expenditures sufficient to meet the need for cov-
ered health care services. 
(4) REGIONAL
ALLOCATION.—The Secretary 
shall annually provide each regional office with an 
allotment the Secretary determines appropriate for 
purposes of carrying out this Act in such region, in-
cluding payments to providers in such region, capital 
expenditures in such region, special projects in such 
region, health professional education in such region, 
administrative expenses in such region, and preven-
tion and public health activities in such region. 
(5) OPERATING BUDGET.—The operating budg-
et described in paragraph (2)(A) shall be used for— 
(A) payments to institutional providers 
pursuant to section 611; and 
(B) payments to individual providers pur-
suant to section 612. 
(6) CAPITAL
EXPENDITURES
BUDGET.—The 
capital expenditures budget described in paragraph 
(2)(B) shall be used for— 
(A) the construction or renovation of 
health care facilities, excluding congregate or 
segregated facilities for individuals with disabil-
ities who receive long-term care services and 
support; and 
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(B) major equipment purchases. 
(7) SPECIAL PROJECTS BUDGET.—The special 
projects budget described in paragraph (2)(C) shall 
be used for the purposes of allocating funds for the 
construction of new facilities, major equipment pur-
chases, and staffing in rural or medically under-
served areas (as defined in section 330(b)(3) of the 
Public Health Service Act (42 U.S.C. 254b(b)(3))), 
including areas designated as health professional 
shortage areas (as defined in section 332(a) of the 
Public Health Service Act (42 U.S.C. 254e(a))), and 
to address health disparities, including racial, ethnic, 
national origin, primary language use, age, dis-
ability, sex (including gender identity and sexual ori-
entation), geography, or socioeconomic health dis-
parities. 
(8) TEMPORARY WORKER ASSISTANCE.— 
(A) IN GENERAL.—For up to 5 years fol-
lowing the date on which benefits first become 
available as described in section 106(a), at least 
1 percent of the budget shall be allocated to 
programs providing assistance to workers who 
perform functions in the administration of the 
health insurance system, or related functions 
within health care institutions or organizations 
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who may be affected by the implementation of 
this Act and who may experience economic dis-
location as a result of the implementation of 
this Act. 
(B) CLARIFICATION.—Assistance described 
in subparagraph (A) shall include wage replace-
ment, retirement benefits, job training and 
placement, preferential hiring, and education 
benefits. 
(9) RESERVE
FUND.—The reserve fund de-
scribed in paragraph (2)(G) shall be used to respond 
to the costs of an epidemic, pandemic, natural dis-
aster, or other such health emergency, or market- 
shift adjustments related to patient volume. 
(10) SUPPLEMENTAL INDIAN HEALTH SERVICE 
ALLOCATION.—The Secretary shall annually deter-
mine the need to provide an allotment of supple-
mental funds to Indian Health Services, including 
payments to providers, capital expenditures, special 
projects, health professional education, administra-
tive expenses, and prevention and public health ac-
tivities. 
(b) DEFINITIONS.—In this section: 
(1) CAPITAL EXPENDITURES.—The term ‘‘cap-
ital expenditures’’ means expenses for the purchase, 
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lease, construction, or renovation of capital facilities 
and for major equipment. 
(2) HEALTH
PROFESSIONAL
EDUCATION
EX-
PENDITURES.—The term ‘‘health professional edu-
cation expenditures’’ means expenditures in hospitals 
and other health care facilities to cover costs associ-
ated with teaching and related research activities, in-
cluding the impact of workforce diversity on patient 
outcomes. 
Subtitle B—Payments to Providers 
SEC. 
611. 
PAYMENTS 
TO 
INSTITUTIONAL 
PROVIDERS 
BASED ON GLOBAL BUDGETS. 
(a) IN GENERAL.—Not later than the beginning of 
each fiscal quarter during which an institutional provider 
of care (including hospitals, skilled nursing facilities, Fed-
erally qualified health centers, and independent dialysis fa-
cilities) is to furnish items and services under this Act, 
the Secretary shall pay to such institutional provider a 
lump sum in accordance with the succeeding provisions of 
this subsection and consistent with the following: 
(1) PAYMENT IN FULL.—Such payment shall be 
considered as payment in full for all operating ex-
penses for items and services furnished under this 
Act, whether inpatient or outpatient, by such pro-
vider for such quarter, including outpatient or any 
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other care provided by the institutional provider or 
provided by any health care provider who provided 
items and services pursuant to an agreement paid 
through the global budget as described in paragraph 
(3). 
(2) QUARTERLY REVIEW.—The regional direc-
tor, on a quarterly basis, shall review whether re-
quirements of the institutional provider’s participa-
tion agreement and negotiated global budget have 
been performed and shall determine whether adjust-
ments to such institutional provider’s payment are 
warranted. This review shall include consideration 
for additional funding necessary for unanticipated 
items and services for individuals with complex med-
ical needs or market-shift adjustments related to pa-
tient volume. The review shall also include an as-
sessment of any adjustments made to ensure that 
accuracy and need for adjustment was appropriate. 
(3) AGREEMENTS
FOR
SALARIED
PAYMENTS 
FOR CERTAIN PROVIDERS.—Certain group practices 
and other health care providers, as determined by 
the Secretary, with agreements to provide items and 
services at a specified institutional provider paid a 
global budget under this subsection may elect to be 
paid through such institutional provider’s global 
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