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Key points:

• The CARES Act invested $100 billion into the Public Health and Social Service Emergency Fund for health care providers. So far:
  • $50 billion is being allocated for “general distribution,” which went out in two phases:
    • First, an interim payment based on proportional 2019 Medicare fee-for-service
    • Second, a “true-up” based on 2018 net patient revenue
  • $10 billion is being allocated to COVID-19 “hot spots”
  • $10 billion is being allocated to assist rural hospitals
  • $400 million is being allocated to Indian Health Service facilities
  • Additional money from this fund will be used for treating uninsured COVID-19 patients
  • Future allocations could target any new COVID-19 hotspots, skilled nursing facilities, dentists, or facilities servicing only Medicaid patients
• The Senate-passed Paycheck Protection Program and Health Care Enhancement Act adds an additional $75 billion to the fund.
• Providers can find more information here.

The details:

• These dollars will provide critical cash flow to providers as they work to lock down COVID-19.
• It’s critical this funding goes out the door in a transparent and rapid way, especially to the providers on the front-line of the COVID-19 fight.
• While no distribution system is perfect, the Administration should be commended for developing a system that delivers support to key health care facilities quickly.
• This funding is in addition to the more than $60 billion CMS has delivered in the past week to the healthcare providers on the frontlines through the expansion of the Accelerated and Advance Payment Program.

FAQs:

How was the first $30 billion tranche of CURES’ $100 billion investment in the Public Health and Social Service Emergency Fund for health care providers allocated?

On Friday, April 10th, the first $30 billion of the $100 billion fund was distributed through the Health Resources and Services Administration (HRSA) to health care providers proportionally, based on the providers’ share of total Medicare payments in 2019.

For example, if total Medicare fee-for-service payments in 2019 were $100 and one physician received $2 in payments from Medicare fee-for-service in 2019, then that physician accounted for 2 percent of total Medicare fee-for-service payments in 2019. According to this formula, that physician would receive 2 percent of this $30 billion.

While this was the best way to get money out the door and into providers hands as quickly as possible, it did leave some providers with more Medicare Advantage or Medicaid patients in need of further assistance.

Who qualified for that first round of funding?

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 were eligible for this initial rapid distribution.

How is the second tranche being distributed?

To build on this first round of funding, HHS has announced an additional $20 billion allocation to providers.  This round of funding will be distributed based on each provider’s revenue data, taking into account what each provider received in the first tranche.

The end result will be that the entire $50 billion in general provider funding will have been distributed proportional to the providers’ share of 2018 net patient revenue.

Who qualifies for this second round of funding?

All facilities and providers with a Medicare Provider Number are eligible for these funds.

How quickly can providers expect to receive payments from the 2^nd tranche?

Beginning on April 24th, payments will go out on a weekly basis based off of previous revenue data submitted in CMS cost reports.

What if a provider is without adequate cost report data on file?

Providers without appropriate cost report data must submit their revenue information to CMS via an online portal: www.hhs.gov/providerrelief.  As newly submitted data is validated, payments will go out on a weekly basis.

What are the restrictions on how grant recipients can spend the $50 billion of “General Distribution” funding?

All providers receiving funds must sign an attestation confirming receipt of funds, confirm the CMS cost report data is accurate, and

What are the restrictions on how grant recipients can spend the $50 billion of “General Distribution” funding?

All providers that accept these funds must agree to certain terms and conditions.  Notably, providers are banned from sending “surprise” balanced bills to any presumptive or actual COVID-19 patient.  Additional terms and conditions include submitting documents to ensure funds received were used for health care expenses or to cover lost revenue from the COVID-19 Public Health Emergency.

What is being done to support providers in COVID hotspots?

In addition to the $50 billion being distributed to all providers, a separate $10 billion will be distributed to hospitals in areas with the most COVID-19 patients.  In order to account for uninsured and low-income patients, the distribution of these funds will also take into account the facilities’ Medicare Disproportionate Share Hospital (DSH) Adjustment.

 

In order to apply for these funds, hospitals need to submit to CMS their Tax Identification Number, National Provider Identifier, Total number of Intensive Care Unit beds as of April 10, 2020, and the total number of admissions with a positive COVID-19 diagnosis from January 1, 202 through April 10, 2020.  This information must be submitted through CMS’s online portal prior to midnight PST, Thursday April 23.

 

What is being done for rural providers?

HHS is designating another $10 billion from the Public Health and Social Service Emergency Fund specifically for rural health clinics and hospitals as a recognition of how vital rural health providers are to offering a safety net for their communities and how the crisis has put many of these providers in a difficult financial position.  This money is expected to be distributed as early as the week of April 27th and will be based off each facility’s operating expenses.

 

What is being done for Indian Health Service facilities?

HHS will also be allocating $400 million to Indian Health Service facilities that have also been strained from this crisis.  Similar to rural health providers, these funds will be distributed based on operating expenses.

 

How will be providers be reimbursed for caring for COVID patients that are uninsured?

A portion of the remaining funds in the Public Health and Social Service Emergency Fund will be used to reimburse providers for COVID-19 related treatment of uninsured patients at Medicare rates.

Providers can register for the program on April 27, 2020 and begin submitting claims in early May 2020. For more information, visit www.hrsa.gov/coviduninsuredclaim.

 

What is can be expected for future allocations from the Provider Relief Fund?

Secretary Azar has indicated some future allocations could be targeted towards skilled nursing facilities, providers that only treat Medicaid patients, and dentists.

 

If a practice ceased operation as a result of the COVID-19 pandemic, then is it still eligible to receive funds?

According to guidance from HHS, yes, so long as the provider provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

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Providers can find more information here or call UnitedHealth Group’s toll-free CARES Provider Relief line at (866) 569-3522.

New Fact Sheet on the program here: (https://republicans-waysandmeansforms.house.gov/uploadedfiles/hd_cares_act_provider_relief_fund_fact_sheet.pdf) 

More resources for providers here: https://waysandmeansforms.house.gov/UploadedFiles/CARES_Support_for_Providers.pdf

Want to read more on the fight against Coronavirus? Read our Coronavirus Bulletin here which contains our extensive FAQ about recent federal actions.