S. 3559 — Immediate Relief for Rural Facilities and Providers Act of 2020

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Full text

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-
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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). 
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(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 
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(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; 
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(B) an assurance that the amount re-
23
quested under the grant exceeds 130 percent of 
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the amount of revenue collected by the facility 
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during the same period of the year preceding 
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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.— 
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(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); 
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(B) any reimbursements received by the 
23
facility from third parties for services provided 
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during such emergency; and 
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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). 
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(f) LIMITATIONS ON USE OF FUNDS.— 
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(1) CONSTRUCTION OF FACILITIES.— 
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(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) 
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upon a facility request for such a waiver, if the 
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Secretary finds that the request describes cir-
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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. 
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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. 
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(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 
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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 that is 24 months after the date on which the 
16
COVID-19 emergency officially ends (as determined by 
17
the Administrator). 
18
‘‘(e) OTHER FEDERAL ASSISTANCE.—Loans made 
19
under this section shall be in addition to any other Federal 
20
emergency assistance available, except that such other as-
21
sistance may be adjusted or modified to the extent deter-
22
mined appropriate by the Administrator. 
23
‘‘(f) DEFINITIONS.—In this section: 
24
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‘‘(1) AMBULATORY
SURGERY
CENTER.—The 
1
term ‘ambulatory surgery center’ has the meaning 
2
given such term in section 1833(i) of the Social Se-
3
curity Act. 
4
‘‘(2) ELIGIBLE HEALTH CARE PRACTICE.—The 
5
term ‘eligible health care practice’ means a corpora-
6
tion, limited liability company, or unincorporated 
7
personal entity that provides health care services of 
8
a physician or a health care provider as licensed 
9
under State law. 
10
‘‘(3) HEALTH
CARE
PROVIDER.—The term 
11
‘health care provider’ means an individual providing 
12
health care services under State law as determined 
13
by the Administrator. 
14
‘‘(4) PHYSICIAN.—The term ‘physician’ means 
15
an individual that meets the definition under section 
16
1861(r) of the Social Security Act. 
17
‘‘(g) SUNSET.—Low-interest loans under this section 
18
to eligible health care practices and ambulatory surgery 
19
centers shall only be made during the duration of the 
20
COVID-19 emergency. 
21
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
22
is authorized to be appropriated such sums as may be nec-
23
essary to carry out this section.’’. 
24
Æ 
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