{"database": "openregs", "table": "crs_reports", "rows": [["IG10095", "Medicare Payment for Rural or Geographically Isolated Hospitals, 2026", "2026-04-30T04:00:00Z", "2026-05-01T10:45:51Z", "Active", "Infographics", "Marco A. Villagrana", "Medicare", "/\nMedicare Payment for Rural or Geographically Isolated Hospitals\nTraditional Medicare pays most acute-care hospitals under the inpatient prospective payment system (IPPS). Some IPPS hospitals receive payment adjustments, which may help address the potential financial distress associated with rural, geographically isolated, and low-volume hospitals. These Medicare payment designations are Sole Community Hospitals (SCHs), Medicare-Dependent Hospitals (MDHs), and Low-Volume Hospitals (LVHs). Other similar acute-care hospitals\u2014Critical Access Hospitals (CAHs)\u2014are paid based on reasonable cost, not under IPPS. 2026\nMedicare Hospital Payment\nIPPS Inpatient Prospective Payment System\nA predetermined, fixed, per discharge payment for inpatient services furnished to Medicare beneficiaries, subject to adjustments.\nAll IPPS Hospital Designations \nSCH, MDH, LVH\nDuplicated; designations not mutually exclusive\nHospital Designation Locations\nEligibility Criteria\nAdjusted payment \nNo. of hospitals\nSole Community Hospital (SCH)\nMeets ONE of the following FOUR criteria:\n\t> 35 miles from another IPPS hospital\n\tRural and 25-35 miles from another hospital and\n\tIs the exclusive hospital provider in the area, or\n\t< 50 beds, meets exclusive hospital provider criterion but for patient transfers to other hospitals for specialized care\n\tRural and 15-15 miles from another hospital(s) that is inaccessible due to topography or severe weather conditions\n\t\tRural and  45-minute drive to nearest other hospital (due to distance, speed limits, and weather conditions)\nThe > of the following:\nHospital-specific rate applicable reference years1 FY - Fiscal Year 423 14%*\nMedicare-Dependent Hospital (MDH)\n\nMeets ALL of the following criteria:\n\tRural \n\t 100 beds\n\tNot an SCH\n\t 60% are Medicare patients\nMDH is a temporary program that will expire January 1, 2027, if Congress does not extend or make it permanent.\n162 5%*\nLow-Volume Hospital (LVH)\nMeets ALL of the following criteria: \n\t> 15 miles from another IPPS hospital\n\t< 3,800 annual total discharges\nLVH eligibility criteria will change effective January 1, 2027, if Congress does not extend the current criteria. Continuous linear adjustment\nAnnual patient discharges $ = IPPS + (IPPS x Applicable %) 572 19%*\nCritical Access Hospital (CAH)\nMeets ALL of the following criteria: \n\tRural\n\t 25 inpatient beds\n\t24/7 emergency services\n\tAnnual average length of stay of  96 hours\n\t> 35-mile drive from another IPPS hospital or CAH, or\n\t> 15-mile drive in mountainous terrain, or\n\t\tDesignated as a \u201cnecessary provider\u201d before January 1, 2006 101% CAH\u2019s reasonable costs 1,378 %\nCAHs are not paid by Medicare under IPPS.\n1Hospital-specific rate (HSR): A per discharge payment based on a hospital\u2019s average operating costs for furnishing inpatient services to Medicare beneficiaries. In contrast, IPPS is a per discharge payment based on the national average operating cost of furnishing inpatient services to Medicare beneficiaries. Both HSR and IPPS use costs from statutorily defined reference years, trended forward.\nDesignations: Mutually exclusive Not mutually exclusive   *Total number of IPPS hospitals: 3,155 (Excludes Maryland hospitals because they are exempt from IPPS.)      \nSources: CRS analysis of relevant statute, regulations, and Centers for Medicare & Medicaid Services \u201cFY2026 Impact File,\u201d www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2026-ipps-final-rule-home-page; and Health Resources and Services Administration, Data Warehouse, Data Explorer \u201cHealth Care Facilities (CMS)\u201d data, https://data.hrsa.gov/data/data-explorer, accessed March 25, 2026. \nInformation as of April 30, 2026. Prepared by Marco Villagrana, Analyst in Health Care Financing; Joe Angert, Research Assistant; Mari Lee, Visual Information Specialist; and Molly Cox, Geospatial Information Systems Analyst.\n", "https://www.congress.gov/crs_external_products/IG/PDF/IG10095/IG10095.1.pdf", "https://www.congress.gov/crs_external_products/IG/HTML/IG10095.html"]], "columns": ["id", "title", "publish_date", "update_date", "status", "content_type", "authors", "topics", "summary", "pdf_url", "html_url"], "primary_keys": ["id"], "primary_key_values": ["IG10095"], "units": {}, "query_ms": 0.5471929907798767, "source": "Federal Register API & Regulations.gov API", "source_url": "https://www.federalregister.gov/developers/api/v1", "license": "Public Domain (U.S. Government data)", "license_url": "https://www.regulations.gov/faq"}