In an effort to support healthcare providers fighting the COVID-19 pandemic, the US Department of Health and Human Services (HHS) announced a June 3, 2020, submission deadline for providers to receive an additional payment from the Provider Relief Fund’s $50 billion General Distribution.
All providers who automatically received a General Distribution payment prior to April 24, must provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements. In addition, these providers must agree to the program terms and conditions if they wish to keep the funds.
It is important to note that these are payments, not loans, to healthcare providers, and do not need to be repaid.
The bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act, Paycheck Protection Program, and Health Care Enhancement Act provide $175 billion in relief funds to hospitals and other healthcare providers on the front lines of the COVID-19 response. This funding supports healthcare-related expenses or lost revenue attributable to COVID-19 and ensures uninsured Americans can get testing and treatment for COVID-19.
The Provider Relief Funds are being disbursed via both “General” and “Targeted” Distributions.
$50 billion of the Provider Relief Fund is allocated for general distribution to Medicare facilities and providers impacted by COVID-19, based on eligible providers' net patient revenue.
The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2 percent of that provider’s net patient revenue regardless of the provider’s payer mix.
In addition, $50 billion is for targeted allocations to providers in areas particularly impacted by the COVID-19 outbreak (e.g., Skilled Nursing Facilities, Indian Health Service Facilities), rural providers and providers who serve low-income populations and uninsured Americans.
All these funds are subject to terms and conditions that vary and are dependent upon the type of distribution as well as based on the specific targeted relief sources. Commitment to full compliance with all terms and conditions is material to HHS’s decision to disburse these relief funds, and non-compliance is grounds for HHS to recoup some or all of the payment made from the Relief Fund. If these conditions are met, payments do not need to be repaid at a later date.
The specifics on the terms and conditions include:
According to HHS, in order to be eligible for a General Distribution payment, providers must have billed Medicare on a fee-for-service basis (Parts A or B) in Calendar Year 2019. Additionally, under the terms and conditions associated with payment, providers are eligible only if they provide or provided diagnoses, testing or care for individuals with possible or actual cases of COVID-19, after January 31, 2020. HHS broadly views every patient as a possible case of COVID-19 for the terms of this program.
Providers must also not seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider. In addition, providers must abstain from "balance billing" any COVID-related treatment/any uninsured patient for whom the provider seeks reimbursement for COVID-19-related treatment.
Prevention of fraud and misuse of the funds is a high priority for HHS. Providers must submit documents sufficient to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to COVID-19. In addition, providers must present tax documents and financial loss estimates if they wish to be eligible for additional funds.
Greater detail and answers to additional questions is available on the HHS FAQ CARES Act Provider Relief Fund FAQ page.
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