Rural Hospital Emergency Room Guarantee Act
Sponsored By: Senator Hawley, Josh [R-MO]
Introduced
Summary
Creates a dedicated federal fund to guarantee emergency room funding for rural hospitals. This bill would set up a 10-year program, run by HRSA, that pays eligible rural 24-hour emergency departments a base annual payment, CPI adjustments, need-based supplements, and short-term emergency grants.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 2 benefits, 0 costs, 1 mixed.
Direct payments to rural ERs
If enacted, approved rural emergency departments would get a $1,000,000 base payment in the first program year. That payment would be paid in four equal quarterly amounts. In later years the base payment would change each year with the Medical Care Services Consumer Price Index for the prior 12 months. The Secretary could add a yearly supplement up to 50% of the base payment and could give one emergency payment up to $250,000 in a year if an ED is at risk of closing within 14 days. These payments would not affect other federal health program eligibility and would be in addition to other federal payments.
New 10-year rural ER fund
If enacted, the bill would create a Rural Hospital Emergency Room Guarantee Fund in the Treasury and a 10-year payment program. The Health Resources and Services Administration would run the program and must start taking applications within 90 days of enactment. Congress would authorize and appropriate such sums as necessary for each fiscal year from 2026 through 2036, and amounts in the Fund would be available without further appropriation or yearly limit.
Who qualifies and how money can be used
If enacted, only rural health facilities that participate in federal health programs and operate a 24-hour hospital emergency department or a 24-hour independent freestanding ED could apply. The Secretary would have to approve qualifying applications within 30 days and approvals would last the 10-year program unless a disqualifying change happens. Program funds could only pay normal ED operating costs, including staffing, and could not be transferred to other facilities or used to pay executives or board members. Recipients would file an annual report, the Secretary would do random audits and could impose civil penalties or remove violators, and CMS would issue rules within 90 days so program payments appear on Medicare cost reports but can be excluded from cost settlements and expense offsets. An approved entity that is acquired by private-equity or similar ownership could lose eligibility.
Sponsors & CoSponsors
Sponsor
Hawley, Josh [R-MO]
MO • R
Cosponsors
Sen. Hassan, Margaret Wood [D-NH]
NH • D
Sponsored 6/24/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov