HB 18 Texas House · 89th Legislature (2025)

Relating to the establishment and administration of certain programs and services providing health care services to rural counties.

This bill, the Rural Health Stabilization and Innovation Act, creates a State Office of Rural Hospital Finance to develop and implement a strategic plan for rural hospitals in Texas. The plan must include specific strategies to improve access to hospital services - such as enhanced Medicaid reimbursement, hospital rate enhancements, or reduced regulatory costs - and require annual financial vulnerability assessments to evaluate each hospital’s ability to maintain services, meet obligations, and remain operational. The office will submit annual reports to the legislature, governor, and budget board detailing progress on these goals. This law directly affects rural hospitals by mandating participation in this structured program to address financial challenges and sustain healthcare access in underserved communities.

Bill status signed all 5 stages cleared

Introduction

Mar 2025

Committee Review

May 2025

House Passage

May 2025

Senate Passage

May 2025

Signed into Law

Jun 2025

Introduced Mar 10, 2025 Signed Jun 20, 2025

Maddy AI version diff · 2 comparisons

What changed between versions

Engrossed → Enrolled · 3 edits · Jun 20, 2025

MINOR

The bill was finalized in its enrolled version with minor formatting corrections and a new accessibility statement added. The substantive policy content remains unchanged from the engrossed version, maintaining the same provisions for rural hospital financial stabilization, grant programs, and telehealth initiatives.

Scope change

No substantive change to the bill's scope or applicability; only formatting and a new accessibility statement were added.

TECHNICAL

Added a statement about digital content accessibility standards aligned with WCAG 2.1.

Corrected formatting inconsistencies in section headers and removed redundant bill identification text.

Standardized spacing and line breaks throughout the document for final publication.

Introduced → Engrossed · 6 edits · May 25, 2025

MODERATE

This bill was substantially rewritten to expand funding and support for rural hospitals through new grant programs, updated definitions, and enhanced training initiatives. The changes shift focus from general rural health stabilization to targeted financial assistance for hospitals at risk of closure, while adding specific provisions for pediatric telemedicine and mental health services in rural areas.

Scope change

The bill's scope expanded from general rural hospital support to include specific grant programs for financial stabilization, emergency hardship, innovation, and rural hospital support, plus new pediatric mental health care access provisions.

FISCAL

Added four new grant programs: Financial Stabilization Grant Program for hospitals at moderate or high risk of instability, Emergency Hardship Grant Program for disasters, Innovation Grant Program for sustainable initiatives, and Rural Hospital Support Grant Program for long-term viability.

DEFINITION

Expanded rural hospital definition to include critical access hospitals, rural referral centers, and sole community hospitals designated by CMS, even if located in metropolitan statistical areas if they have 100 or fewer beds.

REQUIREMENT

Added new Texas Rural Hospital Officers Academy provisions requiring at least 100 hours of coursework annually on financial stability, with expanded advisory committee representation including rural hospital representatives.

SCOPE

Added new Subchapter D-1 to Health and Safety Code establishing Rural Pediatric Mental Health Care Access Program for rural hospitals and clinics, including telemedicine provisions.

TIMELINE

Changed advisory committee expiration date from adopting curriculum to September 1, 2027, with related provisions expiring September 1, 2028.

ELIGIBILITY

Added new eligibility criteria for pediatric telemedicine grants requiring quality assurance programs, full-time pediatric physician, neonatal support, and telemedicine education commitments.

Floor votes · Senate May 25, 2025 · House Apr 24, 2025

How they voted

25–5

Passed

Total votes 30

May 25, 2025

D Democratic10

6 Yea 4 Nay

60% Yea

R Republican20

19 Yea 1 Nay

95% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Jun 20, 2025

Signed into law

Signed by the Governor

executive

May 31, 2025

Upper · Passed

Signed in the Senate

upper

May 30, 2025

Lower · Passed

Signed in the House

lower

May 28, 2025

Introduced

House concurs in Senate amendment(s)-reported

upper

May 28, 2025

Introduced

Text of Senate Amendment(s)

lower

May 28, 2025

Introduced

House concurs in Senate amendment(s)

lower

May 26, 2025

Introduced

Senate Amendments Analysis distributed

lower

May 26, 2025

Introduced

Senate Amendments distributed

lower

May 26, 2025

Lower · Passed

Senate passage as amended reported

lower

May 25, 2025

Upper · Passed

Passed

upper

May 25, 2025

Amended

Amendment fails of adoption

upper

May 25, 2025

Introduced

Amendment(s) offered

upper

May 19, 2025

Upper · Passed

Committee report printed and distributed

upper

May 19, 2025

Upper · Passed

Reported favorably as substituted

upper

May 13, 2025

Upper · Passed

Vote taken in committee

upper

May 7, 2025

Upper · Passed

Left pending in committee

upper

May 7, 2025

Upper · Passed

Testimony taken in committee

upper

Apr 28, 2025

Committee

Referred to Health & Human Services

upper

Apr 28, 2025

Introduced

Read first time

upper

Apr 24, 2025

Introduced

Received from the House

upper

Apr 24, 2025

Lower · Passed

Passed

lower

Apr 23, 2025

Lower · Passed

Passed to engrossment as amended

lower

Apr 23, 2025

Lower · Passed

Amended

lower

Apr 23, 2025

Amended

Amendment withdrawn

lower

Apr 23, 2025

Introduced

Amendment(s) offered

lower

Apr 15, 2025

Lower · Passed

Committee report sent to Calendars

lower

Apr 14, 2025

Lower · Passed

Committee report distributed

lower

Apr 7, 2025

Lower · Passed

Reported favorably as substituted

lower

Mar 24, 2025

Lower · Passed

Left pending in committee

lower

Mar 24, 2025

Lower · Passed

Testimony taken/registration(s) recorded in committee

lower

Mar 10, 2025

Committee

Referred to Public Health

lower

Mar 10, 2025

Introduced

Read first time

lower

4 primary · 12 co-sponsors