[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6804 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 6804
To amend title XVIII of the Social Security Act to strengthen Medicare
rural hospital flexibility program grants.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 17, 2025
Mrs. Miller of West Virginia (for herself and Ms. Sewell) introduced
the following bill; which was referred to the Committee on Ways and
Means
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to strengthen Medicare
rural hospital flexibility program grants.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Hospital Flexibility Act of
2025''.
SEC. 2. MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM GRANTS.
Section 1820(g) of the Social Security Act (42 U.S.C. 1395i-4(g))
is amended--
(1) by amending paragraph (1)(D) to read as follows:
``(D) providing support for critical access
hospitals, certified rural health clinics, and rural
emergency hospitals (as defined in section
1861(kkk)(2)) for quality improvement, quality
reporting, performance improvements, benchmarking,
addressing population health, transforming services,
and providing linkages and services for behavioral
health and substance use disorders responding to public
health emergencies.'';
(2) by redesignating paragraphs (3) through (7) as
paragraphs (4) through (8), respectively;
(3) after paragraph (2), by inserting the following new
paragraph:
``(3) Activities to support carrying out other grants.--The
Secretary may award grants or cooperative agreements to
entities awarded grants or agreements under other provisions of
this subsection for purposes of supporting such entities in
carrying out activities under such other grants or agreements
by providing technical assistance, data analysis, and
evaluation efforts. An entity seeking a grant under this
paragraph shall submit an application to the Secretary at such
time and in such manner as specified by the Secretary.'';
(4) in paragraph (4), as redesignated--
(A) in subparagraph (A)--
(i) in the header, by striking
``hospitals'' and inserting ``State offices of
rural health''; and
(ii) by striking ``grants to hospitals''
and inserting ``grants to State Offices of
Rural Health'';
(B) in subparagraph (B)--
(i) by redesignating clauses (i) and (ii)
as subclauses (I) and (II), respectively;
(ii) by striking ``means a non-Federal''
and inserting the following: ``means--
``(i) a non-Federal''; and
(iii) by striking the period at the end and
inserting the following: ``; or
``(ii) a rural emergency hospital (as
defined in section 1861(kkk)).'';
(C) by amending subparagraph (C) to read as
follows:
``(C) Application.--The State Office of Rural
Health shall submit an application to the Secretary on
or before such date and in such form and manner as the
Secretary specifies.'';
(D) by amending subparagraph (D) to read as
follows:
``(D) Amount of grant.--With respect to funds made
available to make grants under this paragraph in a
fiscal year, the amount awarded to a State Office of
Rural Health shall bear the same ratio to the total
amount of such funds so made available as the number of
eligible small rural hospitals in such State bears to
the total number of eligible small rural hospitals in
all States receiving a grant under this paragraph for
such fiscal year propose.'';
(E) by amending subparagraph (E) to read as
follows:
``(E) Use of funds.--State Offices of Rural Health
may use the funds received through a grant under this
paragraph for the purchase of computer software and
hardware on behalf of eligible small rural hospitals,
for the education and training of eligible small rural
hospital staff on billing, operational, quality
improvement, and related value-focused efforts, and for
other delivery system reform programs determined
appropriate by the Secretary.''; and
(F) in subparagraph (F)--
(i) in clause (i), by striking ``A hospital
receiving a grant under this section'' and
inserting ``An entity receiving a grant under
this paragraph''; and
(ii) in clause (ii), by striking
``section'' each place such term appears and
inserting ``paragraph'' in each such place;
(5) in paragraph (5), as redesignated, by striking
``paragraph (1) or (2)'' and inserting ``paragraph (1), (2), or
(4)''; and
(6) by adding at the end the following new paragraphs:
``(9) Rural health transformation grants.--
``(A) Grants.--The Secretary may award 5-year
grants to State Offices of Rural Health and to eligible
rural health care providers (as defined in subparagraph
(D)) on the transition to new models, including rural
emergency hospitals, extended stay clinics,
freestanding emergency departments, rural health
clinics, and integration of behavioral, oral health
services, telehealth and other transformational models
relevant to rural providers as such providers evolve to
better meet community needs and the changing health
care environment.
``(B) Application.--An eligible rural health care
provider, in consultation with the State Office of
Rural Health in the State in which the rural health
care provider seeking a grant under this paragraph is
located, shall submit an application to the Secretary
on or before such date and in such form and manner as
the Secretary specifies.
``(C) Additional requirements.--The Secretary may
not award a grant under this paragraph to an eligible
rural health care provider unless--
``(i) local organizations or the State in
which the hospital is located provides support
(either direct or in kind); and there are
letters of support from key State payers such
as Medicaid and private insurance; and
``(ii) the applicant describes in detail
how the transition of the health care provider
or providers will better meet local needs and
be sustainable.
``(D) Eligible rural health care provider
defined.--For purposes of this paragraph, the term
`eligible rural health care provider' includes a
critical access hospital, a certified rural health
clinic, a rural nursing home, skilled nursing facility,
emergency care provider, or other entity identified by
the Secretary. An eligible rural health care provider
may include other entities applying on behalf of a
group of rural health care providers such as a State
Office of Rural Health, a State or local health care
authority, a rural health network, or other entity
identified by the Secretary.
``(10) Rural emergency hospital technical assistance.--
``(A) In general.--The Secretary may award grants
or cooperative agreements to eligible entities (as
determined by the Secretary) for the purpose of
providing technical assistance, data analysis, and
other support to hospitals that are seeking to be
designated, or are currently designated, as rural
emergency hospitals (as described in section
1861(kkk)(2)).
``(B) Application.--An entity seeking a grant under
subparagraph (A) shall submit an application to the
Secretary at such time and in such form and manner as
specified by the Secretary.''.
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