,,ii  #aai? ,,congress  #b;d ,session   
,s4 #dada  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #ai1 #bjbf,mr4    
,b5net 7= himself & ,mr4 ,moran7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,agriculture1 ,nutrition1 & ,=e/ry  ,a  
,,bill  ,to am5d ! ,consolidat$ ,f>m &  
,rural ,developm5t ,act to direct !     
,secret>y ( ,agriculture to make        
tempor>y z]o-p]c5t int]e/ loans "u !    
community facilities direct loan program
 to con/ruct or r5ovate c]ta9 rural     
hospitals1 & = o!r purposes4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,rural  
,hospital ,revitalization ,act ( #bjbf4 
#b4 ,rural hospital revitalization loans
 ,subtitle ,a ( ! ,consolidat$ ,f>m &   
,rural ,developm5t ,act is am5d$ by     
ins]t+ aft] section #cjf;,a 7#g         
,u4,s4,c4 #aibf;a7 ! foll[+3  #cjf;,b4  
,rural hospital revitalization loans    
7a7 ,9 g5]al ,"u ! community facilities 
direct loan program e/abli%$ "u section 
#cjf7;a77#a7 7ref]r$ to 9 ?is section z 

! community facilities direct loan      
program71 ! ,secret>y %all make tempor>y
 z]o-p]c5t int]e/ loans to eligible     
rural hospitals describ$ 9 subsection   
7b7 = ! con/ruction ( replacem5t        
hospital facilities or ! improvem5t or  
r5ovation ( exi/+ hospital facilities 9 
accordance ) ?is section4  7b7 ,eligible
 hospitals  7#a7 ,9 g5]al ,an eligible  
rural hospital describ$ 9 ?is subsection
 is a rural hospital-- 7,a7 ! campus 7z 
def9$ 9 section #dac4fe7;a77#b7 ( title 
#db1 ,code ( ,f$]al ,regulations 7or    
successor regulations77 ( :i* is 9 a    
c\nty ) a population ( less ?an #bj1jjj 
inhabitants2  7,b7 7i7 ! campus 7z s    
def9$7 ( :i* is n less ?an #ce miles f !
 ne>e/ hospital2  7ii7 if ! campus 7z s 
def9$7 ( :i* is 9 an area ) m\nta9\s    
t]ra9 or only second>y roads1 z det]m9$ 
by ! ,secret>y1 su* campus is n less ?an
 #ae miles f ! ne>e/ hospital2  7iii7 t 
is a critical access hospital 7z def9$ 9
 section #ahfa7mm77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#aciex7mm77#a7772 or  7iv7 t is a rural 
em]g5cy hospital 7z def9$ 9 section     
#ahfa7kkk77#b7 ( t ,act 7#db ,u4,s4,c4  
#aciex7kkk77#b7772  7,c7 t has be5      
cont9u\sly lic5s$ z a hospital 9 !      
community 9 :i* ! hospital is locat$ = n
 less ?an #cj ye>s2  7,d7 t submits to !
 ,secret>y an application at su* "t1 9  
su* mann]1 & conta9+ su* in=mation to   
det]m9e eligibility "u ?is p>agraph &   
priorities "u p>agraph 7#b7 & su* o!r   
in=mation z ! ,secret>y may require1    
includ+-- 7i7 a /atem5t demon/rat+ ! ne$
 = ! loan1 :i* %all describe-- 7,i7 !   
age & condition ( exi/+ facilities to be
 replac$1 improv$1 or r5ovat$1 includ+ a
 c]tification t funds f a loan "u ?is   
section w n be us$ = facilities t h be5 
significantly improv$ dur+ ! #aj-ye>    
p]iod prec$+ ! date ( ! application2 &  
7,,ii7 ! mann] 9 :i* ! use ( ! loan     
funds w address issues relat+ to !      
quality & viability ( ! facilities to   
pres]ve access to heal?c>e2  7ii7 a     
demon/ration t ! hospital has _h a      

positive impact 9 ! community s]v$ by ! 
hospital1 :i* %all include-- 7,i7 a     
positive impact on access to prim>y     
heal?c>e1 em]g5cy s]vices1 & s]vices    
requir$ "u conditions ( p>ticipation    
applicable "u title ,,xviii ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acie et  
seq472 &  7,,ii7 a mean+ful economic    
impact2 &  7iii7 a /atem5t ( !          
anticipat$ heal? & economic impacts ( ! 
loan1 includ+-- 7,i7 an impact on su/a9+
 ! provision ( s]vices t ! hospital     
curr5tly provides2  7,,ii7 an impact on 
(f]+ heal?c>e s]vices t ! hospital does 
n curr5tly (f]1 z appropriate2  7,,iii7 
an impact on ! provision (              
community-bas$ s]vices1 includ+ su*     
s]vices t influ5ce social det]m9ants (  
heal?2  7,,iv7 any o!r economic impacts2
 &  7,v7 impacts comp>$ to ! impacts if 
! loan funds 7 n made available2 &  7,e7
 t1 subject to p>agraph 7#c71 is        
f9ancially /able1 z measur$ by hav+--   
7i7 n less ?an #cj days ca% on h&2 &    
7ii7 a project$ debt-s]vice cov]age     

ratio ( at lea/ #a4b4  7#b7 ,priorities 
,9 mak+ loans "u ?is section1 !         
,secret>y %all give priority to an      
eligible rural hospital-- 7,a7 t s]ves  
an area 9 :i* !re are few] ?an #f       
inhabitants p] squ>e mile1 tak+ into    
consid]ation-- 7i7 ! di/ance f !        
hospital to a population c5t]2  7ii7 !  
travel "t f ! hospital to rea* a        
population c5t] or specific heal?       
s]vice2 &  7iii7 seasonal v>iations 9 ! 
ne$ = access to heal?c>e s]vices2  7,b7 
t requires replacem5t1 improvem5t1 or   
r5ovation t is n f9ancially feasible at 
! rates & t]ms (f]$ "u ! community      
facilities direct loan program2  7,c7 = 
:i* n less ?an #ej p]c5t ( its inpati5t 
days or dis*>ges & outpati5t visits dur+
 ! mo/ rec5t co/ report+ p]iod = :i*    
data are available 7 attributable to--  
7i7 individuals entitl$ to1 or enroll$  
=1 b5efits "u "p ,a or enroll$ = b5efits
 "u "p ,b ( title ,,xviii ( ! ,social   
,security ,act1 includ+ individuals     
enroll$ 9 a ,m$ic>e ,advantage plan "u  

"p ,c ( su* title2  7ii7 individuals    
eligible = m$ical assi/ance "u a ,/ate  
plan "u title ,,xix ( ! ,social         
,security ,act 7or a waiv] ( su* a      
plan72 or  7iii7 self-pay individuals2  
or  7,d7 t meets #b or m ( ! crit]ia    
describ$ 9 subp>agraphs 7,a7 ?r\gh 7,c74
  7#c7 ,waiv] ,! ,secret>y may waive !  
requirem5ts describ$ 9 p>agraph         
7#a77;,d7 9 ! case ( a hospital t       
demon/rates suffici5t community impacts 
describ$ 9 p>agraph 7#a77;,c77ii74  7#d7
 ,eligibility ,= purposes ( mak+ loans  
"u ?is section1 ! ,secret>y %all consid]
 an eligible rural hospital describ$ 9  
p>agraph 7#a7 to be eligible = !        
community facilities direct loan        
program4  7c7 ,loan int]e/ & t]ms  7#a7 
,initial int]e/-free loan ,except z     
o!rwise provid$ 9 ?is subsection1 a loan
 made "u ?is section %all1 = ! fir/ #e  
ye>s ( ! loan-- 7,a7 h a z]o p]c5t      
int]e/ rate2 &  7,b7 require repaym5t ( 
pr9cipal = a p]iod ( #e ye>s1 amortiz$--
 7i7 9 accordance ) ! expect$           

amortization s*$ule ( a loan "u !       
community facilities direct loan        
program2 &  7ii7 ov] a p]iod t is equal 
to ! less] (-- 7,i7 ! expect$ life ( !  
facility be+ con/ruct$ or r5ovat$2 &    
7,,ii7 a maximum t]m ( #dj ye>s4  7#b7  
,assessm5t ,at ! end ( ! #e-ye> p]iod ( 
a loan describ$ 9 p>agraph 7#a71 !      
,secret>y %all conduct an assessm5t ( ! 
f9ancial /ability ( ! eligible rural    
hospital to det]m9e :e!r ! hospital has 
! f9ancial /r5g? = ! loan to be ref9anc$
 at ! prevail+ rates (f]$ "u ! community
 facilities direct loan program4  7#c7  
,ref9anc+ ,if ! ,secret>y det]m9es ?r\gh
 an assessm5t "u p>agraph 7#b7 t an     
eligible rural hospital has suffici5t   
f9ancial /r5g? to repay a loan "u !     
community facilities direct loan        
program1 subject to subsection 7d77#b71 
! ,secret>y %all ref9ance ! loan "u ?is 
section into a loan "u ! community      
facilities direct loan program-- 7,a7 at
 ! prevail+ int]e/ rate applicable to a 
loan "u ! community facilities direct   

loan program2  7,b7 )\t a requirem5t ( !
 paym5t ( any int]e/ on ! am\nt (       
pr9cipal repaid dur+ ! p]iod 9 :i* !    
int]e/ rate ( ! loan 0 z]o p]c5t2  7,c7 
bas$ on ! unpaid pr9cipal balance2 &    
7,d7 amortiz$ 9 accordance ) ! community
 facilities direct loan program = !     
rema9+ t]m ( ! loan4  7d7 ,r5ewals  7#a7
 ,failure "u assessm5t  7,a7 ,9 g5]al   
,if ! ,secret>y det]m9es ?r\gh an       
assessm5t "u subsection 7c77#b7 t an    
eligible rural hospital does n h        
suffici5t f9ancial /r5g? to repay a loan
 "u ! community facilities direct loan  
program1 ! hospital may submit to !     
,secret>y an application = a #a-"t      
r5ewal ( ! z]o-p]c5t int]e/ loan 9      
accordance ) ! t]ms describ$ 9          
subsection 7c77#a7 = #a additional t]m (
 n m ?an #e ye>s4  7,b7 ,requirem5ts ,to
 be eligible = ! r5ewal ( a z]o-p]c5t   
int]e/ loan "u subp>agraph 7,a71 an     
eligible rural hospital %all demon/rate 
9 ! application submitt$ "u t           
subp>agraph t ! hospital-- 7i7 has fir/ 

appli$ = & accept$ any available ,f$]al 
te*nical assi/ance = rural hospitals to 
support op]ational improvem5ts & improve
 f9ancial /ability2 &  7ii7 cont9ues to 
meet all applicable community facilities
 direct loan program eligibility        
crit]ia4  7,c7 ,ref9anc+ ,at ! end ( !  
p]iod = :i* a z]o-p]c5t int]e/ loan is  
r5ew$ "u subp>agraph 7,a71 ! ,secret>y  
%all ref9ance ! loan into a loan "u !   
community facilities direct loan program
 9 accordance ) subsection 7c77#c74     
7#b7 ,int]e/ rate protection  7,a7 ,9   
g5]al ,if ! ,secret>y det]m9es ?r\gh an 
assessm5t "u subsection 7c77#b7 t an    
eligible rural hospital has suffici5t   
f9ancial /r5g? to repay a loan "u !     
community facilities direct loan        
program1 & ! int]e/ rate applicable to a
 loan "u ! community facilities direct  
loan program is m ?an #b4e p]c5t1 !     
hospital may submit to ! ,secret>y an   
application = a #a-"t r5ewal ( !        
z]o-p]c5t int]e/ loan 9 accordance ) !  
t]ms describ$ 9 subsection 7c77#a7 = #a 

additional t]m ( #e ye>s4  7,b7         
,requirem5ts ,to be eligible = ! r5ewal 
( a z]o-p]c5t int]e/ loan "u subp>agraph
 7,a71 an eligible rural hospital %all  
demon/rate 9 ! application submitt$ "u t
 subp>agraph t ! hospital-- 7i7 has _h a
 positive impact on access to prim>y    
heal?c>e1 em]g5cy s]vices1 & s]vices    
requir$ "u conditions ( p>ticipation    
applicable "u title ,,xviii ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 9 ! community s]v$ by ! hospital2 
&  7ii7 has _h positive impacts 9 !     
community describ$ 9 subsection         
7b77#a77;,c77ii74  7,c7 ,ref9anc+ ,dur+ 
! p]iod ( a z]o-p]c5t int]e/ loan t has 
be5 r5ew$ "u subp>agraph 7,a71 at any "t
 t ! int]e/ rate applicable to a loan "u
 ! community facilities direct loan     
program is #b4e p]c5t or less1 !        
eligible rural hospital may elect to    
ref9ance ! loan into a loan "u !        
community facilities direct loan program
 9 accordance ) subsection 7c77#c74     
7#c7 ,disapproval ,if ! ,secret>y       

disapproves an application to r5ew a    
z]o-p]c5t int]e/ loan "u p>agraph       
7#a77;,a7 or 7#b77;,a71 ! ,secret>y %all
 resolve ! applicable issues 9          
accordance ) ! proc$ures t apply to !   
community facilities direct loan        
program4  7e7 ,te*nical assi/ance grants
  7#a7 ,9 g5]al ,a hospital t receives a
 loan "u ?is section %all be eligible = 
assi/ance ?r\gh an aw>d "u a cov]$      
program to support op]ational           
improvem5ts & improve f9ancial /ability 
dur+-- 7,a7 ! #e-ye> p]iod ( a z]o-p]c5t
 int]e/ loan describ$ 9 subsection      
7c77#a72 &  7,b7 any r5ewal ( a         
z]o-p]c5t int]e/ loan = a lack (        
suffici5t f9ancial /r5g? "u subsection  
7d77#a74  7#b7 ,cov]$ program def9$ ,9  
?is subsection1 ! t]m cov]$ program     
means-- 7,a7 ! ,t>get$ ,te*nical        
,assi/ance = ,rural ,hospitals ,program 
( ! ,heal? ,res\rces & ,s]vices         
,adm9i/ration2 &  7,b7 ! ,rural         
,hospital ,te*nical ,assi/ance ,program 
c>ri$ out by ! rural developm5t mission 

area1 9 coop]ation ) ! ,national ,rural 
,heal? ,association4  4