I 
116TH CONGRESS 
2D SESSION 
H. R. 6365 
To provide emergency financial assistance to rural health care facilities and 
providers impacted by the COVID-19 emergency. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 23, 2020 
Mr. DAVID P. ROE of Tennessee (for himself, Ms. SCHRIER, Mr. BUCSHON, 
Mr. CARTER of Georgia, Mr. MARSHALL, Mr. GREEN of Tennessee, Mr. 
RUIZ, Ms. SEWELL of Alabama, Mr. BERA, Mr. DUNN, Mr. BABIN, and 
Mr. GOSAR) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Small Business, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Immediate Relief for 
Rural Facilities and Providers Act of 2020’’. 
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SEC. 2. RURAL HEALTH CARE FACILITY GRANTS. 
(a) PURPOSE.—It is the purpose of this section to 
provide funding to stabilize rural hospitals and provide im-
mediate financial relief to prepare and respond to the 
COVID-19 emergency. 
(b) GRANTS.—The Secretary, acting through the Ad-
ministrator of the Centers for Medicare & Medicaid Serv-
ices, shall establish an emergency operating grant pro-
gram and shall award an emergency operating grant to 
an eligible Medicare participating health care facility. 
(c) ALLOTMENTS AND PAYMENTS.— 
(1) ALLOTMENTS.—The Secretary shall, from 
amounts appropriated under subsection (i), allot to 
each facility eligible for a grant under this section 
the sum of— 
(A) an amount equal to the number of pa-
tient days (including acute, swing-bed, and ob-
servation days) from January 1, 2019, to April 
1, 2019, with respect to the facility, multiplied 
by $1,000; and 
(B) an amount equal to the total amount 
of reimbursements from all payer sources to the 
facility from January 1, 2019, to April 1, 2019. 
(2) PAYMENTS.—The Secretary shall make pay-
ments under grants awarded to eligible facilities 
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under this section in the amount of the allotments 
described in paragraph (1). 
(3) TIME
OF
GRANT.—A one time payment 
shall be made under a grant awarded under this sec-
tion not later than 14 days after the date of enact-
ment of this Act. 
(d) ELIGIBLE FACILITIES.— 
(1) IN GENERAL.—To be eligible to receive a 
grant under subsection (b), a Medicare participating 
health care facility shall submit to the Secretary an 
application described in paragraph (2). 
(2) APPLICATION.—An application under this 
paragraph shall be submitted to the Secretary not 
later that 180 days after the date of enactment of 
this Act and shall contain such information that the 
Secretary may require, including— 
(A) a certification that— 
(i) the facility will suffer financial 
losses as a result of the COVID-19 emer-
gency; and 
(ii) in the absence of an emergency 
grant under this section, the facility would 
be forced to either reduce staffing or oper-
ations; 
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(B) an assurance that the amount re-
quested under the grant exceeds 130 percent of 
the amount of revenue collected by the facility 
during the same period of the year preceding 
the year for which the request under this sec-
tion is made; 
(C) the amount of spending incurred by 
the facility as a result of the COVID-19 emer-
gency; 
(D) a description on how the facility will 
use grant funds; and 
(E) an assurance that the facility followed 
the Secretary’s recommendations related to the 
COVID-19 emergency. 
(e) RECONCILIATION.— 
(1) IN GENERAL.—Not later than 2 years after 
the date on which the COVID-19 emergency ends 
(as determined by the Secretary), the Secretary shall 
promulgate regulations under which a facility that 
receives an emergency grant under this section shall 
reconcile the amount of the emergency grant with— 
(A) the entire amount of the grant allotted 
to the facility in the case of a facility that was 
determined not to be eligible under subsection 
(d); 
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(B) any reimbursements received by the 
facility from third parties for services provided 
during such emergency; and 
(C) any portion of the grant funds that ex-
ceeds 130 percent of the amount of revenue col-
lected by the facility during the same 90-day 
period of the year preceding the year for which 
the grant is being made as determined through 
such reconciliation to have been recovered by 
the facility through third-party payors, in addi-
tion to any additional spending incurred by the 
facility as a result of the COVID-19 emergency, 
with the Federal Government. 
(2) RECOUPMENT.—The regulations under this 
subsection shall include procedures through which 
the Federal Government may recoup any portion of 
grant funds described in paragraph (1). 
(f) LIMITATIONS ON USE OF FUNDS.— 
(1) CONSTRUCTION OF FACILITIES.— 
(A) LIMITATIONS.—Grants awarded under 
this section shall not be used by the facility for 
the purchase or improvement of land, or the 
purchase, construction, or permanent improve-
ment of any building. 
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(B) WAIVER.—The Secretary may wave 
the limitation contained in subparagraph (A) 
upon a facility request for such a waiver, if the 
Secretary finds that the request describes cir-
cumstances that justify the purchase of land or 
the constrictive of facilities (or the making of 
permanent 
improvements) 
related 
to 
the 
COVID-19 emergency. 
(2) POLITICAL
ACTIVITIES.—Grants awarded 
under this section shall not be used in a manner in-
volving the use of grant funds, provisions of services, 
or the employment or assignment of personnel, in a 
manner supporting or resulting in the identification 
of such programs with any partisan or nonpartisan 
political activity or any political activity associated 
with a candidate, or contending faction or group, in 
an election for public or party office. 
(g) LEGAL ACTION.—A facility that receives an emer-
gency grant under this section shall be prohibited from 
commencing any legal action against a patients to recover 
any costs associated with care provided to the patient dur-
ing the COVID-19 emergency. 
(h) DEFINITIONS.—In this section: 
(1) 
COVID-19
EMERGENCY.—The 
term 
‘‘COVID-19 emergency’’ means the national emer-
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gency declared by the President under the National 
Emergencies Act (50 U.S.C. 1601 et seq.) with re-
spect to the Coronavirus Disease 2019 (COVID-19). 
(2) MEDICARE
PARTICIPATING
HEALTH
CARE 
FACILITY.—The 
terms 
‘‘Medicare 
participating 
health care facility’’ and ‘‘facility’’ mean— 
(A) an entity designated as— 
(i) a Critical Access Hospital under 
section 485 of subpart F of title 42, Code 
of Federal Regulations; or 
(ii) a subsection (d) hospital (as de-
fined in paragraph (1)(B) of section 
1886(d)(1)(B) of the Social Security Act 
(42 U.S.C. 1395ww(d)(1)(B))) that is lo-
cated in a rural area (as defined in para-
graph (2)(D) of such section); and 
(B) a provider of services enrolled in the 
Medicare program under section 1866(j) of the 
Social Security Act (42 U.S.C. 1395cc(j)). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(i) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
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SEC. 3. REIMBURSEMENT ADJUSTMENT FOR SWING BED 
PROGRAM. 
(a) PURPOSE.—It is the purpose of this section to 
improve the health care system to prepare and respond 
to the COVID-19 emergency (as defined in section 2). 
(b) ADJUSTMENT.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall increase 
reimbursements for rural hospitals under the swing bed 
program for the duration of the COVID-19 emergency. 
(c) AMOUNT.—The amount of an increase under sub-
section (b) shall equal 20 percent of the amount of the 
swing bed reimbursement that a rural hospital involved 
would otherwise receive under the swing bed program. 
(d) TERMINATION.—This section shall not apply be-
ginning on the date that is 30 days after the date on which 
the COVID-19 emergency ends (as determined by the Sec-
retary). 
SEC. 4. EMERGENCY GRANTS FOR PHYSICIANS’ AND 
HEALTH CARE PROVIDERS’ PRACTICES. 
(a) PURPOSE.—It is the purpose of this section to 
provide funding to provide immediate relief and stabiliza-
tion for physicians’ and health care providers’ practices 
through emergency grants to prepare and respond to the 
COVID-19 emergency. 
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(b) AMENDMENT.—Title III of the Public Health 
Service Act is amended by inserting after section 330A– 
1 (42 U.S.C. 254c–1a) the following: 
‘‘SEC. 330A–2. EMERGENCY GRANTS FOR PHYSICIANS’ AND 
HEALTH CARE PROVIDERS’ PRACTICES. 
‘‘(a) IN GENERAL.—The Secretary shall establish a 
program to support physicians’ and health care providers’ 
practices by awarding emergency grants to eligible health 
care practices and ambulatory surgery centers. 
‘‘(b) ALLOTMENTS AND PAYMENTS.— 
‘‘(1) ALLOTMENTS.—The Secretary shall, from 
amounts appropriated under subsection (e), allot to 
each eligible health care practice or ambulatory sur-
gery center an amount equal to the actual payroll 
for the eligible health care practice or ambulatory 
surgery center during the period beginning January 
1, 2019, and ending April 1, 2019. 
‘‘(2) PAYMENTS.—The Secretary shall make 
payments under grants awarded under this section 
to each eligible health care practice or ambulatory 
surgery center in the amount of the allotment de-
scribed in paragraph (1) with respect to each such 
practice or center. 
‘‘(3) TIME OF GRANT.—Not later than 14 days 
after the date of enactment of this section, the Sec-
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