II 

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. 

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 of the Social Security Act (42 U.S.C. 

9 1395i–4) is amended— 

10 (1) in subsection (g)— 


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1 (A) in paragraph (1)— 

2 (i) in subparagraph (C), by striking 

3 ‘‘and’’ at the end; 

4 (ii) by amending subparagraph (D) to 

5 read as follows: 

6 ‘‘(D) providing support for critical access 

7 hospitals, certified rural health clinics, and 

8 rural emergency hospitals (as defined in section 

9 1861(kkk)(2)) for quality improvement, quality 

10 reporting, performance improvements, 

11 benchmarking, addressing population health, 

12 transforming services, and providing linkages 

13 and services for behavioral health and sub14 stance use disorders responding to public health 

15 emergencies;’’; and 

16 (iii) by adding at the end the fol17 lowing new subparagraphs: 

18 ‘‘(E) providing support for critical access 

19 hospitals to convert to rural emergency hos20 pitals to stabilize hospital emergency services in 

21 their communities; and 

22 ‘‘(F) conducting outreach regarding the 

23 availability of payments for direct graduate 

24 medical education costs under section 1886(h), 

25 providing information regarding eligibility for 


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1 direct graduate medical education residency po2 sitions, and providing assistance with the appli3 cation process for the distribution of such posi4 tions to— 

5 ‘‘(i) critical access hospitals; 

6 ‘‘(ii) hospitals located in rural areas 

7 (as defined in section 1886(d)(2)(D)), ex8 cluding hospitals that are treated as being 

9 located in a rural area pursuant to section 

10 1886(d)(8)(E); 

11 ‘‘(iii) hospitals located in an area that 

12 has a rural-urban commuting code of no 

13 less than 4.0; 

14 ‘‘(iv) sole community hospitals (as de15 fined in section 1886(d)(5)(D)(iii)); 

16 ‘‘(v) sites that are located within 10 

17 miles of a sole community hospital (as de18 fined in section 1886(d)(5)(D)(iii)); and 

19 ‘‘(vi) rural emergency hospitals.’’; 

20 (B) by redesignating paragraphs (3) 

21 through (7) as paragraphs (4) through (8), re22 spectively; 

23 (C) after paragraph (2), by inserting the 

24 following 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 (D) in paragraph (4), as redesignated by 

11 subparagraph (B)— 

12 (i) in subparagraph (A)— 

13 (I) in the header by striking 

14 ‘‘HOSPITALS ’’ and inserting ‘‘STATE

15 OFFICES OF RURAL HEALTH’’; and 

16 (II) by inserting ‘‘State Offices 

17 of Rural Health on behalf of eligible 

18 small rural’’ after ‘‘award grants to’’; 

19 (ii) by amending subparagraph (B) to 

20 read as follows: 

21 ‘‘(B) ELIGIBLE SMALL RURAL HOSPITAL

22 DEFINED.—For purposes of this paragraph, the 

23 term ‘‘eligible small rural hospital’’ means— 

24 ‘‘(i) a non-Federal, short-term general 

25 acute hospital that— 


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1 ‘‘(I) is located in a rural area (as 

2 defined for purposes of section 

3 1886(d)); and 

4 ‘‘(II) has less than 50 beds; or 

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

6 defined in section 1861(kkk)(2)).’’; 

7 (iii) by amending subparagraph (C) to 

8 read as follows: 

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

10 Rural Health shall submit an application, on 

11 behalf of eligible small rural hospitals, to the 

12 Secretary on or before such date and in such 

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

14 (iv) by amending subparagraph (D) to 

15 read as follows: 

16 ‘‘(D) AMOUNT OF GRANT.—A grant under 

17 this paragraph shall be determined on an equal 

18 national distribution so that each eligible small 

19 rural hospital receives the same amount of sup20 port related to the funds appropriated.’’; 

21 (v) by amending subparagraph (E) to 

22 read as follows: 

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

24 Rural Health and eligible small rural hospitals 


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1 may use the funds received through a grant 

2 under this paragraph for— 

3 ‘‘(i) the purchase of computer soft4 ware and hardware; 

5 ‘‘(ii) the education and training of 

6 hospital staff on billing, operational, qual7 ity improvement, and related value-focused 

8 efforts; and 

9 ‘‘(iii) other delivery system reform 

10 programs determined appropriate by the 

11 Secretary.’’; and 

12 (vi) in subparagraph (F)— 

13 (I) in clause (i), by striking ‘‘A 

14 hospital receiving a grant under this 

15 section’’ and inserting ‘‘An entity re16 ceiving a grant under this para17 graph’’; and 

18 (II) in clause (ii), by striking 

19 ‘‘under this section’’ and inserting 

20 ‘‘under this paragraph’’ each place it 

21 appears; and 

22 (E) in paragraph (5), as redesignated by 

23 subparagraph (B), in the matter preceding sub24 paragraph (A), by striking ‘‘or (2)’’ and insert25 ing ‘‘, (2), or (4)’’; and 


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1 (2) in subsection (j)— 

2 (A) by striking ‘‘from the Federal Hospital 

3 Insurance Trust Fund’’; and 

4 (B) by striking ‘‘in each of fiscal years 

5 2011 and 2012’’ and inserting ‘‘in fiscal year 

6 2011 and each subsequent fiscal year’’. 

Æ 


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