Latest Updates on the CARES Act Public Health and Social Service Emergency Fund

May 9, 2020 — Blog    — Coronavirus Bulletin    — In Case You Missed It...    — Press Releases   
(Updated on 6/16)

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 has been 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
    • $12 billion has been allocated to 395 hospitals in COVID-19 “hot spots”
    • $10 billion has been allocated to rural hospitals
    • $400 million will be allocated to Indian Health Service facilities
    • Nearly $4.9 billion has been allocated to Skilled Nursing facilities
    • $15 billion has been allocated to eligible providers serving those with Medicaid and Children’s Health Insurance Program (CHIP) coverage
    • $10 billion has been allocated to safety-net hospitals
    • Additional money from this fund is being used to reimburse the treatment of uninsured COVID-19 patients
    • Future allocations could target any new COVID-19 hotspots or dentists
  • 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.
  • CARES Act Provider Relief Fund Distribution Summary Timeline 

 

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 interest-free grant funding is in addition to the $100 billion in loans CMS has delivered to providers through the expansion of the Accelerated and Advance Payment Program.

FAQs:

What is the Administration Doing to Accelerate Production of a Vaccine?

Find more information on the vaccine progress and Operation Warp Speed  here.

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.

Allocations based on congressional district can be found here.

How was the second tranche 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 qualified 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 2nd tranche?

Over $9 billion in payments, of the additional $20 billion, went out automatically to providers that have 2018 costs reports on file with the Centers for Medicare & Medicaid Services via electronic deposit on April 27. All providers eligible for the general distribution, including those paid based on revenue data already submitted in CMS cost reports, must submit required revenue information for verification and must attest to the terms and conditions of this additional distribution via hhs.gov/providerrelief.

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.  Medicare providers who did not have cost reports on file will need to submit their revenue data, as this data is needed to calculate their payment from the $20 billion. Payments will go out on a rolling basis as eligible providers submit and verify the required information.

Do these interest-free grants come with restrictions?

All providers that accept Provider Fund money must sign an attestation confirming receipt of funds and agree to certain terms and conditions within a certain time period.  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.

The Department of Health and Human Services has extended the deadline for health care providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. Providers will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. As an example, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24, 2020, from May 9, 2020.

 

What is being done to support providers in COVID hotspots?

In addition to the $50 billion being distributed to all providers, a separate $12 billion was distributed to 395 hospitals in areas with the most COVID-19 patients. These hospitals were paid a fixed amount per COVID-19 inpatient admission, with an additional amount taking into account their Medicare and Medicaid disproportionate share and uncompensated care payments in order to account for uninsured and low-income patients. The funding methodology can be found here. A list of the 395 hospitals and their payment amounts, made the week of May 4, can be found here. Distribution by state and county can be found here.

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. The distribution is based on operating expenses – reaching 2,200 rural acute care general hospitals and critical access hospitals, over 1,300 independent rural health clinics (RHC), and over 4,200 community health centers located in rural areas. Hospitals and RHCs each received a minimum base payment plus a percent of their annual expenses. The base payment accounts for RHCs with no reported Medicare claims, such as pediatric RHCs, and CHCs lacking expense data, by ensuring that all clinical, non-hospital sites receive a minimum level of support no less than $100,000, with additional payment based on operating expenses. Rural acute care general hospitals and CAHs received a minimum level of support of no less than $1,000,000, with additional payment based on operating expenses.

Eligible providers have already begun receiving funds via direct deposit, based on the physical address of the facilities as reported to the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), regardless of their affiliation with organizations based in urban areas. Distribution by state and county can be found here.

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.

What is being done for Skilled Nursing Facilities?

HHS has begun distributing nearly $4.9 billion in additional relief funds to o support skilled nursing facilities (SNFs) suffering from significant expenses or lost revenue attributable to COVID-19. HHS will make relief fund distributions to SNFs based on both a fixed basis and variable basis. Each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed. All certified SNFs with six or more certified beds are eligible for this targeted distribution.

Nursing home recipients must attest that they will only use Provider Relief Fund payments for permissible purposes, as set forth in the Terms and Conditions, and agree to comply with future government audit and reporting requirements.

This provider fund investment is on top of other Trump Administration efforts to help vulnerable SNF residents and those that care for them, including direct Personal Protective Equipment (PPE) shipments, regulatory flexibility and infection control consultations.

 

What is being done for providers who serve primarily Americans who receive their health coverage through Medicaid or CHIP and didn’t receive funding from the initial General Distribution?

HHS has announced it expects to distribute about $15 billion in relief funds to those providers. Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers, serving Medicaid/CHIP beneficiaries, possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities and other home and community-based services providers.

To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding. More information about eligibility and the application process is available here.

What is being done for safety net hospitals?

HHS is announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens, recognizing the incredibly thin margins these hospitals operate on. This payment is being sent directly to these hospitals via direct deposit.

This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:

  • A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater;
  • Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement;
  • Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report.

Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.

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 is being used to reimburse providers for COVID-19 related treatment of uninsured patients at Medicare rates. The new COVID-19 Claims Reimbursement portal can be found here.

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

Secretary Azar has indicated some future allocations could be targeted towards emerging hot spots, 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.

More FAQs from CMS on Price Transparency can be found here.

More FAQs on the General Allocation via HHS can be found here.

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.