The large print giveth: HHS provides more details on its plans to distribute the initial $100 billion from the CARES Act

• The U.S. Department of Health &Human Services on April 22 provided further detail on how it plans to distribute the initial $100 billion appropriated to the CARES Act Provider Relief Fund.
• Included in the HHS release were preliminary details of how to file claims for providing care to uninsured COVID-19 patients.
• Providers can begin May 6 submitting claims for reimbursement of treating uninsured COVID-19 patients.

On April 22, the U.S. Department of Health &Human Services (HHS) provided further detail on how it plans to distribute the initial $100 billion appropriated to the CARES Act Provider Relief Fund.

Also, Congress passed a fourth COVID-19 relief bill. The $484 billion piece of legislation includes another $75 billion for the Public Health and Social Services Emergency Fund (a.k.a. CARES Act Provider Relief Fund). There was no additional instruction from Congress how these funds should be spent, so HHS will have broad discretion in distributing the funds to providers. While the funds are necessary and welcome, unfortunately, the additional amount is not sufficient.

Below is a description of how HHS plans to distribute the initial $100 billion, and I’ve also included commentary in a couple of places.

Providers: HHS began disbursing the remaining $20 billion of the general distribution to these providers on April 24 to augment their allocation so that the whole $50 billion general distribution is allocated proportional to providers’ share of 2018 net patient revenue. On April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to a portal which opened April 24. Payments will go out weekly, on a rolling basis, as information is validated, with the first wave being delivered on April 24.

Commentary/Questions: While the large print giveth, it didn’t giveth a lot of detail which has led to confusion and frustration amongst providers.  Below is where HFMA staff have been able to get clarity from HHS:

The doctor is in: The use of cost report data from 2018 has raised the question: Will physicians who don’t file cost reports be left out of this distribution of funds?  Late on April 24, HHS opened the portal for providers without adequate cost report data on file to submit their revenue information to receive additional general distribution funds. In the associated FAQs, which were posted over the weekend, HHS clarifies that physicians will be included if they submit their net revenue data. HHS stated, “Any provider who has already received a payment from the Provider Relief Fund as of 5:00 pm EST Friday, April 24 can and should apply for additional funding via the Provider Relief Fund Application Portal.”    

How much am I getting? The initial distribution was made based on hospitals’ and providers’ Medicare allowable amount. Last week’s announcement revealed that HHS is using the additional $20 billion it started paying out April 24 to adjust what facilities and providers receive so that the entire $50 billion distribution is based on the facility’s/provider’s portion of net patient service revenue relative to the national total. HHS is using $2.5 trillion as the denominator so the payment calculation for the total $50B “General Distribution” is: (Individual Provider 2018 Revenue/$2.5 Trillion) X $50 Billion = Expected General Distribution. 

There was initially some question as to whether or not providers who received a payment on April 24 would receive additional payments from the $50B “General Distribution.” However, HHS has confirmed that providers who received a payment on April 24 shouldn’t receive any additional payments from the General Distribution Fund, unless HHS/CMS has incomplete cost reports from them in 2018.

One other note … even providers who receive a payment in the second round of distributions from the general allocation will need to submit net revenue data within 30 days through the portal to confirm the numbers on worksheet G are accurate. That’s one of the new terms and conditions that CMS has clarified in its update (more on that below).

• High COVID-19 impact areas: There is $10 billion to distribute to hospitals in areas that have been particularly impacted by the COVID-19 outbreak. The distribution will be calculated using data submitted to HHS. The announcement does not state when these distributions will begin.
• Rural providers: $10 billion will be allocated for rural health clinics and hospitals. This money will be distributed as early as the week of April 27 on the basis of operating expenses, using a methodology that distributes payments proportionately to each facility and clinic.
• Indian Health Service: $400 million will be allocated for Indian Health Service facilities, distributed on the basis of operating expenses. Payments will begin as early as the week of April 27.
• Other providers: An additional allocation will be made to skilled nursing facilities, dentists and providers that solely take Medicaid. The release does not detail how much is provided for safety-net providers, how the funds for these providers will be allocated and when the distribution will occur.
• Uninsured COVID-19 patients: Every healthcare provider who has provided treatment for uninsured COVID-19 patients on or after Feb. 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
• Receiving payment via direct deposit

When does program registration begin?

According to the CMS website, providers can start registering for the program on April 27and begin submitting claims in early May 2020. For more information, visit coviduninsuredclaim.hrsa.gov. The release notice does not provide a specific amount allocated for uninsured COVID-19 patients.

Commentary/questions: There will be an approximately $29.6 billion, by my estimate, available from the first $100 billion allocation to disburse between other providers and the uninsured COVID-19 claims pool. How much goes to each one remains to be determined (or announced) by HHS. Claims for this will be paid on a first-come, first-served basis, with limited funding. If I were a provider, I’d want to be at the front of the line. To do this, I’d start the enrollment process April 27 and would attend the training, available starting on April 29 to understand how to file claims correctly. Providers can start submitting claims May 6.

For dates of service or admittance on or after February 4, 2020, providers will be eligible to seek reimbursement for COVID-19 testing and testing-related visits for uninsured patients, as well as treatment for uninsured patients with a COVID-19 diagnosis. All claims will be subject to the same timely filing requirements required by Medicare.