I 117th CONGRESS 1st Session H. R. 5963 IN THE HOUSE OF REPRESENTATIVES November 12, 2021 Ms. Spanberger (for herself, Mr. Gonzalez of Ohio , Mrs. Axne , Mrs. Miller-Meeks , and Ms. Mace ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , 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 provide for improvements in the reimbursement of eligible health care providers through the Provider Relief Fund, and for other purposes.

1. Short title This Act may be cited as the Provider Relief Fund Improvement Act . 2. COVID–19 provider relief fund improvements (a) Findings Congress makes the following findings: (1) The most recent distribution made from the Provider Relief Fund to eligible health care providers began in 2020. (2) No distributions from the Provider Relief Fund have been made or announced to account for the surge in COVID–19 cases caused by the Delta variant. (3) That surge, at its peak, saw 7-day averages of about 175,000 daily COVID–19 cases, over 100,000 daily hospitalized patients, and almost 2,100 daily deaths in the United States. (4) The COVID–19 pandemic, and the Delta variant surge in particular, has taken a heavy toll on our frontline health care heroes, who have been on the front lines of the pandemic for over a full year and a half, with many suffering from trauma, burnout, and increased behavioral health challenges. (5) Many hospitals have experienced critical staffing and infrastructure issues due to the surge demands of very ill patients infected with the Delta variant of COVID–19, forcing some to make difficult patient care choices, such as postponing non-emergent surgeries or transferring certain patients, including children and expectant mothers, to other hospitals. (6) These challenges are being exacerbated by threats of violence against hospitals and their workforce, so much so that a domestic terror alert has been issued for health care facilities. (7) COVID–19-related expenses are skyrocketing, as demonstrated in a recent study showing that hospitals and health systems are paying $24,000,000,000 more per year for qualified clinical labor than they did before the beginning of the COVID–19 pandemic. (8) Hospitals and other eligible health care providers need additional funding, and continued access to Provider Relief Fund funding already received, to prevent, prepare for, and respond COVID–19, as intended under the law, and to protect their facilities and workforce. (b) Extension of deadline for eligible health care providers To use certain funds received from the COVID–19 provider relief fund (1) Payment received periods 1 and 2 Effective June 29, 2021, the deadline by which an eligible health care provider is required to use reimbursements from the Provider Relief Fund received by such eligible health care provider during a covered payment received period is extended until the end of the COVID–19 emergency period. (2) Adjustment of reporting time period The Secretary shall make appropriate adjustments to the reporting time period (as specified in the Provider Relief Fund guidance) that corresponds to a covered payment received period to reflect the extension of the applicable deadline under paragraph (1). (3) Refund of amounts returned to PRF Not later than 30 days after the date of the enactment of this section, the Secretary shall reimburse an eligible health care provider the total amount of payments such eligible health care provider returned to the Secretary by reason of the deadline referred to in paragraph (1). (4) Modification of deadline for period 3 The deadline by which an eligible health care provider is required to use reimbursements from the Provider Relief Fund received by such eligible health care provider during the Payment Received Period referred to in the Provider Relief Fund Guidance as the Period 3 specified in table 1 of such guidance (beginning on January 1, 2021, and ending on June 30, 2021) shall be the later of— (A) the end of the COVID–19 emergency period; or (B) June 30, 2022. (c) Requirement To distribute remaining COVID–19 provider relief funds by March 31, 2022 (1) Requirement for distributions (A) In general Not later than March 31, 2022, the Secretary shall distribute to eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus, any remaining funds appropriated to the Provider Relief Fund as of the date of the enactment of this section for reimbursements. (B) Deadline to use funds The deadline by which an eligible health care provider is required to use reimbursements received pursuant to subparagraph (A) is June 30, 2023. (2) Accounting for health care related expenses or lost revenues in the second, third, and fourth quarters of 2021 Notwithstanding any other provision of law, distributions made under paragraph (1) to eligible health care providers shall account for financial losses and changes in operating expenses occurring in the second, third, or fourth quarter of calendar year 2021, that are attributable to coronavirus. (d) Clarification of use of funds for workplace safety and security (1) In general Funds appropriated to the Provider Relief Fund for eligible health care providers and funds appropriated under section 1150C of the Social Security Act ( 42 U.S.C. 1320b–26 ) for eligible health care providers (as defined in subsection (e)(1) of such section) before, on or after the date of the enactment of this section may be used to reimburse an eligible health care provider for expenses incurred by the eligible health care provider for measures taken to establish or improve the security of the workplace of such eligible health care provider and improve the safety of personnel of such eligible health care provider present at such workplace. (2) Additional clarification of permissible expenses Expenses for workplace security and safety of personnel of an eligible health care provider described in paragraph (1) shall include the following: (A) Mitigation of risk of violence at the workplace of such eligible health care provider, including the employment of additional security personnel, conduct of risk assessment activities, implementation of response plans, implementation of small-scale changes to physical plant (such as the addition of more secure locks, the use of key card access, altering ingress and egress points, and the installation of additional security cameras), and staff education and training. (B) Measures to prevent violence at the workplace and against personnel of such eligible health care provider, including education and training of personnel on de-escalation protocols and installation of panic buttons and other similar, required equipment. (C) Trauma support for personnel with respect to violence in the workplace, such as counseling and other supports in the event of significant workplace safety episodes, which may include events that do not result in violence but may have significant impacts on personnel and the operations of the eligible health care provider (commonly referred to as near-misses). (e) Definitions In this section: (1) Coronavirus The term coronavirus means severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) or another coronavirus with pandemic potential. (2) Covered payment received period The term covered payment received period means, with respect to Payment Received Periods referred to in the Provider Relief Fund Guidance— (A) the Period 1 specified in table 1 of such guidance (beginning on April 10, 2020, and ending on June 30, 2020); and (B) the Period 2 specified in such table (beginning on July 1, 2020, and ending on December 31, 2020). (3) COVID–19 emergency period The term COVID–19 emergency period means the emergency period described in section 1135(g)(1)(B) of the Social Security Act ( 42 U.S.C. 1320b–5(g)(1)(B) ). (4) Eligible health care provider The term eligible health care provider has the meaning given such term in the third proviso of the third paragraph under the heading Department of Health and Human Services—Office of the Secretary—Public Health and Social Services Emergency Fund in division B of the CARES Act ( Public Law 116–136 ). (5) Provider relief fund The term Provider Relief Fund means the funding appropriated to prevent, prepare for, and respond to coronavirus, domestically or internationally, for necessary expenses to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus for which appropriations are made under— (A) the third paragraph under the heading Department of Health and Human Services—Office of the Secretary—Public Health and Social Services Emergency Fund in division B of the CARES Act ( Public Law 116–136 ); (B) the first paragraph under the heading Department of Health and Human Services—Office of the Secretary—Public Health and Social Services Emergency Fund in division B of the Paycheck Protection Program and Health Care Enhancement Act ( Public Law 116–139 ); and (C) the third paragraph under the heading Department of Health and Human Services—Office of the Secretary—Public Health and Social Services Emergency Fund of the Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (division M of the Consolidated Appropriations Act, 2021 ( Public Law 116–260 )). (6) Provider relief fund guidance The term Provider Relief Fund Guidance refers to the guidance entitled Provider Relief Fund General and Targeted Distribution Post-Payment Notice of Reporting Requirements issued by the Secretary of Health and Human Services on June 11, 2021. (7) Secretary The term Secretary means the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration.