Section 1 Short title
This Act may be cited as the “Defend Rural Health Act of 2026”.
Defend Rural Health Act of 2026
A BILL
To amend title XVIII of the Social Security Act to limit the geographic reclassification of certain hospitals under the Medicare program.
Sec. 2 Limiting geographic reclassification of hospitals under Medicare
In general— Section 1886(d)(8)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(8)(E)) is amended—
in clause (i), by striking “described in clause (ii)” and inserting “that is located in an urban area (as defined in paragraph (2)(D)) and meets any of the criteria described in subclause (I), (II), or (IV) of clause (ii) (or, with respect to a hospital submitting such an application before October 1, 2026, meets any of the criteria described in such clause)”;
in clause (ii)—
in the matter preceding subclause (I), by striking “a subsection (d) hospital” and all that follows through “criteria:” and inserting “the criteria described in this clause are the following:”; and
in subclause (II)—
by inserting “that is” before “designated by any law”; and
by inserting “, and that was so designated as of January 1, 2026” before the period at the end; and
by adding at the end the following new clause:
“(iii) No subsection (d) hospital shall be treated as being located in a rural area of a State under this subparagraph on or after October 1, 2029, regardless of any application described in clause (i) submitted prior to October 1, 2026, unless such hospital demonstrates to the Secretary (in a form and manner specified by the Secretary) that such hospital meets any of the criteria described in subclause (I), (II), or (IV) of clause (ii).”
Prohibiting dual reclassifications through the Medicare Geographic Classification Review Board— Section 1886(d)(10)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(10)(D)) is amended—
in clause (v), by striking “Any decision” and inserting “Subject to clause (viii), any decision”; and
by adding at the end the following new clauses:
“(vii) Such guidelines shall provide that the Board may not approve an application described in subparagraph (C)(i) submitted by a subsection (d) hospital requesting a change in geographic classification for a fiscal year beginning on or after October 1, 2026, if such hospital is treated as being located in a rural area under paragraph (8)(E) for such fiscal year.
“(viii) With respect to a fiscal year beginning on or after October 1, 2026, no change in the geographic classification of a subsection (d) hospital that would otherwise be in effect for such fiscal year pursuant to a decision of the Board shall be effective for any portion of such fiscal year during which such hospital is treated as being located in a rural area under paragraph (8)(E).”