S3250-119

1. Short title This Act may be cited as the Rural Hospital Flexibility Act of 2025.

2. Medicare rural hospital flexibility program grants Section 1820 of the Social Security Act (42 U.S.C. 1395i–4) is amended— in subsection (g)— in paragraph (1)— in subparagraph (C), by striking and at the end; by amending subparagraph (D) to read as follows: providing support for critical access hospitals, 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; by adding at the end the following new subparagraphs: providing support for critical access hospitals to convert to rural emergency hospitals to stabilize hospital emergency services in their communities; and conducting outreach regarding the availability of payments for direct graduate medical education costs under section 1886(h), providing information regarding eligibility for direct graduate medical education residency positions, and providing assistance with the application process for the distribution of such positions to— critical access hospitals; hospitals located in rural areas (as defined in section 1886(d)(2)(D)), excluding hospitals that are treated as being located in a rural area pursuant to section 1886(d)(8)(E); hospitals located in an area that has a rural-urban commuting code of no less than 4.0; sole community hospitals (as defined in section 1886(d)(5)(D)(iii)); sites that are located within 10 miles of a sole community hospital (as defined in section 1886(d)(5)(D)(iii)); and rural emergency hospitals. by redesignating paragraphs (3) through (7) as paragraphs (4) through (8), respectively; after paragraph (2), by inserting the following new paragraph: The Secretary may award grants or cooperative agreements to entities that submit to the Secretary applications, at such time and in such form and manner and containing such information as the Secretary specifies, for purposes of supporting recipients in carrying out the activities under this subsection by providing technical assistance, data analysis, and evaluation efforts. in paragraph (4), as redesignated by subparagraph (B)— in subparagraph (A)— in the header by striking hospitals and inserting State Offices of Rural Health; and by inserting State Offices of Rural Health on behalf of eligible small rural after award grants to; by amending subparagraph (B) to read as follows: For purposes of this paragraph, the term ‘‘eligible small rural hospital’’ means— a non-Federal, short-term general acute hospital that— is located in a rural area (as defined for purposes of section 1886(d)); and has less than 50 beds; or a rural emergency hospital (as defined in section 1861(kkk)(2)). by amending subparagraph (C) to read as follows: The State Office of Rural Health shall submit an application, on behalf of eligible small rural hospitals, to the Secretary on or before such date and in such form and manner as the Secretary specifies. by amending subparagraph (D) to read as follows: A grant under this paragraph shall be determined on an equal national distribution so that each eligible small rural hospital receives the same amount of support related to the funds appropriated. by amending subparagraph (E) to read as follows: State Offices of Rural Health and eligible small rural hospitals may use the funds received through a grant under this paragraph for— the purchase of computer software and hardware; the education and training of hospital staff on billing, operational, quality improvement, and related value-focused efforts; and other delivery system reform programs determined appropriate by the Secretary. in subparagraph (F)— in clause (i), by striking A hospital receiving a grant under this section and inserting An entity receiving a grant under this paragraph; and in clause (ii), by striking under this section and inserting under this paragraph each place it appears; and in paragraph (5), as redesignated by subparagraph (B), in the matter preceding subparagraph (A), by striking or (2) and inserting , (2), or (4); and in subsection (j)— by striking from the Federal Hospital Insurance Trust Fund; and by striking in each of fiscal years 2011 and 2012 and inserting in fiscal year 2011 and each subsequent fiscal year. (D)providing support for critical access hospitals, 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;; and (E)providing support for critical access hospitals to convert to rural emergency hospitals to stabilize hospital emergency services in their communities; and(F)conducting outreach regarding the availability of payments for direct graduate medical education costs under section 1886(h), providing information regarding eligibility for direct graduate medical education residency positions, and providing assistance with the application process for the distribution of such positions to—(i)critical access hospitals;(ii)hospitals located in rural areas (as defined in section 1886(d)(2)(D)), excluding hospitals that are treated as being located in a rural area pursuant to section 1886(d)(8)(E);(iii)hospitals located in an area that has a rural-urban commuting code of no less than 4.0;(iv)sole community hospitals (as defined in section 1886(d)(5)(D)(iii));(v)sites that are located within 10 miles of a sole community hospital (as defined in section 1886(d)(5)(D)(iii)); and(vi)rural emergency hospitals.; (3)Activities to support carrying out other grantsThe Secretary may award grants or cooperative agreements to entities that submit to the Secretary applications, at such time and in such form and manner and containing such information as the Secretary specifies, for purposes of supporting recipients in carrying out the activities under this subsection by providing technical assistance, data analysis, and evaluation efforts.; (B)Eligible small rural hospital definedFor purposes of this paragraph, the term ‘‘eligible small rural hospital’’ means—(i)a non-Federal, short-term general acute hospital that—(I)is located in a rural area (as defined for purposes of section 1886(d)); and(II)has less than 50 beds; or(ii)a rural emergency hospital (as defined in section 1861(kkk)(2)).; (C)ApplicationThe State Office of Rural Health shall submit an application, on behalf of eligible small rural hospitals, to the Secretary on or before such date and in such form and manner as the Secretary specifies.; (D)Amount of grantA grant under this paragraph shall be determined on an equal national distribution so that each eligible small rural hospital receives the same amount of support related to the funds appropriated.; (E)Use of fundsState Offices of Rural Health and eligible small rural hospitals may use the funds received through a grant under this paragraph for— (i)the purchase of computer software and hardware; (ii)the education and training of hospital staff on billing, operational, quality improvement, and related value-focused efforts; and (iii)other delivery system reform programs determined appropriate by the Secretary.; and