Rural Surgery Sustainability Act of 2026
- Sponsor
- Rep. Davids, Sharice [D-KS-3]
- Committees
- Ways and Means Committee (primary)
- Last action
- Oct 5, 2026
Bottom line
The bill aims to enhance access to surgical and obstetric care, particularly in rural areas, by adjusting Medicare reimbursement policies for CRNA services to better reflect current healthcare realities and inflation.
What it actually does
This bill significantly modifies Medicare payment rules for Certified Registered Nurse Anesthetists (CRNAs) by increasing the volume of surgical procedures a hospital can perform while still qualifying for cost pass-through payments. It also exempts hospitals with active labor and delivery units from these volume limits entirely and mandates regular updates to these limits. Furthermore, it requires the Medicare Payment Advisory Commission (MedPAC) to report on including on-call CRNA services in these payments and on sustainable payment modifications.
Proponents argue
Proponents argue that the current Medicare limits on surgical procedures and anesthetist hours are outdated and disproportionately affect rural hospitals and those providing critical labor and delivery services. By increasing these limits and providing exemptions, the bill will ensure that more hospitals, especially those in underserved areas, can receive appropriate reimbursement for CRNA services, thereby sustaining access to essential surgical and obstetric care for Medicare beneficiaries.
Opponents contend
Potential opponents might express concerns that expanding cost pass-through eligibility could lead to increased Medicare expenditures without sufficient oversight on cost-effectiveness. They might also argue that such adjustments could reduce incentives for efficiency in healthcare delivery or create an uneven playing field among different types of anesthesia providers.
The bill is short and relatively straightforward, making it accessible for an informed reader to understand its core provisions within the time given.
Section 2(a)(1)
Increase in Surgical Procedure Limit and Exemption for Labor & Delivery Units
This provision amends existing law to raise the maximum number of surgical procedures a hospital can perform annually from 500 to 1,250 while still qualifying for special Medicare cost pass-through payments for Certified Registered Nurse Anesthetist (CRNA) services. Additionally, it introduces a new exemption, stating that this surgical volume limit will not apply to hospitals that maintain an active labor and delivery unit during the year.
Supporters argue
Supporters argue that increasing the surgical procedure limit and exempting labor and delivery units is crucial for the financial sustainability of smaller and rural hospitals. These changes ensure that these facilities can continue to provide essential anesthesia services without being penalized by outdated volume caps, thereby preserving access to care in underserved communities.
Critics contend
Critics might contend that expanding eligibility for cost pass-through payments could lead to higher Medicare spending without necessarily guaranteeing improved quality or efficiency. They may also question whether such broad exemptions are the most targeted way to address specific access challenges.
Tradeoffs
The provision balances the goal of supporting rural healthcare access and obstetric services with concerns about potential increases in Medicare program costs. It aims to alleviate financial pressures on specific hospital types but could be seen as a less cost-controlled approach than alternative payment models.
Section 2(a)(2) (adding new paragraph (4))
Regular Review and Update of Service Limits
This section mandates that the Secretary of Health and Human Services, in consultation with the American Association of Nurse Anesthetists, must review and update the limits on surgical procedures and anesthetist service hours at least once every two years. The purpose of these updates is to ensure the limits reflect any general increase in the frequency of procedures, including those attributable to new medical advancements.
Section 2(a)(2) (adding new paragraph (5))
Annual Adjustment of Payment Limits by MEI
This provision establishes a new mechanism for adjusting the payment limit for CRNA services that are reimbursed on a reasonable cost basis. It dictates that the payment limit for a given year will be set at the previous year's limit, increased by the percentage change in the Medicare Economic Index (MEI) for that year. The MEI is a measure of inflation in the healthcare sector.
Section 2(a)(2) (adding new paragraph (6))
Elimination of Anesthetist Hour Limits for Labor & Delivery Units
This section directs the Secretary of Health and Human Services to revise existing regulations (specifically 42 CFR 412.113(c)(2)(i)(B)) to ensure that, starting in 2027, no limit on the total number of hours of service furnished by anesthetists will apply to hospitals that have an active labor and delivery unit during that year. This complements the exemption from surgical procedure volume limits for these units.
This subsection mandates that the Secretary of Health and Human Services revise the existing regulatory limit on the total number of hours of service furnished by anesthetists (found in 42 CFR 412.113(c)(2)(i)(B)) for services provided on or after January 1, 2027. This revision must reflect the increased limit on the volume of surgical procedures established in subsection (a)(1) of the bill.
Section 2(b)
Why it matters:This is standard legislative practice for ensuring consistency between statutory changes and existing regulations. It's a necessary technical adjustment rather than a provision intended to be obscured.
Case for: Ensures that the regulatory framework for CRNA services is internally consistent and reflects the updated policy on surgical procedure volume. Without this conforming change, there could be conflicting rules regarding volume and hours, leading to confusion and implementation challenges.
Case against: There is no direct case against this technical conforming amendment. Any opposition would likely be to the underlying policy changes it supports, rather than the act of ensuring regulatory consistency.
Estimated impact: This provision ensures the smooth and consistent implementation of the bill's primary policy changes, preventing regulatory conflicts that could undermine the intended benefits for hospitals and CRNAs.