II 117th CONGRESS 1st Session S. 3105 IN THE SENATE OF THE UNITED STATES October 28, 2021 Mr. Bennet introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to establish a hospital revitalization program to assist certain health facilities in constructing and modernizing their facilities and to support community development.

1. Short title This Act may be cited as the Hospital Revitalization Act of 2021 . 2. Hospital revitalization program Title VI of the Public Health Service Act ( 42 U.S.C. 291 et seq. ) is amended by adding at the end the following: E Hospital revitalization program 651. Establishment of hospital revitalization program (a) In general The Secretary shall award grants and loans to eligible hospitals for purposes of assisting such hospitals in constructing and modernizing their facilities, including rural health clinics, off-site outpatient departments, skilled nursing facilities, and other facilities not physically part of the eligible hospital building, to increase capacity and better serve communities in need. (b) Eligible hospitals (1) In general To be eligible to receive an award under this section, a hospital shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including information to demonstrate that, based on available data for fiscal or calendar years 2017 through 2019, such hospital— (A) had less than $50,000,000 in net patient revenue or fewer than 50 beds (as reported by the Health Care Cost and Information Reporting System); (B) had a negative total margin for at least 2 of the 3 fiscal years prior to fiscal year 2020; and (C) had a public payer mix percentage, for each of the 3 fiscal years prior to fiscal year 2020, that is at least 65 percent (at least 65 percent of net patient revenue from the Medicare program or Medicaid program). (2) Prioritization criteria The Secretary shall develop prioritization criteria for the grant and loans under subsection (d), including— (A) the year in which the hospital was built; (B) the physical state of the hospital; (C) the average age-of-plant ratio (accumulated depreciation divided by annual depreciation expense); (D) the level of the hospital's electronic health record implementation; (E) whether the hospital is located in a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act); and (F) the level of, relative to the national or statewide average, individuals with income below 150 percent of the Federal poverty level in the area served by the hospital. (c) Application Each eligible hospital desiring an award under this section shall submit to the Secretary an application, at such time, in such manner, and containing such information to determine eligibility and prioritization required under subsection (b) and other information as the Secretary may require, including— (1) a community health needs assessment, which shall be made available on the websites of the hospital and the Department of Health and Human Services, that— (A) accounts for health equity through factors (like socioeconomic, racial, ethnic, sexual preference, gender identity, health insurance coverage, education level, and geography) that have an impact on the overall health of the population; (B) honors indigenous history and current presence with a land acknowledgment statement; (C) outlines a projection for not less than 5 years, and if possible for 10 years, with respect to— (i) population and demographic trends within the local community and region; (ii) current availability of, and projected community need for— (I) inpatient hospital services; outpatient and ambulatory services; (II) diagnostic and lab services; (III) post-acute and community services; (IV) emergency medical services; (V) oral and dental care; and (VI) preventive and population health services; (iii) current availability and projected community need for Tribal or veteran health and wellness services; and (iv) current availability and projected community need for non-clinical services, such as food support, housing assistance, transportation, linguistic, and other services that impact the health care status of the impacted population; (D) provides a statement outlining the overarching gap in local community or regional services; (E) provides a statement that identifies the highest priority services that have the potential to improve overall health and wellness of the local region; and (F) establishes a hospital transformation plan that contains— (i) a process for consulting with representatives of the community’s interests and input; (ii) a list of community input sources representing the broad interests of the community, that is representative of individuals who are medically underserved, low-income, or from minority populations and that may include representatives of local hospitals, physicians, allied health professionals, private and public payers, patients and consumers, Tribal representatives, and other relevant stakeholders, including local or regional social service organizations; and (iii) an outline of goals and action steps for improving or maintaining access to care, strengthening quality of care, better coordinating care across the local or regional health care delivery system, and addressing other community needs or gaps identified in the needs assessment; (2) a preliminary construction project plan that— (A) outlines a project budget with costs of— (i) administrative and legal expenses; (ii) land, structure, rights-of-way appraisals; (iii) relocation expenses; (iv) architectural and engineering fees; (v) inspection fees; (vi) site work (such as helipad equipment and telecommunication and data network upgrades); (vii) demolition and removal; (viii) equipment (such as medical equipment and technology systems, furniture, kitchen and bathroom appliances, and signage); and (ix) any other costs the Secretary determines appropriate; and (B) outlines the planned spaces with descriptions (including square footage and purpose), as the Secretary determines appropriate, which shall include— (i) care units or wards and the number of expected beds in such areas; (ii) diagnostic and treatment areas, including imaging areas, emergency departments, laboratories, and pharmacies; (iii) administrative areas, including lobbies, office space, education areas; and (iv) other types of spaces the Secretary determines appropriate; (3) an energy plan for how the project accounts for energy resilience and efficiency; and (4) a report on the economic impact of the award on the area or region served, including an analysis of local labor market effects such as how the hospital may help improve wages, household incomes, employment and unemployment rates, and meet labor demands and how the hospital may help improve wages in the area. (d) Safe structure waiver The Secretary may grant a waiver to eligible hospitals with respect to the timing of submissions of information required under paragraph (1), (3), or (4) of subsection (c), if the Secretary determines that the project to be carried out by the eligible hospital receiving such waiver should be expedited to ensure the safety of patients or workers. (e) Grant and loan amounts (1) In general An award to an eligible hospital under this section shall be in an amount determined by the Secretary, based on the information submitted by the eligible hospital under subsection (c)(2). The total amount of such an award shall not exceed $40,000,000, of which not more than 30 percent may be awarded as a grant, and any remaining amount may be awarded as a low interest loan. (2) No effect on eligibility for other funding Amounts received by an eligible hospital under this section shall have no effect on the hospital's eligibility for funding made available through other Federal programs, including any such funding available with respect to the project supported by the award under this section. (f) Reporting Each recipient of an award under this section shall submit an annual report to the Secretary on the use of such award funds in the previous fiscal year, including the use of such funds to address issues raised in the community health needs assessment, the energy plan, and economic impact report submitted with the recipient’s application under subsection (c). Such recipient shall post each such report on the website of the recipient. (g) Authorization of appropriations (1) In general There are authorized to be appropriated $17,000,000,000 for fiscal year 2022 to carry out this section. Amounts appropriated under this subsection shall remain available through fiscal year 2025. (2) Management and oversight The Secretary may allocate up to 0.1 percent of the funds appropriated under this subsection for the management and oversight of programs under this section. .