Rural Hospital Emergency Room Guarantee Act
- Bill Number
- S. 4927
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Status
- Introduced
- Latest Action
- 2026-06-24: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2026-07-07T04:53:28Z
AI-Generated Summary
Rural Hospital Emergency Room Guarantee Act (S. 4927)
Purpose
This legislation establishes a dedicated funding mechanism to support the ongoing operation of emergency departments at qualifying rural hospitals and freestanding facilities, aiming to prevent closures by providing guaranteed payments for a 10-year period.
Key Provisions
- Fund Establishment: Creates the Rural Hospital Emergency Room Guarantee Fund in the U.S. Treasury, funded through mandatory appropriations and civil monetary penalties.
- Program Creation: Directs the Secretary of Health and Human Services (via the Health Resources and Services Administration) to launch a 10-year payment program within 90 days of enactment.
- Base annual payments begin at $1,000,000 per eligible entity in the first year, adjusted annually for inflation using the Consumer Price Index for Medical Care Services.
- Additional payments (up to 50% of the base amount) may be awarded based on factors such as payor mix, local injury needs, economic conditions, and financial history.
- Emergency payments of up to $250,000 are available if an emergency department faces imminent closure, limited to one per entity per year.
- Eligibility Criteria: Limited to rural health facilities (excluding certain specified entities under Social Security Act definitions) that participate in federal health care programs and maintain 24-hour emergency departments.
- Fund Restrictions: Payments may only cover normal operating expenses (including staffing) of the emergency department; prohibited uses include new development projects, executive compensation, board payments, or transfers to other facilities.
- Oversight and Compliance: Requires annual financial reporting from recipients; mandates random audits; allows civil penalties or removal from the program for violations.
- Regulatory Requirements: Directs the Centers for Medicare & Medicaid Services to issue rules within 90 days for reporting program payments on Medicare cost reports and excluding them from certain calculations.
- Funding Mechanism: Provides mandatory appropriations of "such sums as are necessary" for fiscal years 2026 through 2036.
Significant Changes to Existing Law
- Adds a new section (399V-8) to Part P of title III of the Public Health Service Act, creating a permanent, non-discretionary funding stream outside standard appropriations processes.
- Introduces new eligibility and use restrictions tied to private equity or venture capital acquisitions, which would disqualify facilities from continued participation.
- Establishes specific Medicare reporting and cost-settlement exclusions not previously required for such supplemental payments.
Potential Impacts
- Government Agencies: Increases administrative responsibilities for the Health Resources and Services Administration (program management and audits) and the Centers for Medicare & Medicaid Services (regulation development and cost report updates).
- Citizens: Aims to sustain emergency care access in rural areas by supporting facility operations, though outcomes depend on entity compliance and fund allocation.
- International Relations: No provisions address or affect international matters.
Main Stakeholders Affected
- Qualifying rural hospitals and independent freestanding emergency departments.
- Patients and communities relying on rural emergency services.
- Federal agencies including the Department of Health and Human Services, Health Resources and Services Administration, and Centers for Medicare & Medicaid Services.
- Entities involved in Medicare cost reporting and compliance.
Notable Legal, Constitutional, or Political Implications
- The mandatory funding provision creates an entitlement-like structure that limits congressional discretion over annual appropriations.
- Participation in the program does not alter eligibility for other federal health care programs, and payments are additive to existing reimbursements.
- Restrictions on fund use and acquisition-related disqualifications introduce new compliance conditions that could lead to civil penalties or program removal.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Sen. Hassan, Margaret Wood [D-NH]
Recent Actions
- 2026-06-24: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2026-06-24: Introduced in Senate
Bill Versions
- Rural Hospital Emergency Room Guarantee Act — issued 2026-06-24 — PDF (9 pages)