Maine’s rural hospitals and health care providers continue to lead the fight against COVID-19. Since the onset our financial resources have been stretched thin as hospitals in Maine, and nationwide, were forced to suspend all but essential services.

Congress took action early on to provide some financial relief that enabled hospitals to continue serving their communities and treating vulnerable patients. However, some of the terms of the federal loans and programs now need updating so hospitals can continue addressing the health crisis our nation is facing.

A great first step would be to relax some of the more egregious terms tied to repayment of loans provided through the Medicare Accelerated and Advance Payment Programs. When Congress expanded the MAAPP, it provided an economic lifeline for struggling hospitals, particularly those in our rural communities where access and funding has always been an issue. However, MAAPP loan repayment terms must be updated to provide sufficient flexibility for hospitals that are still battling COVID-19.

With regard to loan repayment deadlines, both the timeframe to begin repayment and complete repayment in full are too short. The former is currently 120 days for hospitals — which for many means they could have to begin loan repayment any day now — while the latter is 12 months. These are unreasonable deadlines as many hospitals are still treating high numbers of COVID-19 patients. Congress should extend both deadlines to 12 months to begin repayment and 36 months to complete it.

Current MAAPP loan repayment terms dictate that hospitals will lose their Medicare fee-for-service payments from the day they begin repayment until they have repaid their loans in full. This is bad policy. Withholding 100% of Medicare fee-for-service payments means an average of roughly 25% of a hospital’s total payments will be lost.

The impact would be even greater in Maine’s rural areas, which often have a larger percentage of Medicare recipients. When hospitals need all the help we can get, such a massive reduction in revenue will undermine our ability to provide quality care, threatening patient access. Congress should reduce the amount of repayment taken out of Medicare claims from 100% to 25% in order to ensure financial solvency, particularly for at-risk hospitals.

Additionally, if hospitals are unable to repay their loans in the current too-short timeframe of 12 months, they begin accruing a staggeringly high interest rate at close to 10%. This is much higher than what Congress required of other industries that received financial support in response to the COVID-19 pandemic. Congress should limit the interest rate applied to MAAPP loans to no more than 1% — if not waive the interest altogether.

In addition to the MAAPP loans, many hospitals and health care providers also received emergency funds through the Public Health and Social Service Emergency Fund. Distributed through the Provider Relief Fund, these grants were intended to help cover expenses or revenue losses due to the pandemic. However, these funds are for some reason subject to taxation, completely undermining the intent of the program and placing yet another financial burden on tax-paying hospitals and providers.

Currently, health care providers who pay taxes — which is the majority of them — and received PRF funds will have to pay back 21% or more of the money they received in taxes. This creates a system in which non-taxpaying health care providers receive more funding than those that pay taxes, which is likely not what Congress intended. To rectify this, Congress should eliminate the tax on PRF funds altogether while ensuring related expenses remain tax-deductible. This will ensure hospitals and providers can access the financial resources necessary to continue responding to the current health care crisis.

Hospitals here and across the country aren’t looking for a handout; they need support and flexibility from Congress. Congress needs to pass S.3750, Medicare Accelerated and Advance Payments Improvement Act and should continue to work with their colleagues to improve the MAAPP loan repayment terms. In addition, they should pass S. 4525 to lift the PRF tax so hospitals can keep doing what they are doing — which is treating patients and supporting communities, both medically and economically.

Peter J. Wright, FACHE is the president of Bridgton and Rumford hospitals and Central Maine Healthcare’s Long-term Care Division. He also serves as a trustee of the American Hospital Association and chairman of AHA’s regional policy board for New England.

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