Bill text used: Engrossed in Senate (passed the Senate May 20, 2026; not yet law) · updated Oct 28, 2026
This breakdown was drafted by AI from the official documents and passed our automatic checks: every quoted word was found in its source, and every number comes from an official record. A person must review it before we mark it reviewed. Tap any small number to see the exact words a sentence rests on.
At a glance
Sourced- This bill would keep a Medicare test program for small rural hospitals going for 5 more years.
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Five-year extension of the rural community hospital demonstration program
[2] Engrossed in Senate (2026-05-20) · Sec. 2is amended by striking 15-year extension period and inserting 20-year extension period
[2] Engrossed in Senate (2026-05-20) · Sec. 2(a) - In the program, Medicare pays these hospitals based on their reasonable costs for inpatient care.
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the reasonable costs of providing such services
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (b)(1)(A)to furnish covered inpatient hospital services (as defined in subsection (f)(2)) to medicare beneficiaries
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(1) - It is open to rural hospitals with fewer than 51 beds and 24-hour emergency care that are not critical access hospitals.
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is located in a rural area
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (f)(1)(A)(i)has fewer than 51 acute care inpatient beds, as reported in its most recent cost report
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (f)(1)(A)(ii)makes available 24-hour emergency care services
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (f)(1)(A)(iii)is not eligible for designation, or has not been designated, as a critical access hospital
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (f)(1)(A)(iv) - It passed the Senate without objection on May 20, 2026. It is not law yet; the House has not voted.
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2026-05-20 | Senate | Passed Senate without amendment by Unanimous Consent.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-202026-05-21 15:30:43 | House floor actions | Held at the desk.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-21 - Sen. Chuck Grassley of Iowa wrote it, with 16 cosponsors from both parties.
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Sponsor: Sen. Grassley, Chuck [R-IA]
[1] Official bill status record (actions, votes, cosponsors) · SponsorCosponsors (16): Sen. Bennet, Michael F. [D-CO] (2026-04-30); Sen. Crapo, Mike [R-ID] (2026-04-30); Sen. Wyden, Ron [D-OR] (2026-04-30)
[1] Official bill status record (actions, votes, cosponsors) · Cosponsors
What it would mean for you
SourcedIf you live near a small rural hospital
A Medicare payment program that helps some rural hospitals would keep going
- Up to 30 hospitals can take part at a time.
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not more than 30 rural community hospitals may participate in the demonstration program
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (g)(3) - A cosponsor says it helps rural hospitals steady their finances and keep their doors open.
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helping steady the finances of rural hospitals so they can keep their doors open.
[6] Sen. Cindy Hyde-Smith press release: Hyde-Smith Welcomes Senate Passage of Rural Hospital Legislation (May 21, 2026) · May 21, 2026
If you run a rural hospital in the program
Five more years, including for newer members
- Hospitals in the program at any time from December 30, 2024 to January 1, 2027 would stay under the same rules for the next 5 years.
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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
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)at any time during the period beginning on December 30, 2024, and ending on January 1, 2027
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C) - Medicare would keep paying based on reasonable costs, then a yearly target.
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the reasonable costs of providing such services
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (b)(1)(A)the lesser of
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (b)(1)(B)
If you live in Iowa
Your senator wrote it
- Sen. Chuck Grassley wrote the bill.
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Sponsor: Sen. Grassley, Chuck [R-IA]
[1] Official bill status record (actions, votes, cosponsors) · Sponsor
What this bill does not do
Sourced- It does not change who can join or how payments are figured. It only adds time.
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is amended by striking 15-year extension period and inserting 20-year extension period
[2] Engrossed in Senate (2026-05-20) · Sec. 2(a)Five-year extension of the rural community hospital demonstration program
[2] Engrossed in Senate (2026-05-20) · Sec. 2 - Total Medicare spending still may not be higher than without the program.
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the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (c)(2) - It is not law yet. The House still has to pass it.
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2026-05-21 15:30:43 | House floor actions | Held at the desk.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-21
Current law vs. the bill
SourcedEvery place the bill changes existing law. On the left, the law as it stands today, quoted from the U.S. Code. On the right, the bill's words.
Pub. L. 108-173, sec. 410A(a)(5) (42 U.S.C. 1395ww note)Replaces words
Current law
for a 5-year period (in this section referred to as the 'initial 5-year period') and, as provided in subsection (g), for the 15-year extension period5
for a 5-year period (in this section referred to as the 'initial 5-year period') and, as provided in subsection (g), for the 15-year extension period[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(5)
The program ran for an initial 5 years plus a 15-year extension.
The bill
is amended by striking 15-year extension period and inserting 20-year extension period2
is amended by striking 15-year extension period and inserting 20-year extension period[2] Engrossed in Senate (2026-05-20) · Sec. 2(a)
In plain words: The extension grows from 15 years to 20 years.
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for a 5-year period (in this section referred to as the 'initial 5-year period') and, as provided in subsection (g), for the 15-year extension period[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(5)
is amended by striking 15-year extension period and inserting 20-year extension period[2] Engrossed in Senate (2026-05-20) · Sec. 2(a)
Pub. L. 108-173, sec. 410A(g)(5) (42 U.S.C. 1395ww note)Adds a new subparagraph
Current law
New: nothing here today.
The bill
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 program2
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[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)
In plain words: Hospitals that joined later keep the same payment rules in the new 5 years.
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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[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)
What the bill decides, and what it leaves to others
SourcedWritten into the bill
These take effect exactly as written.
- The added time is set at 5 years.
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Five-year extension of the rural community hospital demonstration program
[2] Engrossed in Senate (2026-05-20) · Sec. 2 - The dates that decide which later hospitals stay in are written into the bill.
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at any time during the period beginning on December 30, 2024, and ending on January 1, 2027
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)
Left to agencies or states
The real effect depends on rules someone else writes later.
- The Health and Human Services Secretary runs the program and pays the hospitals.
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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
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)The Secretary of Health and Human Services shall establish a demonstration program
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(1)
Section by section
SourcedRead all 3 sections in plain words
- Sec. 1 Short title
- Names the bill the Rural Community Hospital Demonstration Program Reauthorization.
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This Act may be cited as the Rural Community Hospital Demonstration Program Reauthorization.
[2] Engrossed in Senate (2026-05-20) · Sec. 1 - Sec. 2(a) Five more years
- Turns the program's 15-year extension into a 20-year extension.
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for a 5-year period (in this section referred to as the 'initial 5-year period') and, as provided in subsection (g), for the 15-year extension period
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(5)is amended by striking 15-year extension period and inserting 20-year extension period
[2] Engrossed in Senate (2026-05-20) · Sec. 2(a) - Sec. 2(b) Matching changes
- Updates every mention of the 15-year period to 20 years.Hospitals that joined later and were in the program from December 30, 2024 to January 1, 2027 would keep the same treatment for the fourth 5 years.
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by striking additional 15-year and inserting additional 20-year
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(1)(B)(i)2
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
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)at any time during the period beginning on December 30, 2024, and ending on January 1, 2027
[2] Engrossed in Senate (2026-05-20) · Sec. 2(b)(2)(B) → inserted (C)
What changed between versions
Sourced1 step, from first draft to final text
From the Senate bill as introduced to the Senate-passed text
No changes to the wording.
Cost
Sourced- No Congressional Budget Office estimate is listed in the official record for this bill.
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2026-05-20 | Senate | Passed Senate without amendment by Unanimous Consent.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-20 - The bill keeps the existing rule that the program's total payments may not exceed what Medicare would have paid without it.
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the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (c)(2)from the Federal Hospital Insurance Trust Fund
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (c)(1)is amended by striking 15-year extension period and inserting 20-year extension period
[2] Engrossed in Senate (2026-05-20) · Sec. 2(a)
Analysis
AnalysisEvery bill gets the same five questions. Arguments are attributed to the people who made them, and each side gets about the same space.
Path to law
- Sen. Grassley introduced it on April 30, 2026.
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Sponsor: Sen. Grassley, Chuck [R-IA]
[1] Official bill status record (actions, votes, cosponsors) · Sponsor2026-04-30 | Library of Congress | Introduced in Senate
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-04-30 - On May 20, 2026, the Finance Committee was discharged and the Senate passed it without objection.
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2026-05-20 | Senate | Senate Committee on Finance discharged by Unanimous Consent.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-202026-05-20 | Senate | Passed Senate without amendment by Unanimous Consent.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-20There being no objection, the committee was discharged, and the Senate proceeded to consider the bill.
[4] Congressional Record, Senate, May 20, 2026 (S2428) · S2428 - It reached the House on May 21, 2026, where it is waiting.
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2026-05-21 15:30:43 | House floor actions | Held at the desk.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-21
Balance of power
- Grassley, a Republican, had 16 cosponsors, starting with Democrat Michael Bennet, Republican Mike Crapo and Democrat Ron Wyden.
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Sponsor: Sen. Grassley, Chuck [R-IA]
[1] Official bill status record (actions, votes, cosponsors) · SponsorCosponsors (16): Sen. Bennet, Michael F. [D-CO] (2026-04-30); Sen. Crapo, Mike [R-ID] (2026-04-30); Sen. Wyden, Ron [D-OR] (2026-04-30)
[1] Official bill status record (actions, votes, cosponsors) · Cosponsors
Coalitions
- There was no recorded vote, and no senator objected.
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2026-05-20 | Senate | Passed Senate without amendment by Unanimous Consent.
[1] Official bill status record (actions, votes, cosponsors) · Actions, 2026-05-20There being no objection, the committee was discharged, and the Senate proceeded to consider the bill.
[4] Congressional Record, Senate, May 20, 2026 (S2428) · S2428
Precedent
- Congress has extended this test program before; it began with a 5-year trial and grew to a 15-year extension.
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for a 5-year period (in this section referred to as the 'initial 5-year period') and, as provided in subsection (g), for the 15-year extension period
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (a)(5)
The strongest case on each side
For
- The program has a proven track record and helps rural hospitals steady their finances so they can stay open.Sen. Cindy Hyde-Smith (R-MS), cosponsor
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This is an important bill to sustain a program that has a proven track record
[6] Sen. Cindy Hyde-Smith press release: Hyde-Smith Welcomes Senate Passage of Rural Hospital Legislation (May 21, 2026) · May 21, 2026helping steady the finances of rural hospitals so they can keep their doors open.
[6] Sen. Cindy Hyde-Smith press release: Hyde-Smith Welcomes Senate Passage of Rural Hospital Legislation (May 21, 2026) · May 21, 2026
Against
- No senator objected. The program stays small: no more than 30 hospitals at a time.No opponent on the record; limit in the existing law
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There being no objection, the committee was discharged, and the Senate proceeded to consider the bill.
[4] Congressional Record, Senate, May 20, 2026 (S2428) · S2428not more than 30 rural community hospitals may participate in the demonstration program
[5] Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · (g)(3)
Did this make sense?
SourcedThree quick questions. Your answers are anonymous and tell us which breakdowns need clearer writing.
How this was checked
Sourced4 checks
- Automatic: every quote matched its source; every number matched an official record.
- Section 410A as printed in the U.S. Code notes: The 'before' text is the 2024 edition's note; the file is a verbatim excerpt of that note cut from the full 42 U.S.C. 1395ww page by script.
- Hyde-Smith release (May 21, 2026): Quotes are hand-recorded excerpts an editor must confirm. The release says six Mississippi hospitals take part; we did not find which Iowa hospitals, if any, participate.
- CBO estimate: None listed in the official bill record.
Spot an error? See our corrections log and how to report one
Sources
SourcedAll 6 sources
- Official bill status record (actions, votes, cosponsors) · Official bill record · retrieved Oct 28, 2026
- Engrossed in Senate (2026-05-20) · Bill text · retrieved Oct 28, 2026
- Introduced in Senate (2026-04-30) · Bill text · retrieved Oct 28, 2026
- Congressional Record, Senate, May 20, 2026 (S2428) · Congressional Record · retrieved Oct 28, 2026
- Section 410A of Pub. L. 108-173 (Rural Community Hospital Demonstration Program), printed in the notes to 42 U.S.C. 1395ww (U.S. Code, 2024 edition, before this bill) · U.S. Code (current law) · retrieved Oct 28, 2026
- Sen. Cindy Hyde-Smith press release: Hyde-Smith Welcomes Senate Passage of Rural Hospital Legislation (May 21, 2026) · News or advocacy · retrieved Oct 28, 2026 · excerpts recorded by hand, awaiting confirmation
Official summary
SourcedRural 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.
Official summary by the Congressional Research Service (Introduced in Senate, Apr 30, 2026).
What has happened
Sourced- May 21, 2026Held at the desk.House floor actions
- May 21, 2026Received in the House.House floor actions
- May 21, 2026Message on Senate action sent to the House.Senate
- May 20, 2026Passed Senate without amendment by Unanimous Consent. (consideration: CR S2428; text: CR S2428)Senate
- May 20, 2026Passed/agreed to in Senate: Passed Senate without amendment by Unanimous Consent.Library of Congress
- May 20, 2026Senate Committee on Finance discharged by Unanimous Consent.Senate
- May 20, 2026Senate Committee on Finance discharged by Unanimous Consent.Library of Congress
- Apr 30, 2026Read twice and referred to the Committee on Finance.Senate
- Apr 30, 2026Introduced in SenateLibrary of Congress
Cosponsors
- Michael F. Bennet D-CO
- Mike Crapo R-ID
- Deb Fischer R-NE
- Martin Heinrich D-NM
- John W. Hickenlooper D-CO
- Cindy Hyde-Smith R-MS
- Angus S. King, Jr. I-ME
- James Lankford R-OK
- Ben Ray Luján D-NM
- Jeff Merkley D-OR
- Jerry Moran R-KS
- Lisa Murkowski R-AK
Show 4 more cosponsors
- Pete Ricketts R-NE
- Dan Sullivan R-AK
- Peter Welch D-VT
- Ron Wyden D-OR