H.R. 10293 · 119th Congress · Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Bill Would Help More Rural Hospitals Offer Emergency and Other Care
Rural Emergency Hospital Designation Improvement Act
5 cosponsors
- Rep. Bergman, Jack [R-MI-1] (R-MI)
- Rep. Davids, Sharice [D-KS-3] (D-KS)
- Rep. Davis, Donald G. [D-NC-1] (D-NC)
- Rep. Mann, Tracey [R-KS-1] (R-KS)
- Rep. Miller, Carol D. [R-WV-1] (R-WV)
Deep dive September 6, 2026
This bill changes rules for rural emergency hospitals. These are small hospitals with emergency care but no regular overnight beds. The bill lets more hospitals qualify. It adds new services like mental health and maternity care. It also raises some Medicare and Medicaid payments. It helps hospitals hire staff and get improvement grants.
What to know
- More rural hospitals could qualify for this status under looser rules.
- The rules use a longer time window that starts in 2015.
- Hospitals could add overnight units for mental health care.
- Hospitals could also add units for rehab or maternity care.
- Starting in 2027, Medicare would pay 5 percent more for lab tests. Patient copays would stay the same.
- Hospitals could offer nursing home level care in the same beds. This works through new 'swing bed' deals with Medicare.
- Medicaid could start paying for care at these hospitals. Right now, mostly Medicare covers this care.
- These hospitals would qualify for federal health worker programs. They could also get small rural hospital grants.
Heads up
1 buried provision
Provisions we flagged do not match the bill's stated purpose, or repeat language from bills that did not pass on their own.
Waiver for facilities that 'operate similarly' to rural emergency hospitals (Section 2(b))
Why we flagged this
The bill lets the Secretary waive eligibility rules. It applies to facilities that 'operate similarly to a rural emergency hospital.' That phrase is not defined. It gives wide discretion over who can convert and get Medicare payments. This could expand which facilities qualify in unclear ways.
Show the exact bill text
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.
Section by section
Short title of the Act
This section gives the law its official name. It calls the law the Rural Emergency Hospital Designation Improvement Act. This name is used to refer to the law in other documents. It does not create any rules or programs by itself.
This section does not directly affect anyone. It only sets the name used for the rest of the law.
There is no tradeoff, since this section only names the Act and does not set policy.
Show the exact bill text
This Act may be cited as the Rural Emergency Hospital Designation Improvement Act .
Easier rules for hospitals to become rural emergency hospitals
This section changes who can become a rural emergency hospital. Right now, a hospital must have had a certain status as of a set date to qualify. The new rule lets a hospital qualify if it had that status at any point during a longer time window, starting in 2015. The section also tells the Secretary of Health and Human Services to write new rules within one year. Those rules must let some hospitals skip certain requirements if they already work like a rural emergency hospital. This makes it easier for more rural hospitals to switch to this special status.
Rural hospitals that closed or changed services and want to convert to rural emergency hospital status. It also affects patients in rural areas who use these hospitals.
More rural hospitals could qualify for extra federal support and stay open, but loosening the rules means some facilities may get this status without meeting the original strict standards.
Show the exact bill text
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.
Allowing rural emergency hospitals to add special care units
This section changes the rules for rural emergency hospitals. These hospitals are a special type of facility that gives emergency care but does not keep patients overnight in regular beds. The law now says these hospitals can add certain separate units. They can add a mental health unit for inpatient care. They can add a rehabilitation unit for inpatient care. They can also add an obstetric unit, such as a labor and delivery area or an obstetric emergency room. These units can house patients overnight, even though the main hospital cannot.
This affects rural emergency hospitals and the patients they serve, including people needing mental health care, rehab care, or maternity care in rural areas.
Rural areas may get more local access to mental health, rehab, and maternity care, but running these extra units could raise costs and staffing needs for small rural hospitals.
Show the exact bill text
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;
Extra payment for lab tests at rural emergency hospitals
This section changes how Medicare pays rural emergency hospitals for lab tests. Starting January 1, 2027, these hospitals would get 5 percent more than the normal fee schedule amount for certain diagnostic lab tests. This extra money is meant to help cover their higher costs. Patients would still pay copayments based on the normal amount, not the higher amount.
Rural emergency hospitals and Medicare patients who get lab tests at these hospitals.
Rural emergency hospitals get more money to help cover higher costs, but Medicare spends more on these lab tests overall.
Show the exact bill text
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
Swing beds for rural emergency hospitals
This section lets rural emergency hospitals sign a special agreement with the federal government. The agreement lets them use their beds for skilled nursing care. This is called a 'swing bed' service. It means a patient can stay in the same hospital bed but get nursing home level care instead of hospital care. The government will pay these hospitals back based on the reasonable cost of that care. This cost is figured using the same rules as other hospitals with swing beds.
Rural emergency hospitals, their patients, and the Medicare program that pays for the care.
Patients in rural areas may get easier access to nursing care close to home, but the change could raise Medicare costs and requires hospitals to meet new payment and reporting rules.
Show the exact bill text
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.
Regaining necessary provider status after switching back to a critical access hospital
This section deals with rural hospitals that changed their status. Some rural hospitals switched from being a critical access hospital to a rural emergency hospital. This section lets those hospitals switch back if they choose. If they switch back, they can regain their old necessary provider status. This only applies if they had that status before they became a rural emergency hospital. The Health and Human Services Secretary must write rules to allow this within one year.
Rural hospitals that switched to rural emergency hospital status and want to switch back, and the rural communities they serve.
This helps rural hospitals regain funding benefits if they switch back, but only if they already had that status before, which may not help every hospital that wants to switch back.
Show the exact bill text
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
Rural emergency hospitals and health worker programs
This section deals with rural emergency hospitals. These are small hospitals in rural areas that offer emergency and outpatient care. The section tells health officials to write new rules. These rules would treat rural emergency hospitals as places with a shortage of health workers. This label helps hospitals join the National Health Service Corps program. That program sends doctors and nurses to areas that need them. It often pays for their training in exchange for work at these sites.
Rural emergency hospitals, health workers in the National Health Service Corps program, and rural communities that use these hospitals.
Rural hospitals may find it easier to recruit health workers, but the change could shift some staff away from other areas already labeled as shortage zones.
Show the exact bill text
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) ).
Grants for small rural hospital improvement
This section changes who can get money from a federal grant program. The program helps small rural hospitals improve their work. Right now, critical access hospitals can get this money. This section adds rural emergency hospitals to the list. It also adds them to another part of the same rule about small rural hospitals. This means rural emergency hospitals can now apply for these improvement grants too.
Rural emergency hospitals and small rural hospitals across the country. Patients in rural areas may also see effects from hospital improvements.
More hospitals can compete for the same grant money, which may help rural emergency hospitals but could mean smaller shares for other hospitals that already qualify.
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in paragraph (1)(D), by inserting or rural emergency hospitals (as defined in section 1861(kkk)(2)) after critical access hospitals
Adding rural emergency hospital services to Medicaid
This section lets Medicaid pay for care at rural emergency hospitals. These are small hospitals that offer emergency and outpatient care but no long-term inpatient beds. Right now, Medicare covers this type of care, but Medicaid does not always include it. This section changes Medicaid law so states can pay for these services. It also allows Medicaid to cover nursing facility care located inside these rural emergency hospitals. States get extra time to update their own laws if needed, so they will not be penalized for delays caused by state lawmaking.
Rural residents on Medicaid, rural emergency hospitals, and state Medicaid programs.
Rural areas may keep better access to emergency care through Medicaid, but states may face new costs to cover these added services.
Show the exact bill text
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
Citations
- Congress.gov bill text: link (retrieved 2026-09-06)
Public record
Below is the official voting record from Congress.gov. It is not our analysis.
Source: Congress.gov
This bill has no recorded roll-call vote yet. A roll-call vote records how each member voted by name.
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