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COVID-19: Additional Allocations of CARES Act Provider Relief Fund

April 23, 2020

Pursuant to the bipartisan CARES Act legislation signed into law on March 27, 2020 (the “Act”), $100 billion will be made available to health care providers to address the economic harm due to the stoppage of elective procedures and the economic impact as a result of incurring additional expenses in caring for COVID-19 patients.

General Allocation of $50 Billion for Medicare Facilities

Pursuant to the Act, there is a $50 billion general allocation to Medicare facilities and providers impacted by COVID-19, based on eligible providers’ 2018 net patient revenue with $30 billion having been distributed to providers’ bank accounts between April 10th and April 17th.  The remaining $20 billion will begin to be distributed this week (to augment amounts previously received by some providers and children’s hospitals who have a small share of Medicare revenue).  Providers that receive funds from the general distribution will have to sign an attestation confirming receipt of funds and agree to the terms and conditions (discussed below) for payment and submit documents that ensure that the funds were used for healthcare-related expenses or lost revenue attributable to coronavirus.

$50 Billion In Targeted Allocations

Pursuant to the Act, certain specific providers have been targeted for additional allocations as set forth below.

COVID-19 High Impact Areas

  • $10 billion will be allocated for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak (e.g., New York which will receive approximately $4.4 billion).
     
  • Hospitals must apply for a portion of the funds by providing four simple pieces of information via an authentication portal before 3:00 PM, Saturday April 25 (extended from previous deadline of midnight PT, Thursday April 23).  Hospitals will need to provide: (i) Tax Identification Number; (ii) National Provider Identifier; (iii) total number of intensive care unit beds as of April 10, 2020; and (iv) total number of admissions with a positive diagnosis for COVID-19 from January 1, 2020 to April 10, 2020.
     
  • The distribution will take into consideration those who are most impacted from COVID-19, along with the facilities serving a significantly disproportionate number of low-income patients, as reflected by their Medicare Disproportionate Share Hospital (DSH) Adjustment.

Allocation for Treatment of Uninsured

  • 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.
     
  • Steps will involve: enrolling as a provider participant, checking patient eligibility and benefits, submitting patient information, submitting claims, and receiving payment via direct deposit.
     
  • Providers can register for the program on April 27, 2020, and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov.

Allocation for Rural Providers

  • $10 billion will be allocated for rural health clinics and hospitals, and will be distributed as early as next week on the basis of operating expenses, using a methodology that distributes payments proportionately to each facility and clinic.

Allocation for Indian Health Service

  • $400 million will be allocated for Indian Health Service facilities.  This money will be distributed as early as next week on the basis of operating expenses for facilities.

Additional Allocations

  • There are some providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid.

Terms and Conditions

Recipients will need to certify that it will comply with the terms and conditions set forth in https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions.pdf.

Some of the terms and conditions require that:

  • The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Federal health care programs; or have billing privileges revoked.
     
  • The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the Recipient only for healthcare-related expenses or lost revenues that are attributable to coronavirus.
     
  • The Recipient certifies that it 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.
     
  • The Recipient submits reports as the Secretary determines to be needed to ensure compliance.
     
  • The Recipient receiving more than $150,000 submits to the Secretary not later than 10 days after the end of each calendar quarter a report regarding detailed information regarding the use of the funds as specified.
     
  • The Recipient maintains appropriate records and cost documentation including, as applicable, documentation required by 45 CFR § 75.302 – Financial management and 45 CFR § 75.361 through 75.365.
     
  • The Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in network Recipient.
     
  • The Recipient certifies that none of the funds can be used by the recipient for the following:
     
    • Executive pay
    • Gun control advocacy
    • Lobbying
    • Abortions
    • Embryo research
    • Promotion of legalization of controlled substances
    • Pornography
    • Funding ACORN or its affiliates/subsidiaries
    • Propaganda or publicity

There are additional terms and conditions that must be reviewed by Recipients, including the fact that both HHS and the OIG have represented that Recipients will be closely monitored for fraud and abuse in connection with the use of the funds.

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