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US Congress · S. 4460 · Passed the Senate

Rural Community Hospital Demonstration Program Reauthorization

Introduced
Moved
Reached a final decision
Introduced 2026-04-30
Derived from the official record below.

Officially: “Rural Community Hospital Demonstration Program Reauthorization Read the full text

Health

What it does

Rural Community Hospital Demonstration Program Reauthorization This bill extends the Rural Community Hospital Demonstration Program for an additional five years. The program tests the feasibility of cost-based reimbursement under Medicare for small rural hospitals that are too large to qualify for special payment as critical access hospitals. The bill specifies that hospitals that participate in the program between December 30, 2024, and January 1, 2027, may continue to participate during the five-year extension period.
Summary by the Congressional Research Service, from the official record. Plain-language version below. Not legal advice.

Read it in plain language

AI plain language2 sections
Written by AI from the complete official bill text and independently fact-checked against it. Not legal advice.
1Short title

This section would let the Act be officially called the Rural Community Hospital Demonstration Program Reauthorization.

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Official text, verbatim from the record

1. Short title This Act may be cited as the Rural Community Hospital Demonstration Program Reauthorization .

2Five-year extension of the rural community hospital demonstration program

This section would extend the rural community hospital demonstration program created under section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. It would change the program's extension period from 15 years to 20 years, adding 5 more years to the program. To keep the law consistent with that change, it would also update every place in subsection (g) of section 410A that refers to the 15-year extension period so each one instead refers to the 20-year extension period, including the subsection's own heading, which would change from Fifteen-Year to Twenty-Year. This includes references in paragraphs (1) through (6) of that subsection, and in paragraph (1) it covers both the phrase additional 15-year and the phrase 15-year extension period. It would also relabel the heading of subparagraph (B) within paragraph (5) from Additional extension to CAA, 2021 extension. It would add a new subparagraph (C) to paragraph (5) stating that during the fourth 5-year period of the 20-year extension period, the Secretary must apply the same rules that paragraph (4) applies to certain rural community hospitals to a further group of rural community hospitals: those not covered by paragraph (4) that took part in the demonstration program at any time between December 30, 2024, and January 1, 2027. The Secretary would have to treat this further group of hospitals in a manner similar to how paragraph (4) treats the hospitals it already covers.

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Official text, verbatim from the record

2. Five-year extension of the rural community hospital demonstration program (a) In general Subsection (a)(5) of section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108–173 ; 42 U.S.C. 1395ww note), is amended by striking 15-year extension period and inserting 20-year extension period . (b) Conforming amendments for extension (1) Extension of demonstration period Subsection (g) of such section 410A is amended— (A) in the subsection heading, by striking Fifteen-Year and inserting Twenty-Year ; (B) in paragraph (1)— (i) by striking additional 15-year and inserting additional 20-year ; and (ii) by striking 15-year extension period and inserting 20-year extension period ; (C) in paragraph (2), by striking 15-year extension period and inserting 20-year extension period ; (D) in paragraph (3), by striking 15-year extension period and inserting 20-year extension period ; (E) in paragraph (4), by striking 15-year extension period each place it appears and inserting 20-year extension period ; (F) in paragraph (5), by striking 15-year extension period each place it appears and inserting 20-year extension period ; and (G) in subparagraph (A) of paragraph (6), by striking 15-year extension period and inserting 20-year extension period . (2) Rule for hospitals that are not original participants in the demonstration Paragraph (5) of subsection (g) of such section 410A is amended— (A) in subparagraph (B), by striking Additional extension and inserting CAA, 2021 extension ; and (B) by adding at the end the following new subparagraph: (C) Additional extension During the fourth 5 years of the 20-year extension period, the Secretary shall apply the provisions of paragraph (4) to rural community hospitals that are not described in paragraph (4) but are participating in the demonstration program under this section at any time during the period beginning on December 30, 2024, and ending on January 1, 2027, in a similar manner as such provisions apply to rural community hospitals described in paragraph (4). .

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Where it is

Introduced · 2026-04-30

In the Senate.

Passed the Senate · 2026-05-20
House floor vote · next · the next step

Official documents

The on-site text is shown verbatim from the GovInfo publication, captured 2026-07-23. The same version at GovInfo.

The numbers

29%
of bills that passed one chamber became law in the 118th Congress, 2023 to 2024 (n=939)
17
sponsors, out of 51 needed to pass

Who is lobbying on this

AMERICAN HOSPITAL ASSOCIATIONvia AMERICAN HOSPITAL ASSOCIATION
1 filing
From 1 filing in federal lobbying disclosures (LDA), via lda.gov, naming this bill (2026). Filings are self-reported by lobbying firms and show who is paid to influence this bill. They do not say which side, or whether it worked.
Every fact on this page links to its source, starting with the official bill record. Last action: Held at the desk. (2026-05-21).