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‘‘(8) OBLIGOR.—The term ‘obligor’ means a 
party primarily liable for payment of the principal of 
or interest on a Federal credit instrument, which 
party may be a corporation, partnership, joint ven-
ture, trust, or governmental entity, agency, or in-
strumentality. 
‘‘(9) PROJECT.—The term ‘project’ means any 
project that is designed to improve the health care 
infrastructure, including the construction, renova-
tion, or other capital improvement of any hospital, 
medical research facility, or other medical facility or 
the purchase of any equipment to be used in a hos-
pital, research facility, or other medical research fa-
cility. 
‘‘(10) 
PROJECT
OBLIGATION.—The 
term 
‘project obligation’ means any note, bond, debenture, 
lease, installment sale agreement, or other debt obli-
gation issued or entered into by an obligor in con-
nection with the financing of a project, other than 
a Federal credit instrument. 
‘‘(11) RATING
AGENCY.—The term ‘rating 
agency’ means a bond rating agency identified by 
the Securities and Exchange Commission as a Na-
tionally Recognized Statistical Rating Organization.
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‘‘(12) SECURED
LOAN.—The term ‘secured 
loan’ means a direct loan or other debt obligation 
issued by an obligor and funded by the Secretary in 
connection with the financing of a project under sec-
tion 2203. 
‘‘(13) STATE.—The term ‘State’ has the mean-
ing given the term in section 101 of title 23, United 
States Code. 
‘‘(14) SUBSIDY
AMOUNT.—The term ‘subsidy 
amount’ means the amount of budget authority suf-
ficient to cover the estimated long-term cost to the 
Federal Government of a Federal credit instrument, 
calculated on a net present value basis, excluding 
administrative costs and any incidental effects on 
governmental receipts or outlays in accordance with 
the provisions of the Federal Credit Reform Act of 
1990 (2 U.S.C. 661 et seq.). 
‘‘(15) SUBSTANTIAL
COMPLETION.—The term 
‘substantial completion’ means the opening of a 
project to patients or for research purposes. 
‘‘SEC. 2202. DETERMINATION OF ELIGIBILITY AND PROJECT 
SELECTION. 
‘‘(a) ELIGIBILITY.—To be eligible to receive financial 
assistance under this title, a project shall meet the fol-
lowing criteria:
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‘‘(1) APPLICATION.—A State, a local servicer 
identified under section 2205(a), or the entity un-
dertaking a project shall submit a project application 
to the Secretary. 
‘‘(2) ELIGIBLE PROJECT COSTS.—To be eligible 
for assistance under this title, a project shall have 
total eligible project costs that are reasonably antici-
pated to equal or exceed $40,000,000. 
‘‘(3) SOURCES
OF
REPAYMENTS.—Project fi-
nancing shall be repayable, in whole or in part, from 
reliable revenue sources as described in the applica-
tion submitted under paragraph (1). 
‘‘(4) PUBLIC SPONSORSHIP OF PRIVATE ENTI-
TIES.—In the case of a project that is undertaken 
by an entity that is not a State or local government 
or an agency or instrumentality of a State or local 
government, the project that the entity is under-
taking shall be publicly sponsored or sponsored by 
an entity that is described in section 501(c)(3) of 
the Internal Revenue Code of 1986 and exempt from 
tax under section 501(a) of such Code. 
‘‘(b) SELECTION AMONG ELIGIBLE PROJECTS.—
‘‘(1) ESTABLISHMENT.—The Secretary shall es-
tablish criteria for selecting among projects that
650
meet the eligibility criteria specified in subsection 
(a). 
‘‘(2) SELECTION CRITERIA.—
‘‘(A) IN GENERAL.—The selection criteria 
shall include the following:
‘‘(i) The extent to which the project is 
nationally or regionally significant, in 
terms of expanding or improving the 
health care infrastructure of the United 
States or the region or in terms of the 
medical benefit that the project will have. 
‘‘(ii) The creditworthiness of the 
project, including a determination by the 
Secretary that any financing for the 
project has appropriate security features, 
such as a rate covenant, credit enhance-
ment requirements, or debt services cov-
erages, to ensure repayment. 
‘‘(iii) The extent to which assistance 
under this title would foster innovative 
public-private partnerships and attract pri-
vate debt or equity investment. 
‘‘(iv) The likelihood that assistance 
under this title would enable the project to
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proceed at an earlier date than the project 
would otherwise be able to proceed.
‘‘(v) The extent to which the project 
uses or results in new technologies. 
‘‘(vi) The amount of budget authority 
required to fund the Federal credit instru-
ment made available under this title. 
‘‘(vii) The extent to which the project 
helps maintain or protect the environment. 
‘‘(B) SPECIFIC REQUIREMENTS.—The se-
lection criteria shall require that a project ap-
plicant—
‘‘(i) be engaged in research in the 
causes, prevention, and treatment of can-
cer; 
‘‘(ii) be designated as a cancer center 
for the National Cancer Institute or be 
designated by the State as the official can-
cer institute of the State; and 
‘‘(iii) be located in a State that, on 
the date of enactment of this title, has a 
population of less than 3,000,000 individ-
uals. 
‘‘(C) RATING
LETTER.—For purposes of 
subparagraph (A)(ii), the Secretary shall re-
652
quire each project applicant to provide a rating 
letter from at least 1 rating agency indicating 
that the project’s senior obligations have the 
potential to achieve an investment-grade rating 
with or without credit enhancement. 
‘‘SEC. 2203. SECURED LOANS. 
‘‘(a) IN GENERAL.—
‘‘(1) AGREEMENTS.—Subject to paragraphs (2) 
through (4), the Secretary may enter into agree-
ments with 1 or more obligors to make secured 
loans, the proceeds of which shall be used—
‘‘(A) to finance eligible project costs; 
‘‘(B) to refinance interim construction fi-
nancing of eligible project costs; or 
‘‘(C) to refinance existing debt or prior 
project obligations; 
of any project selected under section 2202. 
‘‘(2) LIMITATION ON REFINANCING OF INTERIM 
CONSTRUCTION
FINANCING.—A loan under para-
graph (1) shall not refinance interim construction fi-
nancing under paragraph (1)(B) later than 1 year 
after the date of substantial completion of the 
project. 
‘‘(3) RISK ASSESSMENT.—Before entering into 
an agreement for a secured loan under this sub-