Text of WY HB 122 (2026)

2026 STATE OF WYOMING 26LSO-0400 1 HB0122 HOUSE BILL NO. HB0122 Wyoming rural health transformation program. Sponsored by: Joint Appropriations Committee A BILL for 1 AN ACT relating to the federal rural health transformation 2 program funds; establishing the Wyoming rural health 3 transformation program; creating an advisory committee; 4 creating a perpetuity fund; authorizing investments as 5 specified; creating an expenditure account; continuously 6 appropriating an annually required distribution; providing 7 for governance, fiscal controls, accountability and 8 reporting requirements; authorizing expenditures, 9 initiatives, grants and awards; providing for deposits and 10 appropriations; requiring rulemaking; directing studies; 11 and providing for an effective date. 12 13 Be It Enacted by the Legislature of the State of Wyoming: 14 15 Section 1. W.S. 35-25-701 through 35-25-709 are 16 created to read: 2026 STATE OF WYOMING 26LSO-0400 2 HB0122 1 2 ARTICLE 7 3 WYOMING RURAL HEALTH TRANSFORMATION 4 5 35-25-701. Short title. 6 7 This act shall be known and may be cited as the "Wyoming 8 Rural Health Transformation Sustainability, Accountability 9 and Fiscal Protection Act." 10 11 35-25-702. Definitions. 12 13 (a) As used in this article: 14 15 (i) "Advisory committee" means the Wyoming rural 16 health transformation advisory committee created in W.S. 17 35-25-703; 18 19 (ii) "Annual required distribution" means: 20 21 (A) Beginning July 1, 2026 and ending June 22 30, 2036, the greater of: 23 2026 STATE OF WYOMING 26LSO-0400 3 HB0122 1 (I) The total program income, as 2 defined in 2 C.F.R. § 200.1, earned during the previous 3 fiscal year that is required to be expended under federal 4 statutes, federal regulations or the terms and conditions 5 of the Wyoming rural health transformation plan; or 6 7 (II) Four percent (4%) of the 8 cumulative total of funds deposited into the perpetuity 9 fund since inception, as calculated on the first day of 10 each fiscal year. 11 12 (B) Beginning July 1, 2036 and each fiscal 13 year thereafter, four percent (4%) of the previous five (5) 14 year average market value of the perpetuity fund, as 15 calculated on the first day of each fiscal year. 16 17 (iii) "Department" means the department of 18 health; 19 20 (iv) "Perpetuity fund" means the Wyoming rural 21 health transformation perpetuity fund created in W.S. 22 35-25-704; 23 2026 STATE OF WYOMING 26LSO-0400 4 HB0122 1 (v) "Purpose-dedicated share" means a discrete 2 fractional interest of the annual required distribution 3 allocated to a specific allowable perpetuity fund 4 expenditure authorized in W.S. 35-25-706; 5 6 (vi) "Rural health transformation funds" means 7 federal funds awarded to the state of Wyoming under the 8 federal rural health transformation program established by 9 section 71401 of the federal One Big Beautiful Bill Act, 10 P.L. 119-21; 11 12 (vii) "Wyoming rural health transformation plan" 13 means the rural health transformation program application 14 submitted to and approved by the federal government 15 pursuant to section 71401 of the federal One Big Beautiful 16 Bill Act, P.L. 119-21, and shall include any terms and 17 conditions specified in any associated notice of award, 18 cooperative agreement or similar federal instrument 19 governing the receipt or use of funds, and any amendments 20 thereto; 21 22 (viii) "Wyoming rural health transformation 23 program" means the program established in W.S. 35-25-705. 2026 STATE OF WYOMING 26LSO-0400 5 HB0122 1 2 35-25-703. Wyoming rural health transformation 3 advisory committee; legislative liaisons. 4 5 (a) There is created the Wyoming rural health 6 transformation advisory committee. The advisory committee 7 shall be composed of nine (9) voting members, each of whom 8 shall serve for a term of four (4) years. The governor 9 shall make appointments and fill any vacancies for 10 unexpired terms. Members are eligible for reappointment. 11 The governor may remove any member as provided in W.S. 12 9-1-202. 13 14 (b) The director of the department or the director's 15 designee and the director of the state budget department or 16 the director's designee shall serve as ex officio members 17 of the advisory committee, having the right to speak but 18 not to vote. 19 20 (c) One (1) senator appointed by the president of the 21 senate and one (1) representative appointed by the speaker 22 of the house shall serve as nonvoting legislative liaisons 23 to the advisory committee. 2026 STATE OF WYOMING 26LSO-0400 6 HB0122 1 2 (d) The advisory committee shall select one (1) of 3 its voting members to serve as chairman. 4 5 (e) The advisory committee shall meet not less than 6 two (2) times per year. 7 8 (f) Voting members shall serve without compensation 9 but shall be reimbursed for expenses incurred in the 10 performance of their duties in the manner and amounts 11 provided by law for state employees. Legislative liaisons 12 shall be paid salary, per diem and mileage as provided in 13 W.S. 28-5-101 when attending meetings of the advisory 14 council. 15 16 (g) The advisory committee shall review the 17 operations of the perpetuity fund and provide formal 18 written recommendations to the department regarding the 19 annual required distribution and allowable perpetuity fund 20 expenditures. The department shall review any 21 recommendations from the advisory committee and provide a 22 written response. 23 2026 STATE OF WYOMING 26LSO-0400 7 HB0122 1 (h) The advisory committee shall review and approve 2 each grant, award or expenditure of rural health 3 transformation funds in excess of five hundred thousand 4 dollars ($500,000.00), excluding deposits into the 5 perpetuity fund. 6 7 35-25-704. Wyoming rural health transformation 8 perpetuity fund; investment; distributions. 9 10 (a) There is created the Wyoming rural health 11 transformation perpetuity fund. The perpetuity fund shall 12 consist of monies designated to the fund by law and other 13 contributions, grants, gifts, bequests and donations made 14 to the fund. 15 16 (b) The state treasurer, or the treasurer's designee, 17 who shall be registered under the Investment Advisor's Act 18 of 1940, as amended, if required to be registered by the 19 terms of that act, as amended, shall invest the 20 unobligated, unencumbered balance of the Wyoming rural 21 health transformation perpetuity fund as authorized by law. 22 Investments of the perpetuity fund shall be in accordance 23 with subsection (c) of this section, if effective, and W.S. 2026 STATE OF WYOMING 26LSO-0400 8 HB0122 1 9-4-715(a) and (c) through (e) and 9-4-716. All investment 2 earnings shall be deposited to the perpetuity fund. In 3 adopting investment policy statements for the perpetuity 4 fund, the state loan and investment board, in consultation 5 with the investment funds committee, shall seek to preserve 6 the balance of the fund in a manner that strives for the 7 highest possible risk-adjusted total net return consistent 8 with an appropriate level of safety and liquidity to 9 maintain a consistent annual required distribution. 10 11 (c) If this article is enacted by the legislature 12 pursuant to the voting requirements of article 16, section 13 6(a)(ii)(B) of the Wyoming constitution, the state 14 treasurer may invest the unobligated, unencumbered balance 15 of the perpetuity fund in equities, including stocks of 16 corporations. 17 18 (d) All monies deposited to the perpetuity fund, 19 including investment earnings, shall be expended only for 20 the allowable perpetuity fund expenditures authorized under 21 the Wyoming rural health transformation program and in 22 accordance with the terms and conditions under which the 23 monies are received. Rural health transformation funds, and 2026 STATE OF WYOMING 26LSO-0400 9 HB0122 1 investment earnings thereon, expended in violation of the 2 terms and conditions under which the monies are received 3 shall be returned by the state to the federal source from 4 which the monies originated. 5 6 (e) Each one million dollars ($1,000,000.00) of 7 principal deposited to the perpetuity fund shall be 8 allocated to one (1) purpose-dedicated share by the 9 department, or fractional value thereof if a deposit is 10 less than one million dollars ($1,000,000.00). 11 12 (f) The annual required distribution is continuously 13 appropriated to the Wyoming rural health transformation 14 expenditure account, which is hereby created. The state 15 treasurer shall annually credit the annual required 16 distribution to the expenditure account not later than 17 September 30 of each year. Monies in the expenditure 18 account shall only be expended by the department for 19 allowable perpetuity fund expenditures under W.S. 20 35-25-706, the Wyoming rural health transformation plan and 21 all other requirements and limitations specified in this 22 article. Any unexpended, unobligated funds remaining from 23 an annual required distribution, after a reasonable period 2026 STATE OF WYOMING 26LSO-0400 10 HB0122 1 for expenditure for which the funds were continuously 2 appropriated, as recommended by the advisory committee and 3 determined by the department, shall revert to the Wyoming 4 rural health transformation perpetuity fund. 5 6 (g) Subject to W.S. 35-25-706(a), the total amount of 7 the annual required distribution expended on each allowable 8 perpetuity fund expenditure shall reasonably reflect the 9 total number of purpose-dedicated shares initially 10 allocated to that expenditure, divided by the total number 11 of all purpose-dedicated shares in the perpetuity fund. 12 13 35-25-705. Wyoming rural health transformation 14 program. 15 16 There is established the Wyoming rural health 17 transformation program within the department. The 18 department shall administer the program. The program shall 19 be implemented in accordance with the Wyoming rural health 20 transformation plan and shall be limited to the allowable 21 perpetuity fund expenditures authorized in W.S. 35-25-706 22 and the time-limited initiatives authorized in W.S. 2026 STATE OF WYOMING 26LSO-0400 11 HB0122 1 35-25-707. The department shall promulgate rules necessary 2 to implement this section and the program. 3 4 35-25-706. Wyoming rural health transformation 5 program; allowable perpetuity fund expenditures. 6 7 (a) Subject to the availability of funds, the 8 department shall expend the annual required distribution 9 solely for the allowable perpetuity fund expenditures 10 authorized under this section. The allocation of 11 purpose-dedicated shares and annually required distribution 12 expenditures shall seek to achieve the percentage targets 13 for support, grants and awards specified in this section. 14 Upon a written recommendation of the advisory committee, 15 the department may materially deviate from the percentage 16 targets specified in this section to the extent necessary 17 to meet documented need and demonstrated demand for the 18 support, grants and awards specified in this section. 19 20 (b) Forty and seven-tenths percent (40.7%) of the 21 annual required distribution shall be allocated for the 22 critical access hospital basic incentive (CAHB) program. 23 Under this program, the department shall provide incentive 2026 STATE OF WYOMING 26LSO-0400 12 HB0122 1 payments to hospitals that elect to participate and that 2 meet service delivery requirements, subject to all of the 3 following: 4 5 (i) A participating hospital shall operate a 6 staffed twenty-four (24) hour emergency department with 7 stroke and trauma imaging capability, provide or operate 8 ground ambulance services within its service area, provide 9 basic labor and delivery services if annual births exceed a 10 threshold established by the department and participate in 11 the statewide health information exchange; 12 13 (ii) Incentive payments under this subsection 14 may include tiered payments, one (1) time grants, medical 15 debt relief for Wyoming residents and ongoing payments to 16 offset fixed costs. 17 18 (c) Twenty-six and nine-tenths percent (26.9%) of the 19 annual required distribution shall be allocated for 20 emergency medical service regionalization. After the 21 submission of a statewide emergency medical services 22 response time model to the joint labor, health and social 23 services interim committee as provided in paragraph (i) of 2026 STATE OF WYOMING 26LSO-0400 13 HB0122 1 this subsection, the department shall provide incentive 2 payments to emergency medical service providers that elect 3 to participate and that meet regionalization requirements 4 established by rule of the department, subject to the 5 following: 6 7 (i) The department shall not require or 8 implement emergency medical service regionalization under 9 this subsection unless it first submits to the joint labor, 10 health and human services interim committee a statewide 11 emergency medical service response time model demonstrating 12 no increase in emergency response times, staffing 13 projections including volunteer impacts, inter-county 14 governance and authority agreements and full cost estimates 15 of regionalization, including long-term maintenance costs; 16 17 (ii) Eligibility for incentive payments under 18 this subsection shall be limited to joint applications 19 submitted by two (2) or more ground ambulance providers 20 serving a contiguous rural or frontier region; 21 22 (iii) Joint applicants shall submit a 23 regionalization plan to the department demonstrating 2026 STATE OF WYOMING 26LSO-0400 14 HB0122 1 maximization of revenue sources, integration with public 2 safety answering points, use of interoperable equipment and 3 technology, reduction of administrative overhead and 4 commitment to community emergency medical services and 5 tele-crisis stabilization services; 6 7 (iv) Incentive payments under this subsection 8 shall include ongoing payments to offset fixed readiness 9 costs and grants for ambulances, interoperability equipment 10 and implementation of regional medical dispatch. 11 12 (d) Twenty-one and six-tenths percent (21.6%) of the 13 annual required distribution shall be allocated for 14 workforce education individual support. The department 15 shall administer awards to individual persons for health 16 care workforce education and training costs, including 17 tuition, fees and stipends, subject to the following: 18 19 (i) Awards under this subsection shall be used 20 to pay allowable education and training costs for eligible 21 applicants pursuing credentials in one (1) or more of the 22 following fields: 23 2026 STATE OF WYOMING 26LSO-0400 15 HB0122 1 (A) Nursing, including certified nursing 2 assistant, licensed practical nurse, registered nurse and 3 advanced practice registered nurse programs; 4 5 (B) Emergency medical services, including 6 emergency department technician, emergency medical 7 responder, emergency medical technician and paramedic 8 programs; 9 10 (C) Clinical behavioral health professions; 11 12 (D) Physician education, including 13 undergraduate medical education. 14 15 (ii) As a condition of receiving an award under 16 this subsection, an applicant shall agree to provide health 17 care services in Wyoming for a minimum of five (5) years 18 following completion of the approved program, under terms 19 and conditions established by the department; 20 21 (iii) An applicant who fails to satisfy the 22 service obligation required under paragraph (ii) of this 23 subsection shall be required to repay to the department all 2026 STATE OF WYOMING 26LSO-0400 16 HB0122 1 or a prorated portion of the award, together with any 2 applicable interest, as determined by rule of the 3 department. 4 5 (e) Ten and eight-tenths percent (10.8%) of the 6 annual required distribution shall be allocated for 7 physician post-graduate medical education (GME) individual 8 support. The department shall administer awards to 9 individuals for physician medical education, including 10 residency and fellowship training costs, subject to the 11 following: 12 13 (i) In awarding funds under this subsection, the 14 department shall prioritize awards to applicants in 15 programs that will increase the supply of family medicine 16 physicians and that provide training in obstetrics or other 17 high-demand specialties, as determined by the department; 18 19 (ii) As a condition of receiving an award under 20 this subsection, an applicant shall agree to provide health 21 care services for a minimum of five (5) years in one (1) or 22 more underserved counties within the state, under terms and 23 conditions established by rule of the department. 2026 STATE OF WYOMING 26LSO-0400 17 HB0122 1 2 35-25-707. Wyoming rural health transformation 3 program; time-limited initiatives; sunset. 4 5 (a) Subject to the availability of rural health 6 transformation funds and subsection (b) of this section, 7 the department is authorized to expend funds for 8 time-limited initiatives in amounts that seek to achieve 9 the following percentage targets: 10 11 (i) Thirty-six and four-tenths percent (36.4%) 12 of amounts available for time-limited initiatives for 13 integrated primary care. Expenditures under this paragraph 14 shall be for competitive grants to expand the number and 15 geographical reach of federally qualified health centers in 16 the state through conversion of existing facilities and 17 practices for the integration of primary care delivery 18 models that coordinate primary medical care with behavioral 19 health services, obstetric and gynecological care, dental 20 services and preventive health services; 21 22 (ii) Fifteen and one-tenths percent (15.1%) of 23 amounts available for time-limited initiatives for a 2026 STATE OF WYOMING 26LSO-0400 18 HB0122 1 technology adoption challenge program. Expenditures under 2 this paragraph shall be for competitive grants for health 3 care technology procurement. Grants under this paragraph 4 shall be awarded only to joint applications submitted by 5 two (2) or more health care providers and shall be limited 6 to projects that improve care delivery closer to patients' 7 homes, enhance interoperability and coordination among 8 providers and reduce administrative activity; 9 10 (iii) Nine and eight-tenths percent (9.8%) of 11 amounts available for time-limited initiatives for exercise 12 and diet programs. Expenditures under this paragraph shall 13 be for competitive grants to Wyoming-based entities to 14 promote physical activity and healthy nutrition. Projects 15 that demonstrate measurable increases in participation in 16 exercise, outdoor recreation or evidence-based nutrition 17 practices shall be prioritized for the grants under this 18 paragraph; 19 20 (iv) Eight and two-tenths percent (8.2%) of 21 amounts available for time-limited initiatives for a 22 statewide tele-specialist platform. Expenditures under 23 this paragraph shall be for the procurement and operation 2026 STATE OF WYOMING 26LSO-0400 19 HB0122 1 of a centralized tele-specialty platform to deliver 2 physician-level specialty consultations to health care 3 providers statewide; 4 5 (v) Eight and two-tenths percent (8.2%) of 6 amounts available for time-limited initiatives for 7 workforce education startup costs. Expenditures under this 8 paragraph shall be for competitive grants to support health 9 care workforce training programs operated by educational 10 institutions within the state. Grants under this paragraph 11 shall be awarded to recipients that commit to establishing 12 and maintaining a specified number of training positions 13 for nurses, emergency medical service personnel, 14 physicians, clinical behavioral health providers and other 15 health care professionals; 16 17 (vi) Eight and two-tenths percent (8.2%) of 18 amounts available for time-limited initiatives for care 19 coordination. Expenditures under this paragraph shall be 20 for competitive grants to hospitals, health care providers 21 and rural health facilities to propose clinically 22 integrated care coordination models for one (1) or more 23 counties to improve the management of chronic disease among 2026 STATE OF WYOMING 26LSO-0400 20 HB0122 1 persons who are dually eligible for Medicare and Medicaid 2 and who are identified as high risk. Funding awarded under 3 this paragraph may include capped start-up costs, a 4 per-member, per-month care coordination payment for 5 assigned persons and performance-based payments tied to 6 demonstrated cost savings; 7 8 (vii) Four and nine-tenths percent (4.9%) of 9 amounts available for time-limited initiatives for 10 centralized billing capacity. Expenditures under this 11 paragraph shall be for centralized billing and revenue 12 collection services for voluntarily participating emergency 13 medical services agencies. This centralized billing 14 capacity initiative may be expanded to other health care 15 providers if the initiative demonstrates effectiveness and 16 financial sustainability; 17 18 (viii) Two percent (2.0%) of amounts available 19 for time-limited initiatives for a nonemergency 20 transportation coordination platform. Expenditures under 21 this paragraph shall be for the procurement and operation 22 of a centralized nonemergency medical transportation 23 coordination platform to improve access to health care 2026 STATE OF WYOMING 26LSO-0400 21 HB0122 1 appointments for seniors, persons with disabilities and 2 other eligible populations. The platform shall facilitate 3 the scheduling, coordination and billing of nonemergency 4 transportation; 5 6 (ix) Two and six-tenths percent (2.6%) of 7 amounts available for time-limited initiatives for 8 administration. Expenditures under this paragraph include 9 any administrative costs necessary to implement the rural 10 health transformation program, including expenses of the 11 advisory committee; 12 13 (x) Four and six-tenths percent (4.6%) of 14 amounts available for time-limited initiatives included in 15 the Wyoming rural health transformation plan that are not 16 specifically authorized in this subsection shall be 17 redistributed for expenditure on the initiatives authorized 18 under this subsection. 19 20 (b) Upon a written recommendation of the advisory 21 committee, the department may materially deviate from the 22 percentage targets specified in subsection (a) of this 23 section to the extent necessary to meet documented need and 2026 STATE OF WYOMING 26LSO-0400 22 HB0122 1 demonstrated demand for the time-limited initiatives 2 specified in subsection (a) of this section. 3 4 (c) The authority to administer the time-limited 5 initiatives and any funds for the initiatives under 6 subsection (a) of this section shall terminate upon 7 exhaustion of all rural health transformation funds 8 appropriated or otherwise made available for the 9 initiatives specified in subsection (a) of this section. 10 11 35-25-708. Prohibited uses; legislative notice; 12 reporting. 13 14 (a) In addition to any other limitations imposed by 15 state or federal law, no expenditure of rural health 16 transformation funds shall be made for abortions or for 17 specified sex-trait modification procedures, as defined in 18 45 C.F.R. § 156.400. 19 20 (b) Each grant, award, or expenditure of rural health 21 transformation funds in excess of five hundred thousand 22 dollars ($500,000.00) shall require written approval of the 23 advisory committee and notice to the legislature not less 2026 STATE OF WYOMING 26LSO-0400 23 HB0122 1 than ten (10) days prior to authorization of the grant, 2 award or expenditure. For authorized perpetuity fund 3 expenditures, the notice shall identify the proposed 4 recipient, amount, purpose and material terms of the grant, 5 award or expenditure. For time-limited initiatives, 6 legislative notice shall be satisfied by the department 7 providing written notice to the joint appropriations 8 committee in a manner similar to the process specified in 9 W.S. 9-2-1005(b)(ii) and 9-2-1013(b). 10 11 (c) The state budget department, in consultation with 12 the department, shall develop and maintain an electronic 13 reporting portal to provide current information on 14 expenditures and program activity of rural health 15 transformation funds. 16 17 35-25-709. Recipient reporting; performance and 18 accountability agreements; repayment. 19 20 (a) The department shall require each recipient of 21 funds under the Wyoming rural health transformation program 22 to submit reports sufficient to demonstrate compliance with 23 applicable state and federal requirements. At a minimum, 2026 STATE OF WYOMING 26LSO-0400 24 HB0122 1 required reporting shall include detailed expenditure 2 information, performance measures and documentation 3 demonstrating the authorized use of funds. 4 5 (b) The department shall require each recipient 6 hospital, clinic, emergency medical service provider or 7 other health care-related organization receiving funds 8 under the program to enter into a written performance and 9 accountability agreement with the department. At a minimum, 10 the agreement shall include requirements relating to: 11 12 (i) Operating margin targets; 13 14 (ii) Days cash on hand; 15 16 (iii) Liquidity ratio benchmarks; 17 18 (iv) The adoption of modernization and 19 efficiency practices, including improved revenue cycle 20 management systems; 21 2026 STATE OF WYOMING 26LSO-0400 25 HB0122 1 (v) The development and implementation of a plan 2 to reduce unprofitable, duplicative or nonessential service 3 lines; 4 5 (vi) Participation in shared services, regional 6 collaboration or other cost-containment arrangements where 7 feasible; and 8 9 (vii) Submission of independent financial audits 10 to the department for annual collection and transmittal to 11 the joint appropriations committee. 12 13 (c) A recipient of funds under the Wyoming rural 14 health transformation program that fails to comply with a 15 requirement, condition or obligation imposed by statute, 16 rule or performance and accountability agreement, or that 17 fails to meet required performance targets, misuses funds, 18 expends funds for purposes not authorized under state or 19 federal law or fails or refuses to implement required 20 operational reforms, shall repay to the department all or a 21 prorated portion of the funds received, as determined by 22 the department. The department may recover amounts owed 23 under this subsection by any means authorized by law. 2026 STATE OF WYOMING 26LSO-0400 26 HB0122 1 2 Section 2. The department of health shall adopt all 3 rules necessary to implement this act. 4 5 Section 3. During the 2026 interim, the joint labor, 6 health and social services interim committee shall study 7 policy issues identified in the Wyoming rural health 8 transformation plan, as defined in W.S. 35-25-702(a)(vii) 9 created in this act, and may prepare any legislation it 10 deems necessary for consideration by the legislature. 11 12 Section 4. 13 14 (a) Federal funds awarded to the state of Wyoming 15 under the federal rural health transformation program 16 established by section 71401 of the federal One Big 17 Beautiful Bill Act, P.L. 119-21, are appropriated to the 18 department of health, subject to the following: 19 20 (i) In federal fiscal year 2026, eighty percent 21 (80%) of funds awarded for that fiscal year shall be 22 deposited into the Wyoming rural health transformation 23 perpetuity fund, as defined in W.S. 35-25-702(a)(iv) 2026 STATE OF WYOMING 26LSO-0400 27 HB0122 1 created in this act. Thereafter, in each subsequent federal 2 fiscal year, sixty-nine and five-tenths percent (69.5%) of 3 funds awarded in that fiscal year shall be deposited into 4 the Wyoming rural health transformation perpetuity fund; 5 6 (ii) In federal fiscal year 2026, twenty percent 7 (20%) of funds awarded for that fiscal year are 8 appropriated for the time-limited initiatives authorized in 9 W.S. 35-25-707, as created in this act. Thereafter, in 10 each subsequent federal fiscal year, thirty and five-tenths 11 percent (30.5%) of the funds awarded in that fiscal year 12 are appropriated for the time-limited initiatives. 13 14 Section 5. This act is effective immediately upon 15 completion of all acts necessary for a bill to become law 16 as provided by Article 4, Section 8 of the Wyoming 17 Constitution. 18 19 (END)

ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 1 AN ACT relating to the federal rural health transformation program funds; establishing the Wyoming rural health transformation program; creating an advisory committee; creating a perpetuity fund; authorizing investments as specified; creating an expenditure account; continuously appropriating an annually required distribution; providing for governance, fiscal controls, accountability and reporting requirements; authorizing expenditures, initiatives, grants and awards; providing for deposits and appropriations; requiring rulemaking; directing studies; and providing for an effective date. Be It Enacted by the Legislature of the State of Wyoming: Section 1. W.S. 35-25-701 through 35-25-709 are created to read: ARTICLE 7 WYOMING RURAL HEALTH TRANSFORMATION 35-25-701. Short title. This act shall be known and may be cited as the "Wyoming Rural Health Transformation Sustainability, Accountability and Fiscal Protection Act." 35-25-702. Definitions. (a) As used in this article: (i) "Advisory committee" means the Wyoming rural health transformation advisory committee created in W.S. 35-25-703; (ii) "Annual required distribution" means: ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 2 (A) Beginning July 1, 2026 and ending June 30, 2036, the greater of: (I) The total program income, as defined in 2 C.F.R. § 200.1, earned during the previous fiscal year that is required to be expended under federal statutes, federal regulations or the terms and conditions of the Wyoming rural health transformation plan; or (II) Four percent (4%) of the cumulative total of funds deposited into the perpetuity fund since inception, as calculated on the first day of each fiscal year. (B) Beginning July 1, 2036 and each fiscal year thereafter, four percent (4%) of the previous five (5) year average market value of the perpetuity fund, as calculated on the first day of each fiscal year. (iii) "Department" means the department of health; (iv) "Perpetuity fund" means the Wyoming rural health transformation perpetuity fund created in W.S. 35-25-704; (v) "Purpose-dedicated share" means a discrete fractional interest of the annual required distribution allocated to a specific allowable perpetuity fund expenditure authorized in W.S. 35-25-706; (vi) "Rural health transformation funds" means federal funds awarded to the state of Wyoming under the federal rural health transformation program established by ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 3 section 71401 of the federal One Big Beautiful Bill Act, P.L. 119-21; (vii) "Wyoming rural health transformation plan" means the rural health transformation program application submitted to and approved by the federal government pursuant to section 71401 of the federal One Big Beautiful Bill Act, P.L. 119-21, and shall include any terms and conditions specified in any associated notice of award, cooperative agreement or similar federal instrument governing the receipt or use of funds, and any amendments thereto; (viii) "Wyoming rural health transformation program" means the program established in W.S. 35-25-705. 35-25-703. Wyoming rural health transformation advisory committee; legislative liaisons. (a) There is created the Wyoming rural health transformation advisory committee. The advisory committee shall be composed of nine (9) voting members, each of whom shall serve for a term of four (4) years. The governor shall make appointments and fill any vacancies for unexpired terms. Members are eligible for reappointment. The governor may remove any member as provided in W.S. 9-1-202. (b) The director of the department or the director's designee and the director of the state budget department or the director's designee shall serve as ex officio members of the advisory committee, having the right to speak but not to vote. ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 4 (c) One (1) senator appointed by the president of the senate and one (1) representative appointed by the speaker of the house shall serve as nonvoting legislative liaisons to the advisory committee. (d) The advisory committee shall select one (1) of its voting members to serve as chairman. (e) The advisory committee shall meet not less than two (2) times per year. (f) Voting members shall serve without compensation but shall be reimbursed for expenses incurred in the performance of their duties in the manner and amounts provided by law for state employees. Legislative liaisons shall be paid salary, per diem and mileage as provided in W.S. 28-5-101 when attending meetings of the advisory council. (g) The advisory committee shall review the operations of the perpetuity fund and provide formal written recommendations to the department regarding the annual required distribution and allowable perpetuity fund expenditures. The department shall review any recommendations from the advisory committee and provide a written response. (h) The advisory committee shall review and approve each grant, award or expenditure of rural health transformation funds in excess of five hundred thousand dollars ($500,000.00), excluding deposits into the perpetuity fund. 35-25-704. Wyoming rural health transformation perpetuity fund; investment; distributions. ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 5 (a) There is created the Wyoming rural health transformation perpetuity fund. The perpetuity fund shall consist of monies designated to the fund by law and other contributions, grants, gifts, bequests and donations made to the fund. (b) The state treasurer, or the treasurer's designee, who shall be registered under the Investment Advisor's Act of 1940, as amended, if required to be registered by the terms of that act, as amended, shall invest the unobligated, unencumbered balance of the Wyoming rural health transformation perpetuity fund as authorized by law. Investments of the perpetuity fund shall be in accordance with subsection (c) of this section, if effective, and W.S. 9-4-715(a) and (c) through (e) and 9-4-716. All investment earnings shall be deposited to the perpetuity fund. In adopting investment policy statements for the perpetuity fund, the state loan and investment board, in consultation with the investment funds committee, shall seek to preserve the balance of the fund in a manner that strives for the highest possible risk-adjusted total net return consistent with an appropriate level of safety and liquidity to maintain a consistent annual required distribution. (c) If this article is enacted by the legislature pursuant to the voting requirements of article 16, section 6(a)(ii)(B) of the Wyoming constitution, the state treasurer may invest the unobligated, unencumbered balance of the perpetuity fund in equities, including stocks of corporations. (d) All monies deposited to the perpetuity fund, including investment earnings, shall be expended only for the allowable perpetuity fund expenditures authorized under ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 6 the Wyoming rural health transformation program and in accordance with the terms and conditions under which the monies are received. Rural health transformation funds, and investment earnings thereon, expended in violation of the terms and conditions under which the monies are received shall be returned by the state to the federal source from which the monies originated. (e) Each one million dollars ($1,000,000.00) of principal deposited to the perpetuity fund shall be allocated to one (1) purpose-dedicated share by the department, or fractional value thereof if a deposit is less than one million dollars ($1,000,000.00). (f) The annual required distribution is continuously appropriated to the Wyoming rural health transformation expenditure account, which is hereby created. The state treasurer shall annually credit the annual required distribution to the expenditure account not later than September 30 of each year. Monies in the expenditure account shall only be expended by the department for allowable perpetuity fund expenditures under W.S. 35-25-706, the Wyoming rural health transformation plan and all other requirements and limitations specified in this article. Any unexpended, unobligated funds remaining from an annual required distribution, after a reasonable period for expenditure for which the funds were continuously appropriated, as recommended by the advisory committee and determined by the department, shall revert to the Wyoming rural health transformation perpetuity fund. (g) Subject to W.S. 35-25-706(a), the total amount of the annual required distribution expended on each allowable perpetuity fund expenditure shall reasonably reflect the total number of purpose-dedicated shares initially ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 7 allocated to that expenditure, divided by the total number of all purpose-dedicated shares in the perpetuity fund. 35-25-705. Wyoming rural health transformation program. There is established the Wyoming rural health transformation program within the department. The department shall administer the program. The program shall be implemented in accordance with the Wyoming rural health transformation plan and shall be limited to the allowable perpetuity fund expenditures authorized in W.S. 35-25-706 and the time-limited initiatives authorized in W.S. 35-25-707. The department shall promulgate rules necessary to implement this section and the program. 35-25-706. Wyoming rural health transformation program; allowable perpetuity fund expenditures. (a) Subject to the availability of funds, the department shall expend the annual required distribution solely for the allowable perpetuity fund expenditures authorized under this section. The allocation of purpose-dedicated shares and annually required distribution expenditures shall seek to achieve the percentage targets for support, grants and awards specified in this section. Upon a written recommendation of the advisory committee, the department may materially deviate from the percentage targets specified in this section to the extent necessary to meet documented need and demonstrated demand for the support, grants and awards specified in this section. (b) Forty and seven-tenths percent (40.7%) of the annual required distribution shall be allocated for the critical access hospital basic incentive (CAHB) program. ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 8 Under this program, the department shall provide incentive payments to hospitals that elect to participate and that meet service delivery requirements, subject to all of the following: (i) A participating hospital shall operate a staffed twenty-four (24) hour emergency department with stroke and trauma imaging capability, provide or operate ground ambulance services within its service area, provide basic labor and delivery services if annual births exceed a threshold established by the department and participate in the statewide health information exchange; (ii) Incentive payments under this subsection may include tiered payments, one (1) time grants, medical debt relief for Wyoming residents and ongoing payments to offset fixed costs. (c) Twenty-six and nine-tenths percent (26.9%) of the annual required distribution shall be allocated for emergency medical service regionalization. After the submission of a statewide emergency medical services response time model to the joint labor, health and social services interim committee as provided in paragraph (i) of this subsection, the department shall provide incentive payments to emergency medical service providers that elect to participate and that meet regionalization requirements established by rule of the department, subject to the following: (i) The department shall not require or implement emergency medical service regionalization under this subsection unless it first submits to the joint labor, health and human services interim committee a statewide emergency medical service response time model demonstrating ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 9 no increase in emergency response times, staffing projections including volunteer impacts, inter-county governance and authority agreements and full cost estimates of regionalization, including long-term maintenance costs; (ii) Eligibility for incentive payments under this subsection shall be limited to joint applications submitted by two (2) or more ground ambulance providers serving a contiguous rural or frontier region; (iii) Joint applicants shall submit a regionalization plan to the department demonstrating maximization of revenue sources, integration with public safety answering points, use of interoperable equipment and technology, reduction of administrative overhead and commitment to community emergency medical services and tele-crisis stabilization services; (iv) Incentive payments under this subsection shall include ongoing payments to offset fixed readiness costs and grants for ambulances, interoperability equipment and implementation of regional medical dispatch. (d) Twenty-one and six-tenths percent (21.6%) of the annual required distribution shall be allocated for workforce education individual support. The department shall administer awards to individual persons for health care workforce education and training costs, including tuition, fees and stipends, subject to the following: (i) Awards under this subsection shall be used to pay allowable education and training costs for eligible applicants pursuing credentials in one (1) or more of the following fields: ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 10 (A) Nursing, including certified nursing assistant, licensed practical nurse, registered nurse and advanced practice registered nurse programs; (B) Emergency medical services, including emergency department technician, emergency medical responder, emergency medical technician and paramedic programs; (C) Clinical behavioral health professions; (D) Physician education, including undergraduate medical education. (ii) As a condition of receiving an award under this subsection, an applicant shall agree to provide health care services in Wyoming for a minimum of five (5) years following completion of the approved program, under terms and conditions established by the department; (iii) An applicant who fails to satisfy the service obligation required under paragraph (ii) of this subsection shall be required to repay to the department all or a prorated portion of the award, together with any applicable interest, as determined by rule of the department. (e) Ten and eight-tenths percent (10.8%) of the annual required distribution shall be allocated for physician post-graduate medical education (GME) individual support. The department shall administer awards to individuals for physician medical education, including residency and fellowship training costs, subject to the following: ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 11 (i) In awarding funds under this subsection, the department shall prioritize awards to applicants in programs that will increase the supply of family medicine physicians and that provide training in obstetrics or other high-demand specialties, as determined by the department; (ii) As a condition of receiving an award under this subsection, an applicant shall agree to provide health care services for a minimum of five (5) years in one (1) or more underserved counties within the state, under terms and conditions established by rule of the department. 35-25-707. Wyoming rural health transformation program; time-limited initiatives; sunset. (a) Subject to the availability of rural health transformation funds and subsection (b) of this section, the department is authorized to expend funds for time-limited initiatives in amounts that seek to achieve the following percentage targets: (i) Thirty-six and four-tenths percent (36.4%) of amounts available for time-limited initiatives for integrated primary care. Expenditures under this paragraph shall be for competitive grants to expand the number and geographical reach of federally qualified health centers in the state through conversion of existing facilities and practices for the integration of primary care delivery models that coordinate primary medical care with behavioral health services, obstetric and gynecological care, dental services and preventive health services; (ii) Fifteen and one-tenths percent (15.1%) of amounts available for time-limited initiatives for a technology adoption challenge program. Expenditures under ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 12 this paragraph shall be for competitive grants for health care technology procurement. Grants under this paragraph shall be awarded only to joint applications submitted by two (2) or more health care providers and shall be limited to projects that improve care delivery closer to patients' homes, enhance interoperability and coordination among providers and reduce administrative activity; (iii) Nine and eight-tenths percent (9.8%) of amounts available for time-limited initiatives for exercise and diet programs. Expenditures under this paragraph shall be for competitive grants to Wyoming-based entities to promote physical activity and healthy nutrition. Projects that demonstrate measurable increases in participation in exercise, outdoor recreation or evidence-based nutrition practices shall be prioritized for the grants under this paragraph; (iv) Eight and two-tenths percent (8.2%) of amounts available for time-limited initiatives for a statewide tele-specialist platform. Expenditures under this paragraph shall be for the procurement and operation of a centralized tele-specialty platform to deliver physician-level specialty consultations to health care providers statewide; (v) Eight and two-tenths percent (8.2%) of amounts available for time-limited initiatives for workforce education startup costs. Expenditures under this paragraph shall be for competitive grants to support health care workforce training programs operated by educational institutions within the state. Grants under this paragraph shall be awarded to recipients that commit to establishing and maintaining a specified number of training positions for nurses, emergency medical service personnel, ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 13 physicians, clinical behavioral health providers and other health care professionals; (vi) Eight and two-tenths percent (8.2%) of amounts available for time-limited initiatives for care coordination. Expenditures under this paragraph shall be for competitive grants to hospitals, health care providers and rural health facilities to propose clinically integrated care coordination models for one (1) or more counties to improve the management of chronic disease among persons who are dually eligible for Medicare and Medicaid and who are identified as high risk. Funding awarded under this paragraph may include capped start-up costs, a per-member, per-month care coordination payment for assigned persons and performance-based payments tied to demonstrated cost savings; (vii) Four and nine-tenths percent (4.9%) of amounts available for time-limited initiatives for centralized billing capacity. Expenditures under this paragraph shall be for centralized billing and revenue collection services for voluntarily participating emergency medical services agencies. This centralized billing capacity initiative may be expanded to other health care providers if the initiative demonstrates effectiveness and financial sustainability; (viii) Two percent (2.0%) of amounts available for time-limited initiatives for a nonemergency transportation coordination platform. Expenditures under this paragraph shall be for the procurement and operation of a centralized nonemergency medical transportation coordination platform to improve access to health care appointments for seniors, persons with disabilities and other eligible populations. The platform shall facilitate ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 14 the scheduling, coordination and billing of nonemergency transportation; (ix) Two and six-tenths percent (2.6%) of amounts available for time-limited initiatives for administration. Expenditures under this paragraph include any administrative costs necessary to implement the rural health transformation program, including expenses of the advisory committee; (x) Four and six-tenths percent (4.6%) of amounts available for time-limited initiatives included in the Wyoming rural health transformation plan that are not specifically authorized in this subsection shall be redistributed for expenditure on the initiatives authorized under this subsection. (b) Upon a written recommendation of the advisory committee, the department may materially deviate from the percentage targets specified in subsection (a) of this section to the extent necessary to meet documented need and demonstrated demand for the time-limited initiatives specified in subsection (a) of this section. (c) The authority to administer the time-limited initiatives and any funds for the initiatives under subsection (a) of this section shall terminate upon exhaustion of all rural health transformation funds appropriated or otherwise made available for the initiatives specified in subsection (a) of this section. 35-25-708. Prohibited uses; legislative notice; reporting. ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 15 (a) In addition to any other limitations imposed by state or federal law, no expenditure of rural health transformation funds shall be made for abortions or for specified sex-trait modification procedures, as defined in 45 C.F.R. § 156.400. (b) Each grant, award or expenditure of rural health transformation funds in excess of five hundred thousand dollars ($500,000.00) shall require written approval of the advisory committee and notice to the legislature not less than ten (10) days prior to authorization of the grant, award or expenditure. For authorized perpetuity fund expenditures, the notice shall identify the proposed recipient, amount, purpose and material terms of the grant, award or expenditure. For time-limited initiatives, legislative notice shall be satisfied by the department providing written notice to the joint appropriations committee in a manner similar to the process specified in W.S. 9-2-1005(b)(ii) and 9-2-1013(b). (c) The state budget department, in consultation with the department, shall develop and maintain an electronic reporting portal to provide current information on expenditures and program activity of rural health transformation funds. 35-25-709. Recipient reporting; performance and accountability agreements; repayment. (a) The department shall require each recipient of funds under the Wyoming rural health transformation program to submit reports sufficient to demonstrate compliance with applicable state and federal requirements. At a minimum, required reporting shall include detailed expenditure ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 16 information, performance measures and documentation demonstrating the authorized use of funds. (b) The department shall require each recipient hospital, clinic, emergency medical service provider or other health care-related organization receiving funds under the programs authorized in W.S. 35-25-706 to enter into a written performance and accountability agreement with the department. At a minimum, the agreement shall include requirements relating to: (i) Operating margin targets; (ii) Days cash on hand; (iii) Liquidity ratio benchmarks; (iv) The adoption of modernization and efficiency practices, including improved revenue cycle management systems; (v) The development and implementation of a plan to reduce unprofitable, duplicative or nonessential service lines; (vi) Participation in shared services, regional collaboration or other cost-containment arrangements where feasible; and (vii) Submission of independent financial audits to the department for annual collection and transmittal to the joint appropriations committee. (c) A recipient of funds under the Wyoming rural health transformation program that fails to comply with a ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 17 requirement, condition or obligation imposed by statute, rule or performance and accountability agreement, or that fails to meet required performance targets, misuses funds, expends funds for purposes not authorized under state or federal law or fails or refuses to implement required operational reforms, shall repay to the department all or a prorated portion of the funds received, as determined by the department. The department may recover amounts owed under this subsection by any means authorized by law. Section 2. The department of health shall adopt all rules necessary to implement this act. Section 3. During the 2026 interim, the joint labor, health and social services interim committee shall study policy issues identified in the Wyoming rural health transformation plan, as defined in W.S. 35-25-702(a)(vii) created in this act, and may prepare any legislation it deems necessary for consideration by the legislature. Section 4. (a) Federal funds awarded to the state of Wyoming under the federal rural health transformation program established by section 71401 of the federal One Big Beautiful Bill Act, P.L. 119-21, are appropriated to the department of health, subject to the following: (i) In federal fiscal year 2026, eighty percent (80%) of funds awarded for that fiscal year shall be deposited into the Wyoming rural health transformation perpetuity fund, as defined in W.S. 35-25-702(a)(iv) created in this act. Thereafter, in each subsequent federal fiscal year, sixty-nine and five-tenths percent (69.5%) of ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 18 funds awarded in that fiscal year shall be deposited into the Wyoming rural health transformation perpetuity fund; (ii) In federal fiscal year 2026, twenty percent (20%) of funds awarded for that fiscal year are appropriated for the time-limited initiatives authorized in W.S. 35-25-707, as created in this act. Thereafter, in each subsequent federal fiscal year, thirty and five-tenths percent (30.5%) of the funds awarded in that fiscal year are appropriated for the time-limited initiatives. ORIGINAL HOUSE BILL NO. HB0122 ENROLLED ACT NO. 21, HOUSE OF REPRESENTATIVES SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING 2026 BUDGET SESSION 19 Section 5. This act is effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution. (END) Speaker of the House President of the Senate Governor TIME APPROVED: _________ DATE APPROVED: _________ I hereby certify that this act originated in the House. Chief Clerk