Sec. 30611. Health Care Provider Relief Fund

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Not later than 7 days after the date of enactment of this Act, the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a program under which the Secretary shall reimburse, through grants or other mechanisms, eligible health care providers for eligible expenses or lost revenues occurring during calendar quarters beginning on or after January 1, 2020, to prevent, prepare for, and respond to COVID–19, in an amount calculated under subsection (c).

The Secretary shall give applicants a period of 7 calendar days after the close of a quarter to submit applications under this section with respect to such quarter, except that the Secretary shall give applicants a period of 7 calendar days after the date of enactment of this Act to submit applications with respect to the quarter beginning on January 1, 2020, if the applicant has not previously submitted an application with the respect to such quarter. The Secretary shall— review applications and make awards of reimbursement under this section on a quarterly basis; and award the reimbursements under this section for a quarter not later than 14 calendar days after the close of the quarter, except that the Secretary shall award the reimbursements under this section for the quarter beginning on January 1, 2020, not later than 14 calendar days after the date of enactment of this Act.

The amount of the reimbursement to an eligible health care provider under this section with respect to a calendar quarter shall equal— the sum of— 100 percent of the eligible expenses, as described in subsection (d), of the provider during the quarter; and subject to paragraph (3), 60 percent of the lost revenues, as described in subsection (e), of the provider during the quarter; less any funds that are— received by the provider during the quarter pursuant to the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ( Public Law 116–123 ), the Families First Coronavirus Response Act ( Public Law 116–127 ), the CARES Act ( Public Law 116–136 ), or the Paycheck Protection Program and Health Care Enhancement Act ( Public Law 116–139 ); and not required to be repaid.

If the amount determined under paragraph (1)(B) for a calendar quarter with respect to an eligible health care provider exceeds the amount determined under paragraph (1)(A) with respect to such provider and quarter, the amount of such difference shall be applied in making the calculation under this subsection, over each subsequent calendar quarter for which the eligible health care provider seeks reimbursement under this section. If the amount determined under subsection

(e)with respect to the lost revenue of an eligible health care provider for a calendar quarter does not exceed an amount that equals 10 percent of the net patient revenue (as defined in such subsection) of the provider for the corresponding quarter in 2019, the addend under paragraph (1)(A)(ii), in making the calculation under paragraph (1), is deemed to be zero. Subject to subsection (h)(1), expenses eligible for reimbursement under this section include expenses for— building or construction of temporary structures; leasing of properties; medical supplies and equipment including personal protective equipment; in vitro diagnostic tests, serological tests, or testing supplies; increased workforce and trainings; emergency operation centers; construction or retrofitting of facilities; mobile testing units; surge capacity; retention of workforce; and such other items and services as the Secretary determines to be appropriate, in consultation with relevant stakeholders. Subject to subsection (h)(1), for purposes of subsection (c)(1)(A)(ii), the lost revenues of an eligible health care provider, with respect to the calendar quarter involved, shall be equal to— net patient revenue of the provider for the corresponding quarter in 2019 minus net patient revenue of the provider for such quarter; less the savings of the provider during the calendar quarter involved attributable to foregone wages, payroll taxes, and benefits of personnel who were furloughed or laid off by the provider during that quarter. For purposes of paragraph (1)(A), the term net patient revenue , with respect to an eligible health care provider and a calendar quarter, means the sum of— 200 percent of the total amount of reimbursement received by the provider during the quarter for all items and services furnished under a State plan or a waiver of a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.); 125 percent of the total amount of reimbursement received by the provider during the quarter for all items and services furnished under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.); and 100 percent of the total amount of reimbursement not described in subparagraph

(A)or

(B)received by the provider during the quarter for all items and services. If there are insufficient funds made available to reimburse all eligible health care providers for all eligible expenses and lost revenues for a quarter in accordance with this section, the Secretary shall— prioritize reimbursement of eligible expenses; and using the entirety of the remaining funds, uniformly reduce the percentage of lost revenues otherwise applicable under subsection (c)(1)(A)(ii) to the extent necessary to reimburse a portion of the lost revenues of all eligible health care providers applying for reimbursement. A health care provider seeking reimbursement under this section for a calendar quarter shall submit to the Secretary an application that— provides documentation demonstrating that the health care provider is an eligible health care provider; includes a valid tax identification number of the health care provider or, if the health care provider does not have a valid tax identification number, an employer identification number or such other identification number as the Secretary may accept or may assign; attests to the eligible expenses and lost revenues of the health care provider, as described in subsection (d), occurring during the calendar quarter; includes an itemized listing of each such eligible expense, including expenses incurred in providing uncompensated care; for purposes of subsection (c)(3), attests to whether the amount determined under subsection

(e)with respect to the lost revenue of an eligible health care provider for a calendar quarter exceeds an amount that equals 10 percent of the net patient revenue (as defined in such subsection) of the provider for the corresponding quarter in 2019; includes projections of the eligible expenses and lost revenues of the health care provider, as described in subsection (c), for the calendar quarter that immediately follows the calendar quarter for which reimbursement is sought; and indicates the dollar amounts described in each of subparagraphs

(A)and

(B)of subsection (e)(1) and subparagraphs (A), (B), and

(C)of subsection (e)(2) for the calendar quarter and any other information the Secretary determines necessary to determine expenses and lost revenue related to COVID–19. The Secretary may not provide, and a health care provider may not accept, reimbursement under this section for expenses or losses with respect to which— the eligible health care provider is reimbursed from other sources; or other sources are obligated to reimburse the provider. Reimbursement for eligible expenses (as described in subsection (d)) and lost revenues (as described in subsection (e)) shall not include 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 ). As a condition of receipt of reimbursement under this section, a health care provider, in the case such provider furnishes 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) ) (whether before, on, or after, the date on which the provider submits an application under this section) a medically necessary item or service described in subparagraph (A), (B), or

(C)of paragraph

(3)to an individual who is described in such subparagraph (A), (B), or (C), respectively, and enrolled in a group health plan or group or individual health insurance coverage offered by a health insurance issuer (including grandfathered health plans as defined in section 1251(e) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(e) ) and such provider is a nonparticipating provider with respect to such plan or coverage and such plan or coverage and such items and services would otherwise be covered under such plan if furnished by a participating provider— may not bill or otherwise hold liable such individual for a payment amount for such item or service that is more than the cost-sharing amount that would apply under such plan or coverage for such item or service if such provider furnishing such service were a participating provider with respect to such plan or coverage; shall reimburse such individual in a timely manner for any amount for such item or service paid by the individual to such provider in excess of such cost-sharing amount; shall submit any claim for such item or service directly to the plan or coverage; and shall not bill the individual for such cost-sharing amount until such individual is informed by the plan or coverage of the required payment amount. As a condition of receipt of reimbursement under this section, a health care provider, in the case such reimbursement is with respect to expenses incurred in providing uncompensated care (as described in subsection (g)(4)) with respect to a medically necessary item or service described in subparagraph (A), (B), or

(C)of paragraph

(3)furnished during such emergency period (whether before, on, or after, the date on which the provider submits an application under this section) by the provider to an individual who is described in such subparagraph (A), (B), or (C), respectively— shall consider such reimbursement as payment in full with respect to such item or service so furnished to such individual; may not bill or otherwise hold liable such individual for any payment for such item or service so furnished to such individual; and shall reimburse such individual in a timely manner for any amount for such item or service paid by the individual to such provider. For purposes of this subsection, medically necessary items and services described in this paragraph are— medically necessary items and services (including in-person or telehealth visits in which such items and services are furnished) that are furnished to an individual who has been diagnosed with (or after provision of the items and services is diagnosed with) COVID–19 to treat or mitigate the effects of COVID–19; medically necessary items and services (including in-person or telehealth visits in which such items and services are furnished) that are furnished to an individual who is presumed, in accordance with paragraph (4), to have COVID–19 but is never diagnosed as such; and a diagnostic test (and administration of such test) as described in section 6001(a) of division F of the Families First Coronavirus Response Act ( 42 U.S.C. 1320b–5 note) administered to an individual. For purposes of paragraph (3)(B), an individual shall be presumed to have COVID–19 if the medical record documentation of the individual supports a diagnosis of COVID–19, even if the individual does not have a positive in vitro diagnostic test result in the medical record of the individual. In the case of an eligible health care provider that is paid a reimbursement under this section and that is in violation of paragraph

(1)or (2), in addition to any other penalties that may be prescribed by law, the Secretary may recoup from such provider up to the full amount of reimbursement the provider receives under this section. In this subsection: The term nonparticipating provider means, with respect to an item or service and group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider that does not have a contractual relationship directly or indirectly with the plan or issuer, respectively, for furnishing such an item or service under the plan or coverage. The term participating provider means, with respect to an item or service and group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider that has a contractual relationship directly or indirectly with the plan or issuer, respectively, for furnishing such an item or service under the plan or coverage. The terms group health plan , health insurance issuer , group health insurance coverage , and individual health insurance coverage shall have the meanings given such terms under section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91 ). In making awards under this section, the Secretary shall post in a searchable, electronic format, a list of all recipients and awards pursuant to funding authorized under this section. Each recipient of an award under this section shall, as a condition on receipt of such award, submit reports and maintain documentation, in such form, at such time, and containing such information, as the Secretary determines is needed to ensure compliance with this section. The Secretary shall— not later than 7 days after the date of enactment of this Act, post in a searchable, electronic format, a list of all awards made by the Secretary under this section, including the recipients and amounts of such awards; and update such list not less than every 7 days until all funds made available to carry out this section are expended. Not later than 3 years after final payments are made under this section, the Inspector General of the Department of Health and Human Services shall transmit a final report on audit findings with respect to the program under this section to the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives and the Committee on Health, Education, Labor and Pensions and the Committee on Appropriations of the Senate. Nothing in this paragraph shall be construed as limiting the authority of the Inspector General of the Department of Health and Human Services or the Comptroller General of the United States to conduct audits of interim payments earlier than the deadline described in subparagraph (A). In this section: The term eligible health care provider means a health care provider described in paragraph

(2)that provides diagnostic or testing services or treatment to individuals with a confirmed or possible diagnosis of COVID–19. A health care provider described in this paragraph is any of the following: A health care provider enrolled as a participating provider under a State plan approved under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq.) (or a waiver of such a plan). A provider of services (as defined in subsection

(u)of section 1861 of the Social Security Act ( 42 U.S.C. 1395x )) or a supplier (as defined in subsection

(d)of such section) that is enrolled as a participating provider of services or participating supplier under the Medicare program under title XVIII of such Act ( 42 U.S.C. 1395 et seq.). A public entity. Any other entity not described in this paragraph as the Secretary may specify. There is authorized to be appropriated for an additional amount to carry out this section $100,000,000,000, to remain available until expended. In addition to amounts authorized to be appropriated pursuant to paragraph (1), the unobligated balance of all amounts appropriated to the Health Care Provider Relief Fund shall be made available only to carry out this section. For purposes of clause (i), the following amounts are deemed to be appropriated to the Health Care Provider Relief Fund: The unobligated balance of the appropriation of $100,000,000,000 in 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 ). The unobligated balance of the appropriation 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 ). Of the unobligated balances described in subparagraph (A)(ii), the Secretary may not make available more than $10,000,000,000 to reimburse eligible health care providers for expenses incurred in providing uncompensated care. Any appropriation enacted subsequent to the date of enactment of this Act that is made available for reimbursing eligible health care providers as described in subsection

(a)shall be made available only to carry out this section.

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