Makes multiple changes to Medicare to strengthen payments and support for rural hospitals and other rural health providers. It limits or delays payment cuts, extends or makes permanent higher payment rules for low‑volume hospitals, telehealth, and ambulance services, adds a wage‑index floor for many hospitals, revises some Critical Access Hospital (CAH) payment and inpatient coverage rules, and creates a 5‑year Rural Health Transformation Grants program and updates the FLEX grant program to help rural providers adopt new care models.

Sets a mix of effective dates (including October 1, 2025; January 1, 2026; and roughly 60 days after enactment for some changes), directs the HHS Secretary to issue implementing regulations, and establishes application, eligibility, and distribution rules for new and expanded grants and technical assistance.