SenateS. 4927119th Congress
Rural Hospital Emergency Room Guarantee Act
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4927 Introduced in Senate (IS)]
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119th CONGRESS
2d Session
S. 4927
To establish a guaranteed funding stream to keep existing emergency
rooms at America's rural hospitals open, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 24, 2026
Mr. Hawley (for himself and Ms. Hassan) introduced the following bill;
which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To establish a guaranteed funding stream to keep existing emergency
rooms at America's rural hospitals open, 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 Emergency Room
Guarantee Act''.
SEC. 2. RURAL HOSPITAL EMERGENCY ROOM GUARANTEE FUND.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-8. RURAL HOSPITAL EMERGENCY ROOM GUARANTEE FUND.
``(a) Establishment.--There is established in the Treasury of the
United States a fund, to be known as the `Rural Hospital Emergency Room
Guarantee Fund' (referred to in this section as the `Fund'), consisting
of--
``(1) such amounts as are appropriated to the fund pursuant
to subsection (i); and
``(2) any amounts collected as civil monetary penalties
under subsection (g)(2)(A).
``(b) Administration.--The Fund shall be administered by the
Secretary, acting through the Administrator of the Health Resources and
Services Administration (referred to in this section as the
`Secretary').
``(c) Use of Funds.--
``(1) In general.--Amounts in the Fund shall be available,
without further appropriation or fiscal year limitation, to the
Secretary to make payments under the program established under
paragraph (2).
``(2) Program.--
``(A) In general.--Not later than 90 days after the
date of enactment of the Rural Hospital Emergency Room
Guarantee Act, the Secretary shall establish, and
solicit applications for, a 10-year program (referred
to in this section as the `program') to make payments
to eligible entities for the authorized uses described
in subsection (e).
``(B) Payments.--Each year of the program, the
Secretary shall--
``(i) make a payment--
``(I) in the first year of the
program, in the amount of $1,000,000
(to be distributed in equal payments on
a quarterly basis) to each eligible
entity with an approved application
under subsection (d)(2); and
``(II) in each subsequent year of
the program, in an amount equal to the
amount of the payment for the preceding
year, as adjusted to reflect changes
for the 12-month period ending the
preceding November 30 in the Consumer
Price Index for Medical Care Services
published by the Bureau of Labor
Statistics of the Department of Labor;
and
``(ii) make an additional payment to each
such eligible entity in an amount not greater
than 50 percent of the amount of the payment
made to such eligible entity under clause (i)
for that year, to be determined by the
Secretary with respect to each such eligible
entity pursuant to a formula established by the
Secretary by rulemaking based on, with respect
to an eligible entity--
``(I) the payor mix of the eligible
entity;
``(II) the injury need of patients
within the immediate geographical area
in which the eligible entity is
located;
``(III) the economic conditions in
the geographic area in which such
eligible entity is located; and
``(IV) past financial history of
such eligible entity.
``(C) Emergency payments.--The Secretary may make
an additional payment, in an amount not to exceed
$250,000, to an eligible entity with an approved
application under subsection (d)(2) in any year of the
program if the Secretary determines that the emergency
department of such eligible entity is in danger of
closing in the next 14 days, on the condition that no
eligible entity may receive more than 1 such payment in
any year of the program.
``(d) Applications; Approval; Eligibility.--
``(1) In general.--Each entity desiring to receive payments
under the program shall submit to the Secretary an application
at such time, in such manner, and containing such information
as the Secretary may require.
``(2) Approval.--
``(A) In general.--Not later than 30 days after
receiving an application under paragraph (1), the
Secretary shall approve such application if the
Secretary determines that such entity meets the
eligibility criteria described in paragraph (3). Such
approval shall apply with respect to such an entity for
the duration of the program, except as provided in
paragraph (4).
``(B) Requirement.--If the Secretary does not
approve an application under subparagraph (A), as soon
as practicable after such disapproval, the Secretary
shall provide to the applicant--
``(i) an explanation of the reason for the
disapproval; and
``(ii) an expedited process for curing any
deficiencies in the application and reapplying.
``(3) Eligibility.--To be eligible to receive a payment
under the program, an entity--
``(A) shall be a rural health facility (as defined
in section 2105(h)(3)(D) of the Social Security Act),
other than an entity described in clause (i)(II) of
such section;
``(B) shall participate in a Federal health care
program (as defined in section 1128B(f) of such Act);
and
``(C) shall operate a 24-hour emergency department
of a hospital (as defined in section 2799A-1(a)(3)) or
a 24-hour independent freestanding emergency department
(as so defined).
``(4) Condition of participation.--After the date on which
the application of an eligible entity is approved under
paragraph (2)(A), if such eligible entity is acquired, in whole
or in part, by a private-equity, venture-capital, or similarly
purposed ownership fund, such eligible entity may not continue
to participate in the program.
``(e) Authorized Uses.--An eligible entity receiving payments under
the program--
``(1) may only use the funds to pay for the normal
operating expenses, including for staffing, of the emergency
department of such eligible entity; and
``(2) may not--
``(A) use the funds--
``(i) to develop projects that do not
directly impact the existing operations of such
eligible entity; or
``(ii) to make payments to executives,
executive staff, or members of the board of
directors of such eligible entity; or
``(B) transfer the funds to other facilities,
including other facilities of such eligible entity.
``(f) Reporting.--Each eligible entity receiving payments under the
program shall submit to the Secretary an annual report describing the
financial condition and continued need of such eligible entity and the
impact of such payments received during the preceding year on such
eligible entity. The Secretary may not use such reported information to
disqualify such eligible entity from participation in the program.
``(g) Compliance.--
``(1) In general.--The Secretary shall conduct random
audits of eligible entities receiving payments under the
program to ensure the compliance of such eligible entities with
the requirements of the program.
``(2) Violations.--If the Secretary determines that an
eligible entity has violated a requirement of the program, the
Secretary may--
``(A) impose civil penalties, including civil
monetary penalties, against such eligible entity; or
``(B) remove such eligible entity from
participation in the program.
``(h) Regulations for Reporting.--Not later than 90 days after the
date of enactment of the Rural Hospital Emergency Room Guarantee Act,
the Secretary, acting through the Administrator of the Centers for
Medicare & Medicaid Services, shall promulgate regulations--
``(1) establishing a reporting methodology for eligible
entities enrolled in the Medicare program under title XVIII of
the Social Security Act under section 1866(j) of such Act to
disclose for informational purposes on any required cost
reports under such title XVIII all payments received under the
program; and
``(2) allowing an eligible entity to exclude all payments
received under the program from cost settlement calculations
and expense offsets.
``(i) Mandatory Funding.--Out of any money in the Treasury not
otherwise appropriated, there is authorized to be appropriated, and
there is appropriated, to the Fund such sums as are necessary for each
of fiscal years 2026 through 2036.
``(j) Effect.--Participation in the program shall not be taken into
account in determining eligibility of an eligible entity under any
other Federal health care program (as defined in section 1128B(f) of
the Social Security Act) and any payment under the program shall be in
addition to any payment such eligible entity is eligible to receive
under any other Federal health care program (as so defined).''.
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