N.D. Cent. Code § 6-09-47

6-09-47. Medical facility infrastructure loan fund - Medical facility infrastructure loan

program - Rural health loan program - Medical facility emergency operating loan

program - Continuing appropriation - Audit and costs of administration. (Effective

through June 30, 2027)

1. The Bank of North Dakota shall administer a medical facility infrastructure loan

program to provide loans to medical facilities to conduct construction that improves the

health care infrastructure in the state or improves access to existing nonprofit health

care providers in the state. The construction project may include land purchases and

may include purchase, lease, erection, or improvement of any structure or facility to

the extent the governing board of the health care facility has the authority to authorize

such activity.

2. In order to be eligible under the medical facility infrastructure loan program, the

applicant must be the governing board of the health care facility which shall submit an

application to the Bank. The application must:

a. Detail the proposed construction project, which must be a project of at least

one million dollars and which is expected to be utilized for at least thirty years;

b. Demonstrate the need and long-term viability of the construction project; and

c. Include financial information as the Bank may determine appropriate to determine

eligibility, such as whether there are alternative financing methods.

3. A medical facility infrastructure loan provided under this section:

a. May not exceed the lesser of fifteen million dollars or seventy-five percent of the

actual cost of the project;

b. Must have an interest rate equal to two percent; and

c. Must provide a repayment schedule of no longer than twenty-five years.

4. A recipient of a medical facility infrastructure loan under this section shall complete the

financed construction project within twenty-four months of approval of the loan. Failure

to comply with this subsection may result in forfeiture of the entire loan received under

this section.

5. The Bank shall administer a rural health loan program to provide short-term gap

financing to grant recipients under the federal rural health transformation program with

approved projects and a demonstrated financial need.

a. To be eligible for a rural health loan under this subsection, the applicant:

(1) Must be approved for a grant by the department of health and human

services and the centers for Medicare and Medicaid services, as applicable,

under the federal rural health transformation program based on policies

developed by the department of health and human services.

(2) Provide information as requested by the Bank, including information

substantiating a demonstrated financial need and evidence of project

approval from the department of health and human services under the

federal rural health transformation program.

b. A loan under this subsection must have:

(1) An annual interest rate that does not exceed two percent;

(2) A term that complies with the criteria established by the department of

health and human services, in accordance with the federal rural health

transformation program, and does not exceed three years.

c. From the repayment of loans under this subsection, the principal portion must be

used to replenish the Bank's profits which were transferred to the fund for the

loans under this program, and interest portion must be deposited in the fund.

6. The Bank shall administer a medical facility emergency operating loan program to

provide emergency operating loans to local nonprofit hospitals located in cities with a

population of fewer than two thousand five hundred according to the most recent

decennial census.

a. To be eligible for an emergency operating loan under this subsection, the

governing board of a health care facility shall:

(1) Submit an application to the Bank by March 31, 2026;
operating loan program to

provide emergency operating loans to local nonprofit hospitals located in cities with a

population of fewer than two thousand five hundred according to the most recent

decennial census.

a. To be eligible for an emergency operating loan under this subsection, the

governing board of a health care facility shall:

(1) Submit an application to the Bank by March 31, 2026;

(2) Provide financial information as requested by the Bank to determine

eligibility, including information on alternative financing and other funding

sources; and

(3) Provide an updated operating plan and cash flow projections indicating the

feasibility of future operations after restructuring and sufficient financial

resources to address any operating deficit and to repay the loan.

b. A medical facility emergency operating loan under this subsection:

(1) May not exceed five million dollars per qualified applicant;

(2) Must have an annual interest rate that does not exceed two percent; and

(3) Must have a maximum term that does not exceed eleven years, unless a

shorter term is required based on an analysis by the Bank, with the first year

of the loan eligible for interest-only payments.

7. The medical facility infrastructure loan fund is a special fund in the state treasury. This

fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the

fund, and collections of principal and interest on loans from the fund are appropriated

to the Bank on a continuing basis for the purpose of providing loans under this section.

8. Moneys in the fund may be used for loans as provided under this section and to pay

the costs of administration of the fund. Annually, the Bank may deduct a service fee for

administering the fund.

9. The fund must be audited in accordance with section 6-09-29. The cost of the audit

and any other actual costs incurred by the Bank on behalf of the fund must be paid

from the fund.

10. The Bank shall deposit medical facility infrastructure loan repayments in the fund.

Medical facility infrastructure loan fund - Medical facility infrastructure loan program -

Rural health loan program - Continuing appropriation - Audit and costs of administration.

(Effective after June 30, 2027)

1. The Bank of North Dakota shall administer a medical facility infrastructure loan

program to provide loans to medical facilities to conduct construction that improves the

health care infrastructure in the state or improves access to existing nonprofit health

care providers in the state. The construction project may include land purchases and

may include purchase, lease, erection, or improvement of any structure or facility to

the extent the governing board of the health care facility has the authority to authorize

such activity.

2. In order to be eligible under the medical facility infrastructure loan program, the

applicant must be the governing board of the health care facility which shall submit an

application to the Bank. The application must:

a. Detail the proposed construction project, which must be a project of at least one

million dollars and which is expected to be utilized for at least thirty years;

b. Demonstrate the need and long-term viability of the construction project; and

c. Include financial information as the Bank may determine appropriate to determine

eligibility, such as whether there are alternative financing methods.

3. A medical facility infrastructure loan provided under this section:

a. May not exceed the lesser of fifteen million dollars or seventy-five percent of the

actual cost of the project;

b. Must have an interest rate equal to two percent; and

c. Must provide a repayment schedule of no longer than twenty-five years.

4. A recipient of a medical facility infrastructure loan under this section shall complete the

financed construction project within twenty-four months of approval of the loan. Failure
ifteen million dollars or seventy-five percent of the

actual cost of the project;

b. Must have an interest rate equal to two percent; and

c. Must provide a repayment schedule of no longer than twenty-five years.

4. A recipient of a medical facility infrastructure loan under this section shall complete the

financed construction project within twenty-four months of approval of the loan. Failure

to comply with this subsection may result in forfeiture of the entire loan received under

this section.

5. The Bank shall administer a rural health loan program to provide short-term gap

financing to grant recipients under the federal rural health transformation program with

approved projects and a demonstrated financial need.

a. To be eligible for a rural health loan under this subsection, the applicant:

(1) Must be approved for a grant by the department of health and human

services and the centers for Medicare and Medicaid services, as applicable,

under the federal rural health transformation program based on policies

developed by the department of health and human services.

(2) Provide information as requested by the Bank, including information

substantiating a demonstrated financial need and evidence of project

approval from the department of health and human services under the

federal rural health transformation program.

b. A loan under this subsection must have:

(1) An annual interest rate that does not exceed two percent;

(2) A term that complies with the criteria established by the department of

health and human services, in accordance with the federal rural health

transformation program, and does not exceed three years.

c. From the repayment of loans under this subsection, the principal portion must be

used to replenish the Bank's profits which were transferred to the fund for the

loans under this program, and interest portion must be deposited in the fund.

6. The medical facility infrastructure loan fund is a special fund in the state treasury. This

fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the

fund, and collections of principal and interest on loans from the fund are appropriated

to the Bank on a continuing basis for the purpose of providing loans under this section.

7. Moneys in the fund may be used for loans as provided under this section and to pay

the costs of administration of the fund. Annually, the Bank may deduct a service fee for

administering the fund.

8. The fund must be audited in accordance with section 6-09-29. The cost of the audit

and any other actual costs incurred by the Bank on behalf of the fund must be paid

from the fund.

9. The Bank shall deposit medical facility infrastructure loan repayments in the fund.