II 118th CONGRESS 2d Session S. 5308 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. Short title This Act may be cited as the Rural Hospital Flexibility Act of 2024 . 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 .