Title: Immediate Relief for Rural Facilities and Providers Act of 2020
Policy area: Health

Summary:
Immediate Relief for Rural Facilities and Providers Act of 2020
This bill establishes grant programs and other forms of financial assistance for health care providers in response to the national emergency relating to COVID-19 (i.e., coronavirus disease 2019).
Specifically, the bill establishes (1) a grant program to provide emergency assistance to critical access hospitals, certain rural hospitals, and providers participating in Medicare; (2) a grant program to provide emergency assistance to health care practices and ambulatory surgery centers for staff salaries; and (3) a loan program to provide low-interest loans to health care practices and ambulatory surgery centers.
The bill also temporarily increases reimbursements to rural hospitals under the Medicare swing-bed program. (The program allows rural hospitals to use beds, as needed, for either acute care or skilled nursing facility care.)

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 3559 Introduced in Senate (IS)]

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116th CONGRESS
  2d Session
                                S. 3559

    To provide emergency financial assistance to rural health care 
      facilities and providers impacted by the COVID-19 emergency.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 21, 2020

  Mr. Bennet (for himself, Mr. Barrasso, Ms. Smith, Mr. Gardner, Mr. 
 Jones, and Mrs. Hyde-Smith) introduced the following bill; which was 
          read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To provide emergency financial assistance to rural health care 
      facilities and providers impacted by the COVID-19 emergency.

    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 ``Immediate Relief for Rural 
Facilities and Providers Act of 2020''.

SEC. 2. RURAL HEALTH CARE FACILITY GRANTS.

    (a) Purpose.--It is the purpose of this section to provide funding 
to stabilize rural hospitals and provide immediate financial relief to 
prepare and respond to the COVID-19 emergency.
    (b) Grants.--The Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish an emergency 
operating grant program and shall award an emergency operating grant to 
an eligible Medicare participating health care facility.
    (c) Allotments and Payments.--
            (1) Allotments.--The Secretary shall, from amounts 
        appropriated under subsection (i), allot to each facility 
        eligible for a grant under this section the sum of--
                    (A) an amount equal to the number of patient days 
                (including acute, swing-bed, and observation days) from 
                January 1, 2019, to April 1, 2019, with respect to the 
                facility, multiplied by $1,000; and
                    (B) an amount equal to the total amount of 
                reimbursements from all payer sources to the facility 
                from January 1, 2019, to April 1, 2019.
            (2) Payments.--The Secretary shall make payments under 
        grants awarded to eligible facilities under this section in the 
        amount of the allotments described in paragraph (1).
            (3) Time of grant.--A one time payment shall be made under 
        a grant awarded under this section not later than 14 days after 
        the date of enactment of this Act.
    (d) Eligible Facilities.--
            (1) In general.--To be eligible to receive a grant under 
        subsection (b), a Medicare participating health care facility 
        shall submit to the Secretary an application described in 
        paragraph (2).
            (2) Application.--An application under this paragraph shall 
        be submitted to the Secretary not later that 180 days after the 
        date of enactment of this Act and shall contain such 
        information that the Secretary may require, including--
                    (A) a certification that--
                            (i) the facility will suffer financial 
                        losses as a result of the COVID-19 emergency; 
                        and
                            (ii) in the absence of an emergency grant 
                        under this section, the facility would be 
                        forced to either reduce staffing or operations;
                    (B) an assurance that the amount requested under 
                the grant exceeds 130 percent of the amount of revenue 
                collected by the facility during the same period of the 
                year preceding the year for which the request under 
                this section is made;
                    (C) the amount of spending incurred by the facility 
                as a result of the COVID-19 emergency;
                    (D) a description on how the facility will use 
                grant funds; and
                    (E) an assurance that the facility followed the 
                Secretary's recommendations related to the COVID-19 
                emergency.
    (e) Reconciliation.--
            (1) In general.--Not later than 2 years after the date on 
        which the COVID-19 emergency ends (as determined by the 
        Secretary), the Secretary shall promulgate regulations under 
        which a facility that receives an emergency grant under this 
        section shall reconcile the amount of the emergency grant 
        with--
                    (A) the entire amount of the grant allotted to the 
                facility in the case of a facility that was determined 
                not to be eligible under subsection (d);
                    (B) any reimbursements received by the facility 
                from third parties for services provided during such 
                emergency; and
                    (C) any portion of the grant funds that exceeds 130 
                percent of the amount of revenue collected by the 
                facility during the same 90-day period of the year 
                preceding the year for which the grant is being made as 
                determined through such reconciliation to have been 
                recovered by the facility through third-party payors, 
                in addition to any additional spending incurred by the 
                facility as a result of the COVID-19 emergency, with 
                the Federal Government.
            (2) Recoupment.--The regulations under this subsection 
        shall include procedures through which the Federal Government 
        may recoup any portion of grant funds described in paragraph 
        (1).
    (f) Limitations on Use of Funds.--
            (1) Construction of facilities.--
                    (A) Limitations.--Grants awarded under this section 
                shall not be used by the facility for the purchase or 
                improvement of land, or the purchase, construction, or 
                permanent improvement of any building.
                    (B) Waiver.--The Secretary may wave the limitation 
                contained in subparagraph (A) upon a facility request 
                for such a waiver, if the Secretary finds that the 
                request describes circumstances that justify the 
                purchase of land or the constrictive of facilities (or 
                the making of permanent improvements) related to the 
                COVID-19 emergency.
            (2) Political activities.--Grants awarded under this 
        section shall not be used in a manner involving the use of 
        grant funds, provisions of services, or the employment or 
        assignment of personnel, in a manner supporting or resulting in 
        the identification of such programs with any partisan or 
        nonpartisan political activity or any political activity 
        associated with a candidate, or contending faction or group, in 
        an election for public or party office.
    (g) Legal Action.--A facility that receives an emergency grant 
under this section shall be prohibited from commencing any legal action 
against a patients to recover any costs associated with care provided 
to the patient during the COVID-19 emergency.
    (h) Definitions.--In this section:
            (1) COVID-19 emergency.--The term ``COVID-19 emergency'' 
        means the national emergency declared by the President under 
        the National Emergencies Act (50 U.S.C. 1601 et seq.) with 
        respect to the Coronavirus Disease 2019 (COVID-19).
            (2) Medicare participating health care facility.--The terms 
        ``Medicare participating health care facility'' and 
        ``facility'' mean--
                    (A) an entity designated as--
                            (i) a Critical Access Hospital under 
                        section 485 of subpart F of title 42, Code of 
                        Federal Regulations; or
                            (ii) a subsection (d) hospital (as defined 
                        in paragraph (1)(B) of section 1886(d)(1)(B) of 
                        the Social Security Act (42 U.S.C. 
                        1395ww(d)(1)(B))) that is located in a rural 
                        area (as defined in paragraph (2)(D) of such 
                        section); and
                    (B) a provider of services enrolled in the Medicare 
                program under section 1866(j) of the Social Security 
                Act (42 U.S.C. 1395cc(j)).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (i) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 3. REIMBURSEMENT ADJUSTMENT FOR SWING BED PROGRAM.

    (a) Purpose.--It is the purpose of this section to improve the 
health care system to prepare and respond to the COVID-19 emergency (as 
defined in section 2).
    (b) Adjustment.--The Secretary of Health and Human Services, acting 
through the Administrator of the Centers for Medicare & Medicaid 
Services, shall increase reimbursements for rural hospitals under the 
swing bed program for the duration of the COVID-19 emergency.
    (c) Amount.--The amount of an increase under subsection (b) shall 
equal 20 percent of the amount of the swing bed reimbursement that a 
rural hospital involved would otherwise receive under the swing bed 
program.
    (d) Termination.--This section shall not apply beginning on the 
date that is 30 days after the date on which the COVID-19 emergency 
ends (as determined by the Secretary).

SEC. 4. EMERGENCY GRANTS FOR PHYSICIANS' AND HEALTH CARE PROVIDERS' 
              PRACTICES.

    (a) Purpose.--It is the purpose of this section to provide funding 
to provide immediate relief and stabilization for physicians' and 
health care providers' practices through emergency grants to prepare 
and respond to the COVID-19 emergency.
    (b) Amendment.--Title III of the Public Health Service Act is 
amended by inserting after section 330A-1 (42 U.S.C. 254c-1a) the 
following:

``SEC. 330A-2. EMERGENCY GRANTS FOR PHYSICIANS' AND HEALTH CARE 
              PROVIDERS' PRACTICES.

    ``(a) In General.--The Secretary shall establish a program to 
support physicians' and health care providers' practices by awarding 
emergency grants to eligible health care practices and ambulatory 
surgery centers.
    ``(b) Allotments and Payments.--
            ``(1) Allotments.--The Secretary shall, from amounts 
        appropriated under subsection (e), allot to each eligible 
        health care practice or ambulatory surgery center an amount 
        equal to the actual payroll for the eligible health care 
        practice or ambulatory surgery center during the period 
        beginning January 1, 2019, and ending April 1, 2019.
            ``(2) Payments.--The Secretary shall make payments under 
        grants awarded under this section to each eligible health care 
        practice or ambulatory surgery center in the amount of the 
        allotment described in paragraph (1) with respect to each such 
        practice or center.
            ``(3) Time of grant.--Not later than 14 days after the date 
        of enactment of this section, the Secretary shall make a one-
        time payment under a grant under this section to each eligible 
        health care practice or ambulatory surgery center.
    ``(c) Utilization of Payments.--Payments made under subsection (b) 
shall be utilized, with respect to the grantee involved, to 
compensate--
            ``(1) all hourly staff up to $25 per hour and salaried 
        staff up to $75,000 in full; and
            ``(2) all hourly staff above $25 per hour and salaried 
        staff above $75,000 at a rate of $25 per hour or $75,000 in 
        annual salary.
    ``(d) Definitions.--In this section:
            ``(1) Ambulatory surgery center.--The term `ambulatory 
        surgery center' has the meaning given such term in section 
        1833(i) of the Social Security Act.
            ``(2) Eligible health care practice.--The term `eligible 
        health care practice' means a corporation, limited liability 
        company, or unincorporated personal entity that provides health 
        care services of a physician or a health care provider as 
        licensed under State law.
            ``(3) Health care provider.--The term `health care 
        provider' means an individual providing health care services 
        under State law as determined by the Secretary.
            ``(4) Physician.--The term `physician' means an individual 
        that meets the definition under section 1861(r) of the Social 
        Security Act.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.

SEC. 5. EMERGENCY LOW-INTEREST LOANS FOR PHYSICIANS' AND HEALTH CARE 
              PROVIDERS' PRACTICES.

    The Small Business Act is amended by inserting after section 32 (15 
U.S.C. 657b) the following:

``SEC. 33. 2020 EMERGENCY LOW-INTEREST LOANS FOR PHYSICIANS' AND HEALTH 
              CARE PROVIDERS' PRACTICES.

    ``(a) Purpose.--It is the purpose of this section to provide low-
interest loans for physicians' and health care providers' practices or 
ambulatory surgery centers, which as a result of the COVID-19 
emergency, have suffered a significant financial impact.
    ``(b) Low-Interest Loans.--The Administrator shall provide any 
eligible health care practice or ambulatory surgery center, which as a 
result of the COVID-19 emergency, has suffered a significant financial 
impact, a loan in such amount as may be necessary to enable such 
enterprise to maintain or resume operations in order to assist in 
maintaining and restoring the economic viability of the practice or 
center. Loans authorized by this section shall be made without regard 
to limitations on the size of loans which may otherwise be imposed by 
any other provision of law or regulations promulgated pursuant thereto.
    ``(c) Interest.--Any loan made under this section shall be subject 
to not to exceed .25 percent interest, and the President, if determined 
necessary, may defer payments of principal for a period not to exceed 3 
years after the date of such loan.
    ``(d) Deferred Interest Accrual.--Interest on a loan under this 
section shall not begin to accrue until the date that is 24 months 
after the date on which the COVID-19 emergency officially ends (as 
determined by the Administrator).
    ``(e) Other Federal Assistance.--Loans made under this section 
shall be in addition to any other Federal emergency assistance 
available, except that such other assistance may be adjusted or 
modified to the extent determined appropriate by the Administrator.
    ``(f) Definitions.--In this section:
            ``(1) Ambulatory surgery center.--The term `ambulatory 
        surgery center' has the meaning given such term in section 
        1833(i) of the Social Security Act.
            ``(2) Eligible health care practice.--The term `eligible 
        health care practice' means a corporation, limited liability 
        company, or unincorporated personal entity that provides health 
        care services of a physician or a health care provider as 
        licensed under State law.
            ``(3) Health care provider.--The term `health care 
        provider' means an individual providing health care services 
        under State law as determined by the Administrator.
            ``(4) Physician.--The term `physician' means an individual 
        that meets the definition under section 1861(r) of the Social 
        Security Act.
    ``(g) Sunset.--Low-interest loans under this section to eligible 
health care practices and ambulatory surgery centers shall only be made 
during the duration of the COVID-19 emergency.
    ``(h) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.
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