The proposed bill establishes the Rural Health Transformation Fund, which will be funded by money received from the federal Centers for Medicare and Medicaid Services under the Rural Health Act. The State Treasurer is responsible for crediting these funds to the newly created fund, which is strictly designated for purposes authorized by federal law. The bill prohibits any transfers of these funds to other state programs and mandates that the state investment officer invest any available funds in accordance with Nebraska's investment laws.

Additionally, the bill outlines specific requirements for applications for federal funds, including the necessity for electronic reporting to the Clerk of the Legislature. It mandates that all expenditures from the fund be limited to those approved in the application and requires annual reporting of expenditures, beneficiaries, and outcomes. Importantly, the bill stipulates that no funds from the Rural Health Transformation Fund can replace state rural health spending from the previous fiscal year, and any initiative seeking funds must have an approved sustainability plan before receiving any money. The act is designated to take effect immediately upon passage due to the existence of an emergency.