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II
116TH CONGRESS
2D SESSION
S. 3559
To provide emergency financial assistance to rural health care facilities and
providers impacted by the COVID-19 emergency.
IN THE SENATE OF THE UNITED STATES
MARCH 21, 2020
Mr. BENNET (for himself, Mr. BARRASSO, Ms. SMITH, Mr. GARDNER, Mr.
JONES, and Mrs. HYDE-SMITH) introduced the following bill; which was
read twice and referred to the Committee on Finance
A BILL
To provide emergency financial assistance to rural health
care facilities and providers impacted by the COVID-
19 emergency.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Immediate Relief for
4
Rural Facilities and Providers Act of 2020’’.
5
SEC. 2. RURAL HEALTH CARE FACILITY GRANTS.
6
(a) PURPOSE.—It is the purpose of this section to
7
provide funding to stabilize rural hospitals and provide im-
8
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•S 3559 IS
mediate financial relief to prepare and respond to the
1
COVID-19 emergency.
2
(b) GRANTS.—The Secretary, acting through the Ad-
3
ministrator of the Centers for Medicare & Medicaid Serv-
4
ices, shall establish an emergency operating grant pro-
5
gram and shall award an emergency operating grant to
6
an eligible Medicare participating health care facility.
7
(c) ALLOTMENTS AND PAYMENTS.—
8
(1) ALLOTMENTS.—The Secretary shall, from
9
amounts appropriated under subsection (i), allot to
10
each facility eligible for a grant under this section
11
the sum of—
12
(A) an amount equal to the number of pa-
13
tient days (including acute, swing-bed, and ob-
14
servation days) from January 1, 2019, to April
15
1, 2019, with respect to the facility, multiplied
16
by $1,000; and
17
(B) an amount equal to the total amount
18
of reimbursements from all payer sources to the
19
facility from January 1, 2019, to April 1, 2019.
20
(2) PAYMENTS.—The Secretary shall make pay-
21
ments under grants awarded to eligible facilities
22
under this section in the amount of the allotments
23
described in paragraph (1).
24
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•S 3559 IS
(3) TIME
OF
GRANT.—A one time payment
1
shall be made under a grant awarded under this sec-
2
tion not later than 14 days after the date of enact-
3
ment of this Act.
4
(d) ELIGIBLE FACILITIES.—
5
(1) IN GENERAL.—To be eligible to receive a
6
grant under subsection (b), a Medicare participating
7
health care facility shall submit to the Secretary an
8
application described in paragraph (2).
9
(2) APPLICATION.—An application under this
10
paragraph shall be submitted to the Secretary not
11
later that 180 days after the date of enactment of
12
this Act and shall contain such information that the
13
Secretary may require, including—
14
(A) a certification that—
15
(i) the facility will suffer financial
16
losses as a result of the COVID-19 emer-
17
gency; and
18
(ii) in the absence of an emergency
19
grant under this section, the facility would
20
be forced to either reduce staffing or oper-
21
ations;
22
(B) an assurance that the amount re-
23
quested under the grant exceeds 130 percent of
24
the amount of revenue collected by the facility
25
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•S 3559 IS
during the same period of the year preceding
1
the year for which the request under this sec-
2
tion is made;
3
(C) the amount of spending incurred by
4
the facility as a result of the COVID-19 emer-
5
gency;
6
(D) a description on how the facility will
7
use grant funds; and
8
(E) an assurance that the facility followed
9
the Secretary’s recommendations related to the
10
COVID-19 emergency.
11
(e) RECONCILIATION.—
12
(1) IN GENERAL.—Not later than 2 years after
13
the date on which the COVID-19 emergency ends
14
(as determined by the Secretary), the Secretary shall
15
promulgate regulations under which a facility that
16
receives an emergency grant under this section shall
17
reconcile the amount of the emergency grant with—
18
(A) the entire amount of the grant allotted
19
to the facility in the case of a facility that was
20
determined not to be eligible under subsection
21
(d);
22
(B) any reimbursements received by the
23
facility from third parties for services provided
24
during such emergency; and
25
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(C) any portion of the grant funds that ex-
1
ceeds 130 percent of the amount of revenue col-
2
lected by the facility during the same 90-day
3
period of the year preceding the year for which
4
the grant is being made as determined through
5
such reconciliation to have been recovered by
6
the facility through third-party payors, in addi-
7
tion to any additional spending incurred by the
8
facility as a result of the COVID-19 emergency,
9
with the Federal Government.
10
(2) RECOUPMENT.—The regulations under this
11
subsection shall include procedures through which
12
the Federal Government may recoup any portion of
13
grant funds described in paragraph (1).
14
(f) LIMITATIONS ON USE OF FUNDS.—
15
(1) CONSTRUCTION OF FACILITIES.—
16
(A) LIMITATIONS.—Grants awarded under
17
this section shall not be used by the facility for
18
the purchase or improvement of land, or the
19
purchase, construction, or permanent improve-
20
ment of any building.
21
(B) WAIVER.—The Secretary may wave
22
the limitation contained in subparagraph (A)
23
upon a facility request for such a waiver, if the
24
Secretary finds that the request describes cir-
25
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•S 3559 IS
cumstances that justify the purchase of land or
1
the constrictive of facilities (or the making of
2
permanent
improvements)
related
to
the
3
COVID-19 emergency.
4
(2) POLITICAL
ACTIVITIES.—Grants awarded
5
under this section shall not be used in a manner in-
6
volving the use of grant funds, provisions of services,
7
or the employment or assignment of personnel, in a
8
manner supporting or resulting in the identification
9
of such programs with any partisan or nonpartisan
10
political activity or any political activity associated
11
with a candidate, or contending faction or group, in
12
an election for public or party office.
13
(g) LEGAL ACTION.—A facility that receives an emer-
14
gency grant under this section shall be prohibited from
15
commencing any legal action against a patients to recover
16
any costs associated with care provided to the patient dur-
17
ing the COVID-19 emergency.
18
(h) DEFINITIONS.—In this section:
19
(1)
COVID-19
EMERGENCY.—The
term
20
‘‘COVID-19 emergency’’ means the national emer-
21
gency declared by the President under the National
22
Emergencies Act (50 U.S.C. 1601 et seq.) with re-
23
spect to the Coronavirus Disease 2019 (COVID-19).
24
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(2) MEDICARE
PARTICIPATING
HEALTH
CARE
1
FACILITY.—The
terms
‘‘Medicare
participating
2
health care facility’’ and ‘‘facility’’ mean—
3
(A) an entity designated as—
4
(i) a Critical Access Hospital under
5
section 485 of subpart F of title 42, Code
6
of Federal Regulations; or
7
(ii) a subsection (d) hospital (as de-
8
fined in paragraph (1)(B) of section
9
1886(d)(1)(B) of the Social Security Act
10
(42 U.S.C. 1395ww(d)(1)(B))) that is lo-
11
cated in a rural area (as defined in para-
12
graph (2)(D) of such section); and
13
(B) a provider of services enrolled in the
14
Medicare program under section 1866(j) of the
15
Social Security Act (42 U.S.C. 1395cc(j)).
16
(3) SECRETARY.—The term ‘‘Secretary’’ means
17
the Secretary of Health and Human Services.
18
(i) AUTHORIZATION OF APPROPRIATIONS.—There is
19
authorized to be appropriated such sums as may be nec-
20
essary to carry out this section.
21
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SEC. 3. REIMBURSEMENT ADJUSTMENT FOR SWING BED
1
PROGRAM.
2
(a) PURPOSE.—It is the purpose of this section to
3
improve the health care system to prepare and respond
4
to the COVID-19 emergency (as defined in section 2).
5
(b) ADJUSTMENT.—The Secretary of Health and
6
Human Services, acting through the Administrator of the
7
Centers for Medicare & Medicaid Services, shall increase
8
reimbursements for rural hospitals under the swing bed
9
program for the duration of the COVID-19 emergency.
10
(c) AMOUNT.—The amount of an increase under sub-
11
section (b) shall equal 20 percent of the amount of the
12
swing bed reimbursement that a rural hospital involved
13
would otherwise receive under the swing bed program.
14
(d) TERMINATION.—This section shall not apply be-
15
ginning on the date that is 30 days after the date on which
16
the COVID-19 emergency ends (as determined by the Sec-
17
retary).
18
SEC. 4. EMERGENCY GRANTS FOR PHYSICIANS’ AND
19
HEALTH CARE PROVIDERS’ PRACTICES.
20
(a) PURPOSE.—It is the purpose of this section to
21
provide funding to provide immediate relief and stabiliza-
22
tion for physicians’ and health care providers’ practices
23
through emergency grants to prepare and respond to the
24
COVID-19 emergency.
25
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•S 3559 IS
(b) AMENDMENT.—Title III of the Public Health
1
Service Act is amended by inserting after section 330A–
2
1 (42 U.S.C. 254c–1a) the following:
3
‘‘SEC. 330A–2. EMERGENCY GRANTS FOR PHYSICIANS’ AND
4
HEALTH CARE PROVIDERS’ PRACTICES.
5
‘‘(a) IN GENERAL.—The Secretary shall establish a
6
program to support physicians’ and health care providers’
7
practices by awarding emergency grants to eligible health
8
care practices and ambulatory surgery centers.
9
‘‘(b) ALLOTMENTS AND PAYMENTS.—
10
‘‘(1) ALLOTMENTS.—The Secretary shall, from
11
amounts appropriated under subsection (e), allot to
12
each eligible health care practice or ambulatory sur-
13
gery center an amount equal to the actual payroll
14
for the eligible health care practice or ambulatory
15
surgery center during the period beginning January
16
1, 2019, and ending April 1, 2019.
17
‘‘(2) PAYMENTS.—The Secretary shall make
18
payments under grants awarded under this section
19
to each eligible health care practice or ambulatory
20
surgery center in the amount of the allotment de-
21
scribed in paragraph (1) with respect to each such
22
practice or center.
23
‘‘(3) TIME OF GRANT.—Not later than 14 days
24
after the date of enactment of this section, the Sec-
25
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•S 3559 IS
retary shall make a one-time payment under a grant
1
under this section to each eligible health care prac-
2
tice or ambulatory surgery center.
3
‘‘(c) UTILIZATION OF PAYMENTS.—Payments made
4
under subsection (b) shall be utilized, with respect to the
5
grantee involved, to compensate—
6
‘‘(1) all hourly staff up to $25 per hour and
7
salaried staff up to $75,000 in full; and
8
‘‘(2) all hourly staff above $25 per hour and
9
salaried staff above $75,000 at a rate of $25 per
10
hour or $75,000 in annual salary.
11
‘‘(d) DEFINITIONS.—In this section:
12
‘‘(1) AMBULATORY
SURGERY
CENTER.—The
13
term ‘ambulatory surgery center’ has the meaning
14
given such term in section 1833(i) of the Social Se-
15
curity Act.
16
‘‘(2) ELIGIBLE HEALTH CARE PRACTICE.—The
17
term ‘eligible health care practice’ means a corpora-
18
tion, limited liability company, or unincorporated
19
personal entity that provides health care services of
20
a physician or a health care provider as licensed
21
under State law.
22
‘‘(3) HEALTH
CARE
PROVIDER.—The term
23
‘health care provider’ means an individual providing
24
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•S 3559 IS
health care services under State law as determined
1
by the Secretary.
2
‘‘(4) PHYSICIAN.—The term ‘physician’ means
3
an individual that meets the definition under section
4
1861(r) of the Social Security Act.
5
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There
6
is authorized to be appropriated such sums as may be nec-
7
essary to carry out this section.’’.
8
SEC. 5. EMERGENCY LOW-INTEREST LOANS FOR PHYSI-
9
CIANS’ AND HEALTH CARE PROVIDERS’ PRAC-
10
TICES.
11
The Small Business Act is amended by inserting after
12
section 32 (15 U.S.C. 657b) the following:
13
‘‘SEC. 33. 2020 EMERGENCY LOW-INTEREST LOANS FOR
14
PHYSICIANS’ AND HEALTH CARE PROVIDERS’
15
PRACTICES.
16
‘‘(a) PURPOSE.—It is the purpose of this section to
17
provide low-interest loans for physicians’ and health care
18
providers’ practices or ambulatory surgery centers, which
19
as a result of the COVID-19 emergency, have suffered a
20
significant financial impact.
21
‘‘(b) LOW-INTEREST
LOANS.—The Administrator
22
shall provide any eligible health care practice or ambula-
23
tory surgery center, which as a result of the COVID-19
24
emergency, has suffered a significant financial impact, a
25
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loan in such amount as may be necessary to enable such
1
enterprise to maintain or resume operations in order to
2
assist in maintaining and restoring the economic viability
3
of the practice or center. Loans authorized by this section
4
shall be made without regard to limitations on the size
5
of loans which may otherwise be imposed by any other
6
provision of law or regulations promulgated pursuant
7
thereto.
8
‘‘(c) INTEREST.—Any loan made under this section
9
shall be subject to not to exceed .25 percent interest, and
10
the President, if determined necessary, may defer pay-
11
ments of principal for a period not to exceed 3 years after
12
the date of such loan.
13
‘‘(d) DEFERRED INTEREST ACCRUAL.—Interest on a
14
loan under this section shall not begin to accrue until the
15
date th
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