Revitalize Rural America Act

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 10508 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 10508

To strengthen services provided in rural areas, and for other purposes.

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IN THE HOUSE OF REPRESENTATIVES

September 17, 2026

Mr. Thompson of California (for himself and Mr. Gallagher) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, the Judiciary, Agriculture, Education and Workforce, and Transportation and Infrastructure, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To strengthen services provided in rural areas, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Revitalize Rural America Act''. (b) Table of Contents.--The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents. TITLE I--RURAL AND UNDERSERVED HEALTH CARE

Subtitle A--Telehealth Coverage

Part 1--Removing Barriers to Telehealth Coverage

Sec. 1001. Removing geographic requirements for telehealth services. Sec. 1002. Expanding originating sites. Sec. 1003. Expanding authority for practitioners eligible to furnish teleheath services. Sec. 1004. Federally qualified healthcare centers and rural healthcare clinics. Sec. 1005. Native American health facilities. Sec. 1006. Repeal of six-month in-person visit requirement for telemental health services. Sec. 1007. Waiver of telehealth requirements during public health emergencies. Sec. 1008. Use of telehealth in recertification for hospice care. Part 2--Program Integrity

Sec. 1101. Clarification for fraud and abuse laws regarding technologies provided to beneficiaries. Sec. 1102. Additional resources for telehealth oversight. Sec. 1103. Addressing significant outlier billing patterns for telehealth services. Part 3--Beneficiary and Provider Supports, Quality

Sec. 1201. Beneficiary engagement on telehealth. Sec. 1202. Provider supports on telehealth. Sec. 1203. Ensuring the inclusion of telehealth in measuring quality of care. Sec. 1204. Posting information on telehealth services. Subtitle B--Promoting Access to Physicians

Sec. 1301. Conrad state 30 program. Sec. 1302. Retaining physicians who have practiced in medically underserved communities. Sec. 1303. Employment protections for physicians. Sec. 1304. Allotment of Conrad 30 waivers. Sec. 1305. Amendments to the procedures, definitions, and other provisions related to physician immigration. Sec. 1306. Annual Conrad State 30 J-1 Visa Waiver Program statistical report. Subtitle C--Rural Hospital Retention

Sec. 1401. Employee retention credit for certain rural hospital employers. Subtitle D--Study

Sec. 1501. Study. TITLE II--INFRASTRUCTURE

Sec. 2001. Federal grant-writing services and technical assistance for rural communities. Sec. 2002. Study on accessibility of Federal programs in rural communities. TITLE III--AGRICULTURE

Sec. 3001. Comprehensive study on cost of agriculture regulations. Sec. 3002. Exclusion of gain from sale of qualified farmland. TITLE IV--EDUCATION

Sec. 4001. Enhanced loan repayment program. TITLE V--PUBLIC EMPLOYMENT AND SAFETY

Sec. 5001. Deduction for essential rural employees. Sec. 5002. Grant program for local law enforcement agency accreditation. Sec. 5003. Increased cops hiring grants for small and rural law enforcement agencies. TITLE VI--HOUSING

Sec. 6001. Selection criteria under qualified allocation plans. Sec. 6002. Inclusion of Indian areas as difficult development areas for purposes of certain buildings. Sec. 6003. Inclusion of rural areas as difficult development areas. Sec. 6004. Uniform income eligibility for rural projects. Sec. 6005. Individual household disaster mitigation program. Sec. 6006. Credit for disaster mitigation expenditures. Sec. 6007. Exclusion of amounts received from state-based catastrophe loss mitigation programs. TITLE VII--DEFINITION OF RURAL

Sec. 7001. Definition of rural.

TITLE I--RURAL AND UNDERSERVED HEALTH CARE

Subtitle A--Telehealth Coverage

PART 1--REMOVING BARRIERS TO TELEHEALTH COVERAGE

SEC. 1001. REMOVING GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES.

Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)) is amended-- (1) in clause (i), in the matter preceding subclause (I), by striking ``clause (iii)'' and inserting ``clauses (iii) and (iv)''; and (2) by adding at the end the following new clause: ``(iv) Removal of geographic requirements.--The geographic requirements described in clause (i) shall not apply with respect to telehealth services furnished on or after the date of the enactment of the Always Remember Our Rural America Act of 2026.''.

SEC. 1002. EXPANDING ORIGINATING SITES.

(a) In General.--Section 1834(m)(4)(C)(iii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(iii)) is amended by striking ``In the case that'' and all that follows through ``December 31, 2027,'' and inserting ``Beginning on the date of the enactment of the Always Remember Our Rural America Act of 2026,''. (b) Conforming Amendments.--Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended-- (1) in paragraph (2)(B)(iii), by striking ``In the case that'' and all that follows through ``December 31, 2027,'' and inserting ``With respect to telehealth services furnished on or after the date of the enactment of the Always Remember Our Rural America Act of 2026,''; and (2) in paragraph (4)(C)(ii)(X), by striking ``, but only for purposes of section 1881(b)(3)(B) or telehealth services described in paragraph (7)''.

SEC. 1003. EXPANDING AUTHORITY FOR PRACTITIONERS ELIGIBLE TO FURNISH TELEHEATH SERVICES.

Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) is amended-- (1) by striking ``Practitioner.--The term'' and inserting ``Practitioner.-- ``(i) In general.--Subject to clause (ii), the term''; and (2) by adding at the end the following new clause: ``(ii) Expanding practitioners eligible to furnish telehealth services.-- ``(I) In general.--Notwithstanding any other provision of this subsection, in the case of telehealth services furnished on or after the date of the enactment of the Always Remember Our Rural America Act of 2026, the Secretary may waive any limitation on the types of practitioners who are eligible to furnish telehealth services if the Secretary determines that such waiver is clinically appropriate. ``(II) Implementation.--In implementing a waiver under this clause, the Secretary may establish requirements, as appropriate, for practitioners under such waiver, including with respect to beneficiary and program integrity protections. ``(III) Public comment.--The Secretary shall establish a process by which stakeholders may (on at least an annual basis) provide public comment on such waiver under this clause. ``(IV) Periodic review.--The Secretary shall periodically, but not more frequently than every 3 years, reassess the waiver under this clause to determine whether such waiver continues to be clinically appropriate. The Secretary shall terminate any waiver that the Secretary determines is no longer clinically appropriate.''.

SEC. 1004. FEDERALLY QUALIFIED HEALTHCARE CENTERS AND RURAL HEALTHCARE CLINICS.

Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended-- (1) in paragraph (4)(C)(i), in the matter preceding subclause (I), by striking ``and (7)'' and inserting ``(7), and (8)''; and (2) in paragraph (8)-- (A) in subparagraph (A)-- (i) in the matter preceding clause (i), by striking ``During'' and all that follows through ``December 31, 2027'' and inserting the following: ``Beginning on the first day of the emergency period described in section 1135(g)(1)(B)''; (ii) in clause (ii), by striking ``and'' at the end; (iii) by redesignating clause (iii) as clause (iv); and (iv) by inserting after clause (ii) the following new clause: ``(iii) the geographic requirements described in paragraph (4)(C)(i) shall not apply with respect to such a telehealth service; and''; (B) in subparagraph (B)-- (i) in the subparagraph heading, by inserting ``during initial period'' after ``rule''; (ii) in the first sentence of clause (i) by striking ``during the periods for which subparagraph (A) applies'' and inserting ``during the period beginning on the first day of the emergency period and ending on December 31, 2027''; and (iii) in clause (ii), by striking ``Costs associated'' and inserting ``During the period for which clause (i) applies, costs associated''; (C) by adding at the end the following new subparagraph: ``(C) Payment after initial period.-- ``(i) In general.--A telehealth service furnished by a Federally qualified health center or a rural health clinic to an individual pursuant to this paragraph on or after January 1, 2028, shall be deemed to be so furnished to such individual as an outpatient of such clinic or facility (as applicable) for purposes of paragraph (1) or (3), respectively, of section 1861(aa) and payable as a Federally qualified health center service or rural health clinic service (as applicable) under the prospective payment system established under section 1834(o) or under section 1833(a)(3), respectively. ``(ii) Treatment of costs for fqhc pps calculations and rhc air calculations.--Costs associated with the furnishing of telehealth services by a Federally qualified health center or rural health clinic serving as a distant site pursuant to this paragraph on or after January 1, 2028, shall be considered allowable costs for purposes of the prospective payment system established under section 1834(o) and any payment methodologies developed under section 1833(a)(3), as applicable.''.

SEC. 1005. NATIVE AMERICAN HEALTH FACILITIES.

(a) In General.--Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by section 101, is amended-- (1) in clause (i), by striking ``and (iv)'' and inserting ``, (iv), and (v)''; and (2) by adding at the end the following new clause: ``(v) Native American Health Facilities.--With respect to telehealth services furnished on or after January 1, 2027, the originating site requirements described in clauses (i) and (ii) shall not apply with respect to a facility of the Indian Health Service, whether operated by such Service, or by an Indian tribe (as that term is defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) or a Tribal organization (as that term is defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304)), or a facility of the Native Hawaiian health care systems authorized under the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11701 et seq.).''. (b) No Originating Site Facility Fee for Certain Native American Facilities.--Section 1834(m)(2)(B)(i) of the Social Security Act (42 U.S.C. 1395m(m)(2)(B)(i)) is amended, in the matter preceding subclause (I), by inserting ``(other than an originating site that is only described in clause (v) of paragraph (4)(C), and does not meet the requirement for an originating site under clauses (i) and (ii) of such paragraph)'' after ``the originating site''.

SEC. 1006. REPEAL OF SIX-MONTH IN-PERSON VISIT REQUIREMENT FOR TELEMENTAL HEALTH SERVICES.

(a) In General.--Section 1834(m)(7) of the Social Security Act (42 U.S.C. 1395m(m)(7)(B)) is amended-- (1) in subparagraph (A), by striking ``, subject to subparagraph (B),''; (2) by striking ``(A) In General.--The geographic''; (3) by striking subparagraph (B). (b) Rural Health Clinics.--Section 1834(y)(2) of the Social Security Act (42 U.S.C. 1395m(y)(2)) is amended by striking ``prior to January 1, 2028''. (c) Federally Qualified Health Centers.--Section 1834(o)(4)(B) of the Social Security Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking ``prior to January 1, 2028''.

SEC. 1007. WAIVER OF TELEHEALTH REQUIREMENTS DURING PUBLIC HEALTH EMERGENCIES.

Section 1135(g)(1) of the Social Security Act (42 U.S.C. 1320b- 5(g)(1)) is amended-- (1) in subparagraph (A), in the matter preceding clause (i), by striking ``subparagraph (B)'' and inserting ``subparagraphs (B) and (C)''; and (2) by adding at the end the following new subparagraph: ``(C) Exception for waiver of telehealth requirements during public health emergencies.--For purposes of subsection (b)(8), in addition to the emergency period described in subparagraph (B), an `emergency area' is a geographical area in which, and an `emergency period' is the period during which, there exists a public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act on or after the date of enactment of this subparagraph.''.

SEC. 1008. USE OF TELEHEALTH IN RECERTIFICATION FOR HOSPICE CARE.

(a) In General.--Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by striking ``during the emergency period'' and all that follows through ``December 31, 2027'' and inserting the following: ``during and after the emergency period described in section 1135(g)(1)(B)''. (b) GAO Report.--Not later than 3 years after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report evaluating the impact of section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)), as amended by subsection (a), on-- (1) the number and percentage of beneficiaries recertified for the Medicare hospice benefit at 180 days and for subsequent benefit periods, to the extent such data is available; (2) Federal oversight of the appropriateness for hospice care of the patients recertified through the use of telehealth; and (3) any other factors determined appropriate by the Comptroller General.

PART 2--PROGRAM INTEGRITY

SEC. 1101. CLARIFICATION FOR FRAUD AND ABUSE LAWS REGARDING TECHNOLOGIES PROVIDED TO BENEFICIARIES.

Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a- 7a(i)(6)) is amended-- (1) in subparagraph (I), by striking ``; or'' and inserting a semicolon; (2) in subparagraph (J), by striking the period at the end and inserting ``; or''; and (3) by adding at the end the following new subparagraph: ``(K) the provision of technologies (as defined by the Secretary) on or after the date of the enactment of this subparagraph, by a provider of services or supplier (as such terms are defined for purposes of title XVIII) directly to an individual who is entitled to benefits under part A of title XVIII, enrolled under part B of such title, or both, for the purpose of furnishing telehealth services, remote patient monitoring services, or other services furnished through the use of technology (as defined by the Secretary), if-- ``(i) the technologies are not offered as part of any advertisement or solicitation; and ``(ii) the provision of the technologies meets any other requirements set forth in regulations promulgated by the Secretary.''.

SEC. 1102. ADDITIONAL RESOURCES FOR TELEHEALTH OVERSIGHT.

In addition to amounts otherwise available, there are authorized to be appropriated to the Inspector General of the Department of Health and Human Services for each of fiscal years 2026 through 2030, out of any money in the Treasury not otherwise appropriated, $3,000,000, to remain available until expended, for purposes of conducting audits, investigations, and other oversight and enforcement activities with respect to telehealth services, remote patient monitoring services, or other services furnished through the use of technology (as defined by the Secretary).

SEC. 1103. ADDRESSING SIGNIFICANT OUTLIER BILLING PATTERNS FOR TELEHEALTH SERVICES.

(a) Identification and Notification of Outlier Billers of Telehealth.-- (1) In general.--The Secretary of Health and Human Services shall, using standard unique health identifiers (described in section 1173(b)) of the Social Security Act (42 U.S.C. 1320d-2) reported on claims for telehealth services furnished to individuals under section 1834(m) of such Act (42 U.S.C. 1395m(m)), identify physicians and practitioners that demonstrate significant outlier billing patterns (such as coding of telehealth services for inappropriate length of time and inaccurate complexity and inappropriate or duplicate billing) for telehealth services or items or services ordered or prescribed concurrent to a telehealth service over a period of time specified by the Secretary. (2) Establishment of thresholds.--For purposes of this subsection, the Secretary shall establish thresholds for outlier billing patterns to identify whether a physician or practitioner is a significant outlier biller for telehealth services or items or services ordered or prescribed concurrent to a telehealth service as compared to other physicians or practitioners within the same specialty and geographic area. (b) Notification.-- (1) In general.--The Secretary shall notify physicians and practitioners identified as a significant outlier biller for telehealth services or items or services ordered or prescribed concurrent to a telehealth service under subsection (a). Each notification under the preceding sentence shall include the following: (A) Information on how the physician or practitioner compares to physicians or practitioners within the same specialty and geographic area with respect to billing for telehealth services or items or services ordered or prescribed concurrent to a telehealth service under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). (B) Information on telehealth billing guidelines under the Medicare program. (C) Other information determined appropriate by the Secretary. (2) Clarification.--Nothing in this subsection or subsection (a) shall be construed as directing the Centers for Medicare & Medicaid Services to pursue further audits of providers of services and suppliers outside of those permitted or required under titles XI or XVIII of the Social Security Act, or otherwise under applicable Federal law. (c) Public Availability of Information.--The Secretary shall make aggregate information on outlier billing patterns identified under subsection (a) available on the internet website of the Centers for Medicare & Medicaid Services. Such information shall be in a form and manner determined appropriate by the Secretary and shall not identify any specific physician or practitioner. (d) Other Activities.--Nothing in this section shall preclude the Secretary from conducting activities that provide physicians and practitioners with information as to how they compare to other physicians and practitioners that are in addition to the activities under this section. (e) Telehealth Resource Centers Education Activities.--Section 330I(j)(2) of the Public Health Service Act (42 U.S.C. 254c-14(j)(2)) is amended-- (1) in subparagraph (F), by striking ``and'' at the end; (2) in subparagraph (G), by striking the period at the end and inserting ``; and''; and (3) by adding at the end the following new subparagraph: ``(H) providing technical assistance and education to physicians and practitioners that the Secretary identifies pursuant to section 1103(a) of the Always Remember Our Rural America Act of 2026 as having significant levels of outlier billing patterns with respect to telehealth services or items or services ordered or prescribed concurrent to a telehealth service under the Medicare program under title XVIII of the Social Security Act, including-- ``(i) education on practices to ensure coding of telehealth services for appropriate length of time and accurate complexity; ``(ii) education on prevention of inappropriate or duplicate billing; ``(iii) information provided in the annual physician fee schedule rulemaking regarding-- ``(I) services specified in paragraph (4)(F)(i) of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) for authorized payment under paragraph (1) of such section; and ``(II) the process used to update such services under paragraph (4)(F)(ii) of such section 1834(m); and ``(iv) referral to the appropriate medicare administrative contractor for specific questions that fall outside of the scope of broad best practices.''. (f) Definitions.--In this section: (1) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. (2) Telehealth service.--The term ``telehealth service'' has the meaning given that term in section 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 1395m(m)(4)(F)). (3) Physician; practitioner.--The terms ``physician'' and ``practitioner'' have the meaning given those terms for purposes of section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)).

PART 3--BENEFICIARY AND PROVIDER SUPPORTS, QUALITY

SEC. 1201. BENEFICIARY ENGAGEMENT ON TELEHEALTH.

(a) Resources, Guidance, and Training Sessions.--Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the following new paragraph: ``(10) Resources, guidance, and training sessions.-- ``(A) In general.--Not later than 6 months after the date of the enactment of this paragraph, the Secretary, in consultation with stakeholders, shall issue resources, guidance, and training sessions for beneficiaries, physicians, practitioners, and health information technology software vendors on best practices for ensuring telehealth services are accessible for-- ``(i) individuals with limited English proficiency, including instructions on how to-- ``(I) access telehealth platforms; ``(II) utilize interpreter services; and ``(III) integrate telehealth and virtual interpreter services; and ``(ii) individuals with disabilities, including instructions on accessibility of the telecommunications system being used for telehealth services, engagement with beneficiaries with disabilities prior to, during, and after the furnishing of the telehealth service, and training on captioning and transcripts. ``(B) Accounting for age and other differences.-- Resources, guidance, and training sessions issued under this paragraph shall account for age and sociodemographic, geographic, literacy, cultural, cognitive, and linguistic differences in how individuals interact with technology.''. (b) Study and Report on Tactics To Improve Beneficiary Engagement on Telehealth.-- (1) Study.--The Secretary of Health and Human Services shall, to the maximum extent feasible, collect and analyze qualitative and quantitative data on strategies that clinicians, payers, and other health care organizations use to improve beneficiary engagement on telehealth services (as defined in section 1834(m)(4)(F) of the Social Security Act (42 U.S.C. 1395m(m)(4)(F))), with an emphasis on underserved communities, such as the use of digital navigators, providing patients with pre-visit information on telehealth, caregiver engagement, and training on telecommunications systems, and the investments necessary for health care professionals to effectively furnish telehealth services, including the costs of necessary technology and of training staff. (2) Report.--Not later than 2 years after the date of the enactment of this Act, the Secretary shall submit to Congress and make available on the internet website of the Secretary of Health and Human Services a report containing the results of the study under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate. (c) Funding.--There are authorized to be appropriated such sums as necessary to carry out the provisions of, including the amendments made by, this section.

SEC. 1202. PROVIDER SUPPORTS ON TELEHEALTH.

(a) Educational Resources and Training Sessions.--Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services shall develop and make available to health care professionals educational resources and training sessions on requirements relating to the furnishing of telehealth services under section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) and topics including-- (1) requirements for payment for telehealth services; (2) telehealth-specific health care privacy and security training; (3) utilizing telehealth services to engage and support underserved, high-risk, and vulnerable patient populations; and (4) other topics as determined appropriate by the Secretary. (b) Funding.--There are authorized to be appropriated such sums as necessary to carry out this section.

SEC. 1203. ENSURING THE INCLUSION OF TELEHEALTH IN MEASURING QUALITY OF CARE.

Section 1890A of the Social Security Act (42 U.S.C. 1395aaa-1) is amended by adding at the end the following new subsection: ``(h) Measuring Quality of Telehealth Services.-- ``(1) In general.--Not later than 180 days after the date of the enactment of this subsection, the Secretary shall review quality measures to ensure inclusion of measures relating to telehealth services, including care, prevention, diagnosis, patient experience, health outcomes, and treatment. ``(2) Consultation.--In conducting the review and assessment under paragraph (1), the Secretary shall consult external technical experts in quality measurement, including patient organizations, providers, and experts in telehealth. ``(3) Review and assessment.--The review and assessment under this subsection shall-- ``(A) include review of existing and under development quality measures to identify measures that are currently inclusive of, and measures that fail to account for, telehealth services; ``(B) identify gaps in areas of quality measurement that relate to telehealth services, including health outcomes and patient experience of care; and ``(C) assess how to effectively streamline, implement, and assign accountability for health outcomes for quality measures for telehealth services across health care settings and providers. ``(4) Technical guidance.--The Secretary shall issue technical guidance on the following for health care providers and other stakeholders, as determined appropriate by the Secretary: ``(A) How to stratify measures by care modality and population to identify differences in health outcomes. ``(B) The use of uniform data elements. ``(C) How to identify and catalogue best practices related to the use of quality measurement and quality improvement for telehealth services. ``(D) Other areas determined appropriate by the Secretary. ``(5) Report.--Not later than 2 years after the date of the enactment of this subsection, the Secretary shall submit to Congress and post on the internet website of the Centers for Medicare & Medicaid Services a report on the review and assessment conducted under this subsection.''.

SEC. 1204. POSTING INFORMATION ON TELEHEALTH SERVICES.

Not later than 180 days after the date of the enactment of this Act, and quarterly thereafter, the Secretary of Health and Human Services shall post on the internet website of the Centers for Medicare & Medicaid Services information on-- (1) the furnishing of telehealth services under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), described by patient population, type of service, geography, place of service, and provider type; (2) the impact of telehealth services on expenditures and utilization under the Medicare program for the most recent 4 quarters for which Medicare claims data is available; and (3) other outcomes related to the furnishing of telehealth services under the Medicare program, as determined appropriate by the Secretary.

Subtitle B--Promoting Access to Physicians

SEC. 1301. CONRAD STATE 30 PROGRAM.

(a) Extension.--Section 220(c) of the Immigration and Nationality Technical Corrections Act of 1994 (Public Law 103-416; 8 U.S.C. 1182 note) is amended by striking ``September 30, 2015'' and inserting ``on the date that is 3 years after the date of the enactment of the Always Remember Our Rural America Act of 2026''. (b) Effective Date.--The amendment made by subsection (a) shall take effect as if enacted on September 30, 2026.

SEC. 1302. RETAINING PHYSICIANS WHO HAVE PRACTICED IN MEDICALLY UNDERSERVED COMMUNITIES.

Section 201(b)(1) of the Immigration and Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end the following: ``(F)(i) Alien physicians who have completed service requirements of a waiver requested under section 203(b)(2)(B)(ii), including-- ``(I) alien physicians who completed such service before the date of the enactment of the Always Remember Our Rural America Act of 2026; and ``(II) the spouse or children of an alien physician described in subclause (I). ``(ii) Nothing in this subparagraph may be construed-- ``(I) to prevent the filing of a petition with the Secretary of Homeland Security for classification under section 204(a) or the filing of an application for adjustment of status under section 245 by an alien physician described in this subparagraph before the date by which such alien physician has completed the service described in section 214(l) or worked full-time as a physician for an aggregate of 5 years at the location identified in the section 214(l) waiver or in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals; or ``(II) to permit the Secretary of Homeland Security to grant a petition or application described in subclause (I) until the alien has satisfied all of the requirements of the waiver received under section 214(l).''.

SEC. 1303. EMPLOYMENT PROTECTIONS FOR PHYSICIANS.

(a) Exceptions to 2-Year Foreign Residency Requirement.--Section 214(l)(1) of the Immigration and Nationality Act (8 U.S.C. 1184(l)(1)) is amended-- (1) in the matter preceding subparagraph (A), by striking ``Attorney General'' and inserting ``Secretary of Homeland Security''; (2) in subparagraph (A), by striking ``Director of the United States Information Agency'' and inserting ``Secretary of State''; (3) in subparagraph (B), by inserting ``, except as provided in paragraphs (7) and (8)'' before the semicolon at the end; (4) in subparagraph (C), by striking clauses (i) and (ii) and inserting the following: ``(i) the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization, which employment has been determined by the Secretary of Homeland Security to be in the public interest; and ``(ii) the alien-- ``(I) has accepted employment with the health facility or health care organization in a geographic area or areas which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals; ``(II) begins employment by the later of the date that is-- ``(aa) 120 days after receiving such waiver; ``(bb) 120 days after completing graduate medical education or training under a program approved pursuant to section 212(j)(1); or ``(cc) 120 days after receiving nonimmigrant status or employment authorization, if the alien or the alien's employer petitions for such nonimmigrant status or employment authorization not later than 120 days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section 212(j)(1); and ``(III) agrees to continue to work for a total of not less than 3 years in the status authorized for such employment under this subsection, except as provided in paragraph (8).''; and (5) in subparagraph (D), in the matter preceding clause (i), by inserting ``(except as provided in paragraph (8))'' after ``3 years''. (b) Allowable Visa Status for Physicians Fulfilling Waiver Requirements in Medically Underserved Areas.--Section 214(l)(2)(A) of such Act (8 U.S.C. 1184(l)(2)(A)) is amended to read as follows: ``(A) Upon the request of an interested Federal agency or an interested State agency for recommendation of a waiver under this section by a physician who is maintaining valid nonimmigrant status under section 101(a)(15)(J) and a favorable recommendation by the Secretary of State, the Secretary of Homeland Security may change the status of such physician to any status authorized for employment under this Act. The numerical limitations contained in subsection (g)(1)(A) shall not apply to any alien whose status is changed under this subparagraph.''. (c) Violation of Agreements.--Section 214(l)(3)(A) of such Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting ``substantial requirement of an'' before ``agreement entered into''. (d) Physician Employment in Underserved Areas.--Section 214(l) of such Act, as amended by this section, is further amended by adding at the end the following: ``(4)(A) If an interested State agency denies an application for a waiver under paragraph (1)(B) from a physician pursuing graduate medical education or training pursuant to section 101(a)(15)(J) because the State has requested the maximum number of waivers permitted for that fiscal year, the physician's nonimmigrant status shall be extended for up to 6 months if the physician agrees to seek a waiver under this subsection (except for paragraph (1)(D)(ii)) to work for an employer described in paragraph (1)(C) in a State that has not yet requested the maximum number of waivers. ``(B) Such physician shall be authorized to work only for the employer referred to in subparagraph (A) during the period beginning on the date on which a new waiver application is filed with such State and ending on the earlier of-- ``(i) the date on which the Secretary of Homeland Security denies such waiver; or ``(ii) the date on which the Secretary approves an application for change of status under paragraph (2)(A) pursuant to the approval of such waiver.''. (e) Contract Requirements.--Section 214(l) of such Act, as amended by this section, is further amended by adding at the end the following: ``(5) An alien granted a waiver under paragraph (1)(C) shall enter into an employment agreement with the contracting health facility or health care organization that-- ``(A) specifies the maximum number of on-call hours per week (which may be a monthly average) that the alien will be expected to be available and the compensation the alien will receive for on-call time; ``(B) specifies-- ``(i) whether the contracting facility or organization-- ``(I) has secured medical malpractice liability protection for the alien under section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)); or ``(II) will pay the alien's malpractice insurance premiums; ``(ii) whether the employer will provide malpractice insurance for the alien; and ``(iii) the amount of such liability protection that will be provided; ``(C) describes all of the work locations that the alien will work and includes a statement that the contracting facility or organization will not add additional work locations without the approval of the Federal agency or State agency that requested the waiver; and ``(D) does not include a non-compete provision. ``(6) An alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph (1)(C)(ii) during the 3-year service period required under paragraph (1) shall be considered to be maintaining lawful status in an authorized period of stay during the 120-day period referred to in items (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the 45-day period referred to in subclause (III)(cc) of such paragraph.''. (f) Recapturing Waiver Slots Lost to Other States.--Section 214(l) of such Act, as amended by this section, is further amended by adding at the end the following: ``(7) If a recipient of a waiver under this subsection terminates the recipient's employment with a health facility or health care organization pursuant to paragraph (1)(C)(ii), including termination of employment because of circumstances described in paragraph (1)(C)(ii)(III), and accepts new employment with such a facility or organization in a different State, the State from which the alien is departing may be accorded an additional waiver by the Secretary of State for use in the fiscal year in which the alien's employment was terminated.''. (g) Exception to 3-Year Work Requirement.--Section 214(l) of such Act, as amended by this section, is further amended by adding at the end the following: ``(8) The 3-year work requirement set forth in subparagraphs (C) and (D) of paragraph (1) shall not apply if-- ``(A)(i) the Secretary of Homeland Security determines that extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, exist that justify a lesser period of employment at such facility or organization; and ``(ii) the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), another bona fide offer of employment at a health facility or health care organization in a geographic area or areas which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals, for the remainder of such 3-year period; ``(B)(i) the interested State agency that requested the waiver attests that extenuating circumstances, including violations by the employer of the employment agreement with the alien or of labor and employment laws, exist that justify a lesser period of employment at such facility or organization; and ``(ii) the alien demonstrates, not later than 120 days after the employment termination date (unless the Secretary determines that extenuating circumstances would justify an extension), another bona fide offer of employment at a health facility or health care organization in a geographic area or areas which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals, for the remainder of such 3-year period; or ``(C) the alien-- ``(i) elects not to pursue a determination of extenuating circumstances pursuant to subclause (A) or (B); ``(ii) terminates the alien's employment relationship with the health facility or health care organization at which the alien was employed; ``(iii) demonstrates, not later than 45 days after the employment termination date, another bona fide offer of employment at a health facility or health care organization in a geographic area or areas, in the State that requested the alien's waiver, which are designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and ``(iv) agrees to be employed for the remainder of such 3-year period, and 1 additional year for each termination under clause (ii).''.

SEC. 1304. ALLOTMENT OF CONRAD 30 WAIVERS.

(a) In General.--Section 214(l) of the Immigration and Nationality Act (8 U.S.C. 1184(l)), as amended by section 4, is further amended by adding at the end the following: ``(9)(A)(i) All States shall be allotted a total of 35 waivers under paragraph (1)(B) for a fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year. ``(ii) When an allotment occurs under clause (i), all States shall be allotted an additional 5 waivers under paragraph (1)(B) for each subsequent fiscal year if 90 percent of the waivers available to the States receiving at least 5 waivers were used in the previous fiscal year. If the States are allotted 45 or more waivers for a fiscal year, the States will only receive an additional increase of 5 waivers the following fiscal year if 95 percent of the waivers available to the States receiving at least 1 waiver were used in the previous fiscal year. ``(B) Any increase in allotments under subparagraph (A) shall be maintained indefinitely, unless in a fiscal year, the total number of such waivers granted is 5 percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph, in which case-- ``(i) the number of waivers allotted shall be decreased by 5 for all States beginning in the next fiscal year; and ``(ii) each additional 5 percent decrease in such waivers granted from the last year in which there was an increase in the allotment, shall result in an additional decrease of 5 waivers allotted for all States, provided that the number of waivers allotted for all States shall not drop below 30.''. (b) Academic Medical Centers.--Section 214(l)(1)(D) of such Act (8 U.S.C. 1184(l)(1)(D)), as amended by section 4(a)(5), is further amended-- (1) in clause (ii), by striking ``and'' at the end; (2) in clause (iii), by striking the period at the end and inserting ``; and''; and (3) by adding at the end the following: ``(iv) in the case of a request by an interested State agency-- ``(I) the head of such agency determines that the alien is to practice medicine in, or be on the faculty of a residency program at, an academic medical center (as that term is defined in section 411.355(e)(2) of title 42, Code of Federal Regulations, or similar successor regulation), without regard to whether such facility is located within an area designated by the Secretary of Health and Human Services as having a shortage of health care professionals; and ``(II) the head of such agency determines that-- ``(aa) the alien physician's work is in the public interest; and ``(bb) the grant of such waiver would not cause the number of the waivers granted on behalf of aliens for such State for a fiscal year (within the limitation in subparagraph (B) and subject to paragraph (6)) in accordance with the conditions of this clause to exceed 3.''.

SEC. 1305. AMENDMENTS TO THE PROCEDURES, DEFINITIONS, AND OTHER PROVISIONS RELATED TO PHYSICIAN IMMIGRATION.

(a) Dual Intent for Physicians Seeking Graduate Medical Training.-- Section 214(b) of the Immigration and Nationality Act (8 U.S.C. 1184(b)) is amended by striking ``(other than a nonimmigrant described in subparagraph (L) or (V) of section 101(a)(15), and other than a nonimmigrant described in any provision of section 101(a)(15)(H)(i) except subclause (b1) of such section)'' and inserting ``(other than a nonimmigrant described in subparagraph (L) or (V) of section 101(a)(15), a nonimmigrant described in any provision of section 101(a)(15)(H)(i) (except subclause (b1) of such section), and an alien coming to the United States to receive graduate medical education or training described in section 212(j) or to take examinations required to receive graduate medical education or training described in section 212(j))''. (b) Physician National Interest Waiver Clarifications.-- (1) Practice and geographic area.--Section 203(b)(2)(B)(ii)(I) of the Immigration and Nationality Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by striking items (aa) and (bb) and inserting the following: ``(aa) the alien physician agrees to work on a full-time basis practicing primary care, specialty medicine, or a combination thereof, in an area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals, or at a health care facility under the jurisdiction of the Secretary of Veterans Affairs; or ``(bb) the alien physician is pursuing such waiver based upon service at a facility or facilities that serve patients who reside in a geographic area or areas designated by the Secretary of Health and Human Services as having a shortage of health care professionals (without regard to whether such facility or facilities are located within such an area) and a Federal agency, or a local, county, regional, or State department of public health determines the alien physician's work was or will be in the public interest.''. (2) Five-year service requirement.--Section 203(b)(2)(B)(ii) of the Immigration and Nationality Act (8 U.S.C. 1153(B)(ii)) is amended-- (A) by moving subclauses (II), (III), and (IV) 4 ems to the left; and (B) in subclause (II)-- (i) by inserting ``(aa)'' after ``(II)''; and (ii) by adding at the end the following: ``(bb) The 5-year service requirement under item (aa) shall begin on the date on which the alien physician begins work in the shortage area in any legal status and not on the date on which an immigrant visa petition is filed or approved. Such service shall be aggregated without regard to when such service began and without regard to whether such service began during or in conjunction with a course of graduate medical education. ``(cc) An alien physician shall not be required to submit an employment contract with a term exceeding the balance of the 5-year commitment yet to be served or an employment contract dated within a minimum time period before filing a visa petition under this subsection. ``(dd) An alien physician shall not be required to file additional immigrant visa petitions upon a change of work location from the location approved in the original national interest immigrant petition.''. (c) Technical Clarification Regarding Advanced Degree for Physicians.--Section 203(b)(2)(A) of the Immigration and Nationality Act (8 U.S.C. 1153(b)(2)(A)) is amended by adding at the end the following: ``An alien physician holding a foreign medical degree that has been deemed sufficient for acceptance by an accredited United States medical residency or fellowship program is a member of the professions holding an advanced degree or its equivalent.''. (d) Short-Term Work Authorization for Physicians Completing Their Residencies.-- (1) In general.--A physician completing graduate medical education or training described in section 212(j) of the Immigration and Nationality Act (8 U.S.C. 1182(j)) as a nonimmigrant described in section 101(a)(15)(H)(i) of such Act (8 U.S.C. 1101(a)(15)(H)(i))-- (A) shall have such nonimmigrant status automatically extended until October 1 of the fiscal year for which a petition for a continuation of such nonimmigrant status has been submitted in a timely manner and the employment start date for the beneficiary of such petition is October 1 of that fiscal year; and (B) shall be authorized to be employed incident to status during the period between the filing of such petition and October 1 of such fiscal year. (2) Termination.--The physician's status and employment authorization shall terminate on the date that is 30 days after the date on which a petition described in paragraph (1)(A) is rejected, denied or revoked. (3) Automatic extension.--A physician's status and employment authorization will automatically extend to October 1 of the next fiscal year if all of the visas described in section 101(a)(15)(H)(i) of such Act that were authorized to be issued for the fiscal year have been issued. (e) Applicability of Section 212(e) to Spouses and Children of J-1 Exchange Visitors.--A spouse or child of an exchange visitor described in section 101(a)(15)(J) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be subject to the requirements under section 212(e) of such Act (8 U.S.C. 1182(e)).

SEC. 1306. ANNUAL CONRAD STATE 30 J-1 VISA WAIVER PROGRAM STATISTICAL REPORT.

The Director of U.S. Citizenship and Immigration Services shall submit an annual report to Congress and to the Department of Health and Human Services that identifies the number of aliens admitted during the most recently concluded fiscal year as a result of the Conrad State 30 J-1 Visa Waiver Program established under sections 212(e) and 214(l) of the Immigration and Nationality Act (8 U.S.C. 1182(e) and 1184(l)), disaggregated by State.

Subtitle C--Rural Hospital Retention

SEC. 1401. EMPLOYEE RETENTION CREDIT FOR CERTAIN RURAL HOSPITAL EMPLOYERS.

(a) In General.--Subchapter D of chapter 21 of subtitle C of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

``SEC. 3135. EMPLOYEE RETENTION CREDIT FOR CERTAIN RURAL HOSPITAL EMPLOYERS.

``(a) In General.--In the case of an eligible employer, there shall be allowed as a credit against applicable employment taxes for each calendar quarter an amount equal to 100 percent of the qualified wages with respect to each qualified employee of such employer for such calendar quarter. ``(b) Limitations and Refundability.-- ``(1) Wages taken into account.--The amount of qualified wages which may be taken into account under subsection (a) with respect to any qualified employee shall not exceed, in the aggregate with respect to all calendar quarters in the taxable year, $15,000. ``(2) Credit limited to employment taxes.--The credit allowed by subsection (a) with respect to any calendar quarter shall not exceed the applicable employment taxes (reduced by any credits allowed under subsections (e) and (f) of section 3111) on the wages paid with respect to the employment of all the qualified employees of the eligible employer for such calendar quarter. ``(3) Refundability of excess credit.--If the amount of the credit under subsection (a) exceeds the limitation of paragraph (2) for any calendar quarter, such excess shall be treated as an overpayment that shall be refunded under sections 6402(a) and 6413(b). ``(c) Definitions.--For purposes of this section-- ``(1) Applicable employment taxes.--The term `applicable employment taxes' means the following: ``(A) The taxes imposed under section 3111(a). ``(B) So much of the taxes imposed under section 3221(a) as are attributable to the rate in effect under section 3111(a). ``(2) Eligible employer.-- ``(A) In general.--The term `eligible employer' means any hospital in a rural area which, with respect to a calendar year, employed an average of at least 100 full-time employees (within the meaning of section 4980H) during the preceding calendar year. ``(B) Rural area.--The term `rural area' has the meaning given such term in section 7001 of the Always Remember Our Rural America Act of 2026. ``(3) Qualified employee.-- ``(A) In general.--The term `qualified employee' means any individual who performs any services described in subparagraph (B) on a full-time basis for the eligible employer and to whom the employer is required to furnish a statement under section 6051. Such term shall not include any executive officer of the employer, any centralized corporate personnel of the employer, any independent contractor, or any temporary staffing agency worker. ``(B) Services described.--Services described in this subparagraph are the following: ``(i) Health care services. ``(ii) Health care support services. ``(iii) Essential operations services. ``(4) Qualified wages.--The term `qualified wages' means wages paid by the eligible employer with respect to a qualified employee. ``(5) Wages.-- ``(A) In general.--The term `wages' means wages (as defined in section 3121(a)) and compensation (as defined in section 3231(e)). ``(B) Allowance for certain health plan expenses.-- ``(i) In general.--Such term shall include amounts paid by the eligible employer to provide and maintain a group health plan (as defined in section 5000(b)(1)), but only to the extent that such amounts are excluded from the gross income of employees by reason of section 106(a). ``(ii) Allocation rules.--For purposes of this section, amounts treated as wages under clause (i) shall be treated as paid with respect to any qualified employee (and with respect to any period) to the extent that such amounts are properly allocable to such employee (and to such period) in such manner as the Secretary may prescribe. Except as otherwise provided by the Secretary, such allocation shall be treated as properly made if made on the basis of being pro rata among periods of coverage. ``(6) Other terms.--Any term used in this section which is also used in this chapter or chapter 22 shall have the same meaning as when used in such chapter. ``(d) Aggregation Rule.--All persons treated as a single employer under subsection (a) or (b) of section 52, or subsection (m) or (o) of section 414, shall be treated as one employer for purposes of this section. ``(e) Certain Rules To Apply.--For purposes of this section, rules similar to the rules of sections 51(i)(1) and 280C(a) shall apply. ``(f) Certain Governmental Employers.--This credit shall not apply to the Government of the United States, the government of any State or political subdivision thereof, or any agency or instrumentality of any of the foregoing. ``(g) Election Not To Have Section Apply.--This section shall not apply with respect to any eligible employer for any calendar quarter if such employer elects (at such time and in such manner as the Secretary may prescribe) not to have this section apply. ``(h) Employee Not Taken Into Account More Than Once.--A qualified employee shall not be included for purposes of this section for any period with respect to any eligible employer if such employer is allowed a credit under section 51 with respect to such employee for such period. ``(i) Denial of Double Benefit.--Any wages taken into account in determining the credit allowed under this section shall not be taken into account for purposes of determining the credit allowed under section 45S. ``(j) Third-Party Payors.--Any credit allowed under this section shall be treated as a credit described in section 3511(d)(2). ``(k) Treatment of Deposits.--The Secretary shall waive any penalty under section 6656 for any failure to make a deposit of any applicable employment taxes if the Secretary determines that such failure was due to the reasonable anticipation of the credit allowed under this section. ``(l) Regulations.--The Secretary shall prescribe such regulations or other guidance as may be necessary to carry out the purposes of this section, including regulations or other guidance-- ``(1) to allow the advance payment of the credit under subsection (a), subject to the limitations provided in this section, based on such information as the Secretary shall require, and ``(2) to provide for the reconciliation of such advance payment with the amount of the credit at the time of filing the return of tax for the applicable quarter or taxable year. ``(m) Application.--This section shall only apply to wages paid after December 31, 2026, and before December 31, 2035.''. (b) Refunds.--Section 1324(b)(2) of title 31, United States Code, is amended by inserting ``3135,'' before ``6428,''. (c) Clerical Amendment.--The table of sections for subchapter D of chapter 21 of subtitle C of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

``Sec. 3135. Employee retention credit for certain rural hospital employers.''. (d) Transfers to Federal Old-Age and Survivors Insurance Trust Fund.--There are hereby appropriated to the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund established under section 201 of the Social Security Act (42 U.S.C. 401) and the Social Security Equivalent Benefit Account established under section 15A(a) of the Railroad Retirement Act of 1974 (45 U.S.C. 231n-1(a)) amounts equal to the reduction in revenues to the Treasury by reason of section 3135 of the Internal Revenue Code of 1986 (as added by this section), without regard to this subsection. Amounts appropriated by the preceding sentence shall be transferred from the general fund at such times and in such manner as to replicate to the extent possible the transfers which would have occurred to such Trust Fund or Account had this section not been enacted. (e) Effective Date.--The amendments made by this section shall apply to calendar quarters beginning after December 31, 2026.

Subtitle D--Study

SEC. 1501. STUDY.

The Comptroller General of the United States shall conduct a study on Federal and State regulatory and administrative requirements applicable to rural health care providers, facilities, and patients for the purpose of identifying opportunities to improve coordination among Federal and State agencies, reduce unnecessary duplication, simplify compliance, and increase access for patients, health care workers, and Federal health care programs.

TITLE II--INFRASTRUCTURE

SEC. 2001. FEDERAL GRANT-WRITING SERVICES AND TECHNICAL ASSISTANCE FOR RURAL COMMUNITIES.

Section 607 of the Rural Development Act of 1972 (7 U.S.C. 2204b(d)) is amended-- (1) in paragraph (5), by striking ``and''; (2) in paragraph (6), by adding ``and'' at the end; and (3) by adding at the end the following: ``(7) providing grant-writing services and technical assistance to an entity that is seeking a grant or loan from a department, agency, or instrumentality of the Federal Government, and that has jurisdiction over-- ``(A) an area eligible for a grant under section 306A of the Consolidated Farm and Rural Development Act; ``(B) an area of persistent poverty described in section 6702(a)(1)(A) of title 49, United States Code; ``(C) a community that has a median household income that is less than 80 percent of the median household income for the State in which the community is located; or ``(D) a tribal area.''.

SEC. 2002. STUDY ON ACCESSIBILITY OF FEDERAL PROGRAMS IN RURAL COMMUNITIES.

Within 12 months after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit to the Congress, a report that contains-- (1) a list of all Federal programs under which a grant or loan is may be made available to an entity referred to in section 607(d)(7) of the Rural Development Act of 1972; (2) statistics on the use of the programs; and (3) recommendations on how the Congress and the Executive Branch can make the programs more accessible and beneficial to such an entity.

TITLE III--AGRICULTURE

SEC. 3001. COMPREHENSIVE STUDY ON COST OF AGRICULTURE REGULATIONS.

Not later than 12 months after the date of the enactment of this Act, the Comptroller General of the United States shall conduct a study, and submit to Congress, a report that contains-- (1) an assessment of the financial impacts of Federal regulations on United States farmers; and (2) the Comptroller General's recommendations for regulatory or statutory changes needed to reduce costs associated with compliance with such regulations that are identified in such assessment.

SEC. 3002. EXCLUSION OF GAIN FROM SALE OF QUALIFIED FARMLAND.

(a) In General.--Part III of subchapter B of chapter 1 of the Internal Revenue Code of 1986 is amended by inserting after section 139L the following new section:

``SEC. 139M. EXCLUSION OF GAIN FROM SALE OF QUALIFIED FARMLAND.

``(a) Exclusion.--Gross income shall not include gain from the sale or exchange of qualified farmland if such sale or exchange is made to or with a qualified buyer. ``(b) Limitation.-- ``(1) In general.--The amount of gain excluded from gross income under subsection (a) with respect to any sale or exchange shall not exceed the applicable exclusion amount. ``(2) Applicable exclusion amount.--For purposes of this subsection, the applicable exclusion amount is $500,000 ($1,000,000 in the case of a joint return), reduced (but not below zero) by the aggregate amount excluded under this section for all preceding taxable years with respect to the same buyer. ``(c) Qualified Farmland.--For purposes of this section, the term `qualified farmland' means real property located in the United States which, during the 5-year period ending on the date of the sale or exchange of such property, has been used by the owner of such property (or a lessee thereof) primarily for the production of crops, fruits, other agricultural products, or live st

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