,,ii  #aai? ,,congress  #b;d ,session   
,s4 #dibg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bd1 #bjbf,mr4   
,hawley 7= himself & ,ms4 ,hassan7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to e/abli% a gu>ante$ fund+ 
/ream to keep exi/+ em]g5cy rooms at    
,am]ica's rural hospitals op51 & = o!r  
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,rural ,hospital ,em]g5cy  
,room ,gu>antee ,act4  #b4 ,rural       
,hospital ,em]g5cy ,room ,gu>antee ,fund
 ,"p ,p ( title ,,iii ( ! ,public ,heal?
 ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et  
seq47 is am5d$ by add+ at ! end !       
foll[+3  #cii,v-#h4 ,rural ,hospital    
,em]g5cy ,room ,gu>antee ,fund  7a7     
,e/abli%m5t ,!re is e/abli%$ 9 !        
,treasury ( ! ,unit$ ,/ates a fund1 to  
be kn[n z ! ,rural ,hospital ,em]g5cy   
,room ,gu>antee ,fund 7ref]r$ to 9 ?is  
section z ! ,fund71 consi/+ (-- 7#a7 su*
 am\nts z are appropriat$ to ! fund     

pursuant to subsection 7i72 &  7#b7 any 
am\nts collect$ z civil monet>y p5alties
 "u subsection 7g77#b77;,a74  7b7       
,adm9i/ration ,! ,fund %all be adm9i/]$ 
by ! ,secret>y1 act+ ?r\gh !            
,adm9i/rator ( ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration 7ref]r$ to 9 ?is 
section z ! ,secret>y74  7c7 ,use (     
funds  7#a7 ,9 g5]al ,am\nts 9 ! ,fund  
%all be available1 )\t fur!r            
appropriation or fiscal ye> limitation1 
to ! ,secret>y to make paym5ts "u !     
program e/abli%$ "u p>agraph 7#b74  7#b7
 ,program  7,a7 ,9 g5]al ,n lat] ?an #ij
 days aft] ! date ( enactm5t ( ! ,rural 
,hospital ,em]g5cy ,room ,gu>antee ,act1
 ! ,secret>y %all e/abli%1 & solicit    
applications =1 a #aj-ye> program       
7ref]r$ to 9 ?is section z ! program7 to
 make paym5ts to eligible entities = !  
au?oriz$ uses describ$ 9 subsection 7e74
  7,b7 ,paym5ts ,ea* ye> ( ! program1 ! 
,secret>y %all-- 7i7 make a paym5t--    
7,i7 9 ! fir/ ye> ( ! program1 9 ! am\nt
 ( #a1jjj1jjj 7to be di/ribut$ 9 equal  

paym5ts on a qu>t]ly basis7 to ea*      
eligible entity ) an approv$ application
 "u subsection 7d77#b72 &  7,,ii7 9 ea* 
subsequ5t ye> ( ! program1 9 an am\nt   
equal to ! am\nt ( ! paym5t = ! prec$+  
ye>1 z adju/$ to reflect *anges = !     
#ab-mon? p]iod end+ ! prec$+ ,novemb]   
#cj 9 ! ,consum] ,price ,index = ,m$ical
 ,c>e ,s]vices publi%$ by ! ,bureau (   
,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor2
 &  7ii7 make an additional paym5t to   
ea* su* eligible entity 9 an am\nt n    
great] ?an #ej p]c5t ( ! am\nt ( !      
paym5t made to su* eligible entity "u   
clause 7i7 = t ye>1 to be det]m9$ by !  
,secret>y ) respect to ea* su* eligible 
entity pursuant to a =mula e/abli%$ by !
 ,secret>y by rulemak+ bas$ on1 )       
respect to an eligible entity-- 7,i7 !  
payor mix ( ! eligible entity2  7,,ii7 !
 injury ne$ ( pati5ts )9 ! imm$iate     
geographical area 9 :i* ! eligible      
entity is locat$2  7,,iii7 ! economic   
conditions 9 ! geographic area 9 :i* su*
 eligible entity is locat$2 &  7,,iv7   

pa/ f9ancial hi/ory ( su* eligible      
entity4  7,c7 ,em]g5cy paym5ts ,!       
,secret>y may make an additional paym5t1
 9 an am\nt n to exce$ #bej1jjj1 to an  
eligible entity ) an approv$ application
 "u subsection 7d77#b7 9 any ye> ( !    
program if ! ,secret>y det]m9es t !     
em]g5cy dep>tm5t ( su* eligible entity  
is 9 dang] ( clos+ 9 ! next #ad days1 on
 ! condition t no eligible entity may   
receive m ?an #a su* paym5t 9 any ye> ( 
! program4  7d7 ,applications2 approval2
 eligibility  7#a7 ,9 g5]al ,ea* entity 
desir+ to receive paym5ts "u ! program  
%all submit to ! ,secret>y an           
application at su* "t1 9 su* mann]1 &   
conta9+ su* in=mation z ! ,secret>y may 
require4  7#b7 ,approval  7,a7 ,9 g5]al 
,n lat] ?an #cj days aft] receiv+ an    
application "u p>agraph 7#a71 !         
,secret>y %all approve su* application  
if ! ,secret>y det]m9es t su* entity    
meets ! eligibility crit]ia describ$ 9  
p>agraph 7#c74 ,su* approval %all apply 
) respect to su* an entity = ! duration 

( ! program1 except z provid$ 9 p>agraph
 7#d74  7,b7 ,requirem5t ,if ! ,secret>y
 does n approve an application "u       
subp>agraph 7,a71 z soon z practicable  
aft] su* disapproval1 ! ,secret>y %all  
provide to ! applicant-- 7i7 an         
explanation ( ! reason = ! disapproval2 
&  7ii7 an exp$it$ process = cur+ any   
defici5cies 9 ! application & reapply+4 
7#c7 ,eligibility ,to be eligible to    
receive a paym5t "u ! program1 an       
entity-- 7,a7 %all be a rural heal?     
facility 7z def9$ 9 section             
#baje7;h77#c77;,d7 ( ! ,social ,security
 ,act71 o!r ?an an entity describ$ 9    
clause 7i77,,ii7 ( su* section2  7,b7   
%all p>ticipate 9 a ,f$]al heal? c>e    
program 7z def9$ 9 section #aabh;,b7f7 (
 su* ,act72 &  7,c7 %all op]ate a       
#bd-;h\r em]g5cy dep>tm5t ( a hospital  
7z def9$ 9 section #bgii;,a-#a7;a77#c77 
or a #bd-;h\r indep5d5t free/&+ em]g5cy 
dep>tm5t 7z s def9$74  7#d7 ,condition (
 p>ticipation ,aft] ! date on :i* !     
application ( an eligible entity is     

approv$ "u p>agraph 7#b77;,a71 if su*   
eligible entity is acquir$1 9 :ole or 9 
"p1 by a private-equity1 v5ture-capital1
 or simil>ly purpos$ own]%ip fund1 su*  
eligible entity may n cont9ue to        
p>ticipate 9 ! program4  7e7 ,au?oriz$  
uses ,an eligible entity receiv+ paym5ts
 "u ! program-- 7#a7 may only use !     
funds to pay = ! normal op]at+ exp5ses1 
includ+ = /aff+1 ( ! em]g5cy dep>tm5t ( 
su* eligible entity2 &  7#b7 may n--    
7,a7 use ! funds-- 7i7 to develop       
projects t d n directly impact ! exi/+  
op]ations ( su* eligible entity2 or     
7ii7 to make paym5ts to executives1     
executive /aff1 or memb]s ( ! bo>d (    
directors ( su* eligible entity2 or     
7,b7 transf] ! funds to o!r facilities1 
includ+ o!r facilities ( su* eligible   
entity4  7f7 ,report+ ,ea* eligible     
entity receiv+ paym5ts "u ! program %all
 submit to ! ,secret>y an annual report 
describ+ ! f9ancial condition & cont9u$ 
ne$ ( su* eligible entity & ! impact (  
su* paym5ts receiv$ dur+ ! prec$+ ye> on

 su* eligible entity4 ,! ,secret>y may n
 use su* report$ in=mation to disqualify
 su* eligible entity f p>ticipation 9 ! 
program4  7g7 ,compliance  7#a7 ,9 g5]al
 ,! ,secret>y %all conduct r&om audits (
 eligible entities receiv+ paym5ts "u ! 
program to ensure ! compliance ( su*    
eligible entities ) ! requirem5ts ( !   
program4  7#b7 ,violations ,if !        
,secret>y det]m9es t an eligible entity 
has violat$ a requirem5t ( ! program1 ! 
,secret>y may-- 7,a7 impose civil       
p5alties1 includ+ civil monet>y         
p5alties1 aga9/ su* eligible entity2 or 
7,b7 remove su* eligible entity f       
p>ticipation 9 ! program4  7h7          
,regulations = report+ ,n lat] ?an #ij  
days aft] ! date ( enactm5t ( ! ,rural  
,hospital ,em]g5cy ,room ,gu>antee ,act1
 ! ,secret>y1 act+ ?r\gh ! ,adm9i/rator 
( ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1
 %all promulgate regulations-- 7#a7     
e/abli%+ a report+ me?odology = eligible
 entities enroll$ 9 ! ,m$ic>e program "u
 title ,,xviii ( ! ,social ,security    

,act "u section #ahff7;j7 ( su* ,act to 
disclose = in=mational purposes on any  
requir$ co/ reports "u su* title ,,xviii
 all paym5ts receiv$ "u ! program2 &    
7#b7 all[+ an eligible entity to exclude
 all paym5ts receiv$ "u ! program f co/ 
settlem5t calculations & exp5se (fsets4 
7i7 ,m&atory fund+ ,out ( any money 9 ! 
,treasury n o!rwise appropriat$1 !re is 
au?oriz$ to be appropriat$1 & !re is    
appropriat$1 to ! ,fund su* sums z are  
necess>y = ea* ( fiscal ye>s #bjbf ?r\gh
 #bjcf4  7j7 ,effect ,p>ticipation 9 !  
program %all n be tak5 into acc\nt 9    
det]m9+ eligibility ( an eligible entity
 "u any o!r ,f$]al heal? c>e program 7z 
def9$ 9 section #aabh;,b7f7 ( ! ,social 
,security ,act7 & any paym5t "u !       
program %all be 9 addition to any paym5t
 su* eligible entity is eligible to     
receive "u any o!r ,f$]al heal? c>e     
program 7z s def9$74  4