H.R. 9877

Health Equity and Accountability Act of 2026

Sponsor: Raul Ruiz

26 cosponsors
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I Data collection and reporting

II Culturally and linguistically appropriate health and health care

III Health workforce diversity

A Diversifying the health care workplace

B Substance Use Disorder Treatment and Behavioral and Mental Health Workforce

C ACCESS in Mental Health Act

D Developing the Community Health Workforce Act

IV Improving Health Care Access and Quality

A Reducing Barriers to Accessing Care

B Improvement of Coverage

C Expansion of Access

1 General Provisions

2 Rural

Sec. 4221. Establishment of Rural Community Hospital (RCH) Program

(a) In general. Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 2007(b)(1), is amended by adding at the end of the following new subsection:

Text this section adds to the law

(ppp) Rural Community Hospital; Rural Community Hospital Services

(1) The term rural community hospital means a hospital (as defined in subsection (e)) that—

(A) is located in a rural area (as defined in section 1886(d)(2)(D)) or treated as being so located pursuant to section 1886(d)(8)(E);

(B) subject to paragraph (2), has less than 51 acute care inpatient beds, as reported in its most recent cost report;

(C) makes available 24-hour emergency care services;

(D) subject to paragraph (3), has a provider agreement in effect with the Secretary and is open to the public as of January 1, 2010; and

(E) applies to the Secretary for such designation.

(2) For purposes of paragraph (1)(B), beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted.

(3) Paragraph (1)(D) shall not be construed to prohibit any of the following from qualifying as a rural community hospital:

(A) A replacement facility (as defined by the Secretary in regulations in effect on January 1, 2012) with the same service area (as defined by the Secretary in regulations in effect on such date).

(B) A facility obtaining a new provider number pursuant to a change of ownership.

(C) A facility which has a binding written agreement with an outside, unrelated party for the construction, reconstruction, lease, rental, or financing of a building as of January 1, 2012.

(4) Nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.

(5) Nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395ww note; Public Law 108–173) from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.

(b) Payment

(1) Inpatient hospital services. Section 1814 of the Social Security Act (42 U.S.C. 1395f) is amended by adding at the end the following new subsection:

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(m) Payment for Inpatient Services Furnished in Rural Community Hospitals. The amount of payment under this part for inpatient hospital services furnished in a rural community hospital, other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part, is, at the election of the hospital in the application referred to in section 1861(ppp)(1)(E)—

(1) 101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge, or

(2) the amount of payment provided for under the prospective payment system for inpatient hospital services under section 1886(d).

(2) Outpatient services. Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

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(bb) Payment for outpatient services furnished in rural community hospitals. The amount of payment under this part for outpatient services furnished in a rural community hospital is, at the election of the hospital in the application referred to in section 1861(ppp)(1)(E)—

(1) 101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge and any limitation under section 1861(v)(1)(U), or

(2) the amount of payment provided for under the prospective payment system for covered OPD services under section 1833(t).

(3) Exemption from 30-percent reduction in reimbursement for bad debt. Section 1861(v)(1)(T) of the Social Security Act (42 U.S.C. 1395x(v)(1)(T)) is amended in the matter preceding clause (i) by inserting (other than for a rural community hospital) after In determining such reasonable costs for hospitals.

(c) Beneficiary cost-Sharing for outpatient services. Section 1834(bb) of the Social Security Act (as added by subsection (b)(2)) is amended—

(1) by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;

(2) by inserting (1) after (bb); and

(3) by adding at the end the following:

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(2) The amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows:

(A) For items and services that would have been paid under section 1833(t) if furnished by a hospital, the amount of cost-sharing determined under paragraph (8) of such section.

(B) For items and services that would have been paid under section 1833(h) if furnished by a provider of services or supplier, no cost-sharing shall apply.

(C) For all other items and services, the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician, provider of services, or supplier, as the case may be.

(d) Conforming amendments

(1) Part A payment. Section 1814(b) of the Social Security Act (42 U.S.C. 1395f(b)) is amended in the matter preceding paragraph (1) by inserting other than inpatient hospital services furnished by a rural community hospital, after critical access hospital services,.

(2) Part B payment. Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)), as amended by section 2207(b)(3), is amended—

(A) by striking and at the end of paragraph (10);

(B) by striking the period at the end of paragraph (11) and inserting ; and; and

(C) by adding at the end the following:

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(12) in the case of outpatient services furnished by a rural community hospital, the amounts described in section 1834(bb).

(3) Technical amendments

(A) Consultation with State agencies. Section 1863 of the Social Security Act (42 U.S.C. 1395z) is amended by striking and (dd)(2) and inserting (dd)(2), and (ppp)(1).

(B) Provider agreements. Section 1866(a)(2)(A) of the Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by inserting section 1834(bb)(2), after section 1833(b),.

(e) Effective Date. The amendments made by this section shall apply to items and services furnished on or after the date that is 30 days after the date of the enactment of this Act.

3 Indian Communities

4 Providers

5 Dental

D Advancing Health Equity Through Payment and Delivery Reform

E Health Empowerment Zones

F Equitable Health Care for All

G Investing in Equity

H Miscellaneous

I Territories Health Equity

1 Medicare

A Part A

B Part B

C Medicare Advantage (Part C)

D Part D

2 Miscellaneous

V Improving health outcomes for women, gender-diverse people, children, and families

A Underserved communities

B Pregnancy screening

C Pregnancy-Related care

D Federal agency coordination on maternal health

E Reproductive and Sexual Health

F Children’s Health

G Elder Care

H Miscellaneous provisions

VI Mental health and substance use disorders

A Access to care and funding streams

B Interprofessional care

C Workforce development

D Children’s mental health

E Community-Based care

F Reports

G Miscellaneous provisions

VII Addressing high-impact minority diseases

A Cancer

B Viral hepatitis and liver cancer control and prevention

C Acquired bone marrow failure diseases

D Cardiovascular disease, chronic disease, obesity, and other disease issues

E HIV/AIDS

F Diabetes

G Lung disease

H Tuberculosis

I Osteoarthritis and Musculoskeletal Diseases

J Sleep and circadian rhythm disorders

K Kidney disease research, surveillance, prevention, and treatment

L Diversity in clinical trials

M Additional provisions addressing high-impact minority diseases

N Health Equity and Rare Disease Act

O Asunción Valdivia Heat Illness, Injury, and Fatality Prevention

P New Era of Preventing End-Stage Kidney Disease

VIII Health Information Technology

A Reducing Health Disparities Through Health IT

B Modifications To Achieve Parity in Existing Programs

C Additional Research and Studies

D Closing Gaps in Funding To Adopt Certified EHRs

E Expanding Access to Telehealth Services

IX Accountability and Evaluation

X Addressing Social Determinants and Improving Environmental Justice

A In General

B Gun Violence

C Nutrition for women, children, families

1 Senior hunger prevention

2 Closing the meal gap

D Universal school meals

1 School breakfast program

2 School lunch program

3 Elementary and secondary education data

4 Amendments to other programs and laws

XI Protections to combat regulatory harm to health equity