H.R. 6804

[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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