,,ii  #aai? ,,congress  #a/ ,session    
,s4 #cbej  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #bj1 #bjbe,ms4
 ,hassan 7= h]self1 ,mr4 ,b>rasso1 ,ms4 
,cortez ,ma/o1 & ,mrs4 ,blackburn7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
reau?orize ! ,rural ,flex program1 & =  
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,rural ,hospital       
,flexibility ,act ( #bjbe4  #b4 ,m$ic>e 
rural hospital flexibility program      
grants ,section #ahbj ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7 is am5d$-- 7#a7 9 subsection
 7g7-- 7,a7 9 p>agraph 7#a7-- 7i7 9     
subp>agraph 7,c71 by /rik+ & at ! end2  
7ii7 by am5d+ subp>agraph 7,d7 to read z
 foll[s3  7,d7 provid+ support =        
critical access hospitals1 rural heal?  
cl9ics1 & rural em]g5cy hospitals 7z    
def9$ 9 section #ahfa7kkk77#b77 =       
quality improvem5t1 quality report+1    

p]=mance improvem5ts1 b5*m>k+1 address+ 
population heal?1 trans=m+ s]vices1 &   
provid+ l9kages & s]vices = behavioral  
heal? & sub/ance use disord]s respond+  
to public heal? em]g5cies2  2 &  7iii7  
by add+ at ! end ! foll[+ new           
subp>agraphs3  7,e7 provid+ support =   
critical access hospitals to conv]t to  
rural em]g5cy hospitals to /abilize     
hospital em]g5cy s]vices 9 _!           
communities2 &  7,f7 conduct+ outrea*   
reg>d+ ! availability ( paym5ts = direct
 graduate m$ical education co/s "u      
section #ahhf7;h71 provid+ in=mation    
reg>d+ eligibility = direct graduate    
m$ical education resid5cy positions1 &  
provid+ assi/ance ) ! application       
process = ! di/ribution ( su* positions 
to-- 7i7 critical access hospitals2     
7ii7 hospitals locat$ 9 rural areas 7z  
def9$ 9 section #ahhf7;d77#b77;,d771    
exclud+ hospitals t are treat$ z be+    
locat$ 9 a rural area pursuant to       
section #ahhf7;d77#h77;,e72  7iii7      
hospitals locat$ 9 an area t has a      

rural-urban commut+ code ( no less ?an  
#d4j2  7iv7 sole community hospitals 7z 
def9$ 9 section                         
#ahhf7;d77#e77;,d77iii772  7v7 sites t  
are locat$ )9 #aj miles ( a sole        
community hospital 7z def9$ 9 section   
#ahhf7;d77#e77;,d77iii772 &  7vi7 rural 
em]g5cy hospitals4  2  7,b7 by          
r$esignat+ p>agraphs 7#c7 ?r\gh 7#g7 z  
p>agraphs 7#d7 ?r\gh 7#h71 respectively2
  7,c7 aft] p>agraph 7#b71 by ins]t+ !  
foll[+ new p>agraph3  7#c7 ,activities  
to support c>ry+ out o!r grants ,!      
,secret>y may aw>d grants or coop]ative 
agreem5ts to entities t submit to !     
,secret>y applications1 at su* "t & 9   
su* =m & mann] & conta9+ su* in=mation z
 ! ,secret>y specifies1 = purposes (    
support+ recipi5ts 9 c>ry+ out !        
activities "u ?is subsection by provid+ 
te*nical assi/ance1 data analysis1 &    
evaluation ef=ts4  2  7,d7 9 p>agraph   
7#d71 z r$esignat$ by subp>agraph 7,b7--
 7i7 9 subp>agraph 7,a7-- 7,i7 9 ! head]
 by /rik+ hospitals & ins]t+ ,/ate      

,(fices ( ,rural ,heal?2 &  7,,ii7 by   
ins]t+ ,/ate ,(fices ( ,rural ,heal? on 
behalf ( eligible small rural aft] aw>d 
grants to2  7ii7 by am5d+ subp>agraph   
7,b7 to read z foll[s3  7,b7 ,eligible  
small rural hospital def9$ ,= purposes (
 ?is p>agraph1 ! t]m #8#8eligible small 
rural hospital'' means-- 7i7 a          
non-,f$]al1 %ort-t]m g5]al acute        
hospital t-- 7,i7 is locat$ 9 a rural   
area 7z def9$ = purposes ( section      
#ahhf7;d772 &  7,,ii7 has less ?an #ej  
b$s2 or  7ii7 a rural em]g5cy hospital  
7z def9$ 9 section #ahfa7kkk77#b774  2  
7iii7 by am5d+ subp>agraph 7,c7 to read 
z foll[s3  7,c7 ,application ,! ,/ate   
,(fice ( ,rural ,heal? %all submit an   
application1 on behalf ( eligible small 
rural hospitals1 to ! ,secret>y on or   
be=e su* date & 9 su* =m & mann] z !    
,secret>y specifies4  2  7iv7 by am5d+  
subp>agraph 7,d7 to read z foll[s3  7,d7
 ,am\nt ( grant ,a grant "u ?is p>agraph
 %all be det]m9$ on an equal national   
di/ribution s t ea* eligible small rural

 hospital receives ! same am\nt (       
support relat$ to ! funds appropriat$4  
2  7v7 by am5d+ subp>agraph 7,e7 to read
 z foll[s3  7,e7 ,use ( funds ,/ate     
,(fices ( ,rural ,heal? & eligible small
 rural hospitals may use ! funds receiv$
 ?r\gh a grant "u ?is p>agraph =-- 7i7 !
 pur*ase ( comput] s(tw>e & h>dw>e2     
7ii7 ! education & tra9+ ( hospital /aff
 on bill+1 op]ational1 quality          
improvem5t1 & relat$ value-focus$ ef=ts2
 &  7iii7 o!r deliv]y sy/em re=m        
programs det]m9$ appropriate by !       
,secret>y4  2 &  7vi7 9 subp>agraph     
7,f7-- 7,i7 9 clause 7i71 by /rik+ ,a   
hospital receiv+ a grant "u ?is section 
& ins]t+ ,an entity receiv+ a grant "u  
?is p>agraph2 &  7,,ii7 9 clause 7ii71  
by /rik+ "u ?is section & ins]t+ "u ?is 
p>agraph ea* place x appe>s2 &  7,e7 9  
p>agraph 7#e71 z r$esignat$ by          
subp>agraph 7,b71 9 ! matt] prec$+      
subp>agraph 7,a71 by /rik+ or 7#b7 &    
ins]t+ 1 7#b71 or 7#d72 &  7#b7 9       
subsection 7j7-- 7,a7 by /rik+ f !      

,f$]al ,hospital ,insurance ,tru/ ,fund2
 &  7,b7 by /rik+ 9 ea* ( fiscal ye>s   
#bjaa & #bjab & ins]t+ 9 fiscal ye>     
#bjaa & ea* subsequ5t fiscal ye>4