SB.30 Prioritizing Rural Healthcare and Education Act

[Brink]

119th CONGRESS
1st Session
S. 30

IN THE SENATE
Q3, 2025
Ms. O'Hare (for herself and others with thanks to Ms. Underwood, Mr. Warner, and Ms. Rosen introduced the following bill; 

A BILL

To prioritize rural hospitals, expand telehealth, distance learning, and other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. Short title.

This Act may be cited as the “Prioritizing Rural Healthcare and Education Act”.

SEC. 2. Prioritization under the Community Facilities Loan and Grant Program.

(a) In general.—In selecting recipients of direct loans or grants for the development of essential community facilities under section 306(a) of the Consolidated Farm and Rural Development Act (7 U.S.C. 1926(a)) for fiscal years 2026 through 2032, the Secretary of Agriculture shall give priority to entities eligible for those direct loans or grants to develop facilities to provide healthcare or mental or behavioral healthcare.

(b) Use of funds.—An eligible entity described in subsection (a) that receives a direct loan or grant described in subsection (a) may use the direct loan or grant funds for medical supplies, increasing telehealth capabilities, supporting staffing needs, or renovating and remodeling closed facilities.

(c) Reservation of funds.—Of the amounts made available for guaranteed loans under section 310B(g) of the Consolidated Farm and Rural Development Act for each of fiscal years 2026 through 2032, 10 percent shall be reserved to carry out this section.

SEC 3. 

Ensuring fairness in medicare hospital payments.

(a) Hospital inpatient services.—

(1) IN GENERAL.—Section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) is amended—

(A) in clause (i), in the first sentence, by striking “or (iv)” and inserting “, (iv), or (v)”; and

(B) by adding at the end the following new clause:

“(v) AREA WAGE INDEX FLOOR.—

“(I) IN GENERAL.—For discharges occurring on or after October 1, 2026, the area wage index applicable under this subparagraph to any hospital which is not located in a frontier State (as defined in clause (iii)(II)) may not be less than 0.85.

“(II) WAIVING BUDGET NEUTRALITY.—Pursuant to the fifth sentence of clause (i), this clause shall not be applied in a budget neutral manner.”.

(2) WAIVING BUDGET NEUTRALITY.—

(A) TECHNICAL AMENDATORY CORRECTION.—Section 10324(a)(2) of Public Law 111–148 is amended by striking “third sentence” and inserting “fifth sentence”.

(B) WAIVER.—Section 1886(d)(3)(E)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)(i)) is amended, in the fifth sentence—

(i) by striking “and the amendments” and inserting “, the amendments”; and

(ii) by inserting “, and the amendments made by section 2(a)(1) of the Save Rural Hospitals Act of 2026” after “Act of 2021”.

(b) Hospital outpatient department services.—Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), is amended—

(1) in paragraph (2)(D), by striking “(19), the Secretary” and inserting “(19) and paragraph (23), the Secretary”; and

(2) by adding at the end the following new paragraph:

“(23) FLOOR ON AREA WAGE ADJUSTMENT FACTOR FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES.—With respect to covered OPD services furnished on or after January 1, 2024, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is not located in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) may not be less than 0.85. The preceding sentence shall not be implemented in a budget neutral manner.”.

SEC 4. Distance learning and telemedicine grant program.

(a) Use of grants for operating expenses.—Section 2333 of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa–2) is amended—

(1) in subsection (a), by inserting “and operation” after “construction”;

(2) in subsection (c)—

(A) in paragraph (1)(B), by adding “and” at the end; and

(B) in paragraph (2)(A), by striking “or extend” each place it appears and inserting “extend, or operate”;

(3) in subsection (f)—

(A) in paragraph (3), by striking “or” at the end;

(B) by redesignating paragraph (4) as paragraph (5); and

(C) by inserting after paragraph (3) the following:

“(4) operation of the programming, equipment, or facilities referred to in paragraphs (1) and (2); or”; and

(4) by striking subsection (g) and inserting the following:

“(g) Operating expenses.—Not more than 15 percent of the amount of financial assistance provided to a recipient under this chapter may be used for recurring or operating expenses, including salaries or administrative expenses, that are reasonable and allocable to the project carried out by the recipient.”.

(b) Waiver of matching requirement.—Section 2334 of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa–3) is amended by adding at the end the following:

“(g) Waiver of matching requirement.—The Secretary shall waive any requirement for a recipient of financial assistance under this chapter to provide non-Federal matching funds—

“(1) in a case of demonstrated need or if the matching requirement would create a substantial burden, as determined by the Secretary; or

“(2) if the recipient is a federally recognized Indian Tribe.”.

(c) Authorization of appropriations.—Section 2335A of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa–5) is amended by striking “2019 through 2023” and inserting “2025 through 2030”.

(d) Set-Aside for substance use disorder treatment and mental health services.—

(1) IN GENERAL.—

(A) SUBSTANCE USE DISORDER SET-ASIDE.—Subject to subparagraph (B), for each of fiscal years 2026 through 2030, the Secretary of Agriculture shall make available not less than 20 percent of amounts made available under section 2335A of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa–5) for financial assistance under chapter 1 of subtitle D of title XXIII of that Act (7 U.S.C. 950aaa et seq.) for telemedicine projects that provide substance use disorder treatment services or mental health services.

(B) EXCEPTION.—In the case of a fiscal year for which the Secretary of Agriculture determines that there are not sufficient qualified applicants to receive financial assistance for projects providing substance use disorder treatment services or mental health services to reach the 20-percent requirement under subparagraph (A), the Secretary of Agriculture may make available less than 20 percent of amounts made available under section 2335A of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa–5) for those services.

(2) CONFORMING AMENDMENTS.—Section 6101(a)(1)(A)(i) of the Agriculture Improvement Act of 2018 (Public Law 115–334; 132 Stat. 4726) is amended—

(A) by inserting “for each of fiscal years 2019 through 2023,” before “the Secretary”; and

(B) by striking “(7 U.S.C. 950aaa–2)” and inserting “(7 U.S.C. 950aaa–5)”.

PES:

Section 2: To prioritize healthcare facilities and mental or behavioral health facilities in the Community Facilities program for fiscal years 2026 through 2032 and allow loans and grants under the program to be used for medical supplies, increasing telehealth capabilities, supporting staffing needs, or renovating and remodeling closed facilities.

Section 3: This Section establishes an area wage adjustment floor for Medicare hospital payments in states that are not frontier states and excludes such adjustments from certain budget neutrality rules.

Section 4: This section reauthorizes through FY2030 and modifies the Distance Learning and Telemedicine Loan and Grant Program that is administered by the Department of Agriculture (USDA). The program supports telemedicine and distance learning services in rural areas through telecommunications, computer networks, and other advanced technology by students, teachers, medical professionals, and residents of rural areas. The section expands the scope of the program to specifically allow the use of program funds for operational expenses associated with telemedicine programs. It also allows the USDA to waive matching fund requirements in certain circumstances and requires USDA to set aside a specific amount of funding allotments for programs that focus on substance use disorder treatment or mental health services.

[Brink]

The Senate shall come to order to debate this legislation until cloture is invoked.

[DMH]

Madam President, 

I offer the following amendment to further strengthen this legislation for our rural seniors:

SEC. x. Prohibition on finalizing proposed staffing rule.

The Secretary of Health and Human Services may not implement, enforce, or otherwise give effect to the proposed rule entitled “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting” published by the Department of Health and Human Services on September 6, 2023 (88 Fed. Reg. 61352–61429), and may not promulgate any substantially similar rule.

SEC. x. Advisory panel on nursing home workforce.

(a) In general.—Not later than 60 days after the date of the enactment of this section, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish the Advisory Panel on the Nursing Home Workforce (in this section referred to as the “Panel”).

(b) Membership.—

(1) NUMBER AND APPOINTMENT.—The Panel shall be composed of 17 members representing various geographic areas, appointed by the Secretary as follows:

(A) 1 representative of the Secretary, who shall serve as the chair of the Panel.

(B) 2 registered nurses who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(C) 2 licensed professional nurses who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(D) 2 nurse aides who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(E) 2 physicians who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(F) 1 representative of the Centers for Medicare & Medicaid Services.

(G) 1 representative of the Health Resources and Services Administration.

(H) 2 individuals with professional expertise related to the nursing home workforce, one of whom shall have experience with respect to the nursing home workforce in rural and underserved areas.

(I) 1 licensed administrator or representative of a rural not-for-profit skilled nursing facility.

(J) 1 licensed administrator or representative of a rural for-profit skilled nursing facility.

(K) 2 representatives of State boards of nursing.

(2) TIMING OF APPOINTMENTS.—Each of the appointments under paragraph (1) shall be made not later than 60 days after the date of the enactment of this section.

(3) TERMS; VACANCIES.—Each member shall be appointed for a term not to exceed 2 years, and a vacancy in the Panel shall be filled in the manner in which the original appointment was made.

(4) QUORUM.—13 members of the Panel shall constitute a quorum.

(5) FEDERAL ADVISORY COMMITTEE ACT.—Chapter 10 of title 5, United States Code, shall apply to the Panel.

(c) Duties.—

(1) MEETINGS.—

(A) FREQUENCY.—The Panel shall meet not later than 180 days after the date on which the appointments described in subsection (b) are made, and not less frequently than twice per year thereafter.

(B) PUBLIC ACCESS.—The Panel shall make available on a public website of the Department of Health and Human Services—

(i) real-time virtual access to each meeting of the Panel; and

(ii) not later than 30 days after each such meeting, a recording and transcript of the meeting.

(2) REPORTS.—

(A) INITIAL REPORT.—Not later than 60 days after the initial meeting of the Panel under paragraph (1)(A), the Panel shall submit to the Secretary, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate, and shall publish on a public website of the Centers for Medicare & Medicaid Services, a report on the state of the nursing home workforce, which shall include—

(i) an assessment of the state of the nursing home workforce in rural and underserved areas, including an analysis of—

(I) workforce shortages; and

(II) with respect to individuals entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and individuals entitled to medical assistance under title XIX of such Act (42 U.S.C. 1396 et seq.), barriers to access to skilled nursing facilities and nursing facilities caused by such shortages;

(ii) an analysis of regulations, sub-regulatory guidance, and guidance to State survey agencies issued by the Secretary with respect to skilled nursing facilities and nursing facilities, and the effects of such regulations and guidance on the nursing home workforce;

(iii) recommendations for the Secretary to strengthen the nursing home workforce, including recommendations for decreasing regulatory burdens for skilled nursing facilities and nursing facilities and making financial investments in training for health professionals; and

(iv) other information as the Panel determines necessary.

(B) SUBSEQUENT REPORTS.—Not later than 1 year after submitting the initial report under subparagraph (A), and annually thereafter, the Panel shall submit and publish an updated report in the same manner as required under such subparagraph.

(d) Definitions.—In this section, the following definitions apply:

(1) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).

(2) NURSING HOME WORKFORCE.—The term “nursing home workforce” means the workforce of health professionals that provide direct resident care in skilled nursing facilities and nursing facilities.

(3) RURAL AREA.—The term “rural area” means any area outside a metropolitan statistical area.

(4) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).

(5) UNDERSERVED AREA.—The term “underserved area” means an area that is—

(A) a health professional shortage area, as such term is defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A)); or

(B) designated as a medically underserved area pursuant to section 330(b)(3)(A) of such Act.

I yield.

[Abrams]

Madam President,

I second the Amendments made by the Gentleman from Louisiana.

I yield.

[Brink]

1 hour ago, DMH said:

Madam President, 

I offer the following amendment to further strengthen this legislation for our rural seniors:

SEC. x. Prohibition on finalizing proposed staffing rule.

The Secretary of Health and Human Services may not implement, enforce, or otherwise give effect to the proposed rule entitled “Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting” published by the Department of Health and Human Services on September 6, 2023 (88 Fed. Reg. 61352–61429), and may not promulgate any substantially similar rule.

SEC. x. Advisory panel on nursing home workforce.

(a) In general.—Not later than 60 days after the date of the enactment of this section, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall establish the Advisory Panel on the Nursing Home Workforce (in this section referred to as the “Panel”).

(b) Membership.—

(1) NUMBER AND APPOINTMENT.—The Panel shall be composed of 17 members representing various geographic areas, appointed by the Secretary as follows:

(A) 1 representative of the Secretary, who shall serve as the chair of the Panel.

(B) 2 registered nurses who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(C) 2 licensed professional nurses who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(D) 2 nurse aides who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(E) 2 physicians who actively furnish services in a skilled nursing facility or nursing facility, one of whom shall represent a rural area.

(F) 1 representative of the Centers for Medicare & Medicaid Services.

(G) 1 representative of the Health Resources and Services Administration.

(H) 2 individuals with professional expertise related to the nursing home workforce, one of whom shall have experience with respect to the nursing home workforce in rural and underserved areas.

(I) 1 licensed administrator or representative of a rural not-for-profit skilled nursing facility.

(J) 1 licensed administrator or representative of a rural for-profit skilled nursing facility.

(K) 2 representatives of State boards of nursing.

(2) TIMING OF APPOINTMENTS.—Each of the appointments under paragraph (1) shall be made not later than 60 days after the date of the enactment of this section.

(3) TERMS; VACANCIES.—Each member shall be appointed for a term not to exceed 2 years, and a vacancy in the Panel shall be filled in the manner in which the original appointment was made.

(4) QUORUM.—13 members of the Panel shall constitute a quorum.

(5) FEDERAL ADVISORY COMMITTEE ACT.—Chapter 10 of title 5, United States Code, shall apply to the Panel.

(c) Duties.—

(1) MEETINGS.—

(A) FREQUENCY.—The Panel shall meet not later than 180 days after the date on which the appointments described in subsection (b) are made, and not less frequently than twice per year thereafter.

(B) PUBLIC ACCESS.—The Panel shall make available on a public website of the Department of Health and Human Services—

(i) real-time virtual access to each meeting of the Panel; and

(ii) not later than 30 days after each such meeting, a recording and transcript of the meeting.

(2) REPORTS.—

(A) INITIAL REPORT.—Not later than 60 days after the initial meeting of the Panel under paragraph (1)(A), the Panel shall submit to the Secretary, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate, and shall publish on a public website of the Centers for Medicare & Medicaid Services, a report on the state of the nursing home workforce, which shall include—

(i) an assessment of the state of the nursing home workforce in rural and underserved areas, including an analysis of—

(I) workforce shortages; and

(II) with respect to individuals entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and individuals entitled to medical assistance under title XIX of such Act (42 U.S.C. 1396 et seq.), barriers to access to skilled nursing facilities and nursing facilities caused by such shortages;

(ii) an analysis of regulations, sub-regulatory guidance, and guidance to State survey agencies issued by the Secretary with respect to skilled nursing facilities and nursing facilities, and the effects of such regulations and guidance on the nursing home workforce;

(iii) recommendations for the Secretary to strengthen the nursing home workforce, including recommendations for decreasing regulatory burdens for skilled nursing facilities and nursing facilities and making financial investments in training for health professionals; and

(iv) other information as the Panel determines necessary.

(B) SUBSEQUENT REPORTS.—Not later than 1 year after submitting the initial report under subparagraph (A), and annually thereafter, the Panel shall submit and publish an updated report in the same manner as required under such subparagraph.

(d) Definitions.—In this section, the following definitions apply:

(1) NURSING FACILITY.—The term “nursing facility” has the meaning given such term in section 1919(a) of the Social Security Act (42 U.S.C. 1396r(a)).

(2) NURSING HOME WORKFORCE.—The term “nursing home workforce” means the workforce of health professionals that provide direct resident care in skilled nursing facilities and nursing facilities.

(3) RURAL AREA.—The term “rural area” means any area outside a metropolitan statistical area.

(4) SKILLED NURSING FACILITY.—The term “skilled nursing facility” has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).

(5) UNDERSERVED AREA.—The term “underserved area” means an area that is—

(A) a health professional shortage area, as such term is defined in section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A)); or

(B) designated as a medically underserved area pursuant to section 330(b)(3)(A) of such Act.

I yield.

 

1 hour ago, Abrams said:

Madam President,

I second the Amendments made by the Gentleman from Louisiana.

I yield.

Amendment motion and second are recognized. Senators have 24 hours to vote on the motion.

 

 

[Blake]

Madam President,

I move for cloture. 

I yield. 

[Dogslife]

Madam President,

I second the cloture motion

i yield

[Blake]

Madam President, 

I move to pass the bill by UC. 

I yield

[Storm]

Madam President,

I second,

i yield