DHHS Provider Relief Funds- New Funding Round for Medicaid Providers Excluded from First Rounds of Funding

On June 9, 2020 the U.S. Department Health and Human Services (“DHHS”) announced that it was allocating a total of $15 Billion in Provider Relief Fund payments to Medicaid or Children’s Health Insurance Program (CHIP) providers who have been impacted by the COVID-19 crisis. These funds are specifically for providers who are not enrolled Medicare providers, and thus were ineligible for the first two rounds of the Provider Relief Fund that granted a total of $50 Billion in payments to these providers. DHHS’ goal is to provide those eligible for this round with relief payments equal to the lesser of approximately 2% of their annual patient care revenue or the provider’s reported revenue loss or expense increase due to COVID-19- an amount similar to that provided to Medicare providers in the first rounds of the Program. All of the Provider Relief Fund distributions were authorized under the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) and are intended to assist healthcare providers in covering additional expenses and revenue shortfalls that healthcare providers are experiencing as a result of the COVID-19 crisis.  

             The Application Process

Providers who are eligible for this new round of Provider Relief Funding will need to apply via an online portal. The application must be completed by July 20, and include the following pieces of information- some of which were not required of providers who had previously received funds:

  • The applicant’s total gross revenues from their most recently filed federal income tax return and the percentage of gross revenues derived from patient care
  • The applicant’s lost revenues and increased expenses attributable to the COVID-19 crisis
  • The applicant’s most recent federal income tax return for 2017, 2018
  • The applicant’s Employer’s Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, an Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement indicating why the applicant is not required to submit either form (not required for providers in previous rounds of funding, and is presumably an additional step taken by DHHS to ensure the applicant is an open and operating provider
  • An FTE Worksheet, provided by DHHS, requiring names and NPI information for all entity billing providers (not required for providers in previous rounds of funding).
  • A Gross Revenue Worksheet, provided by DHHS (not required for providers in previous rounds of funding). This worksheet will only need to completed if any entity attempts to report gross revenue that exceeds that on its tax filing by more than 20% due to recent acquisitions that were not included in its tax filing.
  • Payer Mix Data (not required for providers in previous rounds of funding)
  • Paycheck Protection Program Receipt Data (not required for providers in previous rounds of funding)

Terms and Conditions

Providers who apply for this new round of Provider Relief Funds will need to agree to comply with  substantial terms and conditions related to the receipt and use of these funds. Among these terms and conditions are:

  • The provider currently provides diagnosis, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.
  • The provider certifies that the Payment will only be used to prevent, prepare for, and respond to Coronavirus, and that the Payment is only for health care related expenses or lost revenues that are attributable to Coronavirus.
  • The provider 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 provider shall maintain documentation and submit any reports required to show the funds are being used only for their appropriate purpose.
  • The provider must certify that for COVID-19-related care, 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 provider.
  • The provider must certify that the funds are not being used for executive pay, lobbying, provision of abortion services, the promotion of legalizing controlled substances, and embryo research

Providers eligible for this new round of CARES Act-authorized relief funding must carefully review the terms and conditions associated with these payments. Providers who receive over $150,000 will be required to provide a report to DHHS regarding how these funds were utilized, and all providers should expect significant audit activity around the use of these funds as the Federal government has indicated that they will take significant steps to ensure that they were used for their appropriate purpose- to offset revenue loss or additional expenses directly attributable to the COVID-19 crisis.

General information, including a link to the portal, can be found here under the heading “Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance.” The application information from DHHS, including links to any required worksheets for submission via the portal, can be found here.

How Frier Levitt Can Help

The attorneys of Frier Levitt have been carefully monitoring developments related to the Provider Relief Fund and are available to assist in determining your eligibility for Provider Relief Fund payments and providing guidance throughout the application and reporting process. Contact us today for additional guidance.

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