B - Readily funds technology as part of an award
Department of Health and Human Services (HHS)
We expect to see additional rounds of payments through this program as a result of the stimulus funds included in the Consolidated Appropriations Act of 2021. The fund will continue to provide financial support to healthcare providers for health care related expenses and lost revenues attributable to Coronavirus. The legislation notes funds shall be available for building or construction of temporary structures, leasing of properties, medical supplies and equipment including personal protective equipment and testing supplies, increased workforce and trainings, emergency operation centers, retrofitting facilities, and surge capacity.
The new stimulus package also authorizes the parent organizations of recipients to redistribute funds across their health system or subsidiaries. Congress is requiring HHS to follow their original guidance issued in June 2020, which gave healthcare providers greater flexibility in calculating lost revenue. If the provider has a budget approved prior to March 27, 2020, the shortfall between expected and actual revenue can serve as the basis for calculating lost revenue.
Below are the distributions we have seen to date through the CARES Act and 2020 stimulus funding:
General Distribution (Phase I) ($50 billion)
$50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider's net patient revenue regardless of the provider's payer mix. Payments are determined based on the lesser of 2% of a provider's 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April.
- $30 billion
- This is automatic, based on provider's share of Medicare fee-for-service reimbursements in 2019. Distributions were made on April 10 ($26 billion) and April 17 ($4 billion)
- $20 billion
- HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider's net patient revenue regardless of the provider's payer mix. Based on CMS cost reports or incurred losses. A portal opened on April 24 for providers to report 2018 net patient revenue.
General Distribution (Phase II) ($18 billion)
HHS expects to distribute $15 billion to eligible providers that participate in state Medicaid/CHIP programs, Medicaid managed care plans, or provide dental care, and have not yet received a payment from the Provider Relief Fund General Distribution (Phase 1). The providers must have billed Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services from January 1 to May 31, 2020.
General Distribution (Phase III) ($20 billion)
Under this Phase 3 General Distribution allocation announced by HHS, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.
Additional allocations for targeted distribution to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.
- High-Impact Areas
- First Round: HHS is distributing $12 billion to 395 hospitals who provided inpatient care for 100 or more COVID-19 patients through April 10, 2020, $2 billion of which will be distributed to these hospitals based on their Medicare and Medicaid disproportionate share and uncompensated care payments.
- Second Round: $10 billion to hospitals with over 161 COVID-19 admissions between January 1 and June 10, 2020, one admission per day, or a disproportionate intensity of COVID admissions.
- Rural Distribution
- HHS is distributing $11.3 billion to rural hospitals, including rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers located in rural areas.
- Skilled Nursing Facilities
- HHS is distributing $7.4 billion to skilled nursing facilities (SNFs) to help them combat the devastating effects of this pandemic.
- Uninsured Patients
- A portion of the funds will be distributed to healthcare providers who have provided treatment for uninsured COVID-19 patients on or after February 4, 2020. Providers can request claims reimbursement and will be reimbursed at Medicare rates, subject to available funding.
- Indian Health Service
- HHS is distributing $500 million to Indian Health Service Facilities, distributed on the basis of operating expenses. This funding complements other funding provided to expand IHS capacity for telehealth and testing.
- Safety Net Hospitals
- $14.7 billion is being distributed to safety net hospitals, which is defined as providers with a Medicare Disproportionate Payment Percentage (DPP) of 20.2% or greater, average uncompensated care per bed of $25,000 or more, and profitability of 3% or less. On July 10, 2020, $3 billion was distributed to hospitals serving vulnerable populations on thin margins and approximately $1 billion was sent to specialty rural hospitals, urban hospitals with certain rural Medicare designations and hospitals in small metropolitan areas.
General Distribution (Phase IV) ($17 billion).
Under this Phase 4 general distribution funding will be available for a broad range of providers who can document revenue loss and expenses associated with the pandemic. Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers' lost revenues and expenditures between July 1, 2020, and March 31, 2021. As part of the Biden-Harris Administration's ongoing commitment to equity, and to support providers with the most need, PRF Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers. PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.
History of Funding
Payments to providers are being published at: https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6
All Program Components: Providers who have been allocated a payment must use this portal to sign an attestation confirming receipt of the funds and agree to the terms and conditions within 90 days of payment at the following website: https://covid19.linkhealth.com/#/step/1. Terms and conditions for each allocation made through the HHS Provider Relief Fund are available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html. Providers eligible for additional allocations must submit information and agree to terms and conditions through the Enhanced Provider Relief Fund Payment Portal: https://cares.linkhealth.com/#/.
General Distribution Phase I: All providers who had automatically received funds prior to 5:00 pm, Friday, April 24th, must provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements. Documents can be submitted at https://covid19.linkhealth.com/docusign/#/step/1. Certain Medicare providers who experienced challenges will have a second opportunity to apply for funding from General Distribution (Phase I) starting the week of August 10.
General Distribution Phase III: Application instructions are available at https://www.hhs.gov/sites/default/files/provider-distribution-instructions.pdf. A PDF version of the application is available at https://www.hhs.gov/sites/default/files/provider-distribution-application-form.pdf. Applications must be submitted through the online portal: https://cares.linkhealth.com/#/. The terms and conditions for Phase III are available at https://www.hhs.gov/sites/default/files/terms-and-conditions-phase-3-general-distribution-relief-fund.pdf.
Uninsured Patients: Providers seeking reimbursement for care of uninsured COVID patients can find out more information at https://coviduninsuredclaim.linkhealth.com/.
Medicaid and CHIP: The Enhanced Provider Relief Fund Portal (https://cares.linkhealth.com/#/) is currently open to providers eligible under the Medicaid/CHIP component. Applicants must read the distribution instructions (https://www.hhs.gov/sites/default/files/medicaid-provider-distribution-instructions.pdf) and complete the application (https://www.hhs.gov/sites/default/files/medicaid-provider-distribution-application-form.pdf) for upload to the portal.
General Distribution Phase I ($50 billion)
To be eligible for the general distribution, a provider must have billed Medicare in 2019 and provide or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19. $50 billion will be disbursed in the General Distribution. All providers retaining funds must sign an attestation and accept the terms and conditions associated with payment. Providers must also submit tax documents and financial loss estimates if they wish to be eligible for additional funds.
General Distribution Phase II ($18 billion)
Providers that participate in state Medicaid/CHIP programs, Medicaid managed care plans, or provide dental care, and have not yet received a payment from the Provider Relief Fund General Distribution (Phase 1). The provides must have billed Medicaid/CHIP programs or medicaid managed care plans for healthcare-related services from January 1 to May 31, 2020.
General Distribution Phase III ($20 billion)
HHS is making a large number of providers eligible for Phase 3 General Distribution funding, including:
- Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
- Behavioral Health providers, including those that previously received funding and new providers.
- Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers. Providers that began practicing in 2020 were not eligible for previous distributions.
High-Impact Areas: Of the $12 billion distribution, $10 billion is allocated based on a fixed amount per COVID-19 inpatient admission. The remaining $2 billion of the $12 billion is distributed based off each hospital's portion of Medicare Disproportionate Share Hospital (DSH) payments and Medicare Uncompensated Care Payments (UCP). A second round of allocations is being made under this targeted mechanism (total funding unknown) based on COVID-19 inpatient admissions between January 1 and June 10, 2020.
Rural Distribution: Recipients fall into three categories: Rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs) and Community Health Center sites located in rural areas.
Skilled Nursing Facilities: This funding, which supplements previously announced provider relief funds, will be used to support nursing homes suffering from significant expenses or lost revenue attributable to COVID-19. Eligible facilities range in size of between 6 and 1,389 beds.
Uninsured Patients: Health care entities who have conducted COVID-19 testing of uninsured individuals or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, can request claims reimbursement through the program electronically and will be reimbursed generally at Medicare rates, subject to available funding.
Indian Health Service: HHS will allocate funding for IHS, Tribal, and Urban Indian Health programs. This includes IHS and Tribal hospitals.
Safety Net Hospitals: Funds are being distributed to safety net hospitals, which is defined as providers with a Medicare Disproportionate Payment Percentage (DPP) of 20.2% or greater, average uncompensated care per bed of $25,000 or more, and profitability of 3% or less.
General Distribution (Phase IV) ($17 billion).
Eligible applicants are small providers who can document revenue loss and expenses associated with the pandemic. Any provider or supplier of health care, services, and support in a medical setting, at home, or in the community, including, but not limited to:
- Academic Medical Centers
- Children's Hospitals
- Acute care hospitals
- Ambulatory surgical centers
- Assisted Living Facilities
- Behavioral health providers (e.g., substance use disorder, counseling, psychiatric services)
- Dental services
- Diagnostic services (e.g., independent imaging, radiology, labs)
- DME suppliers
In many instances, allocations are being made and distributed to providers based on information they already report to the Center for Medicare and Medicaid Services (CMS). Across all program components, eligible providers have 90 days from receipt of funds to do their attestations for any distributions sent directly.
General Distribution Phase I
The deadline to report net patient revenue information for the $20 billion portion of the General Distribution was June 3, 2020. Certain Medicare providers who experienced challenges will have a second opportunity to apply for funding from General Distribution (Phase I) starting the week of August 10. Applications were due by August 28, 2020.
General Distribution Phase II
Providers must have submitted applications by September 13, 2020.
General Distribution Phase III
Providers must have submitted applications by November 6, 2020.
General Distribution Phase IV
Providers must have submitted applications by October 26, 2021.
High-Impact Areas: The deadline for hospitals to submit information to qualify for the first round of high-impact payments was 3:00 PM ET, Saturday, April 25, 2020. The deadline for hospitals to submit information to qualify for the second round of payments was June 15, 2020.
Uninsured Patients: Claims submissions for the treatment of uninsured COVID patients (after February 4, 2020) are accepted on a rolling basis at https://www.hrsa.gov/coviduninsuredclaim.
At this time, there are no additional deadlines posted or anticipated for the remaining targeted allocations.
The bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act provided $175 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. Payments from the $50 billion general distribution, the $12 billion targeted allocation to high impact areas, and the $10 billion targeted allocation to rural providers are being distributed by the Department of Health and Human Services through the Health Resources and Services Administration.
The stimulus funds contained in Divisions 'M' and 'N' of the Consolidated Appropriations Act of 2021 includes $3 billion in additional appropriations for the HHS Provider Relief Fund. 85% of funding must be used to help providers with losses that occurred in the third and fourth quarter of CY2020 and the first quarter of CY2021.
The stimulus funds approved through the American Rescue Plan that was signed into law in March of 2021 includes $8.5 billion exclusively for rural healthcare providers. The funds will allow for retroactive reimbursement and can be used for IT expenditures such as telehealth and applied to lost revenue.
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