42 U.S.C. § 254r — Grants to State Offices of Rural Health

(a) In general: The Secretary, through the Director of the Federal Office of Rural Health Policy, must give a grant to each State Office of Rural Health to improve rural health care. (b) Requirement of matching funds: (1) Subject to paragraph (2), the Secretary can't make a grant unless the state office agrees to provide non-federal contributions equal to $3 for every $1 of federal grant money. (2) The Secretary may waive or reduce that match if requiring it would limit the office's ability to do its job. (3) These non-federal contributions can be cash or in-kind (like equipment or services), fairly valued — but money from the federal government, or services significantly subsidized by it, don't count. (c) Certain required activities: Grant recipients must use the money to (1) run a clearinghouse collecting and sharing information on rural health care issues, research findings, and innovative rural care approaches; (2) coordinate the state's rural health activities, including avoiding duplicated efforts; and (3) identify federal and state rural health programs and give technical help to public and nonprofit groups trying to participate in them. (d) Requirement regarding annual budget for office: The Secretary can't make a grant unless the state agrees the office will have an annual budget of at least $150,000 for any year it gets the grant. (e) Certain uses of funds: (1) The Secretary can't make a grant unless the state office agrees not to spend it (A) to provide health care directly, including cash payments for care; (B) on activities already covered by other federal funding — technical assistance under section 254c(f), a memorandum of agreement under section 254c(h), or a section 254q–1 grant; (C) to buy medical equipment, ambulances, aircraft, other vehicles, or major communications equipment; (D) to buy or improve real property; or (E) for certificate-of-need activities. (2) The office may spend the grant on (A) the costs of running the rural health office itself; (B) subject to the ban on section 254q–1-type spending above, costs of recruiting and keeping health professionals in the state's rural areas; and (C) grants and contracts to public and nonprofit groups to carry out activities allowed under this section. (3) The Secretary may cap indirect costs at no more than 15 percent of the grant. (f) Reports: The Secretary can't make a grant unless the state office agrees to (1) submit reports or performance data the Secretary requires, and (2) submit them by September 30 of the fiscal year right after each year it got the grant. (g) Requirement of application: The Secretary can't make a grant without a submitted application, in whatever form and with whatever information the Secretary requires. (h) Noncompliance: After the first year of payments, the Secretary can't keep paying a state office unless the Secretary finds it complied with all its agreements the year before. (i) Authorization of appropriations: (1) Congress is authorized to appropriate $12,500,000 for each fiscal year from 2023 through 2027. (2) That money stays available until spent.