The "Save America's Rural Hospitals Act" aims to strengthen rural healthcare infrastructure and ensure access to care for over 60 million rural Americans. Citing high closure rates of rural hospitals and significant health disparities, the bill proposes comprehensive amendments to titles XVIII and XIX of the Social Security Act. Its focus is on financial support, regulatory adjustments, and strategic investments to stabilize the rural healthcare system. To stabilize rural hospital finances, the bill would eliminate Medicare sequestration for various rural hospital types and reverse cuts to bad debt reimbursement for critical access hospitals (CAHs) and rural hospitals. It permanently extends increased payment levels for low-volume hospitals and Medicare-dependent hospitals (MDHs) , and extends disproportionate share payments for sole community hospitals and MDHs. The Act also mandates rebasing target amounts and implements area wage index adjustments, including a floor for low-wage hospitals. For other rural providers, it makes permanent increased Medicare payments for ground ambulance services and permanently extends Medicare telehealth service enhancements for federally qualified health centers and rural health clinics. A significant provision restores State authority to waive the 35-mile rule for certain Medicare CAH designations, allowing more hospitals to qualify if they meet specific criteria related to financial vulnerability or underserved populations, with a cap on total designations. The legislation also addresses rural Medicare beneficiary equity by equalizing beneficiary copayments for CAH services. In terms of regulatory relief, it eliminates the 96-hour average length of stay requirement for inpatient CAH services and removes the hospitalization requirement for extended care services furnished by certain hospitals. Looking to the future, the Act expands Medicare Rural Hospital Flexibility Program grants to support rural emergency hospitals and certified rural health clinics, focusing on business operations and behavioral health services. It also introduces new Rural Health Transformation Grants , offering 5-year grants to State Offices of Rural Health and eligible rural healthcare providers. These grants support transitions to new models of care, such as rural emergency hospitals and extended stay clinics, and the integration of behavioral and oral health services to better meet community needs.