S. 4204 — Rural Health Innovation Act of 2026

This section establishes the Rural Health Center Innovation Awards program under the Public Health Service Act, administered by the Director of the Office of Rural Health Policy of the Health Resources and Services Administration. (As background, federally qualified health centers (FQHCs) and rural health clinics (RHCs) deliver primary and preventive care in medically underserved and rural areas and receive cost-based reimbursement under Medicare and Medicaid.) The program awards five-year grants to eligible entities—FQHCs, RHCs, or entities (including hospitals) agreeing to establish or convert to one—to operate or create an FQHC or RHC in a rural area as a walk-in urgent care center and triage/staging facility for air or ambulance transport to emergency departments. Required features include professional clinical staff (e.g., physicians, nurse practitioners) and resources (e.g., laboratories, x-ray machines, cardiac monitors). Grant funds may be used to (1) expand hours of operation, (2) pay for construction or renovation costs, or (3) support related activities. Applications must demonstrate startup costs if establishing a new center or clinic; the Secretary considers service overlap and prioritizes existing FQHCs or RHCs. Grant amounts are capped at $500,000 for the first year ($750,000 for new centers or clinics) and $500,000 for years two through five, with subsequent amounts adjusted based on prior-year patient volume and treatment types. Not later than three years after enactment, the Secretary must report to specified congressional committees (Senate HELP and Finance; House Energy and Commerce and Ways and Means) on program outcomes, including success, challenges, federal savings, access improvements, and rural service utilization. Grants do not affect FQHC or RHC status. The section authorizes $25 million annually for FY2027 through FY2031.

This section establishes the Rural Health Department Enhancement Program (new section 330R of the Public Health Service Act) under which the Secretary, acting through the Director of the Health Resources and Services Administration's Office of Rural Health Policy, awards competitive grants of up to $500,000 annually for five years to eligible local public health departments located in rural areas. Grants require applicants to demonstrate an existing rural facility, nursing staff, and medical equipment committed to the program; first-year amounts are based on estimated equipment and staffing costs, while amounts for years two through five are based on prior-year patients treated and treatment types; and funds must support emergency services, triage and transport to emergency departments, primary care, and similar services—including through equipment purchases (e.g., x-ray machines, cardiac monitors), hiring providers (e.g., nurse practitioners, physician assistants), limited partnerships with academic medical centers (not more than 3% of annual funds), and community outreach (not more than 3% in the first two years). The section authorizes $25 million annually for FY2027 through FY2031.