The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021
Bill: H.R.1349 | Sponsor: Rep. Kaptur, Marcy (D-OH)
Policy area: Health

Summary:
The COVID-19 Hospital and Health Provider Loan Conversion Act of 2021
This bill establishes and otherwise modifies requirements for the Medicare Accelerated and Advance Payment Program during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019). The program provides Medicare payments in advance to eligible providers experiencing claims or cash flow disruptions, such as during national emergencies; the program was specifically expanded in response to COVID-19 to encompass more types of providers, subject to certain recoupment and repayment provisions.
The bill requires the Centers for Medicare & Medicaid Services to waive recoupment and repayment for providers who meet specified requirements. Among other criteria, providers must not have engaged in surprise billing practices with respect to COVID-19 patients. Providers must still repay any amounts not used for COVID-19 expenses; the bill caps the interest rate on such repayments at 2% upon a demonstration of hardship.
The bill also requires private health insurers to treat out-of-network COVID-19 services as in-network for purposes of payment and cost-sharing.

To amend title XVIII of the Social Security Act to provide for the 
conversion of certain accelerated and advance payments to grants under 
                 parts A and B of the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as ``The COVID-19 Hospital and Health 
Provider Loan Conversion Act of 2021''.

SEC. 2. PROVIDING FOR THE CONVERSION OF CERTAIN ACCELERATED AND ADVANCE 
              PAYMENTS TO GRANTS UNDER PARTS A AND B OF THE MEDICARE 
              PROGRAM.

    (a) Conversion of Payments.--
            (1) Part a.--Section 1815(f) of the Social Security Act (42 
        U.S.C. 1395g(f)) is amended--
                    (A) in paragraph (2), by adding at the end the 
                following new subparagraph:
            ``(D) In the case of an accelerated payment made to a 
        hospital under such program on or after the date of the 
        enactment of the CARES Act and so made during the emergency 
        period described in section 1135(g)(1)(B), the Secretary shall 
        waive the requirement that such payment be repaid (or recouped) 
        if the hospital meets the requirements described in paragraph 
        (5), except that such waiver shall not apply with respect to 
        any amounts from such payment that were not used for health 
        care related expenses or lost revenues that are attributable to 
        coronavirus as of December 31, 2021, based on the attestation 
        of the hospital. The hospital shall repay any such amounts to 
        the Secretary not later than July 1, 2023. The interest rate 
        for any such amount not so repaid as of such date shall be 2 
        percent if the hospital demonstrates hardship.'';
                    (B) in paragraph (3), by inserting ``and paragraph 
                (2)(D)'' after ``paragraph (2)(C)''; and
                    (C) by adding at the end the following new 
                paragraph:
    ``(5) For purposes of paragraph (2)(D), the requirements described 
in this paragraph are the following:
            ``(A) The hospital did not use any portion of a payment 
        described in such paragraph for compensation or benefits, 
        including salary, bonuses, awards of stock, or other financial 
        benefits, for an officer or employee described in section 
        4004(a)(2) of the CARES Act (Public Law 116-136).
            ``(B) The hospital used at least 60 percent of such payment 
        for employee compensation (other than an officer or employee 
        described in subparagraph (A)) during the period beginning on 
        January 1, 2020, and ending on December 31, 2021.
            ``(C) The hospital did not balance bill or surprise bill 
        any COVID-19 patient.''.
            (2) Part b.--
                    (A) In general.--In carrying out the program 
                described in section 421.214 of title 42, Code of 
                Federal Regulations (or a successor regulation), in the 
                case of a payment made under such program to an entity 
                on or after the date of the enactment of the CARES Act 
                (Public Law 116-136) and so made during the emergency 
                period described in section 1135(g)(1)(B) of the Social 
                Security Act (42 U.S.C. 1320b-5(g)(1)(B)), the 
                Secretary of Health and Human Services shall waive the 
                requirement that such payment be repaid (or recouped) 
                if the entity meets the requirements described in 
                subparagraph (B), except that such waiver shall not 
                apply with respect to any amounts from such payment 
                that were not used for health care related expenses or 
                lost revenues that are attributable to coronavirus as 
                of December 31, 2021, based on the attestation of the 
                entity. The entity shall repay any such amounts to the 
                Secretary not later than July 1, 2023. The interest 
                rate for any such amount not so repaid as of such date 
                shall be 2 percent if the entity demonstrates hardship.
                    (B) Requirements.--For purposes of subparagraph 
                (A), the requirements described in this subparagraph 
                are the following:
                            (i) The entity did not use any portion of a 
                        payment described in such subparagraph for 
                        compensation or benefits, including salary, 
                        bonuses, awards of stock, or other financial 
                        benefits, for an officer or employee described 
                        in section 4004(a)(2) of the CARES Act (Public 
                        Law 116-136).
                            (ii) The entity used at least 60 percent of 
                        such payment for employee compensation (other 
                        than an officer or employee described in clause 
                        (i)) during the period beginning on January 1, 
                        2020, and ending on June 30, 2021.
                            (iii) The entity did not balance bill or 
                        surprise bill any COVID-19 patient.
    (b) Ensuring the Solvency of Medicare Trust Funds.--
            (1) Federal hospital insurance trust fund.--Section 1817 of 
        the Social Security Act (42 U.S.C. 1395i) is amended by adding 
        at the end the following new subsection:
    ``(l) Accelerated Payment Program Transfers.--
            ``(1) In general.--There shall be transferred from the 
        General Fund of the Treasury to the Trust Fund, periodically 
        (as determined by the Managing Trustee), amounts such that the 
        aggregate amount so transferred under this paragraph equals the 
        total amount of specified payments (as defined in paragraph 
        (2)) made under this part.
            ``(2) Specified payment.--In this subsection, the term 
        `specified payment' means a payment that is made--
                    ``(A) under section 1815(e)(3); and
                    ``(B) during the emergency period described in 
                section 1135(g)(1)(B).''.
            (2) Federal supplementary medical insurance trust fund.--
        Section 1844(f) of the Social Security Act (42 U.S.C. 1395w(f)) 
        is amended--
                    (A) by striking ``(1) There shall be transferred'' 
                and inserting ``There shall be transferred'';
                    (B) by striking ``during the period beginning on 
                the first day of the emergency period described in 
                section 1135(g)(1)(B) and ending on the date of the 
                enactment of this paragraph'' and inserting ``during 
                the emergency period described in section 
                1135(g)(1)(B)''; and
                    (C) by striking paragraph (2).
    (c) Insurer Requirements.--Subpart II of part A of title XXVII of 
the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) is amended 
by adding at the end the following new section:

``SEC. 2730. COVERAGE AND PAYMENT REQUIREMENTS FOR ITEMS AND SERVICES 
              FURNISHED TO COVID-19 PATIENTS OUT-OF-NETWORK.

    ``In the case of an item or service furnished by a health care 
provider to a COVID-19 patient who is an enrollee in a group health 
plan or group or individual health insurance coverage offered by a 
health insurance issuer, if such provider does not have in effect a 
contractual relationship for furnishing such item or service under such 
plan or coverage, the plan or issuer (as applicable)--
            ``(1) shall pay to such provider the amount which would 
        have been payable to such provider had such provider had in 
        effect such a relationship for furnishing such item or service; 
        and
            ``(2) shall ensure that any applicable cost-sharing 
        requirement is the same requirement that would have applied had 
        such item or service been furnished by a provider that had in 
        effect such a relationship.''.
    (d) Publication.--The Secretary of Health and Human Services shall 
publish on a public website the following:
            (1) A specification of each hospital to which a waiver 
        described in section 1815(f)(2)(D) of the Social Security Act 
        (42 U.S.C. 1395g(f)(2)(D)) applies and each entity to which a 
        waiver described in subsection (a)(2)(A) applies.
            (2) The amount to which such waivers apply with respect to 
        each such hospital and entity.
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