Rural Hospital Flexibility Act of 2025
Sponsored By: Representative Miller, Carol D. [R-WV-1]
Introduced
Summary
Boosts federal support for rural hospitals, clinics, and rural emergency hospitals. This bill would reshape the Medicare Rural Hospital Flexibility Program to fund quality improvement, workforce training, service transformation, and stronger links to behavioral health and substance use services.
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- State Offices of Rural Health would get retooled grants instead of direct hospital grants, with each State’s share based on its number of eligible small rural hospitals. Funds can buy IT, train staff on billing and quality, and back delivery system reforms.
- Rural providers could compete for five-year Rural Health Transformation Grants to shift into new care models like rural emergency hospitals, extended-stay clinics, freestanding emergency departments, and to add behavioral, oral health, and telehealth services. Applications must show local support and letters from major payers and a plan for sustainability.
- The bill authorizes grants and cooperative agreements for technical assistance, data analysis, and evaluation, including help for hospitals seeking rural emergency hospital designation and for entities that already receive related federal grants.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Five-year rural transformation grants
If enacted, the Secretary would be authorized to award five-year grants to State Offices of Rural Health and eligible rural providers to support transitions to new rural care models. Grants would fund moves to rural emergency hospitals, extended-stay clinics, freestanding emergency departments, rural health clinics, and the integration of behavioral and oral health and telehealth services. Eligible providers would need to apply with their State Office, show local direct or in-kind support, include letters from key State payers, and describe how the transition would meet local needs and be sustainable.
More grants to State rural health offices
If enacted, the Secretary would award grants to State Offices of Rural Health. Each State's share would be set by the ratio of eligible small rural hospitals in the State to the total across States receiving grants that year. State Offices would be allowed to buy computer software and hardware for eligible small rural hospitals, train staff on billing, operations, and quality improvement, and support other delivery system reform programs the Secretary finds appropriate. State Offices would need to apply to the Secretary in the form and time the Secretary specifies.
More support for rural health providers
If enacted, the program would explicitly include critical access hospitals, certified rural health clinics, and rural emergency hospitals. These providers would be eligible for help with quality improvement, quality reporting, benchmarking, population health work, transforming services, and links to behavioral health and substance use disorder services during public health emergencies. The change would take effect upon enactment.
Grants for technical help to rural hospitals
If enacted, the Secretary would be able to award grants or cooperative agreements to groups that already have program grants to provide technical assistance, data analysis, and evaluation. The Secretary would also be able to fund entities that provide technical help to hospitals seeking or holding rural emergency hospital designation. Eligible groups would need to apply to the Secretary in the form and time the Secretary specifies.
Sponsors & CoSponsors
Sponsor
Miller, Carol D. [R-WV-1]
WV • R
Cosponsors
Sewell
AL • D
Sponsored 12/17/2025
Bishop
GA • D
Sponsored 2/9/2026
Rep. Figures, Shomari [D-AL-2]
AL • D
Sponsored 4/16/2026
Roll Call Votes
No roll call votes available for this bill.
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