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) intro-
duced 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 pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protect Seniors and 
Cut Waste Act’’. 
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SEC. 2. PAYGO ACT SEQUESTER. 
The budgetary effects of the American Rescue Plan 
Act of 2021 shall not be counted for purposes of deter-
mining whether a sequester occurs under the report issued 
after Congress adjourns to end the 1st session of the 
117th Congress and during January 2022 under section 
5 of the Statutory Pay-As-You-Go Act of 2010. 
SEC. 3. SUPPLEMENTAL APPROPRIATIONS FOR THE PUB-
LIC HEALTH AND SOCIAL SERVICES EMER-
GENCY FUND. 
(a) SUPPLEMENTAL APPROPRIATION.—There is ap-
propriated, out of any amounts in the Treasury not other-
wise appropriated, for an additional amount for ‘‘Public 
Health 
and 
Social 
Services 
Emergency 
Fund’ ’’, 
$12,300,000,000, to remain available until expended, to 
prevent, prepare for, and respond to coronavirus, domesti-
cally or internationally, which shall be for necessary ex-
penses to reimburse, through grants or other mechanisms, 
eligible health care providers for health care related ex-
penses or lost revenues that are attributable to 
coronavirus. 
(b) CONDITIONS.—The following conditions shall 
apply with respect to funds appropriated by subsection 
(a): 
(1) Such funds may not be used to reimburse 
expenses or losses that have been reimbursed from 
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other sources or that other sources are obligated to 
reimburse. 
(2) Recipients of payments under this section 
shall submit reports and maintain documentation as 
the Secretary of Health and Human Services deter-
mines are needed to ensure compliance with condi-
tions that are imposed by this subsection for such 
payments, and such reports and documentation shall 
be in such form, with such content, and in such time 
as the Secretary may prescribe for such purpose. 
(3) The term ‘‘eligible health care providers’’ 
means public entities, Medicare or Medicaid enrolled 
suppliers and providers, and such for-profit entities 
and not-for-profit entities not otherwise described in 
this paragraph as the Secretary may specify, within 
the United States (including territories), that pro-
vide diagnoses, testing, or care for individuals with 
possible or actual cases of COVID–19. 
(4) The Secretary shall, on a rolling basis, re-
view applications and make payments under this sec-
tion. 
(5) Funds appropriated under this section shall 
be available for building or construction of tem-
porary structures, leasing of properties, medical sup-
plies and equipment including personal protective 
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equipment and testing supplies, increased workforce 
and trainings, emergency operation centers, retro-
fitting facilities, and surge capacity. 
(6) In this section, the term ‘‘payment’’ means 
a pre-payment, prospective payment, or retrospective 
payment, as determined appropriate by the Sec-
retary. 
(7) Payments under this section shall be made 
in consideration of the most efficient payment sys-
tems practicable to provide emergency payment. 
(8) To be eligible for a payment under this sec-
tion, an eligible health care provider shall submit to 
the Secretary an application that includes a state-
ment justifying the need of the provider for the pay-
ment and the eligible health care provider shall have 
a valid tax identification number. 
(9) For any reimbursement by the Secretary 
from the Provider Relief Fund to an eligible health 
care provider that is a subsidiary of a parent organi-
zation, the parent organization may, allocate 
(through transfers or otherwise) all or any portion 
of such reimbursement among the subsidiary eligible 
health care providers of the parent organization, in-
cluding reimbursements referred to by the Secretary 
as ‘‘Targeted Distribution’’ payments, among sub-
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sidiary eligible health care providers of the parent 
organization, except that responsibility for reporting 
the reallocated reimbursement shall remain with the 
original recipient of such reimbursement. 
(10) For any reimbursement from the Provider 
Relief Fund to an eligible health care provider for 
health care related expenses or lost revenues that 
are attributable to coronavirus (including reimburse-
ments made before the date of the enactment of this 
Act), such provider may calculate such lost revenues 
using the Frequently Asked Questions guidance re-
leased by the Department of Health and Human 
Services in June 2020, including the difference be-
tween such provider’s budgeted and actual revenue 
budget if such budget had been established and ap-
proved prior to March 27, 2020. 
(11) Of the amount made available in the third 
paragraph under the heading ‘‘Department of 
Health and Human Services—Office of the Sec-
retary—Public Health and Social Services Emer-
gency Fund’’ in Public Law 116–136, not less than 
85 percent of the unobligated balances available as 
of the date of enactment of this Act and of any 
funds recovered from health care providers after the 
date of enactment of this Act shall be for any suc-
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cessor to the Phase 3 General Distribution allocation 
to make payments to eligible health care providers 
based on applications that consider financial losses 
and changes in operating expenses occurring in fis-
cal year 2021 that are attributable to coronavirus. 
(12) Not later than 3 years after final pay-
ments are made under this section, the Office of In-
spector General of the Department of Health and 
Human Services shall transmit a final report on 
audit findings with respect to this program to the 
Committees on Appropriations of the House of Rep-
resentatives and the Senate. 
(13) Nothing in this section limits the authority 
of the Inspector General or the Comptroller General 
to conduct audits of interim payments at an earlier 
date. 
(14) Not later than 60 days after the date of 
enactment of this Act, the Secretary of Health and 
Human Services shall provide a report to the Com-
mittees on Appropriations of the House of Rep-
resentatives and the Senate on the obligation of 
funds, including obligations to such eligible health 
care providers, summarized by State of the payment 
receipt. Such report shall be updated and submitted 
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to such Committees every 60 days until funds are 
expended. 
(c) EMERGENCY DESIGNATIONS.— 
(1) Amounts repurposed in subsection (b) that 
were previously designated by the Congress as an 
emergency requirement pursuant to the Balanced 
Budget and Emergency Deficit Control Act of 1985 
are designated by the Congress as an emergency re-
quirement pursuant to section 251(b)(2)(A)(i) of the 
Balanced Budget and Emergency Deficit Control 
Act of 1985. 
(2) The amount appropriated by subsection (a) 
is designated by the Congress as being for an emer-
gency 
requirement 
pursuant 
to 
section 
251(b)(2)(A)(i) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985. 
(3) Each amount designated in this Act by the 
Congress as an emergency requirement pursuant to 
section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 shall be 
available only if the President subsequently so des-
ignates all such amounts and transmits such des-
ignations to the Congress. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to this section and pursuant to title II 
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of Public Law 117–2 shall be subject to the requirements 
contained in Public Law 116–260 for funds for programs 
authorized under sections 330 through 340 of the Public 
Health Service Act. 
SEC. 4. CORONAVIRUS STATE FISCAL RECOVERY FUND AD-
JUSTMENT. 
(a) IN GENERAL.—Section 602 of the Social Security 
Act is amended— 
(1) 
in 
subsection 
(a)(1), 
by 
striking 
‘‘$219,800,000,000’’ 
and 
inserting 
‘‘$79,800,000,000’’; and 
(2) 
in 
subsection 
(b)(3), 
by 
striking 
‘‘$195,300,000,000’’ 
and 
inserting 
‘‘$55,300,000,000’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect as if included in the enact-
ment of the American Rescue Plan Act of 2021. 
SEC. 5. TECHNICAL CORRECTIONS. 
(a) RURAL HEALTH CLINIC PAYMENTS.— 
(1) IN
GENERAL.—Section 1833(f)(3) of the 
Social Security Act (42 U.S.C. 1395l(f)(3)) is 
amended— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking subclauses 
(I) and (II) and inserting the following: 
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‘‘(I) with respect to a rural health 
clinic that had a per visit payment amount 
established 
for 
services 
furnished 
in 
2020— 
‘‘(aa) the per visit payment 
amount applicable to such rural 
health clinic for rural health clinic 
services furnished in 2020, increased 
by the percentage increase in the MEI 
applicable to primary care services 
furnished as of the first day of 2021; 
or 
‘‘(bb) the limit described in para-
graph (2)(A); and 
‘‘(II) with respect to a rural health 
clinic that did not have a per visit payment 
amount established for services furnished 
in 2020— 
‘‘(aa) the per visit payment 
amount applicable to such rural 
health clinic for rural health clinic 
services furnished in 2021; or 
‘‘(bb) the limit described in para-
graph (2)(A); and’’; and 
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(ii) in clause (ii)(I), by striking 
‘‘under clause (i)(I)’’ and inserting ‘‘under 
subclause (I) or (II) of clause (i), as appli-
cable,’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), 
by striking ‘‘2019, was’’ and inserting 
‘‘2020’’; 
(ii) in clause (i), by inserting ‘‘was’’ 
after ‘‘(i)’’; and 
(iii) by striking clause (ii) and insert-
ing the following: 
‘‘(ii)(I) was enrolled under section 1866(j) 
(including temporary enrollment during the 
emergency 
period 
described 
in 
section 
1135(g)(1)(B) for such period); or 
‘‘(II) submitted an application for enroll-
ment under section 1866(j) (or requested such 
a temporary enrollment for such period) that 
was received not later than December 31, 
2020.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect as if included in 
the enactment of the Consolidated Appropriations 
Act, 2021 (Public Law 116–260). 
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(b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS 
WITH HIGH DISPROPORATIONATE SHARE.—Effective as 
if included in the enactment of section 203(a) of title II 
of division CC of Public Law 116–260, subsection (g) of 
section 1923 of the Social Security Act (42 U.S.C. 1396r– 
4) amended by such section 203(a) is amended by adding 
at the end the following new paragraph: 
‘‘(3) ADDITIONAL AMOUNT FOR CERTAIN HOS-
PITALS WITH HIGH DISPROPORATIONATE SHARE.— 
‘‘(A) IN GENERAL.—In the case of a hos-
pital with high disproportionate share (as de-
fined in subparagraph (B)) located in a State 
referenced in subsection (e) of section 4721 of 
the Balanced Budget Act of 1997, a payment 
adjustment during a State fiscal year shall be 
considered consistent with subsection (c) if the 
payment adjustment does not exceed 175 per-
cent of the costs of furnishing hospital services 
during the year, but only if the Governor of the 
State certifies to the satisfaction of the Sec-
retary that the hospital’s applicable minimum 
amount is used for health services during the 
year. In determining the amount that is used 
for such services during a year, there shall be 
excluded any amounts received under the Public 
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Health Service Act, title V, title XVIII, or from 
third party payors (not including the State plan 
under this title) that are used for providing 
such services during the year. 
‘‘(B) 
HOSPITAL
WITH
HIGH 
DISPROPORATIONATE
SHARE
DEFINED.—In 
subparagraph (A), a hospital is a ‘hospital with 
high disproportionate share’ if— 
‘‘(i) the hospital is owned or operated 
by the State (or by an instrumentality or 
a unit of government within the State); 
and 
‘‘(ii) the hospital— 
‘‘(I) meets the requirement de-
scribed in subparagraphs (A) or (B) 
of subsection (b)(1); or 
‘‘(II) has the largest number of 
inpatient days attributable to individ-
uals entitled to benefits under the 
State plan of any hospital in such 
State for the previous fiscal year. 
‘‘(C) APPLICABLE MINIMUM AMOUNT DE-
FINED.—In subparagraph (A), the ‘applicable 
minimum amount’ for a hospital for a fiscal 
year is equal to the difference between the 
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amount of the hospital’s payment adjustment 
for the fiscal year and the costs to the hospital 
of furnishing hospital services described in 
paragraph (1)(A) during the fiscal year.’’. 
SEC. 6. INDIVIDUALS NOT LAWFULLY PRESENT IN UNITED 
STATES PRECLUDED FROM 2021 RECOVERY 
REBATES. 
(a) IN GENERAL.—Section 6428B(c) of the Internal 
Revenue Code of 1986, as added by the American Rescue 
Plan Act of 2021, is amended by striking ‘‘and’’ at the 
end of paragraph (2), by redesignating paragraph (3) as 
paragraph (4), and by inserting after paragraph (2) the 
following new paragraph: 
‘‘(3) any individual who was not lawfully 
present in the United States as of the date of the 
enactment of the American Rescue Plan Act of 
2021, and’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 9601 of the American Rescue Plan Act 
of 2021. 
SEC. 7. INCARCERATED INDIVIDUALS PRECLUDED FROM 
2021 RECOVERY REBATES. 
(a) IN GENERAL.—Section 6428B(c) of the Internal 
Revenue Code of 1986, as added by the American Rescue 
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Plan Act of 2021 and amended by the preceding provi-
sions of this Act, is amended by striking ‘‘and’’ at the 
end of paragraph (3), by redesignating paragraph (4) as 
paragraph (5), and by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) any individual who was incarcerated on the 
date of the enactment of the American Rescue Plan 
Act of 2021, and’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 9601 of the American Rescue Plan Act 
of 2021. 
SEC. 8. REQUIRING A SOCIAL SECURITY NUMBER TO RE-
CEIVE COBRA CONTINUATION COVERAGE. 
(a) IN GENERAL.—Section 9501(a)(3) of the Amer-
ican Rescue Plan Act of 2021 (Public Law 117–2) is 
amended— 
(1) in subparagraph (A), by striking at the end 
‘‘and’’; 
(2) in subparagraph (B), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) has been issued a social security 
number (as defined in section 24(h)(7) of the 
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Internal Revenue Code of 1986) by the Social 
Security Administration.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as if included in the enact-
ment of section 9501 of the American Rescue Plan Act 
of 2021. 
SEC. 9. RESCISSIONS OF AMERICAN RESCUE PLAN ACT OF 
2021 FUNDS. 
Of the funds appropriated by the American Rescue 
Plan Act of 2021 (Public Law 117–2), all unobligated 
funds available under the following provisions of such Act 
are hereby rescinded: 
(1) Section 2021 (relating to the National En-
dowment for the Arts). 
(2) Section 2022 (relating to the National En-
dowment for the Humanities). 
(3) Section 4001 (relating to the Emergency 
Federal Employee Leave Fund). 
Æ 
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