I 

117TH CONGRESS 

1ST SESSION H. R. 1999 

To delay and offset the sequester under the Statutory Pay-As-You-Go Act 

of 2010 as a result of the enactment of the American Rescue Plan 

Act of 2021, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 18, 2021 

Mr. SMITH of Missouri (for himself, Mr. BRADY, Mr. BURGESS, Mr. COMER, 

Mr. HARRIS, Mr. WENSTRUP, and Mrs. RODGERS of Washington) introduced the following bill; which was referred to the Committee on Ways 

and Means, and in addition to the Committees on Energy and Commerce, 

Oversight and Reform, the Budget, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To delay and offset the sequester under the Statutory PayAs-You-Go Act of 2010 as a result of the enactment 

of the American Rescue Plan Act of 2021, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protect Seniors and 

5 Cut Waste Act’’. 


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1 SEC. 2. PAYGO ACT SEQUESTER. 

2 The budgetary effects of the American Rescue Plan 

3 Act of 2021 shall not be counted for purposes of deter4 mining whether a sequester occurs under the report issued 

5 after Congress adjourns to end the 1st session of the 

6 117th Congress and during January 2022 under section 

7 5 of the Statutory Pay-As-You-Go Act of 2010. 

8 SEC. 3. SUPPLEMENTAL APPROPRIATIONS FOR THE PUB9 LIC HEALTH AND SOCIAL SERVICES EMER10 GENCY FUND. 

11 (a) SUPPLEMENTAL APPROPRIATION.—There is ap12 propriated, out of any amounts in the Treasury not other13 wise appropriated, for an additional amount for ‘‘Public 

14 Health and Social Services Emergency Fund’ ’’, 

15 $12,300,000,000, to remain available until expended, to 

16 prevent, prepare for, and respond to coronavirus, domesti17 cally or internationally, which shall be for necessary ex18 penses to reimburse, through grants or other mechanisms, 

19 eligible health care providers for health care related ex20 penses or lost revenues that are attributable to 

21 coronavirus. 

22 (b) CONDITIONS.—The following conditions shall 

23 apply with respect to funds appropriated by subsection 

24 (a): 

25 (1) Such funds may not be used to reimburse 

26 expenses or losses that have been reimbursed from 


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1 other sources or that other sources are obligated to 

2 reimburse. 

3 (2) Recipients of payments under this section 

4 shall submit reports and maintain documentation as 

5 the Secretary of Health and Human Services deter6 mines are needed to ensure compliance with condi7 tions that are imposed by this subsection for such 

8 payments, and such reports and documentation shall 

9 be in such form, with such content, and in such time 

10 as the Secretary may prescribe for such purpose. 

11 (3) The term ‘‘eligible health care providers’’ 

12 means public entities, Medicare or Medicaid enrolled 

13 suppliers and providers, and such for-profit entities 

14 and not-for-profit entities not otherwise described in 

15 this paragraph as the Secretary may specify, within 

16 the United States (including territories), that pro17 vide diagnoses, testing, or care for individuals with 

18 possible or actual cases of COVID–19. 

19 (4) The Secretary shall, on a rolling basis, re20 view applications and make payments under this sec21 tion. 

22 (5) Funds appropriated under this section shall 

23 be available for building or construction of tem24 porary structures, leasing of properties, medical sup25 plies and equipment including personal protective 


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1 equipment and testing supplies, increased workforce 

2 and trainings, emergency operation centers, retro3 fitting facilities, and surge capacity. 

4 (6) In this section, the term ‘‘payment’’ means 

5 a pre-payment, prospective payment, or retrospective 

6 payment, as determined appropriate by the Sec7 retary. 

8 (7) Payments under this section shall be made 

9 in consideration of the most efficient payment sys10 tems practicable to provide emergency payment. 

11 (8) To be eligible for a payment under this sec12 tion, an eligible health care provider shall submit to 

13 the Secretary an application that includes a state14 ment justifying the need of the provider for the pay15 ment and the eligible health care provider shall have 

16 a valid tax identification number. 

17 (9) For any reimbursement by the Secretary 

18 from the Provider Relief Fund to an eligible health 

19 care provider that is a subsidiary of a parent organi20 zation, the parent organization may, allocate 

21 (through transfers or otherwise) all or any portion 

22 of such reimbursement among the subsidiary eligible 

23 health care providers of the parent organization, in24 cluding reimbursements referred to by the Secretary 

25 as ‘‘Targeted Distribution’’ payments, among subVerDate Sep 11 2014 01:55 May 13, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1999.IH H1999

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1 sidiary eligible health care providers of the parent 

2 organization, except that responsibility for reporting 

3 the reallocated reimbursement shall remain with the 

4 original recipient of such reimbursement. 

5 (10) For any reimbursement from the Provider 

6 Relief Fund to an eligible health care provider for 

7 health care related expenses or lost revenues that 

8 are attributable to coronavirus (including reimburse9 ments made before the date of the enactment of this 

10 Act), such provider may calculate such lost revenues 

11 using the Frequently Asked Questions guidance re12 leased by the Department of Health and Human 

13 Services in June 2020, including the difference be14 tween such provider’s budgeted and actual revenue 

15 budget if such budget had been established and ap16 proved prior to March 27, 2020. 

17 (11) Of the amount made available in the third 

18 paragraph under the heading ‘‘Department of 

19 Health and Human Services—Office of the Sec20 retary—Public Health and Social Services Emer21 gency Fund’’ in Public Law 116–136, not less than 

22 85 percent of the unobligated balances available as 

23 of the date of enactment of this Act and of any 

24 funds recovered from health care providers after the 

25 date of enactment of this Act shall be for any sucVerDate Sep 11 2014 01:55 May 13, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1999.IH H1999

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1 cessor to the Phase 3 General Distribution allocation 

2 to make payments to eligible health care providers 

3 based on applications that consider financial losses 

4 and changes in operating expenses occurring in fis5 cal year 2021 that are attributable to coronavirus. 

6 (12) Not later than 3 years after final pay7 ments are made under this section, the Office of In8 spector General of the Department of Health and 

9 Human Services shall transmit a final report on 

10 audit findings with respect to this program to the 

11 Committees on Appropriations of the House of Rep12 resentatives and the Senate. 

13 (13) Nothing in this section limits the authority 

14 of the Inspector General or the Comptroller General 

15 to conduct audits of interim payments at an earlier 

16 date. 

17 (14) Not later than 60 days after the date of 

18 enactment of this Act, the Secretary of Health and 

19 Human Services shall provide a report to the Com20 mittees on Appropriations of the House of Rep21 resentatives and the Senate on the obligation of 

22 funds, including obligations to such eligible health 

23 care providers, summarized by State of the payment 

24 receipt. Such report shall be updated and submitted 


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1 to such Committees every 60 days until funds are 

2 expended. 

3 (c) EMERGENCY DESIGNATIONS.— 

4 (1) Amounts repurposed in subsection (b) that 

5 were previously designated by the Congress as an 

6 emergency requirement pursuant to the Balanced 

7 Budget and Emergency Deficit Control Act of 1985 

8 are designated by the Congress as an emergency re9 quirement pursuant to section 251(b)(2)(A)(i) of the 

10 Balanced Budget and Emergency Deficit Control 

11 Act of 1985. 

12 (2) The amount appropriated by subsection (a) 

13 is designated by the Congress as being for an emer14 gency requirement pursuant to section 

15 251(b)(2)(A)(i) of the Balanced Budget and Emer16 gency Deficit Control Act of 1985. 

17 (3) Each amount designated in this Act by the 

18 Congress as an emergency requirement pursuant to 

19 section 251(b)(2)(A)(i) of the Balanced Budget and 

20 Emergency Deficit Control Act of 1985 shall be 

21 available only if the President subsequently so des22 ignates all such amounts and transmits such des23 ignations to the Congress. 

24 (d) APPLICATION OF PROVISIONS.—Amounts appro25 priated pursuant to this section and pursuant to title II 


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1 of Public Law 117–2 shall be subject to the requirements 

2 contained in Public Law 116–260 for funds for programs 

3 authorized under sections 330 through 340 of the Public 

4 Health Service Act. 

5 SEC. 4. CORONAVIRUS STATE FISCAL RECOVERY FUND AD6 JUSTMENT. 

7 (a) IN GENERAL.—Section 602 of the Social Security 

8 Act is amended— 

9 (1) in subsection (a)(1), by striking 

10 ‘‘$219,800,000,000’’ and inserting 

11 ‘‘$79,800,000,000’’; and 

12 (2) in subsection (b)(3), by striking 

13 ‘‘$195,300,000,000’’ and inserting 

14 ‘‘$55,300,000,000’’. 

15 (b) EFFECTIVE DATE.—The amendments made by 

16 subsection (a) shall take effect as if included in the enact17 ment of the American Rescue Plan Act of 2021. 

18 SEC. 5. TECHNICAL CORRECTIONS. 

19 (a) RURAL HEALTH CLINIC PAYMENTS.— 

20 (1) IN GENERAL.—Section 1833(f)(3) of the 

21 Social Security Act (42 U.S.C. 1395l(f)(3)) is 

22 amended— 

23 (A) in subparagraph (A)— 

24 (i) in clause (i), by striking subclauses 

25 (I) and (II) and inserting the following: 


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1 ‘‘(I) with respect to a rural health 

2 clinic that had a per visit payment amount 

3 established for services furnished in 

4 2020— 

5 ‘‘(aa) the per visit payment 

6 amount applicable to such rural 

7 health clinic for rural health clinic 

8 services furnished in 2020, increased 

9 by the percentage increase in the MEI 

10 applicable to primary care services 

11 furnished as of the first day of 2021; 

12 or 

13 ‘‘(bb) the limit described in para14 graph (2)(A); and 

15 ‘‘(II) with respect to a rural health 

16 clinic that did not have a per visit payment 

17 amount established for services furnished 

18 in 2020— 

19 ‘‘(aa) the per visit payment 

20 amount applicable to such rural 

21 health clinic for rural health clinic 

22 services furnished in 2021; or 

23 ‘‘(bb) the limit described in para24 graph (2)(A); and’’; and 


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1 (ii) in clause (ii)(I), by striking 

2 ‘‘under clause (i)(I)’’ and inserting ‘‘under 

3 subclause (I) or (II) of clause (i), as appli4 cable,’’; and 

5 (B) in subparagraph (B)— 

6 (i) in the matter preceding clause (i), 

7 by striking ‘‘2019, was’’ and inserting 

8 ‘‘2020’’; 

9 (ii) in clause (i), by inserting ‘‘was’’ 

10 after ‘‘(i)’’; and 

11 (iii) by striking clause (ii) and insert12 ing the following: 

13 ‘‘(ii)(I) was enrolled under section 1866(j) 

14 (including temporary enrollment during the 

15 emergency period described in section 

16 1135(g)(1)(B) for such period); or 

17 ‘‘(II) submitted an application for enroll18 ment under section 1866(j) (or requested such 

19 a temporary enrollment for such period) that 

20 was received not later than December 31, 

21 2020.’’. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall take effect as if included in 

24 the enactment of the Consolidated Appropriations 

25 Act, 2021 (Public Law 116–260). 


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1 (b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS

2 WITH HIGH DISPROPORATIONATE SHARE.—Effective as 

3 if included in the enactment of section 203(a) of title II 

4 of division CC of Public Law 116–260, subsection (g) of 

5 section 1923 of the Social Security Act (42 U.S.C. 1396r– 

6 4) amended by such section 203(a) is amended by adding 

7 at the end the following new paragraph: 

8 ‘‘(3) ADDITIONAL AMOUNT FOR CERTAIN HOS9 PITALS WITH HIGH DISPROPORATIONATE SHARE.— 

10 ‘‘(A) IN GENERAL.—In the case of a hos11 pital with high disproportionate share (as de12 fined in subparagraph (B)) located in a State 

13 referenced in subsection (e) of section 4721 of 

14 the Balanced Budget Act of 1997, a payment 

15 adjustment during a State fiscal year shall be 

16 considered consistent with subsection (c) if the 

17 payment adjustment does not exceed 175 per18 cent of the costs of furnishing hospital services 

19 during the year, but only if the Governor of the 

20 State certifies to the satisfaction of the Sec21 retary that the hospital’s applicable minimum 

22 amount is used for health services during the 

23 year. In determining the amount that is used 

24 for such services during a year, there shall be 

25 excluded any amounts received under the Public 


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1 Health Service Act, title V, title XVIII, or from 

2 third party payors (not including the State plan 

3 under this title) that are used for providing 

4 such services during the year. 

5 ‘‘(B) HOSPITAL WITH HIGH

6 DISPROPORATIONATE SHARE DEFINED.—In 

7 subparagraph (A), a hospital is a ‘hospital with 

8 high disproportionate share’ if— 

9 ‘‘(i) the hospital is owned or operated 

10 by the State (or by an instrumentality or 

11 a unit of government within the State); 

12 and 

13 ‘‘(ii) the hospital— 

14 ‘‘(I) meets the requirement de15 scribed in subparagraphs (A) or (B) 

16 of subsection (b)(1); or 

17 ‘‘(II) has the largest number of 

18 inpatient days attributable to individ19 uals entitled to benefits under the 

20 State plan of any hospital in such 

21 State for the previous fiscal year. 

22 ‘‘(C) APPLICABLE MINIMUM AMOUNT DE23 FINED.—In subparagraph (A), the ‘applicable 

24 minimum amount’ for a hospital for a fiscal 

25 year is equal to the difference between the 


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1 amount of the hospital’s payment adjustment 

2 for the fiscal year and the costs to the hospital 

3 of furnishing hospital services described in 

4 paragraph (1)(A) during the fiscal year.’’. 

5 SEC. 6. INDIVIDUALS NOT LAWFULLY PRESENT IN UNITED 

6 STATES PRECLUDED FROM 2021 RECOVERY 

7 REBATES. 

8 (a) IN GENERAL.—Section 6428B(c) of the Internal 

9 Revenue Code of 1986, as added by the American Rescue 

10 Plan Act of 2021, is amended by striking ‘‘and’’ at the 

11 end of paragraph (2), by redesignating paragraph (3) as 

12 paragraph (4), and by inserting after paragraph (2) the 

13 following new paragraph: 

14 ‘‘(3) any individual who was not lawfully 

15 present in the United States as of the date of the 

16 enactment of the American Rescue Plan Act of 

17 2021, and’’. 

18 (b) EFFECTIVE DATE.—The amendments made by 

19 this section shall take effect as if included in the enact20 ment of section 9601 of the American Rescue Plan Act 

21 of 2021. 

22 SEC. 7. INCARCERATED INDIVIDUALS PRECLUDED FROM 

23 2021 RECOVERY REBATES. 

24 (a) IN GENERAL.—Section 6428B(c) of the Internal 

25 Revenue Code of 1986, as added by the American Rescue 


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1 Plan Act of 2021 and amended by the preceding provi2 sions of this Act, is amended by striking ‘‘and’’ at the 

3 end of paragraph (3), by redesignating paragraph (4) as 

4 paragraph (5), and by inserting after paragraph (3) the 

5 following new paragraph: 

6 ‘‘(4) any individual who was incarcerated on the 

7 date of the enactment of the American Rescue Plan 

8 Act of 2021, and’’. 

9 (b) EFFECTIVE DATE.—The amendments made by 

10 this section shall take effect as if included in the enact11 ment of section 9601 of the American Rescue Plan Act 

12 of 2021. 

13 SEC. 8. REQUIRING A SOCIAL SECURITY NUMBER TO RE14 CEIVE COBRA CONTINUATION COVERAGE. 

15 (a) IN GENERAL.—Section 9501(a)(3) of the Amer16 ican Rescue Plan Act of 2021 (Public Law 117–2) is 

17 amended— 

18 (1) in subparagraph (A), by striking at the end 

19 ‘‘and’’; 

20 (2) in subparagraph (B), by striking the period 

21 at the end and inserting ‘‘; and’’; and 

22 (3) by adding at the end the following new sub23 paragraph: 

24 ‘‘(C) has been issued a social security 

25 number (as defined in section 24(h)(7) of the 


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1 Internal Revenue Code of 1986) by the Social 

2 Security Administration.’’. 

3 (b) EFFECTIVE DATE.—The amendment made by 

4 subsection (a) shall take effect as if included in the enact5 ment of section 9501 of the American Rescue Plan Act 

6 of 2021. 

7 SEC. 9. RESCISSIONS OF AMERICAN RESCUE PLAN ACT OF 

8 2021 FUNDS. 

9 Of the funds appropriated by the American Rescue 

10 Plan Act of 2021 (Public Law 117–2), all unobligated 

11 funds available under the following provisions of such Act 

12 are hereby rescinded: 

13 (1) Section 2021 (relating to the National En14 dowment for the Arts). 

15 (2) Section 2022 (relating to the National En16 dowment for the Humanities). 

17 (3) Section 4001 (relating to the Emergency 

18 Federal Employee Leave Fund). 

Æ 


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