(2) If this Act is enacted after September 30, 
2020, this section shall be applied as if it were in 
effect on September 30, 2020. 
SEC. 172. Amounts made available by section 101 to 
the Department of Housing and Urban Development for 
‘‘Housing Programs—Housing for the Elderly’’ may be 
apportioned up to the rate for operations necessary to— 
(1) maintain project rental assistance for the elderly 
under section 202(c)(2) of the Housing Act of 1959 (12 
U.S.C. 1701q(2)), including making amendments to con-
tracts for such assistance and renewing expiring contracts 
for such assistance for up to a 1-year term; and 
(2) be available to make awards to existing 
grantees to continue, without competition, dem-
onstration programs to test housing with services 
models for the elderly that demonstrate the potential 
to delay or avoid the need for nursing home care. 
SEC. 173. Amounts provided by section 111 to the 
Department of Agriculture for ‘‘Corporations—Com-
modity Credit Corporation Fund—Reimbursement for Net 
Realized Losses’’ may be used, prior to the completion of 
the report described in section 2 of the Act of August 17, 
1961 (15 U.S.C. 713a-11), to reimburse the Commodity 
Credit Corporation for net realized losses sustained, but 
not previously reimbursed, as of September 17, 2020.
This Act may be cited as the ‘‘Continuing Appropria-
tions Act, 2021’’. 
DIVISION B—SURFACE TRANS-
PORTATION 
PROGRAM 
EX-
TENSION 
TITLE I—SURFACE 
TRANSPORTATION PROGRAMS 
SEC. 1101. EXTENSION OF FEDERAL SURFACE TRANSPOR-
TATION PROGRAMS. 
(a) IN GENERAL.—Except as otherwise provided in 
this division, the requirements, authorities, conditions, eli-
gibilities, limitations, and other provisions authorized 
under the covered laws, which would otherwise expire on 
or cease to apply after September 30, 2020, are incor-
porated by reference and shall continue in effect through 
September 30, 2021. 
(b) AUTHORIZATION OF APPROPRIATIONS.— 
(1) HIGHWAY TRUST FUND.— 
(A) HIGHWAY ACCOUNT.—There is author-
ized to be appropriated from the Highway Ac-
count for fiscal year 2021, for each program 
with respect to which amounts are authorized 
to be appropriated from such account for fiscal 
year 2020, an amount equal to the amount au-
thorized for appropriation with respect to the
program from such account under the covered 
laws for fiscal year 2020. 
(B) MASS
TRANSIT
ACCOUNT.—There is 
authorized to be appropriated from the Mass 
Transit Account for fiscal year 2021, for each 
program with respect to which amounts are au-
thorized to be appropriated from such account 
for fiscal year 2020, an amount equal to the 
amount authorized for appropriation with re-
spect to the program from such account under 
the covered laws for fiscal year 2020. 
(2) GENERAL FUND.—There is authorized to be 
appropriated for fiscal year 2021, for each program 
under the covered laws with respect to which 
amounts are authorized to be appropriated for fiscal 
year 2020 from an account other than the Highway 
Account or the Mass Transit Account, an amount 
that is not less than the amount authorized for ap-
propriation with respect to the program under the 
covered laws for fiscal year 2020. 
(c) USE OF FUNDS.—Amounts authorized to be ap-
propriated for fiscal year 2021 with respect to a program 
under subsection (b) shall be distributed, administered, 
limited, and made available for obligation in the same 
manner as amounts authorized to be appropriated with re-
spect to the program for fiscal year 2020 under the cov-
ered laws. 
(d) OBLIGATION LIMITATION.—A program for which 
amounts are authorized to be appropriated under sub-
section (b)(1) shall be subject to a limitation on obliga-
tions for fiscal year 2021 in the same amount and in the 
same manner as the limitation applicable with respect to 
the program for fiscal year 2020. 
(e) DEFINITIONS.—In this section: 
(1) COVERED LAWS.—The term ‘‘covered laws’’ 
means the following: 
(A) Titles I, II, III, IV, V, VI, VII, VIII, 
XI, and XXIV of the FAST Act (Public Law 
114–94). 
(B) Division A, division B, subtitle A of 
title I and title II of division C, and division E 
of MAP–21 (Public Law 112–141). 
(C) Titles I, II, and III of the SAFETEA– 
LU Technical Corrections Act of 2008 (Public 
Law 110–244). 
(D) Titles I, II, III, IV, V, and VI of 
SAFETEA–LU (Public Law 109–59). 
(E) Titles I, II, III, IV, and V of the 
Transportation Equity Act for the 21st Century 
(Public Law 105–178).
(F) Titles II, III, and IV of the National 
Highway System Designation Act of 1995 
(Public Law 104–59). 
(G) Titles I, II, III, IV, V, and VI of the 
Intermodal Surface Transportation Efficiency 
Act of 1991 (Public Law 102–240). 
(H) Title 23, United States Code. 
(I) Sections 116, 117, 330, 5128, 5505, 
and 24905 and chapters 53, 139, 303, 311, 
313, 701, and 702 of title 49, United States 
Code. 
(2) HIGHWAY ACCOUNT.—The term ‘‘Highway 
Account’’ means the portion of the Highway Trust 
Fund that is not the Mass Transit Account. 
(3) MASS TRANSIT ACCOUNT.—The term ‘‘Mass 
Transit Account’’ means the portion of the Highway 
Trust Fund established under section 9503(e)(1) of 
the Internal Revenue Code of 1986. 
SEC. 1102. NATIONALLY SIGNIFICANT FREIGHT AND HIGH-
WAY PROJECTS. 
Section 117(d)(2)(A) of title 23, United States Code, 
is amended in the matter preceding clause (i)— 
(1) by striking ‘‘$500,000,000’’ and inserting 
‘‘$600,000,000’’; and 
(2) by striking ‘‘2020’’ and inserting ‘‘2021’’.
SEC. 1103. HIGHWAY SAFETY RESEARCH AND DEVELOP-
MENT. 
Section 403(h)(2) of title 23, United States Code, is 
amended— 
(1) by striking ‘‘2020’’ and inserting ‘‘2021’’; 
and 
(2) by striking ‘‘$21,248,000’’ and inserting 
‘‘$26,560,000’’. 
SEC. 1104. RAIL-RELATED PROVISIONS. 
(a) FEDERAL FUNDING FOR OPERATING LOSSES.— 
Section 24321 of title 49, United States Code, is amend-
ed— 
(1) by striking subsection (d); and 
(2) by redesignating subsection (e) as sub-
section (d). 
(b) DIRECT LOANS AND LOAN GUARANTEES.—Sec-
tion 502(b)(3) of the Railroad Revitalization and Regu-
latory Reform Act of 1976 (45 U.S.C. 822(b)(3)) is 
amended by striking ‘‘September 30, 2020’’ and inserting 
‘‘September 30, 2021’’. 
SEC. 1105. SUSPENSION FOR EXTENSION PERIOD OF AD-
JUSTMENTS 
FOR 
ADDITIONAL 
DEPOSITS 
INTO HIGHWAY TRUST FUND. 
Section 105 of title 23, United States Code, shall not 
apply to monies deposited into the Highway Trust Fund 
by this division.
SEC. 1106. PROHIBITION ON USE OF FUNDS. 
None of the funds authorized in this division or any 
other Act may be used to adjust apportionments for the 
Mass Transit Account of the Highway Trust Fund or 
withhold funds from apportionments for the Mass Transit 
Account of the Highway Trust Fund pursuant to section 
9503(e)(4) of the Internal Revenue Code of 1986 in fiscal 
year 2021. 
SEC. 1107. APPALACHIAN REGIONAL COMMISSION. 
(a) AUTHORIZATION OF APPROPRIATIONS.—Section 
14703 of title 40, United States Code, is amended— 
(1) in subsection (a)(5) by striking ‘‘2020’’ and 
inserting ‘‘2021’’; and 
(2) in subsection (c) by striking ‘‘2020’’ and in-
serting ‘‘2021’’. 
(b) TERMINATION.—Section 14704 of title 40, 
United States Code, is amended by striking ‘‘2020’’ and 
inserting ‘‘2021’’. 
TITLE II—TRUST FUNDS 
SEC. 1201. EXTENSION OF HIGHWAY TRUST FUND EXPENDI-
TURE AUTHORITY. 
Section 9503 of the Internal Revenue Code of 1986 
is amended— 
(1) by striking ‘‘October 1, 2020’’ in sub-
sections (b)(6)(B), (c)(1), and (e)(3) and inserting 
‘‘October 1, 2021’’; and
(2) by striking ‘‘FAST Act’’ in subsections 
(c)(1) and (e)(3) and inserting ‘‘Continuing Appro-
priations Act, 2021 and Other Extensions Act’’. 
SEC. 1202. SPORT FISH RESTORATION AND BOATING TRUST 
FUND. 
Section 9504 of the Internal Revenue Code of 1986 
is amended— 
(1) by striking ‘‘FAST Act’’ each place it ap-
pears in subsection (b)(2) and inserting ‘‘Continuing 
Appropriations Act, 2021 and Other Extensions 
Act’’; and 
(2) by striking ‘‘October 1, 2020’’ in subsection 
(d)(2) and inserting ‘‘October 1, 2021’’. 
SEC. 1203. LEAKING UNDERGROUND STORAGE TANK TRUST 
FUND. 
Section 9508(e)(2) of the Internal Revenue Code of 
1986 is amended by striking ‘‘October 1, 2020’’ and in-
serting ‘‘October 1, 2021’’. 
SEC. 1204. FURTHER ADDITIONAL TRANSFERS TO HIGHWAY 
TRUST FUND. 
Subsection (f) of section 9503 of the Internal Rev-
enue Code of 1986 is amended by redesignating paragraph 
(10) as paragraph (11) and by inserting after paragraph 
(9) the following new paragraph:
‘‘(10) 
FURTHER
TRANSFERS
TO
TRUST 
FUND.—Out of money in the Treasury not otherwise 
appropriated, there is hereby appropriated— 
‘‘(A) $10,400,000,000 to the Highway Ac-
count (as defined in subsection (e)(5)(B)) in 
the Highway Trust Fund; and 
‘‘(B) $3,200,000,000 to the Mass Transit 
Account in the Highway Trust Fund.’’. 
SEC. 1205. ADDITIONAL TRANSFER TO TRUST FUND. 
Section 9502 of the Internal Revenue Code of 1986 
is amended by adding at the end the following: 
‘‘(f) ADDITIONAL TRANSFER TO TRUST FUND.—Out 
of money in the Treasury not otherwise appropriated, 
there is hereby appropriated $14,000,000,000 to the Air-
port and Airway Trust Fund.’’.
DIVISION C—HEALTH 
EXTENDERS 
TITLE I—PUBLIC HEALTH 
EXTENDERS 
SEC. 2101. COMMUNITY HEALTH CENTERS, NATIONAL 
HEALTH SERVICE CORPS, AND TEACHING 
HEALTH CENTERS THAT OPERATE GRAD-
UATE MEDICAL EDUCATION PROGRAMS. 
(a) 
COMMUNITY
HEALTH
CENTERS.—Section 
10503(b)(1)(F) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(1)(F)) is amended— 
(1) by striking ‘‘$668,493,151’’ and inserting 
‘‘$789,041,096’’; and 
(2) by striking ‘‘November 30, 2020’’ and in-
serting ‘‘December 11, 2020’’. 
(b) NATIONAL HEALTH SERVICE CORPS.—Section 
10503(b)(2)(H) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(2)(H)) is amended— 
(1) by striking ‘‘$51,808,219’’ and inserting 
‘‘$61,150,685’’; and 
(2) by striking ‘‘November 30, 2020’’ and in-
serting ‘‘December 11, 2020’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)(1)) is amended— 
(1) by striking ‘‘$21,141,096’’ and inserting 
‘‘$24,953,425’’; and 
(2) by striking ‘‘November 30, 2020’’ and in-
serting ‘‘December 11, 2020’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to the amendments made by this section 
for the period beginning on October 1, 2020, through De-
cember 11, 2020, shall be subject to the requirements con-
tained in Public Law 116–94 for funds for programs au-
thorized under sections 330 through 340 of the Public 
Health Service Act (42 U.S.C. 254 through 256). 
(e) CONFORMING AMENDMENT.—Paragraph (4) of 
section 3014(h) of title 18, United States Code, is amend-
ed— 
(1) by striking ‘‘Social Services Act,,,’’ and in-
serting ‘‘Social Services Act,’’; and 
(2) by striking ‘‘and section 3831 of the 
CARES Act’’ and inserting ‘‘, section 3831 of the 
CARES Act, and section 2101 of the Continuing 
Appropriations Act, 2021 and Other Extensions 
Act’’.
SEC. 2102. DIABETES PROGRAMS. 
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIA-
BETES.—Section 330B(b)(2)(D) of the Public Health 
Service Act (42 U.S.C. 254c–2(b)(2)(D)) is amended— 
(1) by striking ‘‘$25,068,493’’ and inserting 
‘‘$29,589,042’’; and 
(2) by striking ‘‘November 30, 2020’’ and in-
serting ‘‘December 11, 2020’’. 
(b) SPECIAL DIABETES PROGRAMS FOR INDIANS.— 
Section 330C(c)(2)(D) of the Public Health Service Act 
(42 U.S.C. 254c–3(c)(2)(D)) is amended— 
(1) by striking ‘‘$25,068,493’’ and inserting 
‘‘$29,589,042’’; and 
(2) by striking ‘‘November 30, 2020’’ and in-
serting ‘‘December 11, 2020’’. 
SEC. 2103. PERSONAL RESPONSIBILITY EDUCATION. 
Section 513 of the Social Security Act (42 U.S.C. 
713) is amended by striking ‘‘November 30, 2020’’ each 
place it appears and inserting ‘‘December 11, 2020’’. 
SEC. 2104. SEXUAL RISK AVOIDANCE EDUCATION. 
Section 510 of the Social Security Act (42 U.S.C. 
710) is amended— 
(1) by striking ‘‘November 30, 2020’’ each 
place it appears and inserting ‘‘December 11, 
2020’’;
(2) in subsection (a)(2)(B)(i), by striking ‘‘such 
period, for fiscal year 2020’’ and inserting ‘‘the pe-
riod described in subparagraph (A), for fiscal year 
2021’’; and 
(3) in subsection (f)(2), by striking ‘‘and 2019’’ 
and inserting ‘‘through 2020,’’. 
SEC. 2105. RARE PEDIATRIC DISEASE PRIORITY REVIEW 
VOUCHER EXTENSION. 
Section 529(b)(5) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 360ff(b)(5)) is amended— 
(1) by striking ‘‘September 30, 2020’’ each 
place it appears and inserting ‘‘December 11, 
2020’’; and 
(2) in subparagraph (B), by striking ‘‘Sep-
tember 30, 2022’’ and inserting ‘‘December 11, 
2022’’. 
SEC. 2106. AUTHORIZATION TO ACCUMULATE EXCESS AN-
NUAL LEAVE. 
(a) IN GENERAL.—Notwithstanding section 219 of 
the Public Health Service Act (42 U.S.C. 210–1), a com-
missioned officer of the Public Health Service who, except 
for this section, would lose at the end of the fiscal year 
2020 accumulated annual leave in excess of 60 days, may 
retain such amounts of accumulated annual leave in excess 
of 60 days.
(b) USE OF EXCESS LEAVE.—Annual leave retained 
pursuant to subsection (a) shall be lost unless it is used 
by the officer no later than September 30, 2023. 
(c) APPLICABILITY.—This section shall not apply to 
an officer on terminal leave preceding separation, retire-
ment, or release from active duty, as of the effective date 
specified in subsection (d). 
(d) EFFECTIVE DATE.—This section shall become ef-
fective on the earlier of— 
(1) the date of the enactment of this Act; or 
(2) September 30, 2020. 
SEC. 2107. HHS SERVICES AND SUPPLY FUND. 
Effective as if included in the enactment of the para-
graph beginning with ‘‘Service and supply fund:’’ under 
the heading ‘‘Public Health Service’’ in the Federal Secu-
rity Agency Appropriation Act, 1946 (42 U.S.C. 231), 
such paragraph shall be applied with respect to any fiscal 
year as though the phrase ‘‘central services’’ referred to 
central services for any Federal agency. 
TITLE II—MEDICARE 
EXTENDERS 
SEC. 2201. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR UNDER THE MEDICARE PROGRAM. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)), as amended by section 3801
of the CARES Act (Public Law 116–136), is amended by 
striking ‘‘December 1, 2020’’ and inserting ‘‘December 
12, 2020’’. 
SEC. 2202. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)), as amended by section 3802 of the 
CARES Act (Public Law 116–136), is amended— 
(1) in the first sentence, by striking ‘‘November 
30, 2020’’ and inserting ‘‘December 11, 2020’’; and 
(2) in the third sentence, by striking ‘‘Novem-
ber 30, 2020’’ and inserting ‘‘December 11, 2020’’. 
SEC. 2203. EXTENSION OF FUNDING OUTREACH AND AS-
SISTANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE PROGRAMS.—Sub-
section (a)(1)(B) of section 119 of the Medicare Improve-
ments for Patients and Providers Act of 2008 (42 U.S.C. 
1395b–3 note), as amended by section 3306 of the Patient 
Protection and Affordable Care Act (Public Law 111– 
148), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112–240), section 1110 of the Path-
way for SGR Reform Act of 2013 (Public Law 113–67), 
section 110 of the Protecting Access to Medicare Act of 
2014 (Public Law 113–93), section 208 of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Public
Law 114–10), section 50207 of division E of the Bipar-
tisan Budget Act of 2018 (Public Law 115–123), section 
1402 of division B of the Continuing Appropriations Act, 
2020, and Health Extenders Act of 2019 (Public Law 
116– 59), section 1402 of division B of the Further Con-
tinuing Appropriations Act, 2020, and Further Health 
Extenders Act of 2019 (Public Law 116–69), section 103 
of division N of the Further Consolidated Appropriations 
Act, 2020 (Public Law 116–94), and section 3803 of the 
CARES Act (Public Law 116–136) is amended in clause 
(xi) by striking ‘‘November 30, 2020’’ and inserting ‘‘De-
cember 11, 2020’’. 
(b) 
AREA
AGENCIES
ON
AGING.—Subsection 
(b)(1)(B) of such section 119, as so amended, is amended 
in clause (xi) by striking ‘‘November 30, 2020’’ and insert-
ing ‘‘December 11, 2020’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119, as so amended, 
is amended in clause (xi) by striking ‘‘November 30, 
2020’’ and inserting ‘‘December 11, 2020’’. 
(d) CONTRACT WITH THE NATIONAL CENTER FOR 
BENEFITS
AND OUTREACH ENROLLMENT.—Subsection 
(d)(2) of such section 119, as so amended, is amended 
in clause (xi) by striking ‘‘November 30, 2020’’ and insert-
ing ‘‘December 11, 2020’’.
TITLE III—MEDICAID 
EXTENDERS 
SEC. 2301. EXTENSION OF MONEY FOLLOWS THE PERSON 
REBALANCING DEMONSTRATION. 
Section 6071(h)(1)(H) of the Deficit Reduction Act 
of 2005 (42 U.S.C. 1396a note), as inserted by section 
3811 of the CARES Act (Public Law 116–136), is amend-
ed by striking ‘‘November 30, 2020’’ and inserting ‘‘De-
cember 11, 2020’’. 
SEC. 2302. EXTENSION OF SPOUSAL IMPOVERISHMENT 
PROTECTIONS. 
(a) IN GENERAL.—Section 2404 of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 1396r–5 
note), as amended by section 3812 of the CARES Act 
(Public Law 116–136), is amended by striking ‘‘November 
30, 2020’’ and inserting ‘‘December 11, 2020’’. 
(b) RULE OF CONSTRUCTION.—Nothing in section 
2404 of Public Law 111–148 (42 U.S.C. 1396r–5 note) 
or section 1902(a)(17) or 1924 of the Social Security Act 
(42 U.S.C. 1396a(a)(17), 1396r–5) shall be construed as 
prohibiting a State from— 
(1) applying an income or resource disregard 
under a methodology authorized under section 
1902(r)(2) of such Act (42 U.S.C. 1396a(r)(2))—
(A) to the income or resources of an indi-
vidual 
described 
in 
section 
1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 
1396a(a)(10)(A)(ii)(VI)) (including a disregard 
of the income or resources of such individual’s 
spouse); or 
(B) on the basis of an individual’s need for 
home and community-based services authorized 
under subsection (c), (d), (i), or (k) of section 
1915 of such Act (42 U.S.C. 1396n) or under 
section 1115 of such Act (42 U.S.C. 1315); or 
(2) disregarding an individual’s spousal income 
and assets under a plan amendment to provide med-
ical assistance for home and community-based serv-
ices for individuals by reason of being determined el-
igible under section 1902(a)(10)(C) of such Act (42 
U.S.C. 1396a(a)(10)(C)) or by reason of section 
1902(f) of such Act (42 U.S.C. 1396a(f)) or other-
wise on the basis of a reduction of income based on 
costs incurred for medical or other remedial care 
under which the State disregarded the income and 
assets of the individual’s spouse in determining the 
initial and ongoing financial eligibility of an indi-
vidual for such services in place of the spousal im-
poverishment provisions applied under section 1924 
of such Act (42 U.S.C. 1396r–5). 
SEC. 2303. DELAY OF DSH REDUCTIONS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)), as amended by section 3813 of 
the CARES Act (Public Law 116–136), is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘December 1, 2020’’ and in-
serting ‘‘December 12, 2020’’; and 
(2) in clause (ii)(I), by striking ‘‘December 1, 
2020’’ and inserting ‘‘December 12, 2020’’. 
SEC. 2304. EXTENSION OF COMMUNITY MENTAL HEALTH 
SERVICES DEMONSTRATION PROGRAM. 
Section 223(d)(3) of the Protecting Access to Medi-
care Act of 2014 (42 U.S.C. 1396a note), as amended by 
section 3814 of the CARES Act (Public Law 116–136), 
is amended by striking ‘‘November 30, 2020’’ and insert-
ing ‘‘December 11, 2020’’. 
TITLE IV—MEDICARE PART B 
PREMIUM ADJUSTMENT 
SEC. 2401. 2021 MEDICARE PART B PREMIUM AND DEDUCT-
IBLE. 
(a) 2021 PREMIUM AND DEDUCTIBLE AND REPAY-
MENT THROUGH FUTURE PREMIUMS.—Section 1839(a)
of the Social Security Act (42 U.S.C. 1395r(a)) is amend-
ed— 
(1) in the second sentence of paragraph (1), by 
striking ‘‘(5) and (6)’’ and inserting ‘‘(5), (6), and 
(7)’’; 
(2) in paragraph (6)(C)— 
(A) in clause (i), by striking ‘‘section 
1844(d)(1)’’ and inserting ‘‘subsections (d)(1) 
and (e)(1) of section 1844’’; and 
(B) in clause (ii), by striking ‘‘paragraph 
(5)’’ and inserting ‘‘paragraphs (5) and (7)’’; 
and 
(3) by adding at the end the following: 
‘‘(7)(A) In applying this part (including subsection 
(i) and section 1833(b)), the monthly actuarial rate for 
enrollees age 65 and over for 2021 shall be determined 
to be equal to the sum of— 
‘‘(i) the monthly actuarial rate for enrollees age 
65 and over for 2020; plus 
‘‘(ii) 25 percent of the difference between such 
rate for 2020 and the preliminary monthly actuarial 
rate for enrollees age 65 and over for 2021 (as esti-
mated under subparagraph (B)). 
‘‘(B) For purposes of subparagraph (A)(ii), the Sec-
retary shall estimate a preliminary monthly actuarial rate
for enrollees age 65 and over for 2021 using the method-
ology described in paragraph (1) and as if subparagraph 
(A) of this paragraph did not apply. The Secretary shall 
make the estimate under the previous sentence as if the 
transfers described in section 1844(f)(1) have been 
made.’’. 
(b) TRANSITIONAL GOVERNMENT CONTRIBUTION.— 
Section 1844 of the Social Security Act (42 U.S.C. 
1395w) is amended— 
(1) in subsection (a), by adding at the end the 
following new sentence: ‘‘In applying paragraph (1), 
the amounts transferred under subsection (e)(1) 
with respect to enrollees described in subparagraphs 
(A) and (B) of such subsection shall be treated as 
premiums payable and deposited in the Trust Fund 
under subparagraphs (A) and (B), respectively, of 
paragraph (1).’’; and 
(2) by adding at the end the following: 
‘‘(e)(1) For 2021, there shall be transferred from the 
General Fund to the Trust Fund an amount, as estimated 
by the Chief Actuary of the Centers for Medicare & Med-
icaid Services, equal to the reduction in aggregate pre-
miums payable under this part for a month in such year 
(excluding any changes in amounts collected under section
1839(i)) that are attributable to the application of section 
1839(a)(7) with respect to— 
‘‘(A) enrollees age 65 and over; and 
‘‘(B) enrollees under age 65. 
Such amounts shall be transferred from time to time as 
appropriate. 
‘‘(2) Premium increases affected under section 
1839(a)(6) shall not be taken into account in applying 
subsection (a). 
‘‘(3) There shall be transferred from the Trust Fund 
to the General Fund of the Treasury amounts equivalent 
to the additional premiums payable as a result of the ap-
plication of section 1839(a)(6), excluding the aggregate 
payments attributable to the application of section 
1839(i)(3)(A)(ii)(II).’’. 
(c) ADDITIONAL TRANSITIONAL GOVERNMENT CON-
TRIBUTION.—Section 1844 of the Social Security Act (42 
U.S.C. 1395w), as amended by subsection (b)(2), is 
amended by adding at the end the following: 
‘‘(f)(1) There shall be transferred from the General 
Fund of the Treasury to the Trust Fund an amount, as 
estimated by the Chief Actuary of the Centers for Medi-
care & Medicaid Services, equal to amounts paid in ad-
vance for items and services under this part during the 
period beginning on the first day of the emergency period
described in section 1135(g)(1)(B) and ending on the date 
of the enactment of this paragraph. 
‘‘(2) There shall be transferred from the Trust Fund 
to the General Fund of the Treasury amounts equivalent 
to the sum of— 
‘‘(A) the amounts by which claims have offset 
(in whole or in part) the amount of such payments 
described in paragraph (1); and 
‘‘(B) the amount of such payments that have 
been repaid (in whole or in part). 
‘‘(3) Amounts described in paragraphs (1) and (2) 
shall be transferred from time to time as appropriate.’’. 
(d) 
INDENTATION
CORRECTION.—Section 
1839(i)(3)(A)(ii) of the Social Security Act (42 U.S.C. 
1395r(i)(3)(A)(ii)) is amended by moving the indentation 
of subclause (I) two ems to the right. 
TITLE V—ACCELERATED AND 
ADVANCE PAYMENT PROGRAMS 
SEC. 2501. MODIFYING ACCELERATED AND ADVANCE PAY-
MENT PROGRAMS UNDER PARTS A AND B OF 
THE 
MEDICARE 
PROGRAM 
DURING 
THE 
COVID–19 EMERGENCY. 
(a) SPECIAL REPAYMENT RULES AND OTHER MODI-
FICATIONS.— 
(1) PART A.—
(A) IN GENERAL.—Section 1815(f)(2)(C) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395g(f)(2)(C)) is amended to read as follows: 
‘‘(C) In the case of a payment made under the 
terms of the program under subsection (e)(3), in-
cluding such program as expanded pursuant to this 
subsection, on or after the date of the enactment of 
the CARES Act and so made during the emergency 
period described in section 1135(g)(1)(B), upon re-
quest of a hospital, the Secretary shall— 
‘‘(i) provide 1 year before payments for 
items and services furnished by the hospital are 
offset to recoup payments under such program; 
‘‘(ii) provide that any such offset be an 
amount equal to— 
‘‘(I) during the first 11 months in 
which any such offsets are made with re-
spect to payment for items and services 
furnished by the hospital, 25 percent of the 
amount of such payment for such items 
and services; and 
‘‘(II) during the succeeding 6 months, 
50 percent of the amount of such payment 
for such items and services; and
‘‘(iii) allow 29 months from the date of the 
first payment under such program to such pro-
vider before requiring that the outstanding bal-
ance be paid in full.’’. 
(B) AUTHORITY
FOR
DISCRETION.—Sec-
tion 1815(f)(2)(A)(ii) of the Social Security Act 
(42 U.S.C. 1395g(f)(2)(A)(ii)) is amended by 
inserting ‘‘(or, with respect to requests sub-
mitted to the Secretary after April 26, 2020, 
may)’’after ‘‘shall.’’. 
(C) APPLICATION TO OTHER PART A PRO-
VIDERS.— 
(i) IN
GENERAL.—In the case of a 
payment made under the terms of an ap-
plicable program (as defined in clause (ii)), 
on or after the date of the enactment of 
the CARES Act (Public Law 116–136) 
and so made during the emergency period 
described in section 1135(g)(1)(B) of the 
Social Security Act (42 U.S.C. 1320b– 
5(g)(1)(B)), upon request of an applicable 
provider (as defined in clause (iii)), the 
provisions of section 1815(f)(2)(C) of such 
Act (42 U.S.C. 1395g(f)(2)(C)), as amend-
ed by subparagraph (A), shall apply with