Introduced in Senate

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [S. 5164 Introduced in Senate (IS)] 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.

SECTION 1. SHORT TITLE. This Act may be cited as the ``Rural Emergency Hospital Designation Improvement Act''.

SEC. 2. ELIGIBILITY CHANGES.

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.

SEC. 3. DISTINCT PART UNITS.

Section 1861(kkk)(6) of the Social Security Act (42 U.S.C.

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.

SEC. 4. ADD-ON PAYMENT FOR DIAGNOSTIC LABORATORY TESTS.

Section 1834(x)(1) of the Social Security Act (42 U.S.C.

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

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.

SEC. 5. SWING BEDS.

Section 1861(kkk)(6) of the Social Security Act (42 U.S.C.

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

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.

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.

SEC. 8. SMALL RURAL HOSPITAL IMPROVEMENT PROGRAM GRANTS.

Section 1820(g) of the Social Security Act (42 U.S.C. 42 U.S.C.

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.

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.