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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5308 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 5308

  To amend title XVIII of the Social Security Act to reauthorize the 
              Rural Flex program, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           November 13, 2024

   Ms. Hassan (for herself, Mr. Barrasso, Ms. Cortez Masto, and Mrs. 
  Blackburn) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
  To amend title XVIII of the Social Security Act to reauthorize the 
              Rural Flex program, and for other purposes.

    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 
2024''.

SEC. 2. MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM GRANTS.

    Section 1820 of the Social Security Act (42 U.S.C. 1395i-4) is 
amended--
            (1) in subsection (g)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (C), by striking 
                        ``and'' at the end;
                            (ii) by amending subparagraph (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;''; and
                            (iii) by adding at the end the following 
                        new subparagraphs:
                    ``(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.'';
                    (B) by redesignating paragraphs (3) through (7) as 
                paragraphs (4) through (8), respectively;
                    (C) 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 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.'';
                    (D) in paragraph (4), as redesignated by 
                subparagraph (B)--
                            (i) in subparagraph (A)--
                                    (I) in the header by striking 
                                ``hospitals '' and inserting ``State 
                                offices of rural health''; and
                                    (II) by inserting ``State Offices 
                                of Rural Health on behalf of eligible 
                                small rural'' after ``award grants 
                                to'';
                            (ii) by amending subparagraph (B) to read 
                        as follows:
                    ``(B) Eligible small rural hospital defined.--For 
                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)).'';
                            (iii) by amending subparagraph (C) to read 
                        as follows:
                    ``(C) Application.--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.'';
                            (iv) by amending subparagraph (D) to read 
                        as follows:
                    ``(D) Amount of grant.--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.'';
                            (v) by amending subparagraph (E) to read as 
                        follows:
                    ``(E) Use of funds.--State 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
                            (vi) 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 
                                ``under this section'' and inserting 
                                ``under this paragraph'' each place it 
                                appears; and
                    (E) in paragraph (5), as redesignated by 
                subparagraph (B), in the matter preceding subparagraph 
                (A), by striking ``or (2)'' and inserting ``, (2), or 
                (4)''; and
            (2) in subsection (j)--
                    (A) by striking ``from the Federal Hospital 
                Insurance Trust Fund''; and
                    (B) by striking ``in each of fiscal years 2011 and 
                2012'' and inserting ``in fiscal year 2011 and each 
                subsequent fiscal year''.
                                 <all>
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