PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the House Committee on Ways and Means.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Davids, Sharice [D-KS-3] · D–KS
Legislative record
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Referred to the House Committee on Ways and Means.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 14, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-05 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Rural Surgery Sustainability Act of 2026 would change Medicare’s cost-based payment rules for certified registered nurse anesthetists. It would raise a surgical-procedure threshold and require periodic reviews of service limits. Hospitals with active labor and delivery units would receive an exemption from an anesthetist-hours limit. The main changes would apply to services furnished starting January 1, 2027.
This Act may be cited as the Rural Surgery Sustainability Act of 2026.
Adjusting the cost pass-through for certified registered nurse anesthetists under the Medicare program
by striking 500 and inserting 1,250
The Secretary shall, not less frequently than once every 2 years and in consultation with the American Association of Nurse Anesthetists, review the limit on the volume of surgical procedures applicable under paragraph (2) and the limit on the total number of hours of service furnished by anesthetists
for 2027 and each subsequent year, no limit on the total number of hours of service furnished by anesthetists applies in the case of a hospital that has an active labor and delivery unit during such year.
The amendments made by subsection (a) shall apply with respect to services furnished on or after January 1, 2027.
The bill would replace 500 with 1,250 in the existing surgical-procedure volume limit. The existing paragraph is not reproduced, so the supplied text does not establish the complete eligibility test or how procedures are counted.
in paragraph (2)— (A) by striking 500 and inserting 1,250
the increase in the limit on the volume of surgical procedures provided under the amendment made by subsection (a)(1)
For a year when a hospital has an active labor and delivery unit, the bill would exempt that hospital from the preceding sentence of the amended paragraph (2). Because that existing sentence is not supplied, the exception’s full scope cannot be determined from this bundle.
The preceding sentence shall not apply to a hospital for a year in the case such hospital has an active labor and delivery unit during such year.
The Secretary would have to review the surgical-procedure and anesthetist-hours limits at least every two years, consulting the American Association of Nurse Anesthetists. The Secretary would have to update those limits to reflect general increases in procedure frequency, including increases attributable to new procedures.
The Secretary shall, not less frequently than once every 2 years and in consultation with the American Association of Nurse Anesthetists, review the limit on the volume of surgical procedures applicable under paragraph (2) and the limit on the total number of hours of service furnished by anesthetists under section 412.113(c)(2)(i)(B) of title 42, Code of Federal Regulations (or a successor regulation), and update such limits to reflect any general increase in the frequency of furnishing such procedures, including any such increase attributable to new procedures.
For services paid on a reasonable-cost basis—payment based on costs—the Secretary would have to set any applicable payment limit at the previous year’s limit, increased by that year’s percentage increase in the referenced MEI measure. This rule would apply despite existing paragraph (3); neither that paragraph nor the MEI definition is reproduced.
Notwithstanding paragraph (3), in applying any limit on payment for services furnished during a year payable on a reasonable cost basis pursuant to this subsection, the Secretary shall set such limit at an amount equal to the limit on such payment that would have applied to such services if furnished in the preceding year, increased by the percentage increase in the MEI (as defined in section 1842(i)(3) of the Social Security Act) for such year.
The Secretary would have to revise the specified Medicare regulation so that its anesthetist-hours limit does not apply to hospitals with active labor and delivery units in 2027 and each subsequent year when those units are active.
The Secretary shall revise section 412.113(c)(2)(i)(B) of title 42, Code of Federal Regulations (or a successor regulation), to ensure that, for 2027 and each subsequent year, no limit on the total number of hours of service furnished by anesthetists applies in the case of a hospital that has an active labor and delivery unit during such year.
Separately, the Secretary of Health and Human Services would have to revise the general anesthetist-hours limit for services furnished starting January 1, 2027, to reflect the higher surgical-procedure threshold. The bill does not specify the revised number of hours.
The Secretary of Health and Human Services shall revise the limit on the total number of hours of service furnished by anesthetists applicable under section 412.113(c)(2)(i)(B) of title 42, Code of Federal Regulation, for services furnished on or after January 1, 2027, in a manner that reflects the increase in the limit on the volume of surgical procedures provided under the amendment made by subsection (a)(1).
Within one year after enactment, the Medicare Payment Advisory Commission would have to report to Congress on including on-call nurse anesthetist services among payable services and on potential sustainable payment changes. This provision requires a report; it does not itself make on-call services payable.
Not later than 1 year after the date of the enactment of this Act, the Medicare Payment Advisory Commission shall submit to Congress a report on— (1) including on-call certified registered nurse anesthetist services as services payable pursuant to section 9320(k) of the Omnibus Budget Reconciliation Act of 1986; and (2) potential sustainable payment modifications for services payable pursuant to such section.
The statutory amendments in subsection (a) would apply to services furnished on or after January 1, 2027.
The amendments made by subsection (a) shall apply with respect to services furnished on or after January 1, 2027.
The supplied action snapshot, updated October 14, 2026, records introduction in the House and referral to the House Committee on Ways and Means on October 5, 2026. It does not establish later legislative action or enactment.
Source snapshot updated 2026-10-14T14:00:27Z. 2026-10-05: Referred to the House Committee on Ways and Means. 2026-10-05: Introduced in House
A closer look
Reviewed version: Introduced in House · 2026-10-05. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish what appears in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark disclosures and accompanying materials are not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
The supplied introduced text contains a targeted exception within its main Medicare payment policy. Classification identifies special treatment, without judging its justification.
Hospitals with active labor and delivery units would receive special treatment under the bill’s service-limit rules: exemption from the specified anesthetist-hours limit in 2027 and subsequent qualifying years, plus an exception from the preceding sentence of amended paragraph (2). The existing sentence is not reproduced, limiting assessment of that second exception.
The Secretary shall revise section 412.113(c)(2)(i)(B) of title 42, Code of Federal Regulations (or a successor regulation), to ensure that, for 2027 and each subsequent year, no limit on the total number of hours of service furnished by anesthetists applies in the case of a hospital that has an active labor and delivery unit during such year.
The preceding sentence shall not apply to a hospital for a year in the case such hospital has an active labor and delivery unit during such year.
Full text preserved for this analysis. Legislative record snapshot: Oct 14, 2026. How PlainBill uses AI