I 

118TH CONGRESS 

2D SESSION H. R. 10187 

To amend title XVIII of the Social Security Act to modify Medicare rural 

hospital flexibility program grants. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 20, 2024 

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 modify 

Medicare rural hospital flexibility program grants. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Hospital Flexi5 bility Act of 2024’’. 

6 SEC. 2. MEDICARE RURAL HOSPITAL FLEXIBILITY PRO7 GRAM GRANTS. 

8 Section 1820(g) of the Social Security Act (42 U.S.C. 

9 1395i–4(g)) is amended— 

10 (1) in paragraph (1)— 


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1 (A) in subparagraph (C), by striking 

2 ‘‘and’’ at the end; 

3 (B) by amending subparagraph (D) to 

4 read as follows: 

5 ‘‘(D) providing support for critical access 

6 hospitals, certified rural health clinics, and 

7 rural emergency hospitals (as defined in section 

8 1861(kkk)(2)) for quality improvement, quality 

9 reporting, performance improvements, 

10 benchmarking, addressing population health, 

11 transforming services, and providing linkages 

12 and services for behavioral health and sub13 stance use disorders responding to public health 

14 emergencies; and’’; and 

15 (C) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(E) providing support for critical access 

18 hospitals to convert to rural emergency hos19 pitals to stabilize hospital emergency services in 

20 their communities.’’; 

21 (2) by redesignating paragraphs (3) through 

22 (7) as paragraphs (4) through (8), respectively; 

23 (3) after paragraph (2), by inserting the fol24 lowing new paragraph: 


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1 ‘‘(3) ACTIVITIES TO SUPPORT CARRYING OUT

2 OTHER GRANTS.—The Secretary may award grants 

3 or cooperative agreements to entities that submit to 

4 the Secretary applications, at such time and in such 

5 form and manner and containing such information 

6 as the Secretary specifies, for purposes of supporting 

7 recipients in carrying out the activities under this 

8 subsection by providing technical assistance, data 

9 analysis, and evaluation efforts.’’; 

10 (4) in paragraph (4), as redesignated— 

11 (A) in subparagraph (A)— 

12 (i) in the header, by striking ‘‘HOS13 PITALS’’ and inserting ‘‘STATE OFFICES OF

14 RURAL HEALTH’’; and 

15 (ii) by striking ‘‘grants to hospitals’’ 

16 and inserting ‘‘grants to State Offices of 

17 Rural Health’’; 

18 (B) in subparagraph (B)— 

19 (i) by redesignating clauses (i) and 

20 (ii) as subclauses (I) and (II), respectively; 

21 (ii) by striking ‘‘means a non-Fed22 eral’’ and inserting the following: 

23 ‘‘means— 

24 ‘‘(i) a non-Federal’’; and 


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1 (iii) by striking the period at the end 

2 and inserting the following: ‘‘; or 

3 ‘‘(ii) a rural emergency hospital (as 

4 defined in section 1861(kkk)).’’; 

5 (C) by amending subparagraph (C) to read 

6 as follows: 

7 ‘‘(C) APPLICATION.—The State Office of 

8 Rural Health shall submit an application to the 

9 Secretary on or before such date and in such 

10 form and manner as the Secretary specifies.’’; 

11 (D) by amending subparagraph (D), to 

12 read as follows: 

13 ‘‘(D) AMOUNT OF GRANT.—With respect 

14 to funds made available to make grants under 

15 this paragraph in a fiscal year, the amount 

16 awarded to a State Office of Rural Health shall 

17 bear the same ratio to the total amount of such 

18 funds so made available as the number of eligi19 ble small rural hospitals such Office proposes to 

20 assist with such grant bears to the total num21 ber of eligible small rural hospitals all such Of22 fices receiving a grant under this paragraph for 

23 such fiscal year propose to assist with such 

24 grants.’’; 


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1 (E) by amending subparagraph (E), to 

2 read as follows: 

3 ‘‘(E) USE OF FUNDS.—State Offices of 

4 Rural Health may use the funds received 

5 through a grant under this paragraph for the 

6 purchase of computer software and hardware on 

7 behalf of eligible small rural hospitals, for the 

8 education and training of eligible small rural 

9 hospital staff on billing, operational, quality im10 provement, and related value-focused efforts, 

11 and for other delivery system reform programs 

12 determined appropriate by the Secretary.’’; and 

13 (F) in subparagraph (F)— 

14 (i) in clause (i), by striking ‘‘A hos15 pital receiving a grant under this section’’ 

16 and inserting ‘‘An entity receiving a grant 

17 under this paragraph’’; and 

18 (ii) in clause (ii), by striking ‘‘section’’ 

19 each place such term appears and inserting 

20 ‘‘paragraph’’ in each such place; 

21 (5) in paragraph (5), as redesignated, by strik22 ing ‘‘paragraph (1) or (2)’’ and inserting ‘‘para23 graph (1), (2), or (4)’’; and 

24 (6) by adding at the end the following new 

25 paragraph: 


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1 ‘‘(9) RURAL HEALTH TRANSFORMATION

2 GRANTS.— 

3 ‘‘(A) GRANTS.—The Secretary may award 

4 5-year grants to State Offices of Rural Health 

5 and to eligible rural health care providers (as 

6 defined in subparagraph (D)) on the transition 

7 to new models, including rural emergency hos8 pitals, extended stay clinics, freestanding emer9 gency departments, rural health clinics, and in10 tegration of behavioral, oral health services, 

11 telehealth and other transformational models 

12 relevant to rural providers as such providers 

13 evolve to better meet community needs and the 

14 changing health care environment. 

15 ‘‘(B) APPLICATION.—An eligible rural 

16 health care provider, in consultation with the 

17 State Office of Rural Health in the State in 

18 which the rural health care provider seeking a 

19 grant under this paragraph is located, shall 

20 submit an application to the Secretary on or be21 fore such date and in such form and manner as 

22 the Secretary specifies. 

23 ‘‘(C) ADDITIONAL REQUIREMENTS.—The 

24 Secretary may not award a grant under this 


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1 paragraph to an eligible rural health care pro2 vider unless— 

3 ‘‘(i) local organizations or the State in 

4 which the hospital is located provides sup5 port (either direct or in kind); and there 

6 are letters of support from key State pay7 ers such as Medicaid and private insur8 ance; and 

9 ‘‘(ii) the applicant describes in detail 

10 how the transition of the health care pro11 vider or providers will better meet local 

12 needs and be sustainable. 

13 ‘‘(D) ELIGIBLE RURAL HEALTH CARE PRO14 VIDER DEFINED.—For purposes of this para15 graph, the term ‘eligible rural health care pro16 vider’ includes a critical access hospital, a cer17 tified rural health clinic, a rural nursing home, 

18 skilled nursing facility, emergency care pro19 vider, or other entity identified by the Sec20 retary. An eligible rural health care provider 

21 may include other entities applying on behalf of 

22 a group of rural health care providers such as 

23 a State Office of Rural Health, a State or local 


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1 health care authority, a rural health network, 

2 or other entity identified by the Secretary.’’. 

Æ 


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