Congressional Legislation · bill 119s4460 · built from our database

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Rural Community Hospital Demonstration Program Reauthorization

S. 4460 · 119th Congress (2025-2026)

S. 4460119TH CONGRESSINTRODUCED 04/30/2026SEN. GRASSLEYR-IA · SPONSORLeft: no (Sponsor Ranking)Lean left: no (Sponsor Ranking)Center: no (Sponsor Ranking)Lean right: DW-NOMINATE +0.36 (Sponsor Ranking)Right: no (Sponsor Ranking)LEAN RIGHT(SPONSOR RANKING)HEALTH

17 members · Left 6 · Center 3 · Right 8 (Bill Ranking)

SponsorSen. Grassley, Chuck (R-IA) (Introduced 04/30/2026)
Sponsor Voting RecordLean right · DW-NOMINATE +0.36 · measured from every roll-call vote this member has cast (voteview.com) (Sponsor Ranking)
Support
LLLCLRR

support across the spectrum: 17 members signed on (Bill Ranking) this bill: sponsor + current cosponsors, each once

CommitteesSenate - Finance Committee; Senate - Finance Committee
Latest Action05/21/2026 Held at the desk.
Roll Call VotesThere have been no roll call votes
Sourceview on congress.gov →
IntroducedPassed HousePassed SenateResolving DifferencesTo PresidentBecame Law

Summary (1)

Introduced in Senate (04/30/2026)

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.

Text (2)

Engrossed in Senate (ES)

108 S4460 ES: Rural Community Hospital Demonstration Program Reauthorization U.S. Senate text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. 119th CONGRESS2d SessionS. 4460IN THE SENATE OF THE UNITED STATESAN ACTTo provide for an extension of the rural community hospital demonstration program.1.Short titleThis Act may be cited as the Rural Community Hospital Demonstration Program Reauthorization.2.Five-year extension of the rural community hospital demonstration program(a)In generalSubsection (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 periodSubsection (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 demonstrationParagraph (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 extensionDuring 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)..Passed the Senate May 20, 2026.Secretary

Introduced in Senate (IS)

108 S4460 IS: Rural Community Hospital Demonstration Program Reauthorization U.S. Senate 2026-04-30 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. II119th CONGRESS2d SessionS. 4460IN THE SENATE OF THE UNITED STATESApril 30, 2026Mr. Grassley (for himself, Mr. Bennet, Mr. Crapo, Mr. Wyden, Mr. Sullivan, Mr. Luján, Mrs. Hyde-Smith, Mr. Welch, Mr. Moran, Mr. King, Ms. Murkowski, Mr. Merkley, Mr. Ricketts, Mr. Heinrich, Mr. Lankford, and Mr. Hickenlooper) introduced the following bill; which was read twice and referred to the Committee on FinanceA BILLTo provide for an extension of the rural community hospital demonstration program.1.Short titleThis Act may be cited as the Rural Community Hospital Demonstration Program Reauthorization.2.Five-year extension of the rural community hospital demonstration program(a)In generalSubsection (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 periodSubsection (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 demonstrationParagraph (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 extensionDuring 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)..

The bill's own words, from our database (synced from the GPO BILLS XML); paragraph breaks added at the bill's section boundaries, nothing else changed.

All Actions (9)

DateChamberAll Actions
04/30/2026Library of CongressIntroduced in Senate
04/30/2026SenateRead twice and referred to the Committee on Finance.
05/20/2026Library of CongressSenate Committee on Finance discharged by Unanimous Consent.
05/20/2026SenateSenate Committee on Finance discharged by Unanimous Consent.
05/20/2026Library of CongressPassed/agreed to in Senate: Passed Senate without amendment by Unanimous Consent.
05/20/2026SenatePassed Senate without amendment by Unanimous Consent. (consideration: CR S2428; text: CR S2428)
05/21/2026SenateMessage on Senate action sent to the House.
05/21/2026House floor actionsReceived in the House.
05/21/2026House floor actionsHeld at the desk.

Titles (4)

Title TypeTitle
Display TitleRural Community Hospital Demonstration Program Reauthorization
Short Title(s) as Passed SenateRural Community Hospital Demonstration Program Reauthorization
Short Title(s) as IntroducedRural Community Hospital Demonstration Program Reauthorization
Official Title as IntroducedA bill to provide for an extension of the rural community hospital demonstration program.

Amendments (0)

There are no amendments to this bill.

Cosponsors (16)

* = Original cosponsor

Committees (2)

CommitteeActivity
Senate - Finance Committee05/20/2026 Discharged From
Senate - Finance Committee04/30/2026 Referred To

Related Bills (1)

Subjects (6)

Policy Area: Health

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