$1.9 Trillion American Rescue Plan Act 2021- What Is in It for Rural Healthcare?

The American Rescue Plan Act of 2021 was signed into law by President Biden on March 11, 2021. This rescue package was designed to expedite the United States’ recovery from the economic and health consequences of the COVID-19 Pandemic.

How does rural health care benefit from this package?


  • The Grants subsection (a) states that funds made available by Sec: 1002. would be used to establish an emergency pilot program for rural development no later than 150 days after March 11, 2021 (date of enactment) to provide grants to eligible applicants to be awarded by the Secretary based on rural development needs related to the COVID-19 pandemic.
  • The Uses subsection (b) states that grants awarded to eligible applicants under this section may use the grant funds for:
  • Costs, including those incurred prior to the issuance of the grant, as determined by the Secretary, of facilities which primarily serve rural areas (as defined by 7 U.S.C. 1991(a)(13)(C)) to-
  • Increase capacity of vaccine distribution;
  • Provide medical supplies to increase medical surge capacity;
  • Reimburse for revenue lost during the COVID-19 pandemic, including revenue losses incurred prior to the awarding of the grant;
  • Increase telehealth capabilities, including underlying health care information systems;
  • Construct temporary or permanent structures to provide health care services, including vaccine administration or testing;
  • Support staffing needs for vaccine administration or testing; and
  • Engage in any other efforts to support rural development determined to be critical to address the COVID-19 pandemic, including nutritional assistance to vulnerable individuals, as approved by the Secretary.
  • The Funding subsection (c) states that in addition to amounts otherwise available, $500,000,000 has been made available until September 30, 2023 to carry out this section.


Part A of title XI of the Social Security Act was amended by adding at the end the following:


  • “Funding—In addition to amounts otherwise available, there is appropriated by the Secretary, for fiscal year 2021, out of any monies in the Treasury not otherwise appropriated, $8,500,000,000 for purposes of making payments to eligible healthcare providers for health care related expenses and lost revenues that are attributed to COVID-19. Amounts appropriated under the preceding sentence shall remain available until expended.
  • “Application—To be eligible for a payment under this section, an eligible health care provider shall submit to the Secretary an application in such form and manner as the Secretary shall prescribe. Such application shall contain the following:
  • A statement justifying the need of the provider for the payment, including documentation of the health care related expenses attributable to COVID–19 and lost revenues attributable to COVID–19.
  • The tax identification number of the provider.
  • Such assurances as the Secretary determines appropriate that the eligible health care provider will maintain and make available such documentation and submit such reports (at such time, in such form, and containing such information as the Secretary shall prescribe) as the Secretary determines is necessary to ensure compliance with any conditions imposed by the Secretary under this section.
  • Any other information determined appropriate by the Secretary.
  • Limitation—Payments made to an eligible health care provider under this section may not be used to reimburse any expense or loss that—
  • has been reimbursed from another source; or
  • another source is obligated to reimburse.
  • Application Of Requirements, Rules, And Procedures.—The Secretary shall apply any requirements, rules, or procedures as the Secretary deems appropriate for the efficient execution of this section.
  • “(e) Definitions.—In this section:
  • ELIGIBLE HEALTH CARE PROVIDER.—The term ‘eligible health care provider’ means—

(A) a provider of services (as defined in section 1861(u)) or a supplier (as defined in section 1861(d)) that—

(i) is enrolled in the Medicare program under title XVIII under section 1866(j) (including temporarily enrolled during the emergency period described in section 1135(g)(1)(B) for such period);

(ii) provides diagnoses, testing, or care for individuals with possible or actual cases of COVID–19; and

(iii) is a rural provider or supplier; or

(B) a provider or supplier that—

(i) is enrolled with a State Medicaid plan under title XIX (or a waiver of such plan) in accordance with subsections (a)(77) and (kk) of section 1902 (including enrolled pursuant to section 1902(a)(78) or section 1932(d)(6)) or enrolled with a State child health plan under title XXI (or a waiver of such plan) in accordance with subparagraph (G) of section 2107(e)(1) (including enrolled pursuant to subparagraph (D) or (Q) of such section);

(ii) provides diagnoses, testing, or care for individuals with possible or actual cases of  COVID–19; and

(iii) is a rural provider or supplier.

  • HEALTH CARE RELATED EXPENSES ATTRIBUTABLE TO COVID–19.—The term ‘health care related expenses attributable to COVID–19’ means health care related expenses to prevent, prepare for, and respond to COVID–19, including the building or construction of a temporary structure, the leasing of a property, the purchase of medical supplies and equipment, including personal protective equipment and testing supplies, providing for increased workforce and training (including maintaining staff, obtaining additional staff, or both), the operation of an emergency operation center, retrofitting a facility, providing for surge capacity, and other expenses determined appropriate by the Secretary.
  • LOST REVENUE ATTRIBUTABLE TO COVID–19.—The term ‘lost revenue attributable to COVID–19’ has the meaning given that term in the Frequently Asked Questions guidance released by the Department of Health and Human Services in June 2020, including the difference between such provider’s budgeted and actual revenue if such budget had been established and approved prior to March 27, 2020.
  • — The term ‘payment’ includes, as determined appropriate by the Secretary, a pre-payment, a prospective payment, a retrospective payment, or a payment through a grant or other mechanism.
  • RURAL PROVIDER OR SUPPLIER.—The term ‘rural provider or supplier’ means—

(A) a—

(I) provider or supplier located in a rural area (as defined in section 1886(d)(2)(D)); or

(ii) provider treated as located in a rural area pursuant to section 1886(d)(8)(E);

(B) a provider or supplier located in any other area that serves rural patients (as defined by the Secretary), which may include, but is not required to include, a metropolitan statistical area with a population of less than 500,000 (determined based on the most recently available data);

(C) a rural health clinic (as defined in section 1861(aa)(2));

(D) a provider or supplier that furnishes home health, hospice, or long-term services and supports in an individual’s home located in a rural area (as defined in section 1886(d)(2)(D)); or

(E) any other rural provider or supplier (as defined by the Secretary).”.