119th (2025–2027)
H.R. 3684
H.R. 3684, introduced June 3, 2025, aims to strengthen rural hospital finances and operations through increased Medicare and Medicaid reimbursements and greater operational flexibility. The bill eliminates Medicare budget cuts for rural hospitals, restores bad debt reimbursements to critical access hospitals, and permanently extends higher payment levels for low-volume and Medicare-dependent rural hospitals, while also adjusting wage-based payment formulas and enhancing payments for rural ambulance services and telehealth. Key operational changes include allowing states to waive the 35-mile distance rule for critical access hospital designations and eliminating the 96-hour length-of-stay requirement to help struggling rural facilities adapt. The bill also establishes two grant programs—new five-year Rural Health Transformation Grants and expanded FLEX grants through State Offices of Rural Health—to support rural providers in transitioning to new care models such as rural emergency hospitals, telehealth services, and integrated behavioral health care, with funds distributed equally among eligible rural hospitals and requiring local community and state payer support. This legislation directly affects rural healthcare providers and communities across the country that depend on these hospitals for essential medical services.