This legislation, known as the Sustaining Rural Healthcare Act, seeks to ensure continued access to healthcare in rural areas through two primary mechanisms. First, it amends the Social Security Act to allow a facility previously designated as a critical access hospital (CAH) to retain that status for up to three years, even if it no longer meets a specific geographic criterion. This extension is contingent on the Secretary determining that the loss of designation would significantly reduce access to necessary health services for residents in the facility's service area. Second, the bill grants the Secretary discretionary authority to designate certain hospitals as "Critical Access in Character" for Medicare reimbursement purposes. To qualify, a hospital must be located in a rural or underserved area, serve a high proportion of Medicare beneficiaries, and face a significant risk of closure or service reduction. Hospitals receiving this designation will be eligible for Medicare payment rates equivalent to those of a CAH for up to three years, with potential for renewal, to help stabilize their financial and operational status and ensure the continuation of essential health services in their communities.