This bill amends the Social Security Act to empower states to designate certain financially vulnerable rural hospitals as Critical Access Hospitals (CAHs) under the Medicare program. This authority allows states to waive the standard 35-mile distance requirement for these specific facilities, which are often struggling to remain open and serve their communities. To qualify, a hospital must meet several stringent criteria, including being a sole community , Medicare dependent , low-volume , or subsection (d) hospital located in a rural area. It must also demonstrate financial distress with two consecutive years of negative operating margins and be situated in an area with high poverty, a health professional shortage, or a high Medicare inpatient population. Furthermore, qualifying hospitals must attest to good governance, a plan for financial solvency, and a commitment to establish or expand a high-demand service line, such as obstetrics or behavioral health, based on community needs. The bill imposes limitations, capping the total number of such CAH designations at 120 nationwide and no more than five per state. These special designations are temporary, lasting for nine years from the date of enactment, after which the Secretary of Health and Human Services must facilitate their transition to alternative payment models. The Act also mandates studies by the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MEDPAC) to assess the program's implementation, financial impact, and future payment systems for rural hospitals.