H.R. 8246, the Second Chances for Rural Hospitals Act, would allow critical access hospitals and certain small rural hospitals that closed between January 1, 2014, and December 26, 2020, to reopen as rural emergency hospitals. Those facilities would qualify for additional Medicare payments, including higher reimbursement rates and annual facility payments, depending on their distance from other hospitals. Based on an assessment of the number of additional locations that would become eligible for monthly payments, CBO estimates that enacting the bill would result in about 6,000 additional monthly payments to rural emergency hospitals, increasing Medicare fee-for-service spending by $2 billion. That change also would increase payments to Medicare Advantage plans. CBO estimates that enacting H.R. 8246 would increase total direct spending by $3.4 billion over the 2025‑2034 period and that enacting the bill would not affect revenues.