H. R. 1319—219 
(b) WAIVING BUDGET NEUTRALITY.—Section 1886(d)(3)(E)(i) of 
the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)(i)) is amended, 
in the fifth sentence— 
(1) by striking ‘‘and the amendments’’ and inserting ‘‘, 
the amendments’’; and 
(2) by inserting ‘‘, and the amendments made by section 
9831(a) of the American Rescue Plan Act of 2021’’ after ‘‘Care 
Act’’. 
SEC. 9832. SECRETARIAL AUTHORITY TO TEMPORARILY WAIVE OR 
MODIFY APPLICATION OF CERTAIN MEDICARE REQUIRE-
MENTS WITH RESPECT TO AMBULANCE SERVICES FUR-
NISHED DURING CERTAIN EMERGENCY PERIODS. 
(a) WAIVER AUTHORITY.—Section 1135(b) of the Social Security 
Act (42 U.S.C. 1320b–5(b)) is amended— 
(1) in the first sentence— 
(A) in paragraph (7), by striking ‘‘and’’ at the end; 
(B) in paragraph (8), by striking the period at the 
end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (8) the following new 
paragraph: 
‘‘(9) any requirement under section 1861(s)(7) or section 
1834(l) that an ambulance service include the transport of 
an individual to the extent necessary to allow payment for 
ground ambulance services furnished in response to a 911 
call (or the equivalent in areas without a 911 call system) 
in cases in which an individual would have been transported 
to a destination permitted under Medicare regulations (as 
described in section 410.40 to title 42, Code of Federal Regula-
tions (or successor regulations)) but such transport did not 
occur as a result of community-wide emergency medical service 
(EMS) protocols due to the public health emergency described 
in subsection (g)(1)(B).’’; and 
(2) in the flush matter at the end, by adding at the end 
the following: ‘‘Ground ambulance services for which payment 
is made pursuant to paragraph (9) shall be paid at the base 
rate that would have been paid under the fee schedule estab-
lished under 1834(l) (excluding any mileage payment) if the 
individual had been so transported and, with respect to ambu-
lance services furnished by a critical access hospital or an 
entity described in paragraph (8) of such section, at the amount 
that otherwise would be paid under such paragraph.’’. 
(b) EMERGENCY PERIOD EXCEPTION.—Section 1135(g)(1)(B) of 
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)) is amended, 
in the matter preceding clause (i), by striking ‘‘subsection (b)(8)’’ 
and inserting ‘‘paragraphs (8) and (9) of subsection (b)’’. 
SEC. 9833. FUNDING FOR OFFICE OF INSPECTOR GENERAL. 
In addition to amounts otherwise available, there is appro-
priated to the inspector general of the Department of Health and 
Human Services for fiscal year 2021, out of any money in the 
Treasury not otherwise appropriated, $5,000,000, to remain avail-
able until expended, for oversight of activities supported with funds 
appropriated to the Department of Health and Human Services 
to prevent, prepare for, and respond to coronavirus 2019 or COVID– 
19, domestically or internationally.
H. R. 1319—220 
Subtitle M—Coronavirus State and Local 
Fiscal Recovery Funds 
SEC. 9901. CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY 
FUNDS. 
(a) IN GENERAL.—Title VI of the Social Security Act (42 U.S.C. 
801 et seq.) is amended by adding at the end the following: 
‘‘SEC. 602. CORONAVIRUS STATE FISCAL RECOVERY FUND. 
‘‘(a) APPROPRIATION.—In addition to amounts otherwise avail-
able, there is appropriated for fiscal year 2021, out of any money 
in the Treasury not otherwise appropriated— 
‘‘(1) 
$219,800,000,000, 
to 
remain 
available 
through 
December 31, 2024, for making payments under this section 
to States, territories, and Tribal governments to mitigate the 
fiscal effects stemming from the public health emergency with 
respect to the Coronavirus Disease (COVID–19); and 
‘‘(2) $50,000,000, to remain available until expended, for 
the costs of the Secretary for administration of the funds estab-
lished under this title. 
‘‘(b) AUTHORITY TO MAKE PAYMENTS.— 
‘‘(1) PAYMENTS TO TERRITORIES.— 
‘‘(A) 
IN
GENERAL.—The 
Secretary 
shall 
reserve 
$4,500,000,000 of the amount appropriated under sub-
section (a)(1) to make payments to the territories. 
‘‘(B) ALLOCATION.—Of the amount reserved under 
subparagraph (A)— 
‘‘(i) 50 percent of such amount shall be allocated 
by the Secretary equally to each territory; and 
‘‘(ii) 50 percent of such amount shall be allocated 
by the Secretary as an additional amount to each terri-
tory in an amount which bears the same proportion 
to 1⁄2 of the total amount reserved under subparagraph 
(A) as the population of the territory bears to the 
total population of all such territories. 
‘‘(C) PAYMENT.—The Secretary shall pay each territory 
the total of the amounts allocated for the territory under 
subparagraph (B) in accordance with paragraph (6). 
‘‘(2) PAYMENTS TO TRIBAL GOVERNMENTS.— 
‘‘(A) 
IN
GENERAL.—The 
Secretary 
shall 
reserve 
$20,000,000,000 of the amount appropriated under sub-
section (a)(1) to make payments to Tribal governments. 
‘‘(B) ALLOCATION.—Of the amount reserved under 
subparagraph (A)— 
‘‘(i) $1,000,000,000 shall be allocated by the Sec-
retary equally among each of the Tribal governments; 
and 
‘‘(ii) $19,000,000,000 shall be allocated by the Sec-
retary to the Tribal governments in a manner deter-
mined by the Secretary. 
‘‘(C) PAYMENT.— The Secretary shall pay each Tribal 
government the total of the amounts allocated for the Tribal 
government under subparagraph (B) in accordance with 
paragraph (6). 
‘‘(3) PAYMENTS TO EACH OF THE 50 STATES AND THE DISTRICT 
OF COLUMBIA.—
H. R. 1319—221 
‘‘(A) 
IN
GENERAL.—The 
Secretary 
shall 
reserve 
$195,300,000,000 of the amount appropriated under sub-
section (a)(1) to make payments to each of the 50 States 
and the District of Columbia. 
‘‘(B) ALLOCATIONS.—Of the amount reserved under 
subparagraph (A)— 
‘‘(i) $25,500,000,000 of such amount shall be allo-
cated by the Secretary equally among each of the 50 
States and the District of Columbia; 
‘‘(ii) an amount equal to $1,250,000,000 less the 
amount allocated for the District of Columbia pursuant 
to section 601(c)(6) shall be allocated by the Secretary 
as an additional amount to the District of Columbia; 
and 
‘‘(iii) an amount equal to the remainder of the 
amount reserved under subparagraph (A) after the 
application of clauses (i) and (ii) of this subparagraph 
shall be allocated by the Secretary as an additional 
amount to each of the 50 States and the District of 
Columbia in an amount which bears the same propor-
tion to such remainder as the average estimated 
number of seasonally-adjusted unemployed individuals 
(as measured by the Bureau of Labor Statistics Local 
Area Unemployment Statistics program) in the State 
or District of Columbia over the 3-month period ending 
with December 2020 bears to the average estimated 
number of seasonally-adjusted unemployed individuals 
in all of the 50 States and the District of Columbia 
over the same period. 
‘‘(C) PAYMENT.— 
‘‘(i) IN GENERAL.—Subject to clause (ii), the Sec-
retary shall pay each of the 50 States and the District 
of Columbia, from the amount reserved under subpara-
graph (A), the total of the amounts allocated for the 
State and District of Columbia under subparagraph 
(B) in accordance with paragraph (6). 
‘‘(ii) MINIMUM PAYMENT REQUIREMENT.— 
‘‘(I) IN GENERAL.—The sum of— 
‘‘(aa) the total amounts allocated for 1 of 
the 50 States or the District of Columbia under 
subparagraph (B) (as determined without 
regard to this clause); and 
‘‘(bb) the amounts allocated under section 
603 to the State (for distribution by the State 
to nonentitlement units of local government 
in the State) and to metropolitan cities and 
counties in the State; 
shall not be less than the amount allocated to 
the State or District of Columbia for fiscal year 
2020 under section 601, including any amount paid 
directly to a unit of local government in the State 
under such section. 
‘‘(II) PRO RATA ADJUSTMENT.—The Secretary 
shall adjust on a pro rata basis the amount of 
the allocations for each of the 50 States and the 
District of Columbia determined under subpara-
graph (B)(iii) (without regard to this clause) to
H. R. 1319—222 
the extent necessary to comply with the require-
ment of subclause (I). 
‘‘(4) PRO
RATA
ADJUSTMENT
AUTHORITY.—The amounts 
otherwise determined for allocation and payment under para-
graphs (1), (2), and (3) may be adjusted by the Secretary on 
a pro rata basis to the extent necessary to ensure that all 
available funds are allocated to States, territories, and Tribal 
governments in accordance with the requirements specified in 
each such paragraph (as applicable). 
‘‘(5) POPULATION
DATA.—For purposes of determining 
allocations for a territory under this section, the population 
of the territory shall be determined based on the most recent 
data available from the Bureau of the Census. 
‘‘(6) TIMING.— 
‘‘(A) STATES AND TERRITORIES.— 
‘‘(i) IN GENERAL.—To the extent practicable, subject 
to clause (ii), with respect to each State and territory 
allocated a payment under this subsection, the Sec-
retary shall make the payment required for the State 
or territory not later than 60 days after the date on 
which the certification required under subsection (d)(1) 
is provided to the Secretary. 
‘‘(ii) AUTHORITY TO SPLIT PAYMENT.— 
‘‘(I) IN
GENERAL.—The Secretary shall have 
the authority to withhold payment of up to 50 
percent of the amount allocated to each State and 
territory (other than payment of the amount allo-
cated under paragraph (3)(B)(ii) to the District 
of Columbia) for a period of up to 12 months from 
the date on which the State or territory provides 
the certification required under subsection (d)(1). 
The Secretary shall exercise such authority with 
respect to a State or territory based on the 
unemployment rate in the State or territory as 
of such date. 
‘‘(II) PAYMENT OF WITHHELD AMOUNT.—Before 
paying to a State or territory the remainder of 
an amount allocated to the State or territory (sub-
ject to subclause (III)) that has been withheld by 
the Secretary under subclause (I), the Secretary 
shall require the State or territory to submit a 
second certification under subsection (d)(1), in 
addition to such other information as the Secretary 
may require. 
‘‘(III) RECOVERY
OF
AMOUNTS
SUBJECT
TO 
RECOUPMENT.—If a State or territory is required 
under subsection (e) to repay funds for failing to 
comply with subsection (c), the Secretary may 
reduce the amount otherwise payable to the State 
or territory under subclause (II) by the amount 
that the State or territory would otherwise be 
required to repay under such subsection (e). 
‘‘(B) TRIBAL GOVERNMENTS.—To the extent practicable, 
with respect to each Tribal government for which an 
amount is allocated under this subsection, the Secretary 
shall make the payment required for the Tribal government
H. R. 1319—223 
not later than 60 days after the date of enactment of 
this section. 
‘‘(C) INITIAL PAYMENT TO DISTRICT OF COLUMBIA.—The 
Secretary shall pay the amount allocated under paragraph 
(3)(B)(ii) to the District of Columbia not later than 15 
days after the date of enactment of this section. 
‘‘(c) REQUIREMENTS.— 
‘‘(1) USE OF FUNDS.—Subject to paragraph (2), and except 
as provided in paragraph (3), a State, territory, or Tribal 
government shall only use the funds provided under a payment 
made under this section, or transferred pursuant to section 
603(c)(4), to cover costs incurred by the State, territory, or 
Tribal government, by December 31, 2024— 
‘‘(A) to respond to the public health emergency with 
respect to the Coronavirus Disease 2019 (COVID–19) or 
its negative economic impacts, including assistance to 
households, small businesses, and nonprofits, or aid to 
impacted industries such as tourism, travel, and hospi-
tality; 
‘‘(B) to respond to workers performing essential work 
during the COVID–19 public health emergency by pro-
viding premium pay to eligible workers of the State, terri-
tory, or Tribal government that are performing such essen-
tial work, or by providing grants to eligible employers 
that have eligible workers who perform essential work; 
‘‘(C) for the provision of government services to the 
extent of the reduction in revenue of such State, territory, 
or Tribal government due to the COVID–19 public health 
emergency relative to revenues collected in the most recent 
full fiscal year of the State, territory, or Tribal government 
prior to the emergency; or 
‘‘(D) to make necessary investments in water, sewer, 
or broadband infrastructure. 
‘‘(2) FURTHER RESTRICTION ON USE OF FUNDS.— 
‘‘(A) IN GENERAL.—A State or territory shall not use 
the funds provided under this section or transferred pursu-
ant to section 603(c)(4) to either directly or indirectly offset 
a reduction in the net tax revenue of such State or territory 
resulting from a change in law, regulation, or administra-
tive interpretation during the covered period that reduces 
any tax (by providing for a reduction in a rate, a rebate, 
a deduction, a credit, or otherwise) or delays the imposition 
of any tax or tax increase. 
‘‘(B) PENSION FUNDS.—No State or territory may use 
funds made available under this section for deposit into 
any pension fund. 
‘‘(3) TRANSFER AUTHORITY.—A State, territory, or Tribal 
government receiving a payment from funds made available 
under this section may transfer funds to a private nonprofit 
organization (as that term is defined in paragraph (17) of 
section 401 of the McKinney-Vento Homeless Assistance Act 
(42 U.S.C. 11360(17)), a Tribal organization (as that term is 
defined in section 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 5304)), a public benefit corpora-
tion involved in the transportation of passengers or cargo, or 
a special-purpose unit of State or local government. 
‘‘(d) CERTIFICATIONS AND REPORTS.—
H. R. 1319—224 
‘‘(1) IN GENERAL.—In order for a State or territory to receive 
a payment under this section, or a transfer of funds under 
section 603(c)(4), the State or territory shall provide the Sec-
retary with a certification, signed by an authorized officer of 
such State or territory, that such State or territory requires 
the payment or transfer to carry out the activities specified 
in subsection (c) of this section and will use any payment 
under this section, or transfer of funds under section 603(c)(4), 
in compliance with subsection (c) of this section. 
‘‘(2) REPORTING.—Any State, territory, or Tribal govern-
ment receiving a payment under this section shall provide 
to the Secretary periodic reports providing a detailed accounting 
of— 
‘‘(A) the uses of funds by such State, territory, or 
Tribal government, including, in the case of a State or 
a territory, all modifications to the State’s or territory’s 
tax revenue sources during the covered period; and 
‘‘(B) such other information as the Secretary may 
require for the administration of this section. 
‘‘(e) RECOUPMENT.—Any State, territory, or Tribal government 
that has failed to comply with subsection (c) shall be required 
to repay to the Secretary an amount equal to the amount of funds 
used in violation of such subsection, provided that, in the case 
of a violation of subsection (c)(2)(A), the amount the State or terri-
tory shall be required to repay shall be lesser of— 
‘‘(1) the amount of the applicable reduction to net tax 
revenue attributable to such violation; and 
‘‘(2) the amount of funds received by such State or territory 
pursuant to a payment made under this section or a transfer 
made under section 603(c)(4). 
‘‘(f) REGULATIONS.—The Secretary shall have the authority to 
issue such regulations as may be necessary or appropriate to carry 
out this section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) COVERED PERIOD.—The term ‘covered period’ means, 
with respect to a State, territory, or Tribal government, the 
period that— 
‘‘(A) begins on March 3, 2021; and 
‘‘(B) ends on the last day of the fiscal year of such 
State, territory, or Tribal government in which all funds 
received by the State, territory, or Tribal government from 
a payment made under this section or a transfer made 
under section 603(c)(4) have been expended or returned 
to, or recovered by, the Secretary. 
‘‘(2) ELIGIBLE WORKERS.—The term ‘eligible workers’ means 
those workers needed to maintain continuity of operations of 
essential critical infrastructure sectors and additional sectors 
as each Governor of a State or territory, or each Tribal govern-
ment, may designate as critical to protect the health and well- 
being of the residents of their State, territory, or Tribal govern-
ment. 
‘‘(3) PREMIUM
PAY.—The term ‘premium pay’ means an 
amount of up to $13 per hour that is paid to an eligible 
worker, in addition to wages or remuneration the eligible 
worker otherwise receives, for all work performed by the eligible 
worker during the COVID–19 public health emergency. Such
H. R. 1319—225 
amount may not exceed $25,000 with respect to any single 
eligible worker. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means the Secretary 
of the Treasury. 
‘‘(5) STATE.—The term ‘State’ means each of the 50 States 
and the District of Columbia. 
‘‘(6) TERRITORY.—The term ‘territory’ means the Common-
wealth of Puerto Rico, the United States Virgin Islands, Guam, 
the Commonwealth of the Northern Mariana Islands, and 
American Samoa. 
‘‘(7) TRIBAL GOVERNMENT.—The term ‘Tribal Government’ 
means the recognized governing body of any Indian or Alaska 
Native tribe, band, nation, pueblo, village, community, compo-
nent band, or component reservation, individually identified 
(including parenthetically) in the list published most recently 
as of the date of enactment of this Act pursuant to section 
104 of the Federally Recognized Indian Tribe List Act of 1994 
(25 U.S.C. 5131). 
‘‘SEC. 603. CORONAVIRUS LOCAL FISCAL RECOVERY FUND. 
‘‘(a) APPROPRIATION.—In addition to amounts otherwise avail-
able, there is appropriated for fiscal year 2021, out of any money 
in the Treasury not otherwise appropriated, $130,200,000,000, to 
remain available through December 31, 2024, for making payments 
under this section to metropolitan cities, nonentitlement units of 
local government, and counties to mitigate the fiscal effects stem-
ming from the public health emergency with respect to the 
Coronavirus Disease (COVID–19). 
‘‘(b) AUTHORITY TO MAKE PAYMENTS.— 
‘‘(1) METROPOLITAN CITIES.— 
‘‘(A) IN GENERAL.—Of the amount appropriated under 
subsection (a), the Secretary shall reserve $45,570,000,000 
to make payments to metropolitan cities. 
‘‘(B) ALLOCATION
AND
PAYMENT.—From the amount 
reserved under subparagraph (A), the Secretary shall allo-
cate and, in accordance with paragraph (7), pay to each 
metropolitan city an amount determined for the metropoli-
tan city consistent with the formula under section 106(b) 
of the Housing and Community Development Act of 1974 
(42 U.S.C. 5306(b)), except that, in applying such formula, 
the Secretary shall substitute ‘all metropolitan cities’ for 
‘all metropolitan areas’ each place it appears. 
‘‘(2) NONENTITLEMENT UNITS OF LOCAL GOVERNMENT.— 
‘‘(A) IN GENERAL.—Of the amount appropriated under 
subsection (a), the Secretary shall reserve $19,530,000,000 
to make payments to States for distribution by the State 
to nonentitlement units of local government in the State. 
‘‘(B) ALLOCATION
AND
PAYMENT.—From the amount 
reserved under subparagraph (A), the Secretary shall allo-
cate and, in accordance with paragraph (7), pay to each 
State an amount which bears the same proportion to such 
reserved amount as the total population of all areas that 
are non-metropolitan cities in the State bears to the total 
population of all areas that are non-metropolitan cities 
in all such States. 
‘‘(C) DISTRIBUTION
TO
NONENTITLEMENT
UNITS
OF 
LOCAL GOVERNMENT.—
H. R. 1319—226 
‘‘(i) IN
GENERAL.—Not later than 30 days after 
a State receives a payment under subparagraph (B), 
the State shall distribute to each nonentitlement unit 
of local government in the State an amount that bears 
the same proportion to the amount of such payment 
as the population of the nonentitlement unit of local 
government bears to the total population of all the 
nonentitlement units of local government in the State, 
subject to clause (iii). 
‘‘(ii) DISTRIBUTION OF FUNDS.— 
‘‘(I) EXTENSION
FOR
DISTRIBUTION.—If an 
authorized officer of a State required to make dis-
tributions under clause (i) certifies in writing to 
the Secretary before the end of the 30-day distribu-
tion period described in such clause that it would 
constitute an excessive administrative burden for 
the State to meet the terms of such clause with 
respect to 1 or more such distributions, the author-
ized officer may request, and the Secretary shall 
grant, an extension of such period of not more 
than 30 days to allow the State to make such 
distributions in accordance with clause (i). 
‘‘(II) ADDITIONAL EXTENSIONS.— 
‘‘(aa) IN GENERAL.—If a State has been 
granted an extension to the distribution period 
under subclause (I) but is unable to make 
all the distributions required under clause (i) 
before the end of such period as extended, 
an authorized officer of the State may request 
an additional extension of the distribution 
period of not more than 30 days. The Secretary 
may grant a request for an additional exten-
sion of such period only if— 
‘‘(AA) the authorized officer making 
such request provides a written plan to 
the Secretary specifying, for each distribu-
tion for which an additional extension is 
requested, when the State expects to make 
such distribution and the actions the State 
has taken and will take in order to make 
all such distributions before the end of 
the distribution period (as extended under 
subclause (I) and this subclause); and 
‘‘(BB) the Secretary determines that 
such plan is reasonably designed to dis-
tribute all such funds to nonentitlement 
units of local government by the end of 
the distribution period (as so extended). 
‘‘(bb) FURTHER ADDITIONAL EXTENSIONS.— 
If a State granted an additional extension of 
the distribution period under item (aa) 
requires any further additional extensions of 
such period, the request only may be made 
and granted subject to the requirements speci-
fied in item (aa). 
‘‘(iii) CAPPED AMOUNT.—The total amount distrib-
uted to a nonentitlement unit of local government
H. R. 1319—227 
under this paragraph may not exceed the amount equal 
to 75 percent of the most recent budget for the non-
entitlement unit of local government as of January 
27, 2020. 
‘‘(iv) RETURN OF EXCESS AMOUNTS.—Any amounts 
not distributed to a nonentitlement unit of local govern-
ment as a result of the application of clause (iii) shall 
be returned to the Secretary. 
‘‘(D) PENALTY
FOR
NONCOMPLIANCE.—If, by the end 
of the 120-day period that begins on the date a State 
receives a payment from the amount allocated under 
subparagraph (B) or, if later, the last day of the distribution 
period for the State (as extended with respect to the State 
under subparagraph (C)(ii)), such State has failed to make 
all the distributions from such payment in accordance with 
the terms of subparagraph (C) (including any extensions 
of the distribution period granted in accordance with such 
subparagraph), an amount equal to the amount of such 
payment that remains undistributed as of such date shall 
be booked as a debt of such State owed to the Federal 
Government, shall be paid back from the State’s allocation 
provided under section 602(b)(3)(B)(iii), and shall be depos-
ited into the general fund of the Treasury. 
‘‘(3) COUNTIES.— 
‘‘(A) AMOUNT.—From the amount appropriated under 
subsection (a), the Secretary shall reserve and allocate 
$65,100,000,000 of such amount to make payments directly 
to counties in an amount which bears the same proportion 
to the total amount reserved under this paragraph as the 
population of each such county bears to the total population 
of all such entities and shall pay such allocated amounts 
to such counties in accordance with paragraph (7). 
‘‘(B) SPECIAL RULES.— 
‘‘(i) URBAN COUNTIES.—No county that is an ‘urban 
county’ (as defined in section 102 of the Housing and 
Community Development Act of 1974 (42 U.S.C. 5302)) 
shall receive less than the amount the county would 
otherwise receive if the amount paid under this para-
graph were allocated to metropolitan cities and urban 
counties under section 106(b) of the Housing and 
Community Development Act of 1974 (42 U.S.C. 
5306(b)). 
‘‘(ii) COUNTIES THAT ARE NOT UNITS OF GENERAL 
LOCAL
GOVERNMENT.—In the case of an amount to 
be paid to a county that is not a unit of general 
local government, the amount shall instead be paid 
to the State in which such county is located, and such 
State shall distribute such amount to each unit of 
general local government within such county in an 
amount that bears the same proportion to the amount 
to be paid to such county as the population of such 
units of general local government bears to the total 
population of such county. 
‘‘(iii) DISTRICT OF COLUMBIA.—For purposes of this 
paragraph, the District of Columbia shall be considered 
to consist of a single county that is a unit of general 
local government.
H. R. 1319—228 
‘‘(4) CONSOLIDATED GOVERNMENTS.—A unit of general local 
government that has formed a consolidated government, or 
that is geographically contained (in full or in part) within 
the boundaries of another unit of general local government 
may receive a distribution under each of paragraphs (1), (2), 
and (3), as applicable, based on the respective formulas specified 
in such paragraphs. 
‘‘(5) PRO
RATA
ADJUSTMENT
AUTHORITY.—The amounts 
otherwise determined for allocation and payment under para-
graphs (1), (2), and (3) may be adjusted by the Secretary on 
a pro rata basis to the extent necessary to ensure that all 
available funds are distributed to metropolitan cities, counties, 
and States in accordance with the requirements specified in 
each paragraph (as applicable) and the certification require-
ment specified in subsection (d). 
‘‘(6) POPULATION.—For purposes of determining allocations 
under this section, the population of an entity shall be deter-
mined based on the most recent data are available from the 
Bureau of the Census or, if not available, from such other 
data as a State determines appropriate. 
‘‘(7) TIMING.— 
‘‘(A) FIRST
TRANCHE
AMOUNT.—To the extent prac-
ticable, with respect to each metropolitan city for which 
an amount is allocated under paragraph (1), each State 
for which an amount is allocated under paragraph (2) for 
distribution to nonentitlement units of local government, 
and each county for which an amount is allocated under 
paragraph (3), the Secretary shall pay from such allocation 
the First Tranche Amount for such city, State, or county 
not later than 60 days after the date of enactment of 
this section. 
‘‘(B) SECOND TRANCHE AMOUNT.—The Secretary shall 
pay to each metropolitan city for which an amount is 
allocated under paragraph (1), each State for which an 
amount is allocated under paragraph (2) for distribution 
to nonentitlement units of local government, and each 
county for which an amount is allocated under paragraph 
(3), the Second Tranche Amount for such city, State, or 
county not earlier than 12 months after the date on which 
the First Tranche Amount is paid to the city, State, or 
county. 
‘‘(c) REQUIREMENTS.— 
‘‘(1) USE OF FUNDS.—Subject to paragraph (2), and except 
as provided in paragraphs (3) and (4), a metropolitan city, 
nonentitlement unit of local government, or county shall only 
use the funds provided under a payment made under this 
section to cover costs incurred by the metropolitan city, non-
entitlement unit of local government, or county, by December 
31, 2024— 
‘‘(A) to respond to the public health emergency with 
respect to the Coronavirus Disease 2019 (COVID–19) or 
its negative economic impacts, including assistance to 
households, small businesses, and nonprofits, or aid to 
impacted industries such as tourism, travel, and hospi-
tality;
H. R. 1319—229 
‘‘(B) to respond to workers performing essential work 
during the COVID–19 public health emergency by pro-
viding premium pay to eligible workers of the metropolitan 
city, nonentitlement unit of local government, or county 
that are performing such essential work, or by providing 
grants to eligible employers that have eligible workers 
who perform essential work; 
‘‘(C) for the provision of government services to the 
extent of the reduction in revenue of such metropolitan 
city, nonentitlement unit of local government, or county 
due to the COVID–19 public health emergency relative 
to revenues collected in the most recent full fiscal year 
of the metropolitan city, nonentitlement unit of local 
government, or county prior to the emergency; or 
‘‘(D) to make necessary investments in water, sewer, 
or broadband infrastructure. 
‘‘(2) PENSION FUNDS.—No metropolitan city, nonentitlement 
unit of local government, or county may use funds made avail-
able under this section for deposit into any pension fund. 
‘‘(3) TRANSFER AUTHORITY.—A metropolitan city, nonentitle-
ment unit of local government, or county receiving a payment 
from funds made available under this section may transfer 
funds to a private nonprofit organization (as that term is 
defined in paragraph (17) of section 401 of the McKinney- 
Vento Homeless Assistance Act (42 U.S.C. 11360(17)), a public 
benefit corporation involved in the transportation of passengers 
or cargo, or a special-purpose unit of State or local government. 
‘‘(4) TRANSFERS
TO
STATES.—Notwithstanding paragraph 
(1), a metropolitan city, nonentitlement unit of local govern-
ment, or county receiving a payment from funds made available 
under this section may transfer such funds to the State in 
which such entity is located. 
‘‘(d) REPORTING.—Any metropolitan city, nonentitlement unit 
of local government, or county receiving funds provided under a 
payment made under this section shall provide to the Secretary 
periodic reports providing a detailed accounting of the uses of 
such funds by such metropolitan city, nonentitlement unit of local 
government, or county and including such other information as 
the Secretary may require for the administration of this section. 
‘‘(e) RECOUPMENT.—Any metropolitan city, nonentitlement unit 
of local government, or county that has failed to comply with sub-
section (c) shall be required to repay to the Secretary an amount 
equal to the amount of funds used in violation of such subsection. 
‘‘(f) REGULATIONS.—The Secretary shall have the authority to 
issue such regulations as may be necessary or appropriate to carry 
out this section. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) COUNTY.—The term ‘county’ means a county, parish, 
or other equivalent county division (as defined by the Bureau 
of the Census). 
‘‘(2) ELIGIBLE WORKERS.—The term ‘eligible workers’ means 
those workers needed to maintain continuity of operations of 
essential critical infrastructure sectors and additional sectors 
as each chief executive officer of a metropolitan city, nonentitle-
ment unit of local government, or county may designate as 
critical to protect the health and well-being of the residents
H. R. 1319—230 
of their metropolitan city, nonentitlement unit of local govern-
ment, or county. 
‘‘(3) FIRST
TRANCHE
AMOUNT.—The term ‘First Tranche 
Amount’ means, with respect to each metropolitan city for 
which an amount is allocated under subsection (b)(1), each 
State for which an amount is allocated under subsection (b)(2) 
for distribution to nonentitlement units of local government, 
and each county for which an amount is allocated under sub-
section (b)(3), 50 percent of the amount so allocated to such 
metropolitan city, State, or county (as applicable). 
‘‘(4) METROPOLITAN CITY.—The term ‘metropolitan city’ has 
the meaning given that term in section 102(a)(4) of the Housing 
and Community Development Act of 1974 (42 U.S.C. 5302(a)(4)) 
and includes cities that relinquish or defer their status as 
a metropolitan city for purposes of receiving allocations under 
section 106 of such Act (42 U.S.C. 5306) for fiscal year 2021. 
‘‘(5) NONENTITLEMENT UNIT OF LOCAL GOVERNMENT.—The 
term ‘nonentitlement unit of local government’ means a ‘city’, 
as that term is defined in section 102(a)(5) of the Housing 
and Community Development Act of 1974 (42 U.S.C. 
5302(a)(5))), that is not a metropolitan city. 
‘‘(6) PREMIUM
PAY.—The term ‘premium pay’ has the 
meaning given such term in section 602(g). 
‘‘(7) SECOND TRANCHE AMOUNT.—The term ‘Second Tranche 
Amount’ means, with respect to each metropolitan city for 
which an amount is allocated under subsection (b)(1), each 
State for which an amount is allocated under subsection (b)(2) 
for distribution to nonentitlement units of local government, 
and each county for which an amount is allocated under sub-
section (b)(3), an amount not to exceed 50 percent of the amount 
so allocated to such metropolitan city, State, or county (as 
applicable). 
‘‘(8) SECRETARY.—The term ‘Secretary’ means the Secretary 
of the Treasury. 
‘‘(9) STATE.—The term ‘State’ means each of the 50 States, 
the District of Columbia, the Commonwealth of Puerto Rico, 
the United States Virgin Islands, Guam, the Commonwealth 
of the Northern Mariana Islands, and American Samoa. 
‘‘(10) UNIT OF GENERAL LOCAL GOVERNMENT.—The term 
‘unit of general local government’ has the meaning given that 
term in section 102(a)(1) of the Housing and Community 
Development Act of 1974 (42 U.S.C. 5302(a)(1)). 
‘‘SEC. 604. CORONAVIRUS CAPITAL PROJECTS FUND. 
‘‘(a) APPROPRIATION.—In addition to amounts otherwise avail-
able, there is appropriated for fiscal year 2021, out of any money 
in the Treasury not otherwise appropriated, $10,000,000,000, to 
remain available until expended, for making payments to States, 
territories, and Tribal governments to carry out critical capital 
projects directly enabling work, education, and health monitoring, 
including remote options, in response to the public health emergency 
with respect to the Coronavirus Disease (COVID–19). 
‘‘(b) PAYMENTS.— 
‘‘(1) MINIMUM AMOUNTS.—From the amount appropriated 
under subsection (a)— 
‘‘(A) the Secretary shall pay $100,000,000 to each State;
H. R. 1319—231 
‘‘(B) the Secretary shall pay $100,000,000 of such 
amount in equal shares to the United States Virgin Islands, 
Guam, American Samoa, the Commonwealth of the 
Northern Mariana Islands, the Republic of the Marshall 
Islands, the Federated States of Micronesia, and the 
Republic of Palau; and 
‘‘(C) the Secretary shall pay $100,000,000 of such 
amount in equal shares to Tribal governments and the 
State of Hawaii (in addition to the amount paid to the 
State of Hawaii under subparagraph (A)), of which— 
‘‘(i) not less than $50,000 shall be paid to each 
Tribal government; and 
‘‘(ii) not less than $50,000, and not more than 
$200,000, shall be paid to the State of Hawaii for 
the exclusive use of the Department of Hawaiian Home 
Lands and the Native Hawaiian Education Programs 
to assist Native Hawaiians in accordance with this 
section. 
‘‘(2) REMAINING AMOUNTS.— 
‘‘(A) IN GENERAL.—From the amount of the appropria-
tion under subsection (a) that remains after the application 
of paragraph (1), the Secretary shall make payments to 
States based on population such that— 
‘‘(i) 50 percent of such amount shall be allocated 
among the States based on the proportion that the 
population of each State bears to the population of 
all States; 
‘‘(ii) 25 percent of such amount shall be allocated 
among the States based on the proportion that the 
number of individuals living in rural areas in each 
State bears to the number of individuals living in 
rural areas in all States; and 
‘‘(iii) 25 percent of such amount shall be allocated 
among the States based on the proportion that the 
number of individuals with a household income that 
is below 150 percent of the poverty line applicable 
to a family of the size involved in each State bears 
to the number of such individuals in all States. 
‘‘(B) DATA.—In determining the allocations to be made 
to each State under subparagraph (A), the Secretary of 
the Treasury shall use the most recent data available from 
the Bureau of the Census. 
‘‘(c) TIMING.—The Secretary shall establish a process of applying 
for grants to access funding made available under section (b) not 
later than 60 days after enactment of this section. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) SECRETARY.—The term ‘Secretary’ means the Secretary 
of the Treasury. 
‘‘(2) STATE.—The term ‘State’ means each of the 50 States, 
the District of Columbia, and Puerto Rico. 
‘‘(3) TRIBAL GOVERNMENT.—The term ‘Tribal government’ 
has the meaning given such term in section 602(g). 
‘‘SEC. 605. LOCAL ASSISTANCE AND TRIBAL CONSISTENCY FUND. 
‘‘(a) APPROPRIATION.—In addition to amounts otherwise avail-
able, there is appropriated for fiscal year 2021, out of any money 
in the Treasury not otherwise appropriated, $2,000,000,000 to
H. R. 1319—232 
remain available until September 30, 2023, with amounts to be 
obligated for each of fiscal years 2022 and 2023 in accordance 
with subsection (b), for making payments under this section to 
eligible revenue sharing counties and eligible Tribal governments. 
‘‘(b) AUTHORITY TO MAKE PAYMENTS.— 
‘‘(1) PAYMENTS TO ELIGIBLE REVENUE SHARING COUNTIES.— 
For each of fiscal years 2022 and 2023, the Secretary shall 
reserve $750,000,000 of the total amount appropriated under 
subsection (a) to allocate and pay to each eligible revenue 
sharing county in amounts that are determined by the Sec-
retary taking into account economic conditions of each eligible 
revenue sharing county, using measurements of poverty rates, 
household income, land values, and unemployment rates as 
well as other economic indicators, over the 20-year period 
ending with September 30, 2021. 
‘‘(2) PAYMENTS
TO
ELIGIBLE
TRIBAL
GOVERNMENTS.—For 
each of fiscal years 2022 and 2023, the Secretary shall reserve 
$250,000,000 of the total amount appropriated under subsection 
(a) to allocate and pay to eligible Tribal governments in 
amounts that are determined by the Secretary taking into 
account economic conditions of each eligible Tribe. 
‘‘(c) USE OF PAYMENTS.—An eligible revenue sharing county 
or an eligible Tribal government may use funds provided under 
a payment made under this section for any governmental purpose 
other than a lobbying activity. 
‘‘(d) REPORTING REQUIREMENT.—Any eligible revenue sharing 
county receiving a payment under this section shall provide to 
the Secretary periodic reports providing a detailed accounting of 
the uses of fund by such eligible revenue sharing county and such 
other information as the Secretary may require for the administra-
tion of this section. 
‘‘(e) RECOUPMENT.—Any eligible revenue sharing county that 
has failed to submit a report required under subsection (d) or 
failed to comply with subsection (c), shall be required to repay 
to the Secretary an amount equal to— 
‘‘(1) in the case of a failure to comply with subsection 
(c), the amount of funds used in violation of such subsection; 
and 
‘‘(2) in the case of a failure to submit a report required 
under subsection (d), such amount as the Secretary determines 
appropriate, but not to exceed 5 percent of the amount paid 
to the eligible revenue sharing county under this section for 
all fiscal years. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE
REVENUE
SHARING
COUNTY.—The term 
‘eligible revenue sharing county’ means— 
‘‘(A) a county, parish, or borough— 
‘‘(i) that is independent of any other unit of local 
government; and 
‘‘(ii) that, as determined by the Secretary, is the 
principal provider of government services for the area 
within its jurisdiction; and 
‘‘(iii) for which, as determined by the Secretary, 
there is a negative revenue impact due to implementa-
tion of a Federal program or changes to such program; 
and
H. R. 1319—233 
‘‘(B) the District of Columbia, the Commonwealth of 
Puerto Rico, Guam, and the United States Virgin Islands. 
‘‘(2) ELIGIBLE
TRIBAL
GOVERNMENT.—The term ‘eligible 
Tribal government’ means the recognized governing body of 
an eligible Tribe. 
‘‘(3) ELIGIBLE TRIBE.—The term ‘eligible Tribe’ means any 
Indian or Alaska Native tribe, band, nation, pueblo, village, 
community, component band, or component reservation, individ-
ually identified (including parenthetically) in the list published 
most recently as of the date of enactment of this section pursu-
ant to section 104 of the Federally Recognized Indian Tribe 
List Act of 1994 (25 U.S.C. 5131). 
‘‘(4) SECRETARY.—The term ‘Secretary’ means the Secretary 
of the Treasury.’’. 
(b) CONFORMING AMENDMENT.—The heading for title VI of the 
Social Security Act (42 U.S.C. 801 et seq.) is amended by striking 
‘‘FUND’’ and inserting ‘‘, FISCAL RECOVERY, AND CRITICAL 
CAPITAL PROJECTS FUNDS’’. 
Subtitle N—Other Provisions 
SEC. 9911. FUNDING FOR PROVIDERS RELATING TO COVID–19. 
Part A of title XI of the Social Security Act (42 U.S.C. 1301 
et seq.) is amended by adding at the end the following: 
‘‘SEC. 1150C. FUNDING FOR PROVIDERS RELATING TO COVID–19. 
‘‘(a) FUNDING.—In addition to amounts otherwise available, 
there is appropriated to the Secretary, for fiscal year 2021, out 
of any monies in the Treasury not otherwise appropriated, 
$8,500,000,000 for purposes of making payments to eligible health 
care providers for health care related expenses and lost revenues 
that are attributable to COVID–19. Amounts appropriated under 
the preceding sentence shall remain available until expended. 
‘‘(b) APPLICATION REQUIREMENT.—To be eligible for a payment 
under this section, an eligible health care provider shall submit 
to the Secretary an application in such form and manner as the 
Secretary shall prescribe. Such application shall contain the fol-
lowing: 
‘‘(1) A statement justifying the need of the provider for 
the payment, including documentation of the health care related 
expenses attributable to COVID–19 and lost revenues attrib-
utable to COVID–19. 
‘‘(2) The tax identification number of the provider. 
‘‘(3) Such assurances as the Secretary determines appro-
priate that the eligible health care provider will maintain and 
make available such documentation and submit such reports 
(at such time, in such form, and containing such information 
as the Secretary shall prescribe) as the Secretary determines 
is necessary to ensure compliance with any conditions imposed 
by the Secretary under this section. 
‘‘(4) Any other information determined appropriate by the 
Secretary. 
‘‘(c) LIMITATION.—Payments made to an eligible health care 
provider under this section may not be used to reimburse any 
expense or loss that— 
‘‘(1) has been reimbursed from another source; or
H. R. 1319—234 
‘‘(2) another source is obligated to reimburse. 
‘‘(d) APPLICATION
OF
REQUIREMENTS, RULES, AND
PROCE-
DURES.—The Secretary shall apply any requirements, rules, or 
procedures as the Secretary deems appropriate for the efficient 
execution of this section. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE HEALTH CARE PROVIDER.—The term ‘eligible 
health care provider’ means— 
‘‘(A) a provider of services (as defined in section 
1861(u)) or a supplier (as defined in section 1861(d)) that— 
‘‘(i) is enrolled in the Medicare program under 
title XVIII under section 1866(j) (including temporarily 
enrolled during the emergency period described in sec-
tion 1135(g)(1)(B) for such period); 
‘‘(ii) provides diagnoses, testing, or care for individ-
uals with possible or actual cases of COVID–19; and 
‘‘(iii) is a rural provider or supplier; or 
‘‘(B) a provider or supplier that— 
‘‘(i) is enrolled with a State Medicaid plan under 
title XIX (or a waiver of such plan) in accordance 
with subsections (a)(77) and (kk) of section 1902 
(including enrolled pursuant to section 1902(a)(78) or 
section 1932(d)(6)) or enrolled with a State child health 
plan under title XXI (or a waiver of such plan) in 
accordance with subparagraph (G) of section 2107(e)(1) 
(including enrolled pursuant to subparagraph (D) or 
(Q) of such section); 
‘‘(ii) provides diagnoses, testing, or care for individ-
uals with possible or actual cases of COVID–19; and 
‘‘(iii) is a rural provider or supplier. 
‘‘(2) HEALTH
CARE
RELATED
EXPENSES
ATTRIBUTABLE
TO 
COVID–19.—The term ‘health care related expenses attributable 
to COVID–19’ means health care related expenses to prevent, 
prepare for, and respond to COVID–19, including the building 
or construction of a temporary structure, the leasing of a prop-
erty, the purchase of medical supplies and equipment, including 
personal protective equipment and testing supplies, providing 
for increased workforce and training (including maintaining 
staff, obtaining additional staff, or both), the operation of an 
emergency operation center, retrofitting a facility, providing 
for surge capacity, and other expenses determined appropriate 
by the Secretary. 
‘‘(3) LOST REVENUE ATTRIBUTABLE TO COVID–19.—The term 
‘lost revenue attributable to COVID–19’ has the meaning given 
that term in the Frequently Asked Questions guidance released 
by the Department of Health and Human Services in June 
2020, including the difference between such provider’s budgeted 
and actual revenue if such budget had been established and 
approved prior to March 27, 2020. 
‘‘(4) PAYMENT.— The term ‘payment’ includes, as deter-
mined appropriate by the Secretary, a pre-payment, a prospec-
tive payment, a retrospective payment, or a payment through 
a grant or other mechanism. 
‘‘(5) RURAL PROVIDER OR SUPPLIER.—The term ‘rural pro-
vider or supplier’ means— 
‘‘(A) a—
H. R. 1319—235 
‘‘(i) provider or supplier located in a rural area 
(as defined in section 1886(d)(2)(D)); or 
‘‘(ii) provider treated as located in a rural area 
pursuant to section 1886(d)(8)(E); 
‘‘(B) a provider or supplier located in any other area 
that serves rural patients (as defined by the Secretary), 
which may include, but is not required to include, a metro-
politan statistical area with a population of less than 
500,000 (determined based on the most recently available 
data); 
‘‘(C) a rural health clinic (as defined in section 
1861(aa)(2)); 
‘‘(D) a provider or supplier that furnishes home health, 
hospice, or long-term services and supports in an individ-
ual’s home located in a rural area (as defined in section 
1886(d)(2)(D)); or 
‘‘(E) any other rural provider or supplier (as defined 
by the Secretary).’’. 
SEC. 9912. EXTENSION OF CUSTOMS USER FEES. 
(a) IN GENERAL.—Section 13031(j)(3) of the Consolidated Omni-
bus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is 
amended— 
(1) in subparagraph (A), by striking ‘‘October 21, 2029’’ 
and inserting ‘‘September 30, 2030’’; and 
(2) in subparagraph (B)(i), by striking ‘‘October 21, 2029’’ 
and inserting ‘‘September 30, 2030’’. 
(b) RATE FOR MERCHANDISE PROCESSING FEES.—Section 503 
of the United States-Korea Free Trade Agreement Implementation 
Act (Public Law 112–41; 19 U.S.C. 3805 note) is amended by 
striking ‘‘October 21, 2029’’ and inserting ‘‘September 30, 2030’’. 
TITLE X—COMMITTEE ON FOREIGN 
RELATIONS 
SEC. 10001. DEPARTMENT OF STATE OPERATIONS. 
In addition to amounts otherwise available, there is authorized 
and appropriated to the Secretary of State for fiscal year 2021, 
out of any money in the Treasury not otherwise appropriated, 
$204,000,000, to remain available until September 30, 2022, for 
necessary expenses of the Department of State to carry out the 
authorities, functions, duties, and responsibilities in the conduct 
of the foreign affairs of the United States, to prevent, prepare 
for, and respond to coronavirus domestically or internationally, 
which shall include maintaining Department of State operations. 
SEC. 10002. UNITED STATES AGENCY FOR INTERNATIONAL DEVELOP-
MENT OPERATIONS. 
In addition to amounts otherwise available, there is authorized 
and appropriated to the Administrator of the United States Agency 
for International Development for fiscal year 2021, out of any money 
in the Treasury not otherwise appropriated, $41,000,000, to remain 
available until September 30, 2022, to carry out the provisions 
of section 667 of the Foreign Assistance Act of 1961 (22 U.S.C. 
2427) for necessary expenses of the United States Agency for Inter-
national Development to prevent, prepare for, and respond to
H. R. 1319—236 
coronavirus domestically or internationally, and for other operations 
and maintenance requirements related to coronavirus. 
SEC. 10003. GLOBAL RESPONSE. 
(a) IN GENERAL.—In addition to amounts otherwise available, 
there is authorized and appropriated to the Secretary of State 
for fiscal year 2021, out of any money in the Treasury not otherwise 
appropriated, $8,675,000,000, to remain available until September 
30, 2022, for necessary expenses to carry out the provisions of 
section 531 of chapter 4 of part II of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2346) as health programs to prevent, prepare 
for, and respond to coronavirus, which shall include recovery from 
the impacts of such virus and shall be allocated as follows— 
(1) $905,000,000 to be made available to the United States 
Agency for International Development for global health activi-
ties to prevent, prepare for, and respond to coronavirus, which 
shall include a contribution to a multilateral vaccine develop-
ment partnership to support epidemic preparedness; 
(2) $3,750,000,000 to be made available to the Department 
of State to support programs for the prevention, treatment, 
and control of HIV/AIDS in order to prevent, prepare for, and 
respond to coronavirus, including to mitigate the impact on 
such programs from coronavirus and support recovery from 
the impacts of the coronavirus, of which not less than 
$3,500,000,000 shall be for a United States contribution to 
the Global Fund to Fight AIDS, Tuberculosis and Malaria; 
(3) $3,090,000,000 to be made available to the United 
States Agency for International Development to prevent, pre-
pare for, and respond to coronavirus, which shall include sup-
port for international disaster relief, rehabilitation, and 
reconstruction, for health activities, and to meet emergency 
food security needs; and 
(4) $930,000,000 to be made available to prevent, prepare 
for, and respond to coronavirus, which shall include activities 
to address economic and stabilization requirements resulting 
from such virus. 
(b) WAIVER OF LIMITATION.—Any contribution to the Global 
Fund to Fight AIDS, Tuberculosis and Malaria made pursuant 
to subsection (a)(2) shall be made available notwithstanding section 
202(d)(4)(A)(i) of the United States Leadership Against HIV/AIDS, 
Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7622(d)(4)(A)(i)), 
and such contribution shall not be considered a contribution for 
the purpose of applying such section 202(d)(4)(A)(i). 
SEC. 10004. HUMANITARIAN RESPONSE. 
(a) IN GENERAL.—In addition to amounts otherwise available, 
there is authorized and appropriated to the Secretary of State 
for fiscal year 2021, out of any money in the Treasury not otherwise 
appropriated, $500,000,000, to remain available until September 
30, 2022, to carry out the provisions of section 2(a) and (b) of 
the Migration and Refugee Assistance Act of 1962 (22 U.S.C. 2601(a) 
and (b)) to prevent, prepare for, and respond to coronavirus. 
(b) USE OF FUNDS.—Funds appropriated pursuant to this sec-
tion shall not be made available for the costs of resettling refugees 
in the United States.
H. R. 1319—237 
SEC. 10005. MULTILATERAL ASSISTANCE. 
In addition to amounts otherwise available, there is authorized 
and appropriated to the Secretary of State for fiscal year 2021, 
out of any money in the Treasury not otherwise appropriated, 
$580,000,000, to remain available until September 30, 2022, to 
carry out the provisions of section 301(a) of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2221(a)) to prevent, prepare for, and respond 
to coronavirus, which shall include support for the priorities and 
objectives of the United Nations Global Humanitarian Response 
Plan COVID–19 through voluntary contributions to international 
organizations and programs administered by such organizations. 
TITLE XI—COMMITTEE ON INDIAN 
AFFAIRS 
SEC. 11001. INDIAN HEALTH SERVICE. 
(a) In addition to amounts otherwise available, there is appro-
priated to the Secretary of Health and Human Services (in this 
section referred to as the ‘‘Secretary’’) for fiscal year 2021, out 
of any money in the Treasury not otherwise appropriated, 
$6,094,000,000, to remain available until expended, of which— 
(1) $5,484,000,000 shall be for carrying out the Act of 
August 5, 1954 (42 U.S.C. 2001 et seq.) (commonly referred 
to as the Transfer Act), the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5301 et seq.), the Indian 
Health Care Improvement Act (25 U.S.C. 1601 et seq.), and 
titles II and III of the Public Health Service Act (42 U.S.C. 
201 et seq. and 241 et seq.) with respect to the Indian Health 
Service, of which— 
(A) $2,000,000,000 shall be for lost reimbursements, 
in accordance with section 207 of the Indian Health Care 
Improvement Act (25 U.S.C. 1621f); 
(B) $500,000,000 shall be for the provision of additional 
health care services, services provided through the Pur-
chased/Referred Care program, and other related activities; 
(C) $140,000,000 shall be for information technology, 
telehealth infrastructure, and the Indian Health Service 
electronic health records system; 
(D) $84,000,000 shall be for maintaining operations 
of the Urban Indian health program, which shall be in 
addition to other amounts made available under this sub-
section for Urban Indian organizations (as defined in sec-
tion 4 of the Indian Health Care Improvement Act (25 
U.S.C. 1603)); 
(E) $600,000,000 shall be for necessary expenses to 
plan, prepare for, promote, distribute, administer, and 
track COVID–19 vaccines, for the purposes described in 
subparagraphs (F) and (G), and for other vaccine-related 
activities; 
(F) $1,500,000,000 shall be for necessary expenses to 
detect, diagnose, trace, and monitor COVID–19 infections, 
activities necessary to mitigate the spread of COVID–19, 
supplies necessary for such activities, for the purposes 
described in subparagraphs (E) and (G), and for other 
related activities;