsection shall apply with respect to medical
assistance provided on or after the date of enactment of this
Act.
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) that the Secretary of Health and Human
Services determines requires State legislation in order for
such plan to meet any requirement imposed by the amendments
made by this section, such plan shall not be regarded as
failing to comply with the requirements of such title solely on
the basis of its failure to meet such an additional requirement
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of the
session shall be considered to be a separate regular session of
the State legislature.
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