HHS’s Cares Act Provider Relief Act FAQ updates provide additional guidance for healthcare providers

• The U.S. Department of Health & Human Services (HHS) has for the most part gotten high marks for getting checks out the door to providers from the CARES Act Provider Relief Fund.
• What HHS has not gotten high marks for is transparency and responsiveness to questions from the industry.
• The lack of guidance from HHS has the unfortunate side effect of leaving well-meaning providers to interpret HHS’s intent from its limited guidance and the statute under tight time frames.

The U.S. Department of Health & Human Services (HHS) has for the most part gotten high marks for getting checks out the door to providers from the CARES Act Provider Relief Fund (PRF). What they haven’t gotten high marks for is transparency and responsiveness to questions from the industry. Typically, HHS hasn’t  been prescriptive enough in terms of where it’s pulling data elements from to help providers calculate what they should receive, they’ve left basic definitional questions unanswered about requested data elements and when HHS requests data, it tends to be a bit of a pop quiz for providers.

This has had the unfortunate side effect of leaving well-meaning providers to interpret HHS’s intent from its limited guidance and the statute under tight time frames. And, these providers must hope they’ve guessed right when the OIG comes knocking despite near daily updates of the CARES Act PRF provider website and related FAQs.

Here are four odds and ends from the past week’s HHS updates that may be of interest to members.

1. Quarterly reporting requirements: Providers were anticipating the first quarterly report (as required by the terms and conditions of the various distributions) will be due to HHS shortly. Based on the CARES Act, the reports are technically due on July 10. The statute requires that not later than 10 days after the end of each calendar quarter, each covered recipient shall submit to the agency (HHS) and the Pandemic Response Accountability Committee a report that contains the total amount of funds received, the amount of funds expended, a list of projects or activities that funds were expended on or obligated to, and a list of subcontracts or subgrants awarded.

In an FAQ added on June 13 (page 8 as of 6/18), HHS states it will develop a report based on distributed amounts to comply with the CARES Act reporting requirements so providers will not need to submit a separate quarterly report. However, the FAQ goes on to state providers are required to submit any reports necessary to allow HHS to monitor compliance with the terms and conditions. “HHS will notify recipients of the content and due date(s) of such reports in the coming weeks,” according to the FAQ. This replaced a FAQ from May 6 that stated the first report would be due for the quarter ending June 30.

2. Cost report treatment of CARES Act Provider Relief Fund: Stay tuned…“CMS will issue guidance about how Provider Relief Fund payments should be treated for purposes of uncompensated care and how it should be reported on cost reports” (Page 2 FAQs as of June 18). HFMA is working with its members to compile a list of cost reporting issues created by the pandemic and recommend solutions to ameliorate these challenges. HFMA will make recommendations to CMS staff in a forthcoming comment letter.

3. High impact data reporting: Data for the next round of high impact funding was due on June 15. In response, HHS made several updates to the FAQs during the previous week (June 12 – June 15) leading up to the data submission (starts on page 29 of FAQ as of June 18). Among other items clarified:

• Emergency department or observation cases should not be counted (including deaths that occur in either area)
• Providers should only count admissions if the confirmatory diagnosis occurred prior to discharge and before the end of the day on June 10, 2020
• If a patient is admitted and subsequently readmitted, both admissions count if COVID-19 is the primary diagnosis for each admission
• How to handle reporting if you have multiple campuses reporting under one TIN

First, this is helpful as I think it’s safe to assume there will be additional calls for data to inform future high-impact distributions. Second, my sense is most hospitals are waiting until close to the deadline to submit data. Given how HHS has a penchant for providing last-minute clarifications, that’s a prudent strategy to give the folks pulling reports time to review any updated FAQs and adjust the report parameters appropriately. However, providers will need to balance waiting long enough to make sure they have the most current clarifications against the need to submit with enough time to address any SNAFUs with their submission or HHS’s teletracking platform.

4. Detailed methodology for safety net hospitals: The HHS Provider Relief Fund website offers a detailed explanation of how it determined which hospitals were eligible for the $10 billion Safety Net Hospital Distribution. It also provides a list of the definitions and data sources from the Medicare Cost report to help providers check the amount they received. Like other distributions and related material, the definitions tend to evolve. For example, last week, HHS’s website stated one of the criteria for the safety net distribution was an operating margin of 3% or less. The current website states profit margin of 3% or less.