H.R. 9005

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9005 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 9005

To amend the Consolidated Farm and Rural Development Act to direct the 
Secretary of Agriculture to make temporary zero-percent interest loans 
under the community facilities direct loan program to construct or 
renovate certain rural hospitals, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

May 21, 2026

Ms. Tokuda (for herself, Mr. Bergman, Mr. Figures, Mrs. Miller of West 
Virginia, Ms. Dexter, Mr. Mann, Ms. Davids of Kansas, Mr. Hurd of 
Colorado, and Ms. Boebert) introduced the following bill; which was 
referred to the Committee on Agriculture

_______________________________________________________________________

A BILL

To amend the Consolidated Farm and Rural Development Act to direct the 
Secretary of Agriculture to make temporary zero-percent interest loans 
under the community facilities direct loan program to construct or 
renovate certain rural hospitals, 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 ``Rural Hospital Revitalization Act of 
2026''.

SEC. 2. RURAL HOSPITAL REVITALIZATION LOANS.

Subtitle A of the Consolidated Farm and Rural Development Act is 
amended by inserting after section 306A (7 U.S.C. 1926a) the following:

``SEC. 306B. RURAL HOSPITAL REVITALIZATION LOANS.

``(a) In General.--Under the community facilities direct loan 
program established under section 306(a)(1) (referred to in this 
section as the `community facilities direct loan program'), the 
Secretary shall make temporary zero-percent interest loans to eligible 
rural hospitals described in subsection (b) for the construction of 
replacement hospital facilities or the improvement or renovation of 
existing hospital facilities in accordance with this section.
``(b) Eligible Hospitals.--
``(1) In general.--An eligible rural hospital described in 
this subsection is a rural hospital--
``(A) the campus (as defined in section 
413.65(a)(2) of title 42, Code of Federal Regulations 
(or successor regulations)) of which is in a county 
with a population of less than 20,000 inhabitants;
``(B)(i) the campus (as so defined) of which is not 
less than 35 miles from the nearest hospital;
``(ii) if the campus (as so defined) of which is in 
an area with mountainous terrain or only secondary 
roads, as determined by the Secretary, such campus is 
not less than 15 miles from the nearest hospital;
``(iii) that is a critical access hospital (as 
defined in section 1861(mm)(1) of the Social Security 
Act (42 U.S.C. 1395x(mm)(1))); or
``(iv) that is a rural emergency hospital (as 
defined in section 1861(kkk)(2) of that Act (42 U.S.C. 
1395x(kkk)(2)));
``(C) that has been continuously licensed as a 
hospital in the community in which the hospital is 
located for not less than 30 years;
``(D) that submits to the Secretary an application 
at such time, in such manner, and containing such 
information to determine eligibility under this 
paragraph and priorities under paragraph (2) and such 
other information as the Secretary may require, 
including--
``(i) a statement demonstrating the need 
for the loan, which shall describe--
``(I) the age and condition of 
existing facilities to be replaced, 
improved, or renovated, including a 
certification that funds from a loan 
under this section will not be used for 
facilities that have been significantly 
improved during the 10-year period 
preceding the date of the application; 
and
``(II) the manner in which the use 
of the loan funds will address issues 
relating to the quality and viability 
of the facilities to preserve access to 
healthcare;
``(ii) a demonstration that the hospital 
has had a positive impact in the community 
served by the hospital, which shall include--
``(I) a positive impact on access 
to primary healthcare, emergency 
services, and services required under 
conditions of participation applicable 
under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.); 
and
``(II) a meaningful economic 
impact; and
``(iii) a statement of the anticipated 
health and economic impacts of the loan, 
including--
``(I) an impact on sustaining the 
provision of services that the hospital 
currently provides;
``(II) an impact on offering 
healthcare services that the hospital 
does not currently offer, as 
appropriate;
``(III) an impact on the provision 
of community-based services, including 
such services that influence social 
determinants of health;
``(IV) any other economic impacts; 
and
``(V) impacts compared to the 
impacts if the loan funds were not made 
available; and
``(E) that, subject to paragraph (3), is 
financially stable, as measured by having--
``(i) not less than 30 days cash on hand; 
and
``(ii) a projected debt-service coverage 
ratio of at least 1.2.
``(2) Priorities.--In making loans under this section, the 
Secretary shall give priority to an eligible rural hospital--
``(A) that serves an area in which there are fewer 
than 6 inhabitants per square mile, taking into 
consideration--
``(i) the distance from the hospital to a 
population center;
``(ii) the travel time from the hospital to 
reach a population center or specific health 
service; and
``(iii) seasonal variations in the need for 
access to healthcare services;
``(B) that requires replacement, improvement, or 
renovation that is not financially feasible at the 
rates and terms offered under the community facilities 
direct loan program;
``(C) for which not less than 50 percent of its 
inpatient days or discharges and outpatient visits 
during the most recent cost reporting period for which 
data are available were attributable to--
``(i) individuals entitled to, or enrolled 
for, benefits under part A or enrolled for 
benefits under part B of title XVIII of the 
Social Security Act, including individuals 
enrolled in a Medicare Advantage plan under 
part C of such title;
``(ii) individuals eligible for medical 
assistance under a State plan under title XIX 
of the Social Security Act (or a waiver of such 
a plan); or
``(iii) self-pay individuals; or
``(D) that meets 2 or more of the criteria 
described in subparagraphs (A) through (C).
``(3) Waiver.--The Secretary may waive the requirements 
described in paragraph (1)(D) in the case of a hospital that 
demonstrates sufficient community impacts described in 
paragraph (1)(C)(ii).
``(4) Eligibility.--For purposes of making loans under this 
section, the Secretary shall consider an eligible rural 
hospital described in paragraph (1) to be eligible for the 
community facilities direct loan program.
``(c) Loan Interest and Terms.--
``(1) Initial interest-free loan.--Except as otherwise 
provided in this subsection, a loan made under this section 
shall, for the first 5 years of the loan--
``(A) have a zero percent interest rate; and
``(B) require repayment of principal for a period 
of 5 years, amortized--
``(i) in accordance with the expected 
amortization schedule of a loan under the 
community facilities direct loan program; and
``(ii) over a period that is equal to the 
lesser of--
``(I) the expected life of the 
facility being constructed or 
renovated; and
``(II) a maximum term of 40 years.
``(2) Assessment.--At the end of the 5-year period of a 
loan described in paragraph (1), the Secretary shall conduct an 
assessment of the financial stability of the eligible rural 
hospital to determine whether the hospital has the financial 
strength for the loan to be refinanced at the prevailing rates 
offered under the community facilities direct loan program.
``(3) Refinancing.--If the Secretary determines through an 
assessment under paragraph (2) that an eligible rural hospital 
has sufficient financial strength to repay a loan under the 
community facilities direct loan program, subject to subsection 
(d)(2), the Secretary shall refinance the loan under this 
section into a loan under the community facilities direct loan 
program--
``(A) at the prevailing interest rate applicable to 
a loan under the community facilities direct loan 
program;
``(B) without a requirement of the payment of any 
interest on the amount of principal repaid during the 
period in which the interest rate of the loan was zero 
percent;
``(C) based on the unpaid principal balance; and
``(D) amortized in accordance with the community 
facilities direct loan program for the remaining term 
of the loan.
``(d) Renewals.--
``(1) Failure under assessment.--
``(A) In general.--If the Secretary determines 
through an assessment under subsection (c)(2) that an 
eligible rural hospital does not have sufficient 
financial strength to repay a loan under the community 
facilities direct loan program, the hospital may submit 
to the Secretary an application for a 1-time renewal of 
the zero-percent interest loan in accordance with the 
terms described in subsection (c)(1) for 1 additional 
term of not more than 5 years.
``(B) Requirements.--To be eligible for the renewal 
of a zero-percent interest loan under subparagraph (A), 
an eligible rural hospital shall demonstrate in the 
application submitted under that subparagraph that the 
hospital--
``(i) has first applied for and accepted 
any available Federal technical assistance for 
rural hospitals to support operational 
improvements and improve financial stability; 
and
``(ii) continues to meet all applicable 
community facilities direct loan program 
eligibility criteria.
``(C) Refinancing.--At the end of the period for 
which a zero-percent interest loan is renewed under 
subparagraph (A), the Secretary shall refinance the 
loan into a loan under the community facilities direct 
loan program in accordance with subsection (c)(3).
``(2) Interest rate protection.--
``(A) In general.--If the Secretary determines 
through an assessment under subsection (c)(2) that an 
eligible rural hospital has sufficient financial 
strength to repay a loan under the community facilities 
direct loan program, and the interest rate applicable 
to a loan under the community facilities direct loan 
program is more than 2.5 percent, the hospital may 
submit to the Secretary an application for a 1-time 
renewal of the zero-percent interest loan in accordance 
with the terms described in subsection (c)(1) for 1 
additional term of 5 years.
``(B) Requirements.--To be eligible for the renewal 
of a zero-percent interest loan under subparagraph (A), 
an eligible rural hospital shall demonstrate in the 
application submitted under that subparagraph that the 
hospital--
``(i) has had a positive impact on access 
to primary healthcare, emergency services, and 
services required under conditions of 
participation applicable under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et 
seq.) in the community served by the hospital; 
and
``(ii) has had positive impacts in the 
community described in subsection 
(b)(1)(C)(ii).
``(C) Refinancing.--During the period of a zero-
percent interest loan that has been renewed under 
subparagraph (A), at any time that the interest rate 
applicable to a loan under the community facilities 
direct loan program is 2.5 percent or less, the 
eligible rural hospital may elect to refinance the loan 
into a loan under the community facilities direct loan 
program in accordance with subsection (c)(3).
``(3) Disapproval.--If the Secretary disapproves an 
application to renew a zero-percent interest loan under 
paragraph (1)(A) or (2)(A), the Secretary shall resolve the 
applicable issues in accordance with the procedures that apply 
to the community facilities direct loan program.
``(e) Technical Assistance Grants.--
``(1) In general.--A hospital that receives a loan under 
this section shall be eligible for assistance through an award 
under a covered program to support operational improvements and 
improve financial stability during--
``(A) the 5-year period of a zero-percent interest 
loan described in subsection (c)(1); and
``(B) any renewal of a zero-percent interest loan 
for a lack of sufficient financial strength under 
subsection (d)(1).
``(2) Covered program defined.--In this subsection, the 
term `covered program' means--
``(A) the Targeted Technical Assistance for Rural 
Hospitals Program of the Health Resources and Services 
Administration; and
``(B) the Rural Hospital Technical Assistance 
Program carried out by the rural development mission 
area, in cooperation with the National Rural Health 
Association.''.
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