I 
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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Hospital Flexi-
bility Act of 2025’’. 
SEC. 2. MEDICARE RURAL HOSPITAL FLEXIBILITY PRO-
GRAM GRANTS. 
Section 1820(g) of the Social Security Act (42 U.S.C. 
1395i–4(g)) is amended— 
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(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 sub-
stance 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 fol-
lowing 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 sub-
section 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 applica-
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and for other delivery system reform programs 
determined appropriate by the Secretary.’’; and 
(F) in subparagraph (F)— 
(i) in clause (i), by striking ‘‘A hos-
pital 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 strik-
ing ‘‘paragraph (1) or (2)’’ and inserting ‘‘para-
graph (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 hos-
pitals, extended stay clinics, freestanding emer-
gency departments, rural health clinics, and in-
tegration of behavioral, oral health services, 
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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 be-
fore 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 pro-
vider unless— 
‘‘(i) local organizations or the State in 
which the hospital is located provides sup-
port (either direct or in kind); and there 
are letters of support from key State pay-
ers such as Medicaid and private insur-
ance; and 
‘‘(ii) the applicant describes in detail 
how the transition of the health care pro-
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vider or providers will better meet local 
needs and be sustainable. 
‘‘(D) ELIGIBLE RURAL HEALTH CARE PRO-
VIDER DEFINED.—For purposes of this para-
graph, the term ‘eligible rural health care pro-
vider’ includes a critical access hospital, a cer-
tified rural health clinic, a rural nursing home, 
skilled nursing facility, emergency care pro-
vider, or other entity identified by the Sec-
retary. 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
TECH-
NICAL ASSISTANCE.— 
‘‘(A) IN
GENERAL.—The Secretary may 
award grants or cooperative agreements to eligi-
ble 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 cur-
rently designated, as rural emergency hospitals 
(as described in section 1861(kkk)(2)). 
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‘‘(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 Sec-
retary.’’. 
Æ 
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