I
105TH CONGRESS
1ST SESSION
H. R. 735
To amend the Internal Revenue Code of 1986 and title XVIII of the Social
Security Act to establish a program of assistance for essential community
providers of health care services, to establish a program to update and
maintain the infrastructure requirements of safety net hospitals, and
to require States to develop plans for the allocation and review of expend-
itures for the capital-related costs of health care services.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 12, 1997
Mr. STARK introduced the following bill; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend the Internal Revenue Code of 1986 and title
XVIII of the Social Security Act to establish a program
of assistance for essential community providers of health
care services, to establish a program to update and main-
tain the infrastructure requirements of safety net hos-
pitals, and to require States to develop plans for the
allocation and review of expenditures for the capital-
related costs of health care services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Essential Health Fa-
cilities Investment Act of 1997’’.
TITLE 
I—ESSENTIAL 
ACCESS
COMMUNITY HOSPITAL PRO-
GRAM
SEC. 101. REVISIONS TO CURRENT PROGRAM.
(a) EXPANSION
OF CURRENT PROGRAM
TO ALL
STATES.—Section 1820(a)(1) of the Social Security Act
(42 U.S.C. 1395i–4(a)(1)) is amended by striking ‘‘not
more than 7’’.
(b) INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS.—Section 1820(l) of such Act (42 U.S.C. 1395i–
4(l)) is amended—
(1) by striking ‘‘1990, 1991, and 1992’’ and in-
serting ‘‘1998 through 2003’’;
(2) by amending paragraph (1) to read as fol-
lows:
‘‘(1) $50,000,000 for grants to States under
subsection (a)(1) and grants to States and units of
local government under section 1821(a)(1); and’’;
and
(3) 
in 
paragraph 
(2), 
by 
striking
‘‘$15,000,000’’ and inserting ‘‘$40,000,000’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall take effect October 1, 1997.
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SEC. 102. EXTENSION OF PROGRAM TO NETWORKS OF ES-
SENTIAL COMMUNITY PROVIDERS.
(a) IN GENERAL.—Part A of title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) is amended by add-
ing at the end the following new section:
‘‘ASSISTANCE FOR ESSENTIAL COMMUNITY PROVIDERS
‘‘SEC. 1821. (a) ESTABLISHMENT OF PROGRAM.—
There is hereby established a program under which the
Secretary—
‘‘(1) shall make grants to States and units of
local government to carry out the activities described
in subsection (d)(1); and
‘‘(2) shall make grants to eligible hospitals and
facilities (or consortia of hospitals and facilities) to
carry out the activities described in subsection
(d)(2).
‘‘(b) ELIGIBILITY
OF STATES
AND COMMUNITIES
FOR GRANTS.—
‘‘(1) REQUIREMENTS FOR APPLICATION.—Sub-
ject to paragraph (2), a State or unit of local gov-
ernment is eligible to receive a grant under sub-
section (a)(1) only if the State or unit of local gov-
ernment submits to the Secretary, at such time and
in such form as the Secretary may require, an appli-
cation containing such information and assurances
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as the Secretary may require, together with assur-
ances that the State or unit of local government—
‘‘(A) has developed, or is in the process of
developing, a community health plan that—
‘‘(i) provides for the creation of a
community health network (as defined in
subsection (f)) in the State or locality,
‘‘(ii) promotes the integration of the
delivery of health care services in the State
or locality,
‘‘(iii) improves access to hospital and
other services (including primary care serv-
ices) for urban residents in the State or lo-
cality, and
‘‘(iv) in the case of a plan of a unit
of local government, is approved by the
State;
‘‘(B) has developed (or intends to develop)
the plan described in subparagraph (A) in con-
sultation with appropriate State and community
hospital associations, public hospitals, and pri-
mary care associations; and
‘‘(C) has designated, or is in the process of
designating, nonprofit or public hospitals and
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facilities located in the State or locality as es-
sential community providers within such com-
munity health networks (with the approval of
the State in the case of designations by units
of local government).
‘‘(2) COORDINATION
BETWEEN
STATE
AND
LOCAL
RECIPIENTS.—A unit of local government
may not receive a grant under subsection (a)(1) if
it is located in a State receiving a grant under such
subsection, except that a unit of local government lo-
cated in an urban area (as defined in section
1886(d)(2)(D)) in such a State may receive such a
grant with the approval of the State.
‘‘(c) ELIGIBILITY OF HOSPITALS, FACILITIES, AND
CONSORTIA FOR GRANTS.—
‘‘(1) IN GENERAL.—A hospital or facility is eli-
gible to receive a grant under subsection (a)(2) only
if the hospital or facility—
‘‘(A) is located in a State or locality receiv-
ing a grant under subsection (a)(1);
‘‘(B) is designated as an essential commu-
nity provider by the State or unit of local gov-
ernment or is a member of a community health
network;
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‘‘(C) submits an application to the State or
unit of local government at such time and con-
taining such information and assurances as the
Secretary may require; and
‘‘(D) has received certification by the State
or unit of local government that the receiving of
such grant by the hospital or facility is consist-
ent with the community health plan of the
State or unit or local government and that the
State or unit or local government has approved
the application submitted under subparagraph
(C).
‘‘(2) TREATMENT
OF
CONSORTIA.—A consor-
tium of hospitals or facilities each of which is part
of the same community health network is eligible to
receive a grant under subsection (a)(2) if each of its
members would individually be eligible to receive
such a grant.
‘‘(d) ACTIVITIES
FOR
WHICH
GRANT
MAY
BE
USED.—
‘‘(1) GRANTS TO STATES OR LOCAL GOVERN-
MENTS.—A State or unit of local government shall
use a grant received under subsection (a)(1) to carry
out activities relating to planning and implementing
its community health plan.
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‘‘(2) GRANTS TO HOSPITALS, FACILITIES, AND
CONSORTIA.—A hospital or facility shall use a grant
received under subsection (a)(2) to finance the costs
it incurs in becoming part of a community health
network and in serving as part of such a network,
including costs related to—
‘‘(A) the development of primary care serv-
ice sites;
‘‘(B) the development of integrated infor-
mation, billing, and reporting systems;
‘‘(C) planning and needs assessments;
‘‘(D) the recruitment and training of
health professionals and administrative staff;
and
‘‘(E) conducting health promotion outreach
activities for medically underserved populations
in its service area.
‘‘(e) DESIGNATION OF ESSENTIAL COMMUNITY PRO-
VIDERS.—A State or unit of local government may des-
ignate a hospital or facility as an essential community pro-
vider only if—
‘‘(1) the hospital or facility is a member of (or
is in the process of becoming a member of) a com-
munity health network (as defined in subsection (f));
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‘‘(2) in the case of a facility other than a hos-
pital—
‘‘(A) the facility is a federally-qualified
health 
center 
(as 
defined 
in 
section
1861(aa)(4)), or
‘‘(B) the facility would be a federally-quali-
fied health center but for its failure to meet the
requirement described in section 329(f)(2)(G)(i)
of the Public Health Service Act or the require-
ment described in section 330(e)(3)(G)(i) of
such Act (relating to the composition of the fa-
cility’s governing board), but only if the facility
provides assurances to the State or unit of local
government that consumers have significant
input into the governance of the facility; and
‘‘(3) in the case of a hospital—
‘‘(A) the hospital is designated as an es-
sential access community hospital by the Sec-
retary under section 1820(i)(1),
‘‘(B) the hospital is designated as a rural
primary care hospital by the Secretary under
section 1820(i)(2),
‘‘(C) the hospital is described in section
1886(d)(5)(F)(i)(II), or
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‘‘(D) the hospital receives an additional
payment amount under section 1886(d)(5)(F)
based on the formula described in clause (vii)(I)
of such section.
‘‘(f) COMMUNITY HEALTH NETWORK DEFINED.—In
this section, the term ‘community health network’ means
a public or nonprofit entity that meets the following re-
quirements:
‘‘(1) The entity provides primary care services
and acute care services to a medically underserved
community (as defined in section 799(6) of the Pub-
lic Health Service Act) in the entity’s service area,
either directly through its members or through con-
tracts with other entities (under such limited cir-
cumstances as the Secretary may permit in regula-
tions).
‘‘(2) The entity consists of—
‘‘(A) at least one hospital that is located in
an 
urban 
area 
(as 
defined 
in 
section
1886(d)(2)(D)) and that has been designated
as an essential community provider under sub-
section (e);
‘‘(B) at least 3 facilities (other than hos-
pitals) that have been designated as essential
community providers under subsection (e); and
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‘‘(C) at the election of the entity’s mem-
bers, any other entities that provide primary
care or other health care services.
‘‘(3) The members of the entity have entered
into an agreement under which—
‘‘(A) each member agrees to provide appro-
priate emergency and medical support services
to other members,
‘‘(B) each member agrees to accept refer-
rals from other members,
‘‘(C) each hospital member has arrange-
ments to provide staff privileges to physicians
providing care for other members, and
‘‘(D) each member has in effect (or is in
the process of establishing) agreements with
other members to share in the member’s com-
munication system, including (where appro-
priate) the electronic sharing of patient data,
medical records, and billing services.
‘‘(g) LIMIT ON AMOUNT OF GRANT TO HOSPITAL OR
FACILITY.—A grant made to a hospital or facility under
subsection (a)(2) may not exceed $200,000, except that
the total amount of a grant awarded to a consortia of hos-
pitals or facilities under such subsection may not exceed
$1,000,000.’’.
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(b) FUNDING FOR GRANTS TO HOSPITALS THROUGH
CURRENT EACH PROGRAM.—Section 1820(l) of the So-
cial Security Act (42 U.S.C. 1395i–4(l)) is amended—
(1) in the heading, by striking ‘‘Appropria-
tions’’ and inserting ‘‘Appropriations for EACH
Program and Essential Community Provider Pro-
gram’’;
(2) by striking ‘‘and’’ at the end of paragraph
(1);
(3) by striking the period at the end of para-
graph (2) and inserting ‘‘; and’’; and
(4) by adding at the end the following new
paragraph:
‘‘(3) $80,000,000 for grants to hospitals under
section 1821(a)(2).’’.
(c) INCLUDING INTERNS AND RESIDENTS PROVIDING
SERVICES AT ESSENTIAL COMMUNITY PROVIDERS IN DE-
TERMINING PAYMENT FOR INDIRECT COSTS OF MEDICAL
EDUCATION.—Section 1886(d)(5)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by add-
ing at the end the following new clause:
‘‘(v) In determining such adjustment, the Sec-
retary shall count services of interns and residents
under a medical residency training program that is
conducted at a facility designated as an essential
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TITLE II—CAPITAL FINANCING
ASSISTANCE FOR SAFETY NET
PROVIDERS
Subtitle A—Amendments of
Internal Revenue Code of 1986
SEC. 201. GROSS RECEIPTS TAX ON HOSPITALS.
(a) IN GENERAL.—Subchapter A of chapter 1 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following new part:
‘‘PART VII—HOSPITAL CAPITAL FINANCING
ASSISTANCE TAX
‘‘Sec. 59B. Imposition of tax.
‘‘SEC. 59B. IMPOSITION OF TAX.
‘‘(a) GENERAL RULE.—In addition to any other tax
imposed by this subtitle, there is hereby imposed a tax
of 0.5 percent of the hospital gross receipts of any person
for the taxable year.
‘‘(b) HOSPITAL GROSS RECEIPTS.—For purposes of
this section, the term ‘hospital gross receipts’ means gross
receipts received or accrued during the taxable year from
the operation of any hospital, other than payments re-
ceived under a State plan for medical assistance under
title XIX of the Social Security Act.
‘‘(c) PERSON.—The term ‘person’ includes persons
exempt from tax under section 501(a), the United States,
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any State or political subdivision thereof, the District of
Columbia, and any agency or instrumentality of the fore-
going.
‘‘(d) NOT TREATED AS TAX FOR CERTAIN PUR-
POSES.—The taxes imposed by this section shall not be
treated as taxes imposed by this chapter for purposes of
determining—
‘‘(1) the amount of any credit allowable under
this chapter, or
‘‘(2) the amount of the minimum tax imposed
by section 55.’’
(b) TAXES INCLUDED IN ESTIMATED TAX.—Sub-
paragraph (A) of section 6655(g)(1) of such Code is
amended by striking ‘‘plus’’ at the end of clause (iii), by
redesignating clause (iv) as clause (v), and by inserting
after clause (iii) the following new clause:
‘‘(iv) the tax imposed by section 59B,
plus’’.
(c) CLERICAL AMENDMENT.—The table of parts for
subchapter A of chapter 1 of such Code is amended by
adding at the end thereof the following new item:
‘‘Part VII. Hospital capital financing assistance tax.’’
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to taxable years beginning after
September 30, 1997.
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Subtitle B—Capital Financing
Assistance for Safety Net Providers
SEC. 211. ESTABLISHMENT OF CAPITAL FINANCING ASSIST-
ANCE PROGRAM.
(a) IN GENERAL.—The Social Security Act is amend-
ed by adding at the end the following new title:
‘‘TITLE XXI—CAPITAL FINANCING ASSIST-
ANCE FOR SAFETY NET PROVIDERS
‘‘Subtitle A—General Provisions
‘‘PAYMENTS TO HOSPITALS AND FACILITIES
‘‘SEC. 2101. (a) IN GENERAL.—The Secretary, with
the approval of the Capital Financing Trust Fund Board
of Trustees described in section 2104(d) (hereafter in this
title referred to as the ‘Trust Fund Board’), shall make
payments during fiscal year 1998 through 2003, from
amounts in the Capital Financing Trust Fund established
under section 2104(a) (hereafter in this title referred to
as the ‘Trust Fund’), for capital financing assistance to
eligible hospitals and facilities whose applications for as-
sistance have been approved under this title.
‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS-
SISTANCE.—
‘‘(1) REQUIREMENTS FOR HOSPITALS.—
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‘‘(A) IN
GENERAL.—A hospital shall be
generally eligible for capital financing assist-
ance under this title if the hospital—
‘‘(i) is designated as an essential ac-
cess community hospital by the Secretary
under section 1820(i)(1);
‘‘(ii) is designated as a rural primary
care hospital by the Secretary under sec-
tion 1820(i)(2);
‘‘(iii) 
is 
described 
in 
section
1886(d)(5)(F)(i)(II); or
‘‘(iv) receives an additional payment
amount under section 1886(d)(5)(F) based
on the formula described in clause (vii) (I)
of such section.
‘‘(B) 
OWNERSHIP
REQUIREMENTS.—In
order to qualify for assistance under this title,
a hospital must—
‘‘(i) be owned or operated by a unit of
State or local government;
‘‘(ii) be a quasi-public corporation, de-
fined as a private, nonprofit corporation or
public benefit corporation which is formally
granted one or more governmental powers
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by legislative action through (or is other-
wise partially funded by) the State legisla-
ture, city or county council; or
‘‘(iii) be a private nonprofit hospital
which has contracted with, or is otherwise
funded by, a governmental agency to pro-
vide health care services to low income in-
dividuals not eligible for assistance under
title XVIII or title XIX of this Act, where
revenue from such contracts constitute at
least 10 percent of the hospital’s operating
revenues over the prior 3 fiscal years.
‘‘(2) REQUIREMENTS FOR NON-HOSPITAL FA-
CILITIES.—A facility that is not a hospital shall be
generally eligible for capital financing assistance
under this title if the facility is designated as an es-
sential community provider under section 1821.
‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.—
Hospitals and facilities that are generally eligible for as-
sistance under this title under subsection (b) may apply
for the specific programs described in this title and must
meet any additional criteria for participation in such pro-
grams.
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‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as-
sistance available under this title shall include loan guar-
antees, interest rate subsidies, matching loans and direct
grants. Hospitals and facilities determined to be generally
eligible for assistance under this title may apply for and
receive more than one type of assistance under this title.
‘‘APPLICATION FOR ASSISTANCE
‘‘SEC. 2102. (a) IN GENERAL.—No hospital or facil-
ity may receive assistance for a qualifying project under
this title unless the hospital or facility—
‘‘(1) has filed with the Secretary, in a form and
manner specified by the Secretary, with the advice
and approval of the Trust Fund Board (as described
in section 2104(d)), an application for assistance
under this title;
‘‘(2) establishes in its application (for its most
recent cost reporting period) that it meets the cri-
teria for general eligibility under this title);
‘‘(3) includes a description of the project, in-
cluding the community in which it is located, and
describes utilization and services characteristics of
the project and the hospital or facility, and the pa-
tient population that is to be served;
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‘‘(4) provides assurances that the undertaking
of the project is in conformity with the State’s cap-
ital allocation plan established pursuant to section
1890;
‘‘(5) describes the extent to which the project is
intended to include the financial participation of
State and local governments; and all other sources
of financing sought for the project; and
‘‘(6) establishes, to the satisfaction of the Sec-
retary and the Trust Fund Board, that the project
meets the additional criteria for each type of capital
financing assistance for which it is applying.
‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with
the approval of the Trust Fund Board, shall determine
for each application for assistance under this title—
‘‘(1) whether the hospital or facility meets the
general eligibility criteria under section 2101(b);
‘‘(2) whether the hospital or facility meets the
specific eligibility criteria of each type of assistance
for which it has applied, including whether the hos-
pital or facility meets any criteria for priority con-
sideration for the type of assistance for which it has
applied;
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‘‘(3) whether the capital project for which as-
sistance is being requested in a qualifying project
under this title; and
‘‘(4) whether funds are available, pursuant to
the limitations of each program, to fully fund the re-
quest for assistance.
‘‘(c) PRIORITY OF APPLICATIONS.—In addition to
meeting the criteria otherwise described in this title, at
the discretion of the Trust Fund Board, the Secretary
shall give preference to those qualifying projects that—
‘‘(1)(A) are necessary to bring safety net facili-
ties into compliance with accreditation standards or
fire and life safety, seismic, or other related Federal,
State or local regulatory standards;
‘‘(B) improve the provision of essential services
such as emergency medical and trauma services,
AIDS and infections disease, perinatal, burn, pri-
mary care, and other services which the Trust
Fund’s Board may designate; or
‘‘(C) will result in the provision of access to es-
sential health services (as designated by the Board
of the Trust Fund) to indigent and other needy per-
sons within the hospital’s or facility’s service area
that would otherwise be unavailable;
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‘‘(2) include specific anticipated State or local
governmental or other non-Federal assurances of fi-
nancial support;
‘‘(3) are unlikely to be financed without the as-
sistance provided under this title; and
‘‘(4) are conducted by entities designated as es-
sential community providers under section 1821.
‘‘(d) SUBMISSION OF APPLICATIONS.—Applications
under this Act shall be submitted to the Secretary through
the Trust Fund Board. If two or more applicants join in
the project, the application shall be submitted by all par-
ticipating hospitals and facilities jointly. Such applications
shall set forth all of the descriptions, plans, specifications,
and assurances as required by this Act and contain other
such information as the Trust Fund Board shall require.
‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund
Board shall afford a hospital or facility applying for a loan
guarantee under this section an opportunity for a hearing
if the guarantee is denied.
‘‘(f) APPLICATIONS
FOR
AMENDMENTS.—Amend-
ment of an approved application shall be subject to ap-
proval in the same manner as an original application.
‘‘PUBLIC SERVICE RESPONSIBILITIES
‘‘SEC. 2103. (a) IN GENERAL.—Any hospital or facil-
ity accepting capital financing assistance under this title
shall agree—
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‘‘(1) to make the services of the facility or por-
tion thereof to be constructed, acquired, or modern-
ized available to all persons the construction, acqui-
sition, or modernization is intended to serve (as
identified in the hospital’s or facility’s application
under this title and the State’s capital allocation
plan established under section 1890); and
‘‘(2) to provide a significant volume of services
to persons unable to pay therefore, consistent with
other provisions of this Act.
‘‘(b) ENFORCEMENT.—The Director of the Office of
Civil Rights of the Department of Health and Human
Services shall be given the power to enforce the public
service responsibilities described in this section.
‘‘CAPITAL FINANCING TRUST FUND
‘‘SEC. 2104. (a) CREATION OF TRUST FUND.—There
is established in the Treasury of the United States a trust
fund to be known as the Capital Financing Trust Fund,
consisting of such amounts as may be appropriated or
credited to such Trust Fund as provided in this section.
‘‘(b) TRANSFERS TO TRUST FUND.—There are here-
by appropriated to the Trust Fund amounts equivalent to
the taxes received in the Treasury under section 59B of
the Internal Revenue Code of 1986 (relating to hospital
capital financing assistance tax).
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‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts
in the Trust Fund shall be available only—
‘‘(1) for making expenditures to carry out this
title;
‘‘(2) for grants to non-hospital facilities and
consortia under section 1821(a)(2) for fiscal years
1998 through 2003, except that not more than
$80,000,000 may be available for such grants for
any fiscal year; and
‘‘(3) for providing grants to States under sec-
tion 1890(d) for carrying out capital allocation
plans.
‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET-
INGS; DUTIES.—
‘‘(1) IN GENERAL.—There shall be created a
Captial Financing Trust Fund Board of Trustees
composed of the Secretary of Health and Human
Services, the Secretary of the Treasury, the Assist-
ant Secretary for Health, and the Administrator of
the Health Care Financing Administration (all serv-
ing in their ex officio capacities), and 5 public mem-
bers who shall be appointed for 4 year terms by the
President, from the following categories—
‘‘(A) one chief health officer from a State;
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‘‘(B) one chief executive officer of a hos-
pital or facility that meets the general eligibility
criteria of this title;
‘‘(C) one representative of the financial
community; and
‘‘(D) two additional public or consumer
representatives.
‘‘(2) DUTIES.—The Board of Trustees shall
meet no less than quarterly and shall have the re-
sponsibility to approve implementing regulations, to
establish criteria, and to recommend and approve ex-
penditures by the Secretary under the programs set
forth in this title.
‘‘(3) MANAGING TRUSTEE.—The Secretary of
the Treasury shall serve as the Managing Trustee of
the Trust Fund, and shall be responsible for the in-
vestment of funds. The provisions of subsections (b)
through (e) of section 1817 shall apply to the Trust
Fund and the Managing Trustee of the Trust Fund
in the same manner as they apply to the Federal
Hospital Insurance Trust Fund and the Managing
Trustee of that Trust Fund.
‘‘ADMINISTRATION
‘‘SEC. 2105. (a) IN GENERAL.—The Administrator
of the Health Care Financing Administration shall serve
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as Secretary of the Board of Trustees and shall administer
the programs under this title.
‘‘(b) 
LIMITATION
AND
ADMINISTRATIVE
EX-
PENSES.—Not more than 5 percent of the funds annually
appropriated to the Trust Fund may be available for ad-
ministration of the Trust Fund or programs under this
title.
‘‘ASSISTANCE FOR PUERTO RICO AND OTHER
COMMONWEALTHS AND TERRITORIES
‘‘SEC. 2106. (a) IN GENERAL.—
‘‘(1) AMOUNT OF ALLOCATION.—Notwithstand-
ing any other provision of this title, there shall be
allocated from the Capital Financing Trust Fund for
each of the fiscal years 1998 through 2003 a total
of $25,000,000 for assistance under this title for
hospitals and facilities located in the Commonwealth
of Puerto Rico, the Commonwealth of the Northern
Mariana Islands, Guam, the Virgin Islands, and
American Samoa.
‘‘(2) REALLOCATION
OF
AMOUNTS
NOT
EX-
CEEDED.—To the extent that any funds allocated
under paragraph (1) to hospitals and facilities de-
scribed in such paragraph for a year are not ex-
pended for assistance under this title, such funds
shall be made available for assistance under this title
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during the year for hospitals and facilities not de-
scribed in such paragraph.
‘‘(b) LIMIT ON AMOUNT AVAILABLE FOR GRANTS.—
Of the total amount allocated from the Capital Financing
Trust Fund during a year for assistance for hospitals and
facilities described in subsection (a), not more than 40%
may be used for grants under subtitle E.
‘‘Subtitle B—Loan Guarantees
‘‘PROVISION OF LOAN GUARANTEES TO SAFETY NET
PROVIDERS
‘‘SEC. 2110. (a) IN GENERAL.—Subject to the an-
nual limitation on the allotment from the Trust Fund de-
scribed in section 2112(a), the Capital Financing Trust
Fund will provide a Federal guarantee of loan repayment,
including guarantees of repayment of refinancing loans,
to non-Federal lenders making loans to qualified hospitals
and facilities for replacement (either by construction or
acquisition), modernization, and renovation projects and
capital equipment acquisitions.
‘‘(b) PURPOSES.—The loan guarantee program shall
be designed by the Trust Fund Board with the goal of
rebuilding and maintaining the essential health services of
hospitals and facilities eligible for assistance under this
title.
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‘‘ELIGIBLE LOANS
‘‘SEC. 2111. (a) IN GENERAL.—Loan guarantees
under this subtitle are available for loans made to qualify-
ing hospitals and facilities for replacement facilities, the
modernization and renovation of existing facilities, and
capital equipment acquisitions.
‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO
BOND FINANCING.—Qualifying hospitals and facilities
must demonstrate that a Federal loan guarantee is essen-
tial to obtaining bond financing from non-Federal lenders
at a reasonably affordable rate of interest.
‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN
GUARANTEES.—In order to quality for assistance under
this subtitle, a hospital or facility must meet the following
criteria:
‘‘(1) The hospital or facility must demonstrate
evidence of an ability to meet debt service.
‘‘(2) The assistance, when considered with other
resources available to the project, is necessary and
will restore, maintain, or improve the financial or
physical soundness of the hospital or facility.
‘‘(3) The applicant agrees to assume the public
service responsibilities described in section 2103.
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‘‘(4) The project is being operated and man-
aged (or will be operated and managed) in accord-
ance with a management-improvement-and-operating
plan which is designed to reduce the operating costs
of the project, which has been approved by the Trust
Fund Board, and which includes—
‘‘(A) a detailed maintenance schedule;
‘‘(B) a schedule for correcting any past de-
ficiencies in maintenance, repairs, and replace-
ments;
‘‘(C) a plan to upgrade the project to meet
cost-effective energy efficiency standards pre-
scribed by the Trust Fund Board;
‘‘(D) a plan to improve financial and man-
agement control systems;
‘‘(E) a detailed annual operating budget
taking into account such standards for operat-
ing costs in the area as may be determined by
the Trust Fund Board; and
‘‘(F) such other requirements as the Trust
Fund Board may determine.
‘‘(5) The application includes stringent provi-
sions for continued State or local support of the pro-
gram, both with respect to operating and financial
capital.
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‘‘(6) The terms, conditions, maturity, security
(if any), and schedule and amount of repayments
with respect to the loan are sufficient to protect the
financial interests to the United States and are oth-
erwise reasonable and in accord with regulation, in-
cluding a determination that the rate of interest
does not exceed such annual percentage on the prin-
cipal obligation outstanding as the Trust Fund
Board determines to be reasonable, taking into ac-
count the range of interest rates prevailing in the
private market for similar loans and the risks as-
sumed by the United States.
‘‘(7) The hospital or facility must meet such
other additional criteria as the Secretary may im-
pose.
‘‘(d) STATE OR LOCAL PARTICIPATION.—Projects in
which State or local governmental entities participate in
the form of first guarantees of part or all of the total loan
value shall be given a preference for loan guarantees under
this subtitle.
‘‘GUARANTEE ALLOTMENTS
‘‘SEC. 2112. (a) IN GENERAL.—Not more than
$150,000,000 shall be annually allocated from the Trust
Fund for purposes of the loan guarantee program estab-
lished by this subtitle.
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‘‘(b) LOAN GUARANTEES
FOR RURAL HOSPITALS
AND FACILITIES.—At least 10 percent of the dollar value
of loan guarantees made under this program during any
given year shall be allocated for eligible rural hospitals and
facilities, to the extent a sufficient number of applications
made by such hospitals and facilities is approved.
‘‘(c) SPECIAL RULE FOR REFINANCING LOANS.—Not
more than 20 percent of the amount allocated each year
to the loan guarantee program established by this subtitle
may be allocated to guarantee refinancing loans during the
year.
‘‘TERMS AND CONDITIONS OF LOAN GUARANTEES
‘‘SEC. 2113. (a) IN
GENERAL.—The principle
amount of the guaranteed loan, when added to any Fed-
eral grant assistance made under this title, may not exceed
95 percent of the total value of the project, including land.
‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT
OTHER FUNDS.—Guarantees provided under this subtitle
Act may not be used to supplant other forms of State or
local support.
‘‘(c) RIGHT TO RECOVER FUNDS.—The United
States shall be entitled to recover from any applicant the
amount of payments made pursuant to any loan guarantee
under this subtitle, unless the Trust Fund Board for good
cause waives its right of recovery, and, upon making any
such payment, the United States shall be subrogated to
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all of the rights of the recipients of the payments with
respect to which the guarantee was made.
‘‘(d) MODIFICATION OF TERMS.—Loan guarantees
made under this subtitle shall be subject to further terms
and conditions as the Trust Fund Board determines to
be necessary to assure that the purposes of this Act will
be achieved, and any such terms and conditions may be
modified by the Trust Fund Board to the extent that it
determines such modifications to be consistent with the
financial interest of the United States.
‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD
OR MISREPRESENTATION.—Any loan guarantee made by
the Trust Fund Board pursuant to this subtitle shall be
incontestable in the hands of an applicant on whose behalf
such guarantee is made, and as to any person who makes
or contracts to make a loan to such applicant in reliance
thereon, except for fraud or misrepresentation on the part
of such applicant or other person.
‘‘PREMIUMS FOR LOAN GUARANTEES
SEC. 2114. (a) IN GENERAL.—The Trust Fund
Board shall determine a reasonable loan insurance pre-
mium which shall be charged for loan guarantees under
this subtitle, taking into account the availability of the
rseserves created under section 2112. Premium charges
shall be payable in cash to the Trust Fund (either in full
upon issuance or annually in advance). In addition to the
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premium charge herein provided for, the Trust Fund is
authorized to charge and collect such amount as it may
deem reasonable for the appraisal of a property or project
offered for insurance and for the inspection of such prop-
erty or project.
‘‘(b) PAYMENT IN ADVANCE.—In the event that the
principal obligation of any loan accepted for insurance
under this subtitle is paid in full prior to the maturity
date, the Trust Fund Board is authorized in its discretion
to require the payment by the borrower of an adjusted
premium charge in such amount as the Board determines
to be equitable, but not in excess of the aggregate amount
of the premium charges that the hospital or facility would
otherwise have been required to pay if the loan had contin-
ued to be insured until maturity date.
‘‘(c) TRUST FUND BOARD MAY WAIVE PREMIUMS.—
The Trust Fund Board may in its discretion partially or
totally waive premiums charged for loan insurance under
this section for financially distressed hospitals and facili-
ties (as described by the Secretary).
‘‘PROCEDURES IN THE EVENT OF LOAN DEFAULT
‘‘SEC. 2115. (a) PAYMENT OF INSURANCE AFTER
DEFAULT.—
‘‘(1) TRANSFER OF RIGHTS AND INTERESTS.—
The failure of the borrower hospital or facility to
make payment due under or provided by the terms
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of a loan insured under this subtitle shall be consid-
ered in default under such loan and, if such default
continues for a period of 30 days, the lender shall
be entitled to receive the benefits of the insurance as
hereinafter provided, upon assignment, transfer, and
delivery to the Trust Fund Board, within a period
and in accordance with rules and regulations to be
prescribed by the Trust Fund Board of—
‘‘(A) all rights and interests arising under
the loan in default;
‘‘(B) all claims of the lender against the
borrower or others, arising out the loan trans-
actions;
‘‘(C) all policies of title or other insurance
or surety bonds or other guarantees and any
and all claims thereunder;
‘‘(D) any balance of the loan not advanced
to the borrower;
‘‘(E) any cash or assets held by the lender,
or to which it is entitled, as deposits made for
the account of the borrower and which have not
been applied in reduction of the principal of the
loan indebtedness; and
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‘‘(F) all records, documents, books, papers,
and accounts relating to the mortgage trans-
action.
‘‘(2) PAYMENTS
BY
TRUST
FUND.—Upon an
assignment, transfer, and delivery described in para-
graph (1), the obligation of the borrower to pay the
premium charges for the loan insurance shall cease,
and the Trust Fund shall, subject to the cash ad-
justment provided for in subsection (d), issue to the
lender a certificate of claim as provided in sub-
section (b), and debentures having total face value
equal to the original principal face amount of the
loan plus such amount as the borrower may have
paid for taxes, special assessments, and water rates,
which are liens prior to the mortgage; insurance on
the assets; and reasonable expenses for the comple-
tion and preservation of the assets and any loan in-
surance premiums paid after default, less the sum
of—
‘‘(A) that part of the amount of the prin-
cipal obligation that has been repaid by the bor-
rower;
‘‘(B) an amount equivalent to 1 percent of
the unpaid amount of such principal obligation;
and
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‘‘(C) any net income received by the lender
from the assets.
‘‘(3) OPTION TO FORECLOSE.—
‘‘(A) IN GENERAL.—In the event of a de-
fault under the loan the lender may, at its op-
tion and in accordance with the regulations of,
and in a period of time to be determined by the
Trust Fund Board, proceed to foreclose on and
obtain possession of or otherwise acquire such
assets from the borrower after default, and re-
ceive the benefits of the insurance as herein
provided, upon—
‘‘(i) the prompt conveyance to the
Trust Fund of title to the assets which
meets the requirements of the rules and
regulations of the Trust Fund Board in
force at the time the loan was insured and
which is evidenced in the manner pre-
scribed by such rules and regulations; and
‘‘(ii) the assignment to the Trust
Fund of all claims of the lender against
the borrower or others, arising out of the
loan transaction or foreclosure proceedings,
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except such claims that may have been re-
leased with the consent of the Trust Fund
Board.
‘‘(B) REPEAL OF OBLIGATION TO PAY PRE-
MIUM.—Upon such conveyance and assignment,
the obligation of the borrower to pay the pre-
mium charges for insurance shall cease and the
borrower shall be entitled to receive the benefits
of the insurance as provided in this subsection,
except that in such event the 1 percent deduc-
tion set out above shall not apply.
‘‘(b) CERTIFICATE OF CLAIM; DIVISION OF EXCESS
PROCEEDS.—
‘‘(1) VALUE OF CERTIFICATE.—The certificate
of claim issued under this section shall be for an
amount which the Trust Fund Board determines to
be sufficient, when added to the face value of the de-
bentures issued and the cash adjustment paid to the
lender, to equal the amount which the lender would
have received if, on the date of the assignment,
transfer and delivery to the Trust Fund provided for
in subsection (a) of this section, the mortgagor had
extinguished the mortgage indebtedness by payment
in full of all obligations under the loan and a reason-
able amount for necessary expenses incurred by the
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lender in connection with the default proceedings, or
the acquisition of the mortgaged assets otherwise,
and the conveyance thereof to the Trust Fund. Each
such certificate of claim shall provide that there
shall accrue to the holder of such certificate with re-
spect to the face amount of such certificate, an in-
crement at the rate of 3 percent per annum which
shall not be compounded.
‘‘(2) TREATMENT
OF
EXCESS.—If the net
amount realized from the mortgage, and all claims
in connection therewith, so assigned, transferred,
and delivered, and from the assets covered by such
mortgage and all claims in connection with such as-
sets, after deducting all expenses incurred by the
Trust Fund in handling, dealing with, acquiring title
to, and disposing of such mortgage and assets and
in collecting such claims, exceeds the face value of
the debentures issued and the case adjustment paid
to the mortgagee plus all interest paid on such de-
bentures, such excess shall be divided as follows:
‘‘(A) If such excess is greater than the
total amount payable under the certificate of
claim issued in connection with such assets, the
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Trust Fund shall pay to the holder of such cer-
tificate the full amount so payable, and any ex-
cess remaining thereafter shall be retained by
the Trust Fund and credited to the loan insur-
ance program of the Trust Fund.
‘‘(B) If such excess is equal to or less than
the total amount payable under such certificate
of claim, the Trust Fund Board shall pay to the
holder of such certificate the full amount of
such excess.
‘‘(c) ACQUISITION OF ASSETS BY CONVEYANCE OR
FORECLOSURE.—
‘‘(1) IN GENERAL.—The Trust Fund Board is
authorized to—
‘‘(A) acquire possession of and title to any
assets, covered by a mortgage insured under
this section and assigned to it, by voluntary
conveyance in extinguishment of the mortgage
indebtedness, or
‘‘(B) institute proceeding for foreclosure on
the assets covered by any such insured mort-
gage and prosecute such proceedings to conclu-
sion.
‘‘(2) 
BIDDING
PROCEDURES
AT
FORE-
CLOSURE.—The Trust Fund Board at any sale
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under foreclosure may, in its discretion, for the pro-
tection of the Trust Fund, bid any sum up to but
not in excess of the total unpaid indebtedness se-
cured by the mortgage plus taxes, insurance, fore-
closure costs, fees, and other expenses, and may be-
come the purchaser of the assets at such sale. In de-
termining the amount to be bid, the Trust Fund
Board shall act consistently with its duties.
‘‘(3) PAYMENT
OF
EXPENSES.—The Trust
Fund Board is authorized to pay from the Trust
Fund such sums as may be necessary to defray such
taxes, insurance, costs, fees, and other expenses in
connection with the acquisition or foreclosure of as-
sets under this section.
‘‘(4) EXERCISE OF RIGHTS PENDING ACQUISI-
TION.—Pending such acquisition by voluntary con-
veyance or by foreclosure, the Trust Fund Board is
authorized, with respect to any mortgage assigned to
it under the provisions of subsection (a), to exercise
all the rights of a mortgagee under such mortgage,
including the right to sell such a mortgage, and to
take such action and advance such sums as may be
necessary to preserve or protect the lien of such
mortgage.
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‘‘(d) HANDLING AND DISPOSAL OF ASSETS; SETTLE-
MENT OF CLAIMS.—
‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not-
withstanding any other provisions of law relating to
the acquisition, handling, or disposal of real and
other property by the United States, the Trust Fund
Board shall also have power, for the protection of
the interests of the Trust Fund, to pay out of the
Trust Fund all expenses or charges in connection
with, and to deal with, complete, reconstruct, rent,
renovate, modernize, insure, make contracts for the
management of, or establish suitable agencies for
the management of, or sell for cash or credit or lease
in its discretion, any assets acquired by it under this
section.
‘‘(2) SETTLEMENT OF CLAIMS.—Notwithstand-
ing any other provision of law, the Trust Fund
Board shall also have the power to pursue to final
collection by way of compromise or otherwise all
claims assigned and transferred to it in connection
with the assignment, transfer, and delivery provided
for in this section, and at any time, upon default, to
foreclose or refrain from foreclosing on any assets
secured by any mortgage assigned and transferred
to or held by it.
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‘‘(3) 
LIMITATIONS
ON
AUTHORITY.—Sub-
sections (a) and (b) shall not be construed to apply
to any contract for hazard insurance, or to any pur-
chase or contract for services or supplies on account
of such assets if the amount thereof does not exceed
$1,000.
‘‘Subtitle C—Interest Rate Subsidies
‘‘PROVISION OF INTEREST RATE SUBSIDIES
‘‘SEC. 2121. (a) IN GENERAL.—The Secretary, with
the approval of the Trust Fund Board, shall make avail-
able interest subsidies to reduce the cost of financing
qualifying projects.
‘‘(b) PURPOSES.—The interest subsidy program shall
provide a partial Federal subsidy of debt service payment
for financing replacement (whether by construction or ac-
quisition), modernization, and renovation projects or cap-
ital equipment acquisitions by undertaking the issuance of
bonds.
‘‘ELIGIBLE LOANS
‘‘SEC. 2122. (a) IN GENERAL.—Qualifying hospitals
and facilities should have issued or plan to issue bonds
for capital projects or be responsible for paying debt serv-
ice on general obligation or revenue bonds issued on the
qualifying hospital’s or facility’s behalf. To be eligible,
bonds must have been issued after December 31, 1997.
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‘‘(b) 
NON-FEDERAL
PARTICIPATION
REQUIRE-
MENT.—In order to obtain assistance under this subtitle,
a hospital or facility must receive assistance from non-
Federal sources in an amount not less than the amount
of the assistance provided under this subtitle.
‘‘ALLOTMENT OF SUBSIDIES
‘‘SEC. 2123. (a) IN GENERAL.—Interest subsidy
grants will be made in the amount of 3 percent for qualify-
ing non-Federal loans.
‘‘(b) QUALIFYING FEDERAL LOANS MADE UNDER
THIS ACT.—Interest subsidy grants in an amount of up
to 5 percent will be made for qualifying Federal loans
made under this title if it is determined by the Trust Fund
Board that the project would not be otherwise financially
feasible.
‘‘(c) RESERVE FOR RURAL HOSPITALS AND FACILI-
TIES.—At least 10 percent of the total value of all interest
subsidies awarded in any given year shall be awarded to
rural hospitals and facilities, provided that a sufficient
number of applications are approved.
‘‘(d) LIMITATION
ON
AMOUNT
OF
SUBSIDIES
AWARDED IN A GIVEN STATE.—The aggregate value of
interest subsidies made to hospitals and facilities in any
State in a given year shall not exceed 25 percent of the
total value of all interest subsidies made during that year.
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‘‘(e) AMOUNT ALLOCATED FROM TRUST FUND.—
The Trust Fund Board shall make available $220,000,000
annually for interest subsidies under this subtitle.
‘‘TERMS AND CONDITIONS FOR SUBSIDIES
‘‘SEC. 2124. (a) STATE OR LOCAL PARTICIPATION.—
State or local participation in an amount equal to not less
than the Federal subsidy is required.
‘‘(b) ISSUANCE OF FEDERAL COMMITMENTS.—Suc-
cessful applicants will receive a Federal commitment of in-
terest subsidy grant. Applicants will then have 12 months
to finalize financing arrangements before unobligated
funds would be returned to the subsidy program pool. A
commitment, when issued, shall be valid for as long as
a hospital or facility continues to meet the eligibility quali-
fications of this title.
‘‘SUBSIDIES FOR LOAN REFINANCING
‘‘SEC. 2125. In addition to providing interest rate
subsidies for new loans, the Trust Fund may provide sub-
sidies to assist in refinancing if the hospital or facility
presently lacks permanent financing at an affordable cur-
rent market rate.
‘‘Subtitle D—Direct Matching Loans
‘‘PROVISION OF MATCHING LOANS
‘‘SEC. 2131. (a) IN GENERAL.—The Secretary, with
the approval of the Trust Fund Board, shall provide direct
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matching loans to qualified hospitals and facilities unable
otherwise to obtain essential financing.
‘‘(b) PURPOSES.—The purpose of this subtitle is to
provide qualifying hospitals and facilities with direct
matching loans for essential replacement (whether by con-
struction or acquisition), modernization, and renovation
projects and capital equipment acquisitions. These loans
are to be primarily provided for the funding of smaller
projects where the transaction costs of securing financing
from other sources may be disporportionately onerous in
relationship to the amounts financed.
‘‘ELIGIBLE PROJECTS
‘‘SEC. 2132. (a) IN GENERAL.—Qualified applicants
may seek a project loan of up to $50,000,000. Not more
than 75 percent of the cost of the project may come from
Federal sources.
‘‘(b) EXCEPTION FOR FINANCIALLY DISTRESSED AP-
PLICANTS.—The Trust Fund Board shall have the discre-
tion to waive the 25 percent match requirement for finan-
cially distressed hospitals and facilities (as described by
the Secretary).
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‘‘ALLOTMENT OF LOANS
‘‘Sec. 2133. (a) IN GENERAL.—The Trust Fund
Board shall make available $200,000,000 in direct match-
ing loans annually. Funded projects should be divided be-
tween projects designed to achieve compliance with accred-
itation standards, life safety code, and other certification
standards, and those related to the provision of new serv-
ices.
‘‘(b) RESERVE FOR RURAL HOSPITALS AND FACILI-
TIES.—No less than 10 percent of the total value of loans
made under the program shall be made to rural hospitals
and facilities, if there are a sufficient number of approved
applications from such hospitals and facilities.
‘‘TERMS AND CONDITIONS OF LOANS
‘‘SEC. 2134. (a) GENERAL TERM.—Loans will be
made for a period equal to the construction period plus
up to 39 years amortization.
‘‘(b) INTEREST RATE.—The interest rate will be a
market rate determined by the Trust Fund Board to be
the most recent applicable index for revenue bonds, based
on the index published by the Bond Buyer and such other
information as the Board finds appropriate.
‘‘USE OF LOANS FOR REFINANCING
‘‘SEC. 2135. In addition to providing loans for new
projects, the Trust Fund Board may grant loans under
this subtitle to refinance existing loans if the hospital or
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facility has been unable to secure permanent financing at
an affordable current market rate, except that the amount
of assistance provided under this subtitle during a year
for refinancing existing loans may not exceed 20 percent
of the total amount made available for assistance under
this subtitle for the year.
‘‘CREATION OF REVOLVING FUND
‘‘SEC. 2136. In addition to the new amounts made
available each year, all loan repayments made by hospitals
and facilities shall be held in a revolving fund that may
be used for additional loans.
‘‘LOAN DEFAULT
‘‘SEC. 2137. (a) IN GENERAL.—The failure of the
borrower hospital or facility to make payment due under
or provided by the terms of a loan granted under this sub-
title shall be considered a default under such loan and,
if such default continues for a period of 30 days, the Trust
Fund Board shall have the right to begin collection pro-
ceedings against the borrower.
‘‘(b) PRIORITY OF FEDERAL INTEREST.—In the case
of default, the United States shall be paid prior to State
or local bonds.
‘‘(c) SETTLEMENT
OF CLAIMS.—Notwithstanding
any other provision of law, the Trust Fund Board shall
have the power to pursue to final collection by way of com-
promise or otherwise all claims assigned and transferred
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to the Trust Fund in connection with an assignment,
transfer, and delivery and at any time, upon default, to
foreclose or refrain from foreclosing on any assets secured
by any defaulted loan held by the Trust Fund.
‘‘Subtitle E—Grants for Urgent Capital Needs
‘‘PROVISION OF GRANTS
‘‘SEC. 2141. (a) IN GENERAL.—The Secretary, with
the approval of the Trust Fund Board, shall make direct
grants to qualified hospitals and facilities with urgent cap-
ital needs.
‘‘(b) PURPOSES.—Direct grants shall be available to
eligible hospitals and facilities for 3 types of projects:
‘‘(1) Emergency certification and licensure
grants would be available to eligible hospitals and fa-
cilities that are threatened with closure or loss of ac-
creditation or certification of a facility or of essential
services as a result of life or safety code violations
or similar facility or equipment failures. Such grants
would provide limited funding for repair and renova-
tion or capital equipment acquisition where failure to
fund would disrupt the provision of essential public
health services such as emergency care.
‘‘(2) Emergency grants would be available for
capital 
renovation, 
expansion, 
or 
replacement
(whether by construction or acquisition) necessary to
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the maintenance or expansion of essential safety and
health services such as obstetrics, perinatal, emer-
gency and trauma, primary care and preventive
health services.
‘‘(3) Planning grants would be available to
qualified hospitals and facilities requiring pre-ap-
proval assistance related to management and finance
in order to apply for loans, loan guarantees, and in-
terest subsidies under this Act.
‘‘(c) PRIORITY TO FINANCIALLY DISTRESSED PRO-
VIDERS.—Priority for direct grants under this section
would be given to financially distressed hospitals and fa-
cilities (as described by the Secretary).
‘‘(d) APPLICATION PROCESS.—The Secretary, with
the approval of the Trust Fund Board, shall create an
expedited application process for direct grants.
‘‘(e) AMOUNT ALLOCATED FROM TRUST FUND.—
The 
Trust 
Fund 
Board 
shall 
annually 
allocate
$400,000,000 from the Trust Fund for grants under this
subtitle.
‘‘ELIGIBLE PROJECTS
‘‘SEC. 2142. (a) MATCHING GRANTS.—
‘‘(1) LIMITATION ON AMOUNT.—Grants for cap-
ital expenditures by qualified hospitals and facilities
will be limited to $25,000,000.