,,ii  #aaith ,,congress  #ast ,session  
,s4 #cbej  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #bj1 
#bjbe,ms4 ,hassan 7for herself1 ,mr4    
,barrasso1 ,ms4 ,cortez ,masto1 and     
,mrs4 ,blackburn7 introduced the        
following bill2 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 program1   
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,rural ,hospital ,flexibility ,act of   
#bjbe4  #b4 ,medicare rural hospital    
flexibility program grants ,section     
#ahbj of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acie;i-#d7 is amended-- 7#a7
 in subsection 7g7-- 7,a7 in paragraph  
7#a7-- 7i7 in subparagraph 7,c71 by     
striking and at the end2  7ii7 by       
amending subparagraph 7,d7 to read as   
follows3  7,d7 providing support for    
critical access hospitals1 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   
emergencies2  2 and  7iii7 by adding at 
the end the following new subparagraphs3
  7,e7 providing support for critical   
access hospitals to convert to rural    
emergency hospitals to stabilize        
hospital emergency services in their    
communities2 and  7,f7 conducting       
outreach regarding the availability of  
payments for direct graduate medical    
education costs under section #ahhf7;h71
 providing information regarding        
eligibility for direct graduate medical 
education residency positions1 and      
providing assistance with the           
application process for the distribution
 of such positions to-- 7i7 critical    
access hospitals2  7ii7 hospitals       

located in rural areas 7as defined in   
section #ahhf7;d77#b77;,d771 excluding  
hospitals that are treated as being     
located in a rural area pursuant to     
section #ahhf7;d77#h77;,e72  7iii7      
hospitals located in an area that has a 
rural-urban commuting code of no less   
than #d4j2  7iv7 sole community         
hospitals 7as defined in section        
#ahhf7;d77#e77;,d77iii772  7v7 sites    
that are located within #aj miles of a  
sole community hospital 7as defined in  
section #ahhf7;d77#e77;,d77iii772 and   
7vi7 rural emergency hospitals4  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 that submit to the ,secretary  
applications1 at such time and in such  
form and manner and containing such     

information as the ,secretary specifies1
 for purposes of supporting recipients  
in carrying out the activities under    
this subsection by providing technical  
assistance1 data analysis1 and          
evaluation efforts4  2  7,d7 in         
paragraph 7#d71 as redesignated by      
subparagraph 7,b7-- 7i7 in subparagraph 
7,a7-- 7,i7 in the header by striking   
hospitals and inserting ,state ,offices 
of ,rural ,health2 and  7,,ii7 by       
inserting ,state ,offices of ,rural     
,health on behalf of eligible small     
rural after award grants to2  7ii7 by   
amending subparagraph 7,b7 to read as   
follows3  7,b7 ,eligible small rural    
hospital defined ,for purposes of this  
paragraph1 the term #8#8eligible small  
rural hospital'' means-- 7i7 a          
non-,federal1 short-term general acute  
hospital that-- 7,i7 is located in a    
rural area 7as defined for purposes of  
section #ahhf7;d772 and  7,,ii7 has less
 than #ej beds2 or  7ii7 a rural        
emergency hospital 7as defined in       

section #ahfa7kkk77#b774  2  7iii7 by   
amending subparagraph 7,c7 to read as   
follows3  7,c7 ,application ,the ,state 
,office of ,rural ,health shall submit  
an application1 on behalf of eligible   
small rural hospitals1 to the ,secretary
 on or before such date and in such form
 and manner as the ,secretary specifies4
  2  7iv7 by amending subparagraph 7,d7 
to read as follows3  7,d7 ,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  
appropriated4  2  7v7 by amending       
subparagraph 7,e7 to read as follows3   
7,e7 ,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-- 7i7 the purchase of computer      
software and hardware2  7ii7 the        
education and training of hospital staff
 on billing1 operational1 quality       

improvement1 and related value-focused  
efforts2 and  7iii7 other delivery      
system reform programs determined       
appropriate by the ,secretary4  2 and   
7vi7 in subparagraph 7,f7-- 7,i7 in     
clause 7i71 by striking ,a hospital     
receiving a grant under this section and
 inserting ,an entity receiving a grant 
under this paragraph2 and  7,,ii7 in    
clause 7ii71 by striking under this     
section and inserting under this        
paragraph each place it appears2 and    
7,e7 in paragraph 7#e71 as redesignated 
by subparagraph 7,b71 in the matter     
preceding subparagraph 7,a71 by striking
 or 7#b7 and inserting 1 7#b71 or 7#d72 
and  7#b7 in subsection 7j7-- 7,a7 by   
striking from the ,federal ,hospital    
,insurance ,trust ,fund2 and  7,b7 by   
striking in each of fiscal years #bjaa  
and #bjab and inserting in fiscal year  
#bjaa and each subsequent fiscal year4