Summary

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.

Key Points

• Protects and boosts Medicare payments for rural hospitals by limiting or delaying payment cuts.
• Makes permanent or extends higher payment rules for low‑volume hospitals, telehealth, and ambulance services.
• Creates a wage‑index floor to reduce disparities in hospital Medicare payments by area.
• Revises CAH copayment and inpatient/extended care coverage rules to broaden or clarify benefit coverage.
• Creates a 5‑year Rural Health Transformation Grants program to fund care model changes and technical assistance.
• Updates the FLEX program to add grant purposes, clarify award rules, and authorize evaluation and technical assistance.
• Sets multiple effective dates (including Oct 1, 2025; Jan 1, 2026; and ~60 days after enactment) and requires HHS rulemaking to implement provisions.
• Gives States additional authority to help hospitals convert to Critical Access Hospital status.

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