“(a) Establishment.—There is established in the Treasury of the United States a fund, to be known as the ‘Rural Hospital Emergency Room Guarantee Fund’ (referred to in this section as the ‘Fund’), consisting of—

“(1) such amounts as are appropriated to the fund pursuant to subsection (i); and

“(2) any amounts collected as civil monetary penalties under subsection (g)(2)(A).

“(b) Administration.—The Fund shall be administered by the Secretary, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the ‘Secretary’).

“(c) Use of funds.—

“(1) IN GENERAL.—Amounts in the Fund shall be available, without further appropriation or fiscal year limitation, to the Secretary to make payments under the program established under paragraph (2).

“(2) PROGRAM.—

“(A) IN GENERAL.—Not later than 90 days after the date of enactment of the Rural Hospital Emergency Room Guarantee Act, the Secretary shall establish, and solicit applications for, a 10-year program (referred to in this section as the ‘program’) to make payments to eligible entities for the authorized uses described in subsection (e).

“(B) PAYMENTS.—Each year of the program, the Secretary shall—

“(i) make a payment—

“(I) in the first year of the program, in the amount of $1,000,000 (to be distributed in equal payments on a quarterly basis) to each eligible entity with an approved application under subsection (d)(2); and

“(II) in each subsequent year of the program, in an amount equal to the amount of the payment for the preceding year, as adjusted to reflect changes for the 12-month period ending the preceding November 30 in the Consumer Price Index for Medical Care Services published by the Bureau of Labor Statistics of the Department of Labor; and

“(ii) make an additional payment to each such eligible entity in an amount not greater than 50 percent of the amount of the payment made to such eligible entity under clause (i) for that year, to be determined by the Secretary with respect to each such eligible entity pursuant to a formula established by the Secretary by rulemaking based on, with respect to an eligible entity—

“(I) the payor mix of the eligible entity;

“(II) the injury need of patients within the immediate geographical area in which the eligible entity is located;

“(III) the economic conditions in the geographic area in which such eligible entity is located; and

“(IV) past financial history of such eligible entity.

“(C) EMERGENCY PAYMENTS.—The Secretary may make an additional payment, in an amount not to exceed $250,000, to an eligible entity with an approved application under subsection (d)(2) in any year of the program if the Secretary determines that the emergency department of such eligible entity is in danger of closing in the next 14 days, on the condition that no eligible entity may receive more than 1 such payment in any year of the program.

“(d) Applications; approval; eligibility.—

“(1) IN GENERAL.—Each entity desiring to receive payments under the program shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

“(2) APPROVAL.—

“(A) IN GENERAL.—Not later than 30 days after receiving an application under paragraph (1), the Secretary shall approve such application if the Secretary determines that such entity meets the eligibility criteria described in paragraph (3). Such approval shall apply with respect to such an entity for the duration of the program, except as provided in paragraph (4).

“(B) REQUIREMENT.—If the Secretary does not approve an application under subparagraph (A), as soon as practicable after such disapproval, the Secretary shall provide to the applicant—

“(i) an explanation of the reason for the disapproval; and

“(ii) an expedited process for curing any deficiencies in the application and reapplying.

“(3) ELIGIBILITY.—To be eligible to receive a payment under the program, an entity—

“(A) shall be a rural health facility (as defined in section 2105(h)(3)(D) of the Social Security Act), other than an entity described in clause (i)(II) of such section;

“(B) shall participate in a Federal health care program (as defined in section 1128B(f) of such Act); and

“(C) shall operate a 24-hour emergency department of a hospital (as defined in section 2799A–1(a)(3)) or a 24-hour independent freestanding emergency department (as so defined).

“(4) CONDITION OF PARTICIPATION.—After the date on which the application of an eligible entity is approved under paragraph (2)(A), if such eligible entity is acquired, in whole or in part, by a private-equity, venture-capital, or similarly purposed ownership fund, such eligible entity may not continue to participate in the program.

“(e) Authorized uses.—An eligible entity receiving payments under the program—

“(1) may only use the funds to pay for the normal operating expenses, including for staffing, of the emergency department of such eligible entity; and

“(2) may not—

“(A) use the funds—

“(i) to develop projects that do not directly impact the existing operations of such eligible entity; or

“(ii) to make payments to executives, executive staff, or members of the board of directors of such eligible entity; or

“(B) transfer the funds to other facilities, including other facilities of such eligible entity.

“(f) Reporting.—Each eligible entity receiving payments under the program shall submit to the Secretary an annual report describing the financial condition and continued need of such eligible entity and the impact of such payments received during the preceding year on such eligible entity. The Secretary may not use such reported information to disqualify such eligible entity from participation in the program.

“(g) Compliance.—

“(1) IN GENERAL.—The Secretary shall conduct random audits of eligible entities receiving payments under the program to ensure the compliance of such eligible entities with the requirements of the program.

“(2) VIOLATIONS.—If the Secretary determines that an eligible entity has violated a requirement of the program, the Secretary may—

“(A) impose civil penalties, including civil monetary penalties, against such eligible entity; or

“(B) remove such eligible entity from participation in the program.

“(h) Regulations for reporting.—Not later than 90 days after the date of enactment of the Rural Hospital Emergency Room Guarantee Act, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall promulgate regulations—

“(1) establishing a reporting methodology for eligible entities enrolled in the Medicare program under title XVIII of the Social Security Act under section 1866(j) of such Act to disclose for informational purposes on any required cost reports under such title XVIII all payments received under the program; and

“(2) allowing an eligible entity to exclude all payments received under the program from cost settlement calculations and expense offsets.

“(i) Mandatory funding.—Out of any money in the Treasury not otherwise appropriated, there is authorized to be appropriated, and there is appropriated, to the Fund such sums as are necessary for each of fiscal years 2026 through 2036.

“(j) Effect.—Participation in the program shall not be taken into account in determining eligibility of an eligible entity under any other Federal health care program (as defined in section 1128B(f) of the Social Security Act) and any payment under the program shall be in addition to any payment such eligible entity is eligible to receive under any other Federal health care program (as so defined).”.

“(a) Establishment.—There is established in the Treasury of the United States a fund, to be known as the ‘Rural Hospital Emergency Room Guarantee Fund’ (referred to in this section as the ‘Fund’), consisting of—

“(1) such amounts as are appropriated to the fund pursuant to subsection (i); and

“(2) any amounts collected as civil monetary penalties under subsection (g)(2)(A).

“(b) Administration.—The Fund shall be administered by the Secretary, acting through the Administrator of the Health Resources and Services Administration (referred to in this section as the ‘Secretary’).

“(c) Use of funds.—

“(1) IN GENERAL.—Amounts in the Fund shall be available, without further appropriation or fiscal year limitation, to the Secretary to make payments under the program established under paragraph (2).

“(2) PROGRAM.—

“(A) IN GENERAL.—Not later than 90 days after the date of enactment of the Rural Hospital Emergency Room Guarantee Act, the Secretary shall establish, and solicit applications for, a 10-year program (referred to in this section as the ‘program’) to make payments to eligible entities for the authorized uses described in subsection (e).

“(B) PAYMENTS.—Each year of the program, the Secretary shall—

“(i) make a payment—

“(I) in the first year of the program, in the amount of $1,000,000 (to be distributed in equal payments on a quarterly basis) to each eligible entity with an approved application under subsection (d)(2); and

“(II) in each subsequent year of the program, in an amount equal to the amount of the payment for the preceding year, as adjusted to reflect changes for the 12-month period ending the preceding November 30 in the Consumer Price Index for Medical Care Services published by the Bureau of Labor Statistics of the Department of Labor; and

“(ii) make an additional payment to each such eligible entity in an amount not greater than 50 percent of the amount of the payment made to such eligible entity under clause (i) for that year, to be determined by the Secretary with respect to each such eligible entity pursuant to a formula established by the Secretary by rulemaking based on, with respect to an eligible entity—

“(I) the payor mix of the eligible entity;

“(II) the injury need of patients within the immediate geographical area in which the eligible entity is located;

“(III) the economic conditions in the geographic area in which such eligible entity is located; and

“(IV) past financial history of such eligible entity.

“(C) EMERGENCY PAYMENTS.—The Secretary may make an additional payment, in an amount not to exceed $250,000, to an eligible entity with an approved application under subsection (d)(2) in any year of the program if the Secretary determines that the emergency department of such eligible entity is in danger of closing in the next 14 days, on the condition that no eligible entity may receive more than 1 such payment in any year of the program.

“(d) Applications; approval; eligibility.—

“(1) IN GENERAL.—Each entity desiring to receive payments under the program shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

“(2) APPROVAL.—

“(A) IN GENERAL.—Not later than 30 days after receiving an application under paragraph (1), the Secretary shall approve such application if the Secretary determines that such entity meets the eligibility criteria described in paragraph (3). Such approval shall apply with respect to such an entity for the duration of the program, except as provided in paragraph (4).

“(B) REQUIREMENT.—If the Secretary does not approve an application under subparagraph (A), as soon as practicable after such disapproval, the Secretary shall provide to the applicant—

“(i) an explanation of the reason for the disapproval; and

“(ii) an expedited process for curing any deficiencies in the application and reapplying.

“(3) ELIGIBILITY.—To be eligible to receive a payment under the program, an entity—

“(A) shall be a rural health facility (as defined in section 2105(h)(3)(D) of the Social Security Act), other than an entity described in clause (i)(II) of such section;

“(B) shall participate in a Federal health care program (as defined in section 1128B(f) of such Act); and

“(C) shall operate a 24-hour emergency department of a hospital (as defined in section 2799A–1(a)(3)) or a 24-hour independent freestanding emergency department (as so defined).

“(4) CONDITION OF PARTICIPATION.—After the date on which the application of an eligible entity is approved under paragraph (2)(A), if such eligible entity is acquired, in whole or in part, by a private-equity, venture-capital, or similarly purposed ownership fund, such eligible entity may not continue to participate in the program.

“(e) Authorized uses.—An eligible entity receiving payments under the program—

“(1) may only use the funds to pay for the normal operating expenses, including for staffing, of the emergency department of such eligible entity; and

“(2) may not—

“(A) use the funds—

“(i) to develop projects that do not directly impact the existing operations of such eligible entity; or

“(ii) to make payments to executives, executive staff, or members of the board of directors of such eligible entity; or

“(B) transfer the funds to other facilities, including other facilities of such eligible entity.

“(f) Reporting.—Each eligible entity receiving payments under the program shall submit to the Secretary an annual report describing the financial condition and continued need of such eligible entity and the impact of such payments received during the preceding year on such eligible entity. The Secretary may not use such reported information to disqualify such eligible entity from participation in the program.

“(g) Compliance.—

“(1) IN GENERAL.—The Secretary shall conduct random audits of eligible entities receiving payments under the program to ensure the compliance of such eligible entities with the requirements of the program.

“(2) VIOLATIONS.—If the Secretary determines that an eligible entity has violated a requirement of the program, the Secretary may—

“(A) impose civil penalties, including civil monetary penalties, against such eligible entity; or

“(B) remove such eligible entity from participation in the program.

“(h) Regulations for reporting.—Not later than 90 days after the date of enactment of the Rural Hospital Emergency Room Guarantee Act, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall promulgate regulations—

“(1) establishing a reporting methodology for eligible entities enrolled in the Medicare program under title XVIII of the Social Security Act under section 1866(j) of such Act to disclose for informational purposes on any required cost reports under such title XVIII all payments received under the program; and

“(2) allowing an eligible entity to exclude all payments received under the program from cost settlement calculations and expense offsets.

“(i) Mandatory funding.—Out of any money in the Treasury not otherwise appropriated, there is authorized to be appropriated, and there is appropriated, to the Fund such sums as are necessary for each of fiscal years 2026 through 2036.

“(j) Effect.—Participation in the program shall not be taken into account in determining eligibility of an eligible entity under any other Federal health care program (as defined in section 1128B(f) of the Social Security Act) and any payment under the program shall be in addition to any payment such eligible entity is eligible to receive under any other Federal health care program (as so defined).”.