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Senate Bill 4460
119th Congress(2025-2026)
Rural Community Hospital Demonstration Program Reauthorization
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Passed Senate on May 20, 2026
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S. 4460 (Introduced-in-Senate)


119th CONGRESS
2d Session
S. 4460


To provide for an extension of the rural community hospital demonstration program.

IN THE SENATE OF THE UNITED STATES

April 30, 2026

Mr. 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 Finance

A BILL

To provide for an extension of the rural community hospital demonstration program.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. Short title.

This Act may be cited as the “Rural Community Hospital Demonstration Program Reauthorization”.

SEC. 2. Five-year extension of the rural community hospital demonstration program.

(a) In general.—Subsection (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 PERIOD.—Subsection (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 DEMONSTRATION.—Paragraph (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 EXTENSION.—During 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).”.