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119-hr-6804119th CongressWALLET

Rural Hospital Flexibility Act of 2025

Sponsored By: Representative Miller, Carol D. [R-WV-1]

Introduced

Summary

Expand and modernize federal grants to help rural providers transform care and shore up services like behavioral health and emergency access. This bill would restructure the Medicare Rural Hospital Flexibility Program to fund State Offices of Rural Health, provide multi-year transformation grants, and offer technical help for rural emergency hospital conversion.

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  • Families and patients: Would support local expansions of behavioral health, substance use disorder services, population health work, and improved quality reporting. These changes aim to keep more care available in rural communities.
  • Rural providers: Would create 5-year rural health transformation grants for critical access hospitals, rural health clinics, rural emergency hospitals, freestanding emergency departments, and related providers to try new care models and show sustainability. Grants can fund software, hardware, training, and delivery system reforms.
  • State Offices of Rural Health and technical assistance: Would shift many grants to State Offices of Rural Health and allow those offices and other entities to get funds proportional to their State’s share of eligible small rural hospitals. The bill also authorizes grants or cooperative agreements to give technical assistance and data analysis to hospitals seeking rural emergency hospital designation.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Five-year transformation grants for rural providers

If enacted, the Secretary would be able to award five-year transformation grants to State Offices of Rural Health and eligible rural providers. The grants would help providers move to new care models like rural emergency hospitals, extended stay clinics, freestanding emergency departments, rural health clinics, telehealth, and integrated behavioral or oral health services. Applicants would need to consult their State Office, show local or State support, include letters from Medicaid and private payers, and explain how the change will be sustainable.

State grants to improve rural hospitals

If enacted, State Offices of Rural Health would be able to apply for grants to help eligible small rural hospitals. Each State's award would be sized so it is proportional to that State's share of eligible small rural hospitals among States getting grants that year. Funds could buy computer software and hardware for eligible small rural hospitals and pay for staff training on billing, operations, and quality improvement. These grants could be combined with other program grants the Secretary allows.

Technical assistance for rural providers

If enacted, the Secretary would be able to award grants or cooperative agreements to entities that already have awards under this subsection so they can get technical help, data analysis, and evaluation. The Secretary could also award grants to entities that help hospitals seek or operate as rural emergency hospitals. Applicants would apply to the Secretary in the time and form the Secretary specifies.

Sponsors & CoSponsors

Sponsor

Miller, Carol D. [R-WV-1]

WV • R

Cosponsors

  • Rep. Sewell, Terri A. [D-AL-7]

    AL • D

    Sponsored 12/17/2025

  • Rep. Bishop, Sanford D. [D-GA-2]

    GA • D

    Sponsored 2/9/2026

  • Rep. Figures, Shomari [D-AL-2]

    AL • D

    Sponsored 4/16/2026

  • Rep. Thompson, Glenn [R-PA-15]

    PA • R

    Sponsored 9/10/2026

Roll Call Votes

No roll call votes available for this bill.

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