‘‘(F) supporting certified rural health clin-
ics for maintaining and building business oper-
ations, increasing financial indicators, address-
ing population health, transforming services, 
and providing linkages and services for behav-
ioral health and substance use disorders re-
sponding 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 
FLEX 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 
States and hospitals in carrying out the activities 
under this subsection by providing technical assist-
ance, data analysis, and evaluation efforts.’’; 
(4) in paragraph (4), as redesignated— 
(A) in subparagraph (A), by inserting 
‘‘State Offices of Rural Health on behalf of eli-
gible hospitals and’’ after ‘‘award grants to’’; 
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(B) by amending subparagraph (C) to read 
as follows: 
‘‘(C) APPLICATION.—The State Office of 
Rural Health shall submit an application, on 
behalf of eligible rural hospitals, to the Sec-
retary on or before such date and in such form 
and manner as the Secretary specifies.’’; 
(C) by amending subparagraph (D), to 
read as follows: 
‘‘(D) AMOUNT OF GRANT.—A grant to a 
hospital under this paragraph shall be deter-
mined on an equal national distribution so that 
each hospital receives the same amount of sup-
port related to the funds appropriated.’’; 
(D) by amending subparagraph (E), to 
read as follows: 
‘‘(E) USE
OF
FUNDS.—State Offices of 
Rural Health and eligible hospitals may use the 
funds received through a grant under this para-
graph for the purchase of computer software 
and hardware; the education and training of 
hospital staff on billing, operational, quality im-
provement and related value-focused efforts; 
and other delivery system reform programs de-
termined appropriate by the Secretary.’’; and 
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(5) by adding at the end the following new 
paragraph: 
‘‘(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, 
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 applicable rural 
health care provider, in partnership 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. 
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‘‘(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-
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 providers such as a State Office of 
Rural Health, a State or local health care au-
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thority, a rural health network, or other entity 
identified by the Secretary.’’. 
Æ 
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