,,ii #aaith ,,congress #b;d ,session ,s4 #dada ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ai1 #bjbf,mr4 ,bennet 7for himself and ,mr4 ,moran7 introduced the following bill2 which was read twice and referred to the ,committee on ,agriculture1 ,nutrition1 and ,forestry ,a ,,bill ,to amend the ,consolidated ,farm and ,rural ,development ,act to direct the ,secretary of ,agriculture to make temporary zero-percent interest loans under the community facilities direct loan program to construct or renovate certain rural hospitals1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,rural ,hospital ,revitalization ,act of #bjbf4 #b4 ,rural hospital revitalization loans ,subtitle ,a of the ,consolidated ,farm and ,rural ,development ,act is amended by inserting after section #cjf;,a 7#g ,u4,s4,c4 #aibf;a7 the following3 #cjf;,b4 ,rural hospital revitalization loans 7a7 ,in general ,under the community facilities direct loan program established under section #cjf7;a77#a7 7referred to in this section as the community facilities direct loan program71 the ,secretary shall make temporary zero-percent interest loans to eligible rural hospitals described in subsection 7b7 for the construction of replacement hospital facilities or the improvement or renovation of existing hospital facilities in accordance with this section4 7b7 ,eligible hospitals 7#a7 ,in general ,an eligible rural hospital described in this subsection is a rural hospital-- 7,a7 the campus 7as defined in section #dac4fe7;a77#b7 of title #db1 ,code of ,federal ,regulations 7or successor regulations77 of which is in a county with a population of less than #bj1jjj inhabitants2 7,b7 7i7 the campus 7as so defined7 of which is not less than #ce miles from the nearest hospital2 7ii7 if the campus 7as so defined7 of which is in an area with mountainous terrain or only secondary roads1 as determined by the ,secretary1 such campus is not less than #ae miles from the nearest hospital2 7iii7 that is a critical access hospital 7as defined in section #ahfa7mm77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7mm77#a7772 or 7iv7 that is a rural emergency hospital 7as defined in section #ahfa7kkk77#b7 of that ,act 7#db ,u4,s4,c4 #aciex7kkk77#b7772 7,c7 that has been continuously licensed as a hospital in the community in which the hospital is located for not less than #cj years2 7,d7 that submits to the ,secretary an application at such time1 in such manner1 and containing such information to determine eligibility under this paragraph and priorities under paragraph 7#b7 and such other information as the ,secretary may require1 including-- 7i7 a statement demonstrating the need for the loan1 which shall describe-- 7,i7 the age and condition of existing facilities to be replaced1 improved1 or renovated1 including a certification that funds from a loan under this section will not be used for facilities that have been significantly improved during the #aj-year period preceding the date of the application2 and 7,,ii7 the manner in which the use of the loan funds will address issues relating to the quality and viability of the facilities to preserve access to healthcare2 7ii7 a demonstration that the hospital has had a positive impact in the community served by the hospital1 which shall include-- 7,i7 a positive impact on access to primary healthcare1 emergency services1 and services required under conditions of participation applicable under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 and 7,,ii7 a meaningful economic impact2 and 7iii7 a statement of the anticipated health and economic impacts of the loan1 including-- 7,i7 an impact on sustaining the provision of services that the hospital currently provides2 7,,ii7 an impact on offering healthcare services that the hospital does not currently offer1 as appropriate2 7,,iii7 an impact on the provision of community-based services1 including such services that influence social determinants of health2 7,,iv7 any other economic impacts2 and 7,v7 impacts compared to the impacts if the loan funds were not made available2 and 7,e7 that1 subject to paragraph 7#c71 is financially stable1 as measured by having-- 7i7 not less than #cj days cash on hand2 and 7ii7 a projected debt-service coverage ratio of at least #a4b4 7#b7 ,priorities ,in making loans under this section1 the ,secretary shall give priority to an eligible rural hospital-- 7,a7 that serves an area in which there are fewer than #f inhabitants per square mile1 taking into consideration-- 7i7 the distance from the hospital to a population center2 7ii7 the travel time from the hospital to reach a population center or specific health service2 and 7iii7 seasonal variations in the need for access to healthcare services2 7,b7 that requires replacement1 improvement1 or renovation that is not financially feasible at the rates and terms offered under the community facilities direct loan program2 7,c7 for which not less than #ej percent of its inpatient days or discharges and outpatient visits during the most recent cost reporting period for which data are available were attributable to-- 7i7 individuals entitled to1 or enrolled for1 benefits under part ,a or enrolled for benefits under part ,b of title ,,xviii of the ,social ,security ,act1 including individuals enrolled in a ,medicare ,advantage plan under part ,c of such title2 7ii7 individuals eligible for medical assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7or a waiver of such a plan72 or 7iii7 self-pay individuals2 or 7,d7 that meets #b or more of the criteria described in subparagraphs 7,a7 through 7,c74 7#c7 ,waiver ,the ,secretary may waive the requirements described in paragraph 7#a77;,d7 in the case of a hospital that demonstrates sufficient community impacts described in paragraph 7#a77;,c77ii74 7#d7 ,eligibility ,for purposes of making loans under this section1 the ,secretary shall consider an eligible rural hospital described in paragraph 7#a7 to be eligible for the community facilities direct loan program4 7c7 ,loan interest and terms 7#a7 ,initial interest-free loan ,except as otherwise provided in this subsection1 a loan made under this section shall1 for the first #e years of the loan-- 7,a7 have a zero percent interest rate2 and 7,b7 require repayment of principal for a period of #e years1 amortized-- 7i7 in accordance with the expected amortization schedule of a loan under the community facilities direct loan program2 and 7ii7 over a period that is equal to the lesser of-- 7,i7 the expected life of the facility being constructed or renovated2 and 7,,ii7 a maximum term of #dj years4 7#b7 ,assessment ,at the end of the #e-year period of a loan described in paragraph 7#a71 the ,secretary shall conduct an assessment of the financial stability of the eligible rural hospital to determine whether the hospital has the financial strength for the loan to be refinanced at the prevailing rates offered under the community facilities direct loan program4 7#c7 ,refinancing ,if the ,secretary determines through an assessment under paragraph 7#b7 that an eligible rural hospital has sufficient financial strength to repay a loan under the community facilities direct loan program1 subject to subsection 7d77#b71 the ,secretary shall refinance the loan under this section into a loan under the community facilities direct loan program-- 7,a7 at the prevailing interest rate applicable to a loan under the community facilities direct loan program2 7,b7 without a requirement of the payment of any interest on the amount of principal repaid during the period in which the interest rate of the loan was zero percent2 7,c7 based on the unpaid principal balance2 and 7,d7 amortized in accordance with the community facilities direct loan program for the remaining term of the loan4 7d7 ,renewals 7#a7 ,failure under assessment 7,a7 ,in general ,if the ,secretary determines through an assessment under subsection 7c77#b7 that an eligible rural hospital does not have sufficient financial strength to repay a loan under the community facilities direct loan program1 the hospital may submit to the ,secretary an application for a #a-time renewal of the zero-percent interest loan in accordance with the terms described in subsection 7c77#a7 for #a additional term of not more than #e years4 7,b7 ,requirements ,to be eligible for the renewal of a zero-percent interest loan under subparagraph 7,a71 an eligible rural hospital shall demonstrate in the application submitted under that subparagraph that the hospital-- 7i7 has first applied for and accepted any available ,federal technical assistance for rural hospitals to support operational improvements and improve financial stability2 and 7ii7 continues to meet all applicable community facilities direct loan program eligibility criteria4 7,c7 ,refinancing ,at the end of the period for which a zero-percent interest loan is renewed under subparagraph 7,a71 the ,secretary shall refinance the loan into a loan under the community facilities direct loan program in accordance with subsection 7c77#c74 7#b7 ,interest rate protection 7,a7 ,in general ,if the ,secretary determines through an assessment under subsection 7c77#b7 that an eligible rural hospital has sufficient financial strength to repay a loan under the community facilities direct loan program1 and the interest rate applicable to a loan under the community facilities direct loan program is more than #b4e percent1 the hospital may submit to the ,secretary an application for a #a-time renewal of the zero-percent interest loan in accordance with the terms described in subsection 7c77#a7 for #a additional term of #e years4 7,b7 ,requirements ,to be eligible for the renewal of a zero-percent interest loan under subparagraph 7,a71 an eligible rural hospital shall demonstrate in the application submitted under that subparagraph that the hospital-- 7i7 has had a positive impact on access to primary healthcare1 emergency services1 and services required under conditions of participation applicable under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 in the community served by the hospital2 and 7ii7 has had positive impacts in the community described in subsection 7b77#a77;,c77ii74 7,c7 ,refinancing ,during the period of a zero-percent interest loan that has been renewed under subparagraph 7,a71 at any time that the interest rate applicable to a loan under the community facilities direct loan program is #b4e percent or less1 the eligible rural hospital may elect to refinance the loan into a loan under the community facilities direct loan program in accordance with subsection 7c77#c74 7#c7 ,disapproval ,if the ,secretary disapproves an application to renew a zero-percent interest loan under paragraph 7#a77;,a7 or 7#b77;,a71 the ,secretary shall resolve the applicable issues in accordance with the procedures that apply to the community facilities direct loan program4 7e7 ,technical assistance grants 7#a7 ,in general ,a hospital that receives a loan under this section shall be eligible for assistance through an award under a covered program to support operational improvements and improve financial stability during-- 7,a7 the #e-year period of a zero-percent interest loan described in subsection 7c77#a72 and 7,b7 any renewal of a zero-percent interest loan for a lack of sufficient financial strength under subsection 7d77#a74 7#b7 ,covered program defined ,in this subsection1 the term covered program means-- 7,a7 the ,targeted ,technical ,assistance for ,rural ,hospitals ,program of the ,health ,resources and ,services ,administration2 and 7,b7 the ,rural ,hospital ,technical ,assistance ,program carried out by the rural development mission area1 in cooperation with the ,national ,rural ,health ,association4 4