This bill aims to support rural healthcare providers by extending critical Medicare payment programs. It specifically extends the special payment methodology for Medicare-dependent hospitals (MDHs) from its current expiration date of April 1, 2025, to October 1, 2031. Similarly, the bill prolongs the enhanced payments for low-volume hospitals (LVHs) through fiscal year 2031, with some provisions extending into fiscal year 2032. Beyond these extensions, the legislation directs the Comptroller General of the United States to conduct a comprehensive report on Medicare rural hospital classifications. This report, due within 180 days of enactment, must detail the number of hospitals holding various rural classifications over the past five fiscal years, including critical access hospitals and sole community hospitals. It will also analyze the extent of overlap between these classification criteria and propose recommendations for simplification to enhance financial sustainability for rural hospitals and improve healthcare access in rural areas. Additionally, the report will project the effects of allowing certain hospitals to use a fiscal year 2021 cost reporting period for calculating adjusted payments.