S. 5164 · 119th Congress · Read twice and referred to the Committee on Finance.
More Help for Rural Emergency Hospitals
Rural Emergency Hospital Designation Improvement Act
8 cosponsors
- Sen. Boozman, John [R-AR] (R-AR)
- Sen. Britt, Katie Boyd [R-AL] (R-AL)
- Sen. Capito, Shelley Moore [R-WV] (R-WV)
- Sen. Heinrich, Martin [D-NM] (D-NM)
- Sen. Hyde-Smith, Cindy [R-MS] (R-MS)
- Sen. Marshall, Roger [R-KS] (R-KS)
- Sen. Smith, Tina [D-MN] (D-MN)
- Sen. Tuberville, Tommy [R-AL] (R-AL)
Deep dive November 12, 2026
This bill changes rules for rural emergency hospitals. These are small hospitals with emergency care but no regular overnight stays. The bill lets more hospitals qualify. It lets them add special care units. It raises some Medicare and Medicaid payments. It also gives them easier access to grants and worker programs.
What to know
- More hospitals could qualify, based on their status any year since 2015.
- Hospitals could add mental health, rehab, or maternity units.
- They would keep their special status if they add these units.
- Starting in 2027, Medicare would pay 5 percent more for some lab tests.
- Patients would not pay extra for these lab tests.
- Hospitals could offer short-term recovery care, called swing beds, paid by actual cost.
- These hospitals would count as areas short on doctors and nurses.
- That would make it easier to hire health workers.
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' (Section 2(b))
Why we flagged this
This provision lets the Secretary waive eligibility rules. It applies to facilities that "operate similarly" to a rural emergency hospital. The phrase is not defined in the bill. It could let many kinds of facilities qualify for a special payment status. The scope depends on later regulations. This makes the fiscal effect hard to predict.
Show the exact bill text
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 a short name. It can be called 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 any group. It only names the law for later reference.
There is no real tradeoff here, since this section only sets the law's title and has no other effect.
Show the exact bill text
This Act may be cited as the Rural Emergency Hospital Designation Improvement Act .
Who can become a rural emergency hospital
This section changes rules about which hospitals can become a rural emergency hospital. Right now, a hospital must have been a certain type of facility as of a specific date. The new rule lets a hospital qualify if it was that type of facility at any point between January 1, 2015, and a later date. The section also tells the Secretary of Health and Human Services to write new rules within one year. These new rules must let facilities that act like a rural emergency hospital qualify, even if they do not meet the usual requirements.
This affects rural hospitals and other health facilities that want to convert to rural emergency hospital status. It also affects rural patients who rely on these facilities for care.
Widening eligibility may let more struggling rural facilities qualify for support, but it could also let facilities in with less of a track record as a true emergency hospital.
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 special care units in rural emergency hospitals
This section changes the rules for rural emergency hospitals. These hospitals can now add certain special units. They can add a mental health unit for inpatient care. They can add a rehabilitation unit for patients who need inpatient recovery care. They can also add a maternity area, like a labor and delivery unit or birth emergency room. These units count as separate parts of the hospital. This lets small rural hospitals offer more types of care without losing their special hospital status.
Rural emergency hospitals, their patients, and people in rural areas who need mental health care, rehab care, or maternity care.
Rural hospitals gain more flexibility to offer needed services, but running extra units may cost more money and staff than small rural hospitals have available.
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(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.
Extra payment for lab tests at rural emergency hospitals
This section changes how Medicare pays rural emergency hospitals for certain lab tests. These are tests not already covered under outpatient payment rules. Starting January 1, 2027, Medicare will pay the normal fee schedule amount plus 5 percent extra. This extra money is meant to help cover the higher costs these hospitals face. Patient copayments will stay the same as if the 5 percent increase did not happen.
Rural emergency hospitals and the patients who get lab tests there. Medicare's payment system is also affected.
Rural hospitals get more money to help cover costs, but this means higher spending by Medicare without extra cost to patients through copays.
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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
Swing beds for rural emergency hospitals
This section lets rural emergency hospitals offer a new type of care. They can sign an agreement with the government. Under this deal, they can give care like a nursing home would. This is called extended care. It helps patients who need more recovery time but not full hospital care. The hospital would get paid based on its actual costs. These costs are figured out using the same rules used for other small rural hospitals with similar agreements.
Rural emergency hospitals, their patients needing extended recovery care, and the Medicare program that pays for these services.
Patients in rural areas may get easier access to recovery care close to home, but the government may pay more because hospitals get reimbursed based on actual costs instead of a fixed rate.
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.
Rules for hospitals switching back to critical access status
This section tells a federal health agency to write new rules within one year. The rules cover rural hospitals that changed their type to become a 'rural emergency hospital.' If one of these hospitals later switches back to its old type, called a 'critical access hospital,' it can regain a special label called 'necessary provider' status. This only applies if the hospital had that label before it switched to being a rural emergency hospital. The label can help a hospital get certain funding or rules treatment tied to being seen as essential for its area.
Rural hospitals that switched designations, their staff, and patients in rural communities who depend on these hospitals for care.
Hospitals that switch back gain an easier path to reclaim their old status, but only if they already had it before, which may not help hospitals that never held that label.
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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
Rural emergency hospitals get automatic shortage area status
This section deals with rural emergency hospitals. These are small hospitals in rural areas that offer emergency care but not full inpatient services. The section tells a federal health agency to write new rules. These rules would automatically treat every rural emergency hospital as a health professional shortage area. That label normally takes time and review to get. With this rule, rural emergency hospitals would not need separate proof. This status helps hospitals join the National Health Service Corps program. That program places doctors and nurses in areas that need more health workers.
Rural emergency hospitals, health workers in the National Health Service Corps program, and rural patients who need care.
Rural emergency hospitals could more easily attract health workers, but this may give them an advantage over other facilities that still must prove they have a shortage.
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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) ).
Grant access for rural emergency hospitals
This section changes a federal grant program for small rural hospitals. The program is called the Small Rural Hospital Improvement Program. Right now, the law lists critical access hospitals as a type of hospital that can get these grants. This section adds a new type of hospital called a rural emergency hospital to that list. This means rural emergency hospitals can now apply for the same grant money. The money can help with costs like switching to new billing systems or meeting health care rules.
Rural emergency hospitals and the communities they serve. It also affects federal health officials who run the grant program.
More hospitals can now compete for the same pool of grant money, which may help rural emergency hospitals but could mean smaller shares for other qualifying hospitals.
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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 given at rural emergency hospitals. These are small hospitals that handle emergencies but do not keep patients overnight for regular care. The law changes Medicaid's list of covered services. It adds rural emergency hospital services to that list. It also covers nursing care given in a special nursing unit inside one of these hospitals. States can start covering these services right after the law passes. If a state needs its own new law first, it gets extra time to make that change. The extra time matches the state's normal lawmaking schedule.
People on Medicaid who live near rural emergency hospitals, state Medicaid programs, and rural hospitals themselves.
Rural patients may get more covered care close to home, but states must update their Medicaid rules and pay for 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 2026-11-12)
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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