,i #aaith ,,congress #ast ,session ,h4 ,r4 #fhjd ,,in ,,the ,,house ,,of ,,representatives ,december #ag1 #bjbe,mrs4 ,miller of ,west ,virginia 7for herself and ,ms4 ,sewell7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to strengthen ,medicare rural hospital flexibility program grants4 #a4 ,short title ,this ,act may be cited as the ,rural ,hospital ,flexibility ,act of #bjbe4 #b4 ,medicare rural hospital flexibility program grants ,section #ahbj7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;g77 is amended-- 7#a7 by amending paragraph 7#a77;,d7 to read as follows3 7,d7 providing support for critical access hospitals1 certified rural health clinics1 and rural emergency hospitals 7as defined in section #ahfa7kkk77#b77 for quality improvement1 quality reporting1 performance improvements1 benchmarking1 addressing population health1 transforming services1 and providing linkages and services for behavioral health and substance use disorders responding to public health emergencies4 2 7#b7 by redesignating paragraphs 7#c7 through 7#g7 as paragraphs 7#d7 through 7#h71 respectively2 7#c7 after paragraph 7#b71 by inserting the following new paragraph3 7#c7 ,activities to support carrying out other grants ,the ,secretary may award grants or cooperative agreements to entities awarded grants or agreements under other provisions of this subsection for purposes of supporting such entities in carrying out activities under such other grants or agreements by providing technical assistance1 data analysis1 and evaluation efforts4 ,an entity seeking a grant under this paragraph shall submit an application to the ,secretary at such time and in such manner as specified by the ,secretary4 2 7#d7 in paragraph 7#d71 as redesignated-- 7,a7 in subparagraph 7,a7-- 7i7 in the header1 by striking hospitals and inserting ,state ,offices of ,rural ,health2 and 7ii7 by striking grants to hospitals and inserting grants to ,state ,offices of ,rural ,health2 7,b7 in subparagraph 7,b7-- 7i7 by redesignating clauses 7i7 and 7ii7 as subclauses 7,i7 and 7,,ii71 respectively2 7ii7 by striking means a non-,federal and inserting the following3 means-- 7i7 a non-,federal 2 and 7iii7 by striking the period at the end and inserting the following3 2 or 7ii7 a rural emergency hospital 7as defined in section #ahfa7kkk774 2 7,c7 by amending subparagraph 7,c7 to read as follows3 7,c7 ,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 specifies4 2 7,d7 by amending subparagraph 7,d7 to read as follows3 7,d7 ,amount of grant ,with respect to funds made available to make grants under this paragraph in a fiscal year1 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 eligible small rural hospitals in such ,state bears to the total number of eligible small rural hospitals in all ,states receiving a grant under this paragraph for such fiscal year propose4 2 7,e7 by amending subparagraph 7,e7 to read as follows3 7,e7 ,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 hospitals1 for the education and training of eligible small rural hospital staff on billing1 operational1 quality improvement1 and related value-focused efforts1 and for other delivery system reform programs determined appropriate by the ,secretary4 2 and 7,f7 in subparagraph 7,f7-- 7i7 in clause 7i71 by striking ,a hospital receiving a grant under this section and inserting ,an entity receiving a grant under this paragraph2 and 7ii7 in clause 7ii71 by striking section each place such term appears and inserting paragraph in each such place2 7#e7 in paragraph 7#e71 as redesignated1 by striking paragraph 7#a7 or 7#b7 and inserting paragraph 7#a71 7#b71 or 7#d72 and 7#f7 by adding at the end the following new paragraphs3 7#i7 ,rural ,health ,transformation ,grants 7,a7 ,grants ,the ,secretary may award #e-year grants to ,state ,offices of ,rural ,health and to eligible rural health care providers 7as defined in subparagraph 7,d77 on the transition to new models1 including rural emergency hospitals1 extended stay clinics1 freestanding emergency departments1 rural health clinics1 and integration of behavioral1 oral health services1 telehealth and other transformational models relevant to rural providers as such providers evolve to better meet community needs and the changing health care environment4 7,b7 ,application ,an eligible rural health care provider1 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 located1 shall submit an application to the ,secretary on or before such date and in such form and manner as the ,secretary specifies4 7,c7 ,additional requirements ,the ,secretary may not award a grant under this paragraph to an eligible rural health care provider unless-- 7i7 local organizations or the ,state in which the hospital is located provides support 7either direct or in kind72 and there are letters of support from key ,state payers such as ,medicaid and private insurance2 and 7ii7 the applicant describes in detail how the transition of the health care provider or providers will better meet local needs and be sustainable4 7,d7 ,eligible rural health care provider defined ,for purposes of this paragraph1 the term eligible rural health care provider includes a critical access hospital1 a certified rural health clinic1 a rural nursing home1 skilled nursing facility1 emergency care provider1 or other entity identified by the ,secretary4 ,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 ,health1 a ,state or local health care authority1 a rural health network1 or other entity identified by the ,secretary4 7#aj7 ,rural emergency hospital technical assistance 7,a7 ,in general ,the ,secretary may award grants or cooperative agreements to eligible entities 7as determined by the ,secretary7 for the purpose of providing technical assistance1 data analysis1 and other support to hospitals that are seeking to be designated1 or are currently designated1 as rural emergency hospitals 7as described in section #ahfa7kkk77#b774 7,b7 ,application ,an entity seeking a grant under subparagraph 7,a7 shall submit an application to the ,secretary at such time and in such form and manner as specified by the ,secretary4 4