Today, Congressman Henry Cuellar, Ph.D. (TX-28), co-led the introduction of the Sustaining Rural Healthcare Act alongside Congressman Mark Alford (MO-04), Congressman Glenn “GT” Thompson (PA-15), and Congresswoman Jill Tokuda (HI-02). The bipartisan bill expands access to care and provides a financial lifeline for struggling hospitals in rural communities by designating rural hospitals that serve underserved communities as “Critical in Character”.

This comes after the Center for Medicare and Medicaid (CMS) services instituted an updated mapping framework, causing some rural hospitals to lose eligibility for Critical Access Hospital (CAH) designation, despite the physical location of the facility being unchanged. The bill ensures continued designation of certain Critical Access Hospitals (CAHs), when loss of status would reduce local healthcare access. It also adds a discretionary authority to temporarily designate certain rural hospitals providing service to underserved populations as “Critical Access in Character,” enabling them to receive CAH-level Medicare reimbursement for up to 3 years to preserve access to healthcare for our rural communities.

Read the text of the legislation here.

“Border communities like ours in South Texas rely on rural hospitals to deliver care close to home,” said Rep. Cuellar. “In many of these areas, the nearest alternative may be miles away, and when a hospital is forced to scale back services or risks closure, families feel the impact immediately. Our bill provides rural hospitals with the stability they need to keep essential health care services accessible for our communities. It also strengthens technical assistance efforts to help these facilities improve operations and long‑term financial stability. I’m proud to co‑lead this bipartisan effort to support the providers who keep rural Texas strong, healthy, and cared for.”

“We aren’t just talking about supporting Missouri’s rural hospitals, we’re taking action,” said Congressman Alford. “This vital legislation will sustain our rural hospitals like Bates County Memorial, preventing closures and ensuring continued access to emergency care for communities like those in the Fourth District. After visiting almost every rural hospital in the Fourth District, I’ve seen first-hand how these facilities are often the only places families can turn to when they need care. We’re proud to introduce the Sustaining Rural Healthcare Act and double down on our efforts to support rural health care providers.”

“Rural America continues to face challenges when it comes to delivering healthcare services,” Rep. Thompson said. “By expanding and providing increased flexibility for at-risk rural hospitals, we can help ensure our communities continue to have robust access to world-class care.”

“For Hawaiʻi’s neighbor islands, rural hospitals are lifelines, but outdated federal rules are keeping critical resources and designations out of reach,” said Rep. Tokuda. “Current Critical Access Hospital criteria disqualify facilities serving some of our most isolated and high-need populations. This bill stabilizes rural hospitals so they can keep their doors open and continue delivering critical access care to the communities that depend on them. We’re ensuring rural hospitals have the support and flexibility to provide high-quality care close to home, where patients belong.”

Background:

CAH Designation

• Allows hospitals to receive cost-based Medicare reimbursement, which improves financial viability for small, isolated facilities.
• Prevents closures to ensure rural communities can access to emergency and acute care, while allowing operational flexibility, such as operating swing beds, to meet community needs.
• Makes hospitals eligible to receive funding through their respective state's Rural Health Transformation Program allotment.

The Sustaining Rural Healthcare Act

This bill intends to provide financial relief to our rural hospitals and increase access to health care for patients in rural communities by:

• Ensuring continued Critical Access Hospital designation for those already designated
• Allowing the Secretary of Health and Human Services (HHS) discretionary authority to designate facilities as In Character Critical Access Hospitals for up to 3 years if they meet certain criteria, including:

• Facilities in a designated rural area;
• Facilities facing healthcare staffing shortages;
• Facilities serving a medically underserved population;
• Facilities providing inpatient and outpatient services to a high proportion of Medicare beneficiaries; and
• Facilities facing significant risk of partial or full closure of services.
• Directing HHS to issue guidance on eligibility standards, documentation requirements, and renewal conditions
• Directing HHS to establish monitoring and reporting requirements for “In Character” CAH facilities to ensure performance, patient access, and financial stability improvements during the in-character designation
• Directing HHS to collaborate with U.S. Department of Agriculture in making available technical assistance free of charge to the in-character designated facilities to help strengthen financial and operational status during the designation period

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Congressman Henry Cuellar, Ph.D. is a senior member of the U.S. House Appropriations Committee. Previously, he served as a Texas State Representative and Texas Secretary of State.

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