Defend Rural Health Act of 2026

Section 1886(d)(8)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(8)(E)) is amended—

(1) 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);

(2) in clause (ii)—

(A) 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

(B) in subclause (II)—

(i) by inserting that is before designated by any law; and

(ii) by inserting, and that was so designated as of January 1, 2026 before the period at the end; and

(3) 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).

Section 1886(d)(10)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(10)(D)) is amended—

(1) in clause (v), by striking Any decision and inserting Subject to clause (viii), any decision; and

(2) 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).