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. 
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 2024’’. 
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— 
(1) in paragraph (1)— 
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(A) in subparagraph (C), by striking 
‘‘and’’ at the end; 
(B) 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 sub-
stance use disorders responding to public health 
emergencies; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) providing support for critical access 
hospitals to convert to rural emergency hos-
pitals to stabilize hospital emergency services in 
their communities.’’; 
(2) by redesignating paragraphs (3) through 
(7) as paragraphs (4) through (8), respectively; 
(3) after paragraph (2), by inserting the fol-
lowing new paragraph: 
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‘‘(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.’’; 
(4) in paragraph (4), as redesignated— 
(A) in subparagraph (A)— 
(i) in the header, by striking ‘‘HOS-
PITALS’’ and inserting ‘‘STATE OFFICES OF 
RURAL HEALTH’’; and 
(ii) by striking ‘‘grants to hospitals’’ 
and inserting ‘‘grants to State Offices of 
Rural Health’’; 
(B) in subparagraph (B)— 
(i) by redesignating clauses (i) and 
(ii) as subclauses (I) and (II), respectively; 
(ii) by striking ‘‘means a non-Fed-
eral’’ 
and 
inserting 
the 
following: 
‘‘means— 
‘‘(i) a non-Federal’’; and 
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(iii) by striking the period at the end 
and inserting the following: ‘‘; or 
‘‘(ii) a rural emergency hospital (as 
defined in section 1861(kkk)).’’; 
(C) by amending subparagraph (C) to read 
as follows: 
‘‘(C) APPLICATION.—The State Office of 
Rural Health shall submit an application to the 
Secretary on or before such date and in such 
form and manner as the Secretary specifies.’’; 
(D) by amending subparagraph (D), to 
read as follows: 
‘‘(D) AMOUNT OF GRANT.—With respect 
to funds made available to make grants under 
this paragraph in a fiscal year, the amount 
awarded to a State Office of Rural Health shall 
bear the same ratio to the total amount of such 
funds so made available as the number of eligi-
ble small rural hospitals such Office proposes to 
assist with such grant bears to the total num-
ber of eligible small rural hospitals all such Of-
fices receiving a grant under this paragraph for 
such fiscal year propose to assist with such 
grants.’’; 
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(E) by amending subparagraph (E), to 
read as follows: 
‘‘(E) USE
OF
FUNDS.—State Offices of 
Rural Health may use the funds received 
through a grant under this paragraph for the 
purchase of computer software and hardware on 
behalf of eligible small rural hospitals, for the 
education and training of eligible small rural 
hospital staff on billing, operational, quality im-
provement, and related value-focused efforts, 
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 
paragraph: 
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‘‘(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 
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 
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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 rural health care providers such as 
a State Office of Rural Health, a State or local 
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