Application

(A) In general To be eligible for an allotment under this subsection, a State shall submit to the Administrator during an application submission period to be specified by the Administrator (but that ends not later than December 31, 2025 ) an application in such form and manner as the Administrator may specify, that includes— (i) a detailed rural health transformation plan— (I) to improve access to hospitals, other health care providers, and health care items and services furnished to rural residents of the State; (II) to improve health care outcomes of rural residents of the State; (III) to prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management; (IV) to initiate, foster, and strengthen local and regional strategic partnerships between rural hospitals and other health care providers in order to promote measurable quality improvement, increase financial stability, maximize economies of scale, and share best practices in care delivery; (V) to enhance economic opportunity for, and the supply of, health care clinicians through enhanced recruitment and training; (VI) to prioritize data and technology driven solutions that help rural hospitals and other rural health care providers furnish high-quality health care services as close to a patient’s home as is possible; (VII) that outlines strategies to manage long-term financial solvency and operating models of rural hospitals in the State; and (VIII) that identifies specific causes driving the accelerating rate of stand-alone rural hospitals becoming at risk of closure, conversion, or service reduction; (ii) a certification that none of the amounts provided under this subsection shall be used by the State for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law, including under the State plan established under this subchapter, the State plan established under subchapter XIX, or under a waiver of such plans; and (iii) such other information as the Administrator may require.

(B) Deadline for approval Not later than December 31, 2025 , the Administrator shall approve or deny all applications submitted for an allotment under this subsection.

(C) One-time application If an application of a State for an allotment under this subsection is approved by the Administrator, the State shall be eligible for an allotment under this subsection for each of fiscal years 2026 through 2030, except as provided in paragraph (1)(B)(iv).

(D) Eligibility Only the 50 States shall be eligible for an allotment under this subsection and all references in this subsection to a State shall be treated as only referring to the 50 States.