Floods have been one of the most threatening and devastating natural hazards in India. Their recurrence, magnitude, and damage costs keep increasing globally. Bihar, the third-largest populous Indian state, has about 6.88 million hectares (73.06%) of flood-prone area. The state suffers from flooding almost every year, causing huge losses of lives, property, agriculture, and infrastructure. The policymakers established various institutions like WRD, FMISC, WALMI, BSDMA, DMD, etc., for flood management in the state. However, even after the establishment of these institutions, the devastation due to floods has continued. The flood management paradigm is changing worldwide by incorporating nature-based solutions (NbS) like “Green Infrastructure.” The measures adopted as NbS also serve as an adaptation measure for climate change. Therefore, it is essential to revisit these institutions to assess the gaps that have prevented the intended objectives from being achieved and to find out the way forward. The paper critically analyzes these institutions and identifies the need for improvements to ensure their effective and efficient operation. To reorient the existing flood management practices in Bihar, the successful flood management approaches of the United States and the Netherlands have also been briefly discussed in the present study. Based on the comparative study, the paper recommends a conceptual framework for sustainable and integrated FRM in the state, considering factors like risk management and integrated floodplain-river management. This proposed framework is significant for guiding policy implementation in Bihar.