The Department of Health and Human Services (HHS) has announced the additional distribution of Provider Relief Payments beginning April 24th.  While there are still many questions yet remaining on the initial $30 billion dispensed two weeks ago, HHS has now stated that another $20 billion in funds will start going out to providers and hospitals this Friday. These new funds, as with the prior $30 billion, are part of the $100 billion allocated to HHS through the passage of the CAREs act.

In addition, HHS has also announced how some of the remaining funds ($100 billion less prior $30 billion less this $20 billion = $50 billion left) will be spent, going towards hospitals in heavily hit COVID-19 areas, rural and native American health services, and for covering uninsured patients.

Separately, you may be hearing in the news today that Congress is voting on an additional interim spending bill which would allocate another $75 billion to HHS to distribute to healthcare providers. We will provide more information on this as it becomes available.

General Distribution of the Additional $20 billion starting April 24:

  • The $30 billion previously dispersed was considered a ‘general distribution’. Now, HHS is adding $20 billion to the ‘general distribution’, totaling $50 billion in payments going to Medicare enrolled providers.
  • Unlike the previous $30 billion that was distributed two weeks ago, HHS is using a different calculation method to determine the amount going to providers for this next $20 billion. HHS has not provided the calculation formula but states that it will be based on 2018 net patient revenue from all sources and proportional to the total amount ($50 billion) in the general distribution.
  • Some providers will automatically be sent an advance payment based on the revenue data they have previously submitted to CMS in cost reports.
    • Providers who receive their money automatically will still need to submit their revenue information so that it can be verified.
    • Providers without adequate cost report data on file will need to submit their revenue information to a portal opening this week on the HHS website – HERE
      • Please note, the second portal is not open currently.
    • Like the first $30 billion distributed, providers that receive a payment must accept the terms and conditions of the payments by completing an attestation available on the HHS website. If they do not return the funds within 30 days, HHS will automatically assume the recipient is accepting the terms and conditions without completing the attestation. HHS’s website now says that the attestation portal will include a way to “confirm the CMS cost report” as noted in the bullet above.
      • The terms and conditions were recently updated to include verbiage further detailing the acceptance of the terms. HERE
  • The overall terms and conditions themselves, however, have not changed since the last update on April 16th and questions still remain on, among other things, specifics around balance billing, overlap with other stimulus programs, and reporting requirements outlined in the terms.

Targeted Allocations for the Remaining $50 billion

As previously mentioned, $100 billion was first allocated to HHS via the CAREs act. The first $30 billion in the general distribution was dispensed two weeks ago and the next $20 billion of general distribution will start being distributed on April 24th. HHS has released the following details on how the remaining $50 billion will be released via targeted allocations.

Hospitals

  • Hospitals located in areas of high impact, such as New York, may receive a portion of a separate $10 billion-dollar allocation.
    • Hospitals need to apply for a portion of the funds by providing four simple pieces of information via an authentication portal before midnight PT, Thursday April 23. This portal is live, and hospitals have already been contacted directly to provide this information.
    • Supplying information through the application process does not guarantee that funds will be received but is required to know if the facility is eligible.

Uninsured COVID-19 Patients

  • Every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursement through the program and will be reimbursed at Medicare rates, subject to available funding.
  • Providers can register for the program starting on April 27, 2020 and begin submitting claims on May 6, 2020. For more information, HERE
    • More information on the claim submission process will be available on April 27th with ‘on demand training’ becoming available on April 29th.
    • Claims reimbursement will be based on incurred date of service and the Medicare Physician Fee Schedule.
    • Advocate clients who wish to take advantage of this will need to notify us that you’ve registered and will also need to provide a means to identify these patients.
  • Just as with acceptance of the terms and conditions of the HHS Provider Relief Payments, providers are obligated to abstain from “balance billing” any patient for COVID-19-related treatment as a condition of participation in the uninsured reimbursement program.

Some of the Many Questions That Still Remain:

  • It is still unclear if all providers who have already received a payment from the HHS Provider Relief Fund will be receiving an additional payment and, if so, what the amount of the payment will be. HHS did not provide a way to estimate the additional payments as they did with the initial $30 billion. The Secretary of HHS indicated during a press conference on April 22nd that the $20 billion will be a secondary payment that makes up for the disparity between providers that bill a high proportion of Medicare payments and those that do not.
  • It is still unclear if or how the attestation process will be changed if providers end up receiving another payment – The updates on the HHS website now mentions another step regarding confirming CMS cost reports or submitting cost reports via another portal opening this week. It is unclear if those who have already accepted the terms and conditions from the initial distribution will need to take another step if they end up receiving more funds. For those who do not have cost reports on file with CMS, it is unclear on what information will need to be submitted to be eligible for the second round of funding
  • Questions also remain regarding the terms and conditions of the initial $30 billion – HHS has been asked to provide more details on, among other things, the following:
    • Clarify the scope of the balance billing provisions in the terms and conditions – HHS has not clarified if the promise to not balance bill applies to all patients, just COVID-19 related patients, or the duration this agreement will last.
    • Clarify the overlap with those participating in other COVID-19 economic stimulus programs. While those who have received HHS payments may still be eligible to participate in other programs, such as the Paycheck Protection Program, there are still questions on the sections of the terms and conditions section stating recipients ‘will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.’
    • Clarify the documentation required for providers with limited expenses outside of physician payroll. This question is relevant due to Section 202 of the Terms and Conditions, which states that “none of the funds shall be used to pay the salary of an individual, through a grant or extramural mechanism, at a rate in excess of Executive Level II”. The current Executive Level II compensation is $197,300.
    • Clarify what records are sufficient for the reporting requirements outlined in the terms and conditions. Generally, most in the industry are promoting the idea of keeping detailed records when using these funds, but it is expected that HHS will provide more guidance on exactly what needs to be provided for quarterly reporting and audits.

More information from HHS clarifying the outstanding questions should be forthcoming. In the meantime, please see the HHS website on the Provider Relief Fund for more details – HERE.

As always, ADVOCATE will continue to keep you informed on the issues impacting medical groups as they develop.

Todd Walker         
CEO

Kirk Reinitz
President