The CRITICAL Act (Comprehensive Reimbursement Initiative Targeting Investment and Care in rural Locations) is a Senate bill introduced in the 119th Congress. It would amend several parts of the Medicare program (title XVIII of the Social Security Act) to boost payments for critical access hospitals (CAHs) that are located in noncontiguous states (for example, Alaska and Hawaii). Specifically, starting January 1, 2026, the bill would increase certain Medicare payment rates from 101% to 105% of applicable costs for CAH inpatient services, CAH outpatient services, ambulance services (including CAH-owned ambulance entities), and certain skilled nursing facility (SNF) services furnished under a CAH arrangement. The bill is sponsored by Senators Sullivan and Schatz and is currently introduced and referred to the Senate Finance Committee.
Key Points
- 1Purpose and scope: The bill targets CAHs located in noncontiguous states and raises reimbursement rates for four service areas to 105% starting January 1, 2026.
- 2Inpatient CAH services: For CAHs in noncontiguous states, Medicare payment for inpatient CAH services would be increased from 101% to 105% of applicable costs.
- 3Outpatient CAH services: For CAHs in noncontiguous states, Medicare payment for outpatient CAH services would be increased from 101% to 105% of applicable costs.
- 4Ambulance services: For ambulance services furnished on or after January 1, 2026, CAHs in noncontiguous states (or entities owned and operated by such CAHs) would receive 105% rather than 101%.
- 5Skilled nursing facility (SNF) services: For covered SNF services furnished on or after January 1, 2026 under an agreement by a noncontiguous-state CAH, payments would be 105% instead of 101%.
- 6Effective date and scope: These changes take effect January 1, 2026 and apply specifically to CAHs located in noncontiguous states; contiguous-state CAHs are not affected by these provisions.