H.R. 7727

[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.

_______________________________________________________________________

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

_______________________________________________________________________

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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