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HR 6804

Rural Hospital Flexibility Act of 2025

119th Congress Introduced by Sanford Bishop and 3 co-sponsors

Expands Rural Hospital Flexibility grants to fund quality, transformation, telehealth, and behavioral health integration, plus new 5-year Rural Health Transformation Grants.

Introduced in House
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Bill Summary · HR 6804

Summary of HR 6804 (119th Congress) – Rural Hospital Flexibility Act of 2025

Purpose and Intent

  • The bill, introduced December 17, 2025, seeks to amend title XVIII of the Social Security Act to strengthen and expand Medicare rural hospital flexibility program grants.
  • Its overarching aim is to support rural health infrastructure and care delivery by enhancing quality improvement efforts, data use, and innovative rural health models.

Key Provisions and Changes

  1. Expanded Use of Medicare Rural Hospital Flexibility Grants (Section 1820(g))

    • Updates to paragraphs governing grants to rural hospitals, certified rural health clinics, and rural emergency hospitals (as defined in 1861(kkk)(2)).
    • Emphasizes grant support for:
      • Quality improvement and quality reporting
      • Performance improvements and benchmarking
      • Population health initiatives
      • Transformation of services
      • Linkages and services for behavioral health and substance use disorders, including responses to public health emergencies

  2. New Authority to Support Other Grants (Paragraph (3))

    • Allows the Secretary to award grants or cooperative agreements to entities already receiving grants, to help them carry out activities related to those other grants.
    • Provides for technical assistance, data analysis, and evaluation.

  3. State Office of Rural Health and Grant Administration (Paragraphs Amended)

    • Revisions to grant administration to state-level offices, replacing terms that previously referenced “hospitals” with “State Offices of Rural Health.”
    • Grants to State Offices of Rural Health would be proportionate to the number of eligible small rural hospitals in a state relative to all states receiving grants.

  4. Use of Funds by State Offices of Rural Health (Subparagraph E)

    • Permits use of grant funds for:
      • Purchasing computer software and hardware for eligible small rural hospitals
      • Education and training of hospital staff in billing, operations, quality improvement, and value-focused efforts
      • Other delivery-system reform activities as determined appropriate by the Secretary

  5. Transformation and Funding Allocation (Paragraph (9) – Rural Health Transformation Grants)

    • Establishes a new 5-year grant mechanism to support transition to new rural health care models, including:
      • Rural emergency hospitals
      • Extended stay clinics, freestanding emergency departments
      • Rural health clinics
      • Integration of behavioral and oral health services
      • Telehealth and other transformational care delivery models
    • Eligibility and Application:
      • Eligible rural health care providers include CAHs, CRCSs, rural nursing facilities, emergency providers, and other entities the Secretary designates
      • Applicants must obtain local support (direct or in-kind) and letters from key payers (e.g., Medicaid, private insurers)
      • Applicants must detail how transformation will meet local needs and be sustainable

  6. Definition of Eligible Rural Health Care Providers (Transformation Grants)

    • Broadly includes CAHs, CRCSs, rural nursing facilities, skilled nursing facilities, emergency care providers, and other entities identified by the Secretary
    • Allows groups (e.g., State Offices of Rural Health, rural health networks) to apply on behalf of multiple providers

  7. Rural Emergency Hospital Technical Assistance (Paragraph (10))

    • Provides for grants or cooperative agreements to assist entities in becoming or maintaining designation as rural emergency hospitals
    • Requires an application process for such grants

Who Is Affected

  • Primary: Small rural hospitals, certified rural health clinics, rural emergency hospitals, and other rural health care facilities.
  • State-level entities: State Offices of Rural Health and related state health authorities, which would administer grants and coordinate activities.
  • Rural health providers and networks seeking to transition to new care models (e.g., telehealth, integrated behavioral health).

Procedural and Timeline Aspects

  • Introduced in December 2025; referred to the House Committee on Ways and Means.
  • The bill outlines grant cycles, application requirements, and timelines for support, including 5-year transformation grants and ongoing rural health emergency hospital assistance.
  • Specific implementation dates are not provided in the text provided; the act would become law if enacted and signed, with subsequent rulemaking and guidance from the Secretary of Health and Human Services to operationalize grants.

Bottom Line

HR 6804 expands and strengthens federal support for rural health care delivery by broadening the use of Rural Hospital Flexibility grants, enabling shared and technical assistance, and creating long-term Rural Health Transformation Grants to modernize rural health infrastructure and care delivery, including behavioral health integration, telehealth, and new rural hospital models.

Compiled from official sources — confirm details with the bill’s official record.

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