Rural Hospital Emergency Room Guarantee Act

[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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