Home Health & Hospice Week

Medicaid home care providers left out of Provider Relief Fund dispersal so far can now apply for their piece of $15 billion in additional funding.

The Department of Health and Human Services announced on June 9 “additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs.”

Condition No. 1: “HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation,” HHS explains in the release. That refers to either of the two rounds of CARES Act PRF funding in April and May that totaled $50 billion.

Condition No. 2: Providers must “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,” HHS stipulates in the release.

HHS estimates that “the initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs,” the release says.“The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent.”

Further, “HHS has already provided relief funding to over one million providers,” and this round of Medicaid funding relief “is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins,” the release says.

But in another part of the release, HHS says “close to one million health care providers may be eligible for this funding.”

Keep in mind: “Home care companies that do no Medicare [business] and large amounts of Medicaid” are the ones that will see relief from this round of PRF funding, explains National Association for Home Care & Hospice President William Dombi.“This should mostly affect those companies that focus on Medicaid personal care services and Home and Community Based Services under Medicaid or those Medicaid Private Duty Nursing companies that primarily care for a pediatric population,” Dombi notes.

Related: “A Medicare HHA might operate in a company that has a separate Medicaid home care company” that could be eligible, Dombi expects. But it would need to be “a separate company with a separate Tax Identification Number,” he says.

Medicaid home care providers have been waiting for some financial relief. The general allocation payments, which paid “skilled home health and hospice … did not include any Medicaid providers,” David Totaro, chief government affairs officer for BAYADA Home Health Care and chair of The Partnership for Medicaid Home-Based Care, tells Eli.

Providers furnishing Medicaid skilled home health and Medicaid hospice services would have been covered under the second round of funding from the General Distribution, since they would have been listed on the Medicare providers’ cost reports filed with CMS, Totaro adds. That means “very few will see any distribution from this round of funding,” he expects.

Providers furnishing personal care services, which don’t have a Medicare-paid parallel, are the ones that could see relief money from this round.

HHS ‘Enhances’ PRF Portal

Unlike many of the General Allocation payments, funding from the Medicaid round won’t automatically come to providers.HHS had tried to figure out how to make at least some of the payments automatic, but ran into trouble largely centering on communication with individual states’ Medicaid programs, reports indicate.

Instead, providers that meet the two con­ditions need to report their annual patient revenue on the newly “enhanced Provider Relief Fund Payment Portal,” HHS instructs.

How much will eligible providers receive? “The payment to each provider will be at least 2 percent of reported gross revenue from patient care,” HHS says.“The final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.”

Watch for: HHS hasn’t revealed a funding requirement that providers have a certain number of patients served to qualify for the Medicaid-related funding. But on the hospital side, it is requiring “high impact” hospitals to have 100 or more COVID-19 admissions before qualifying for a portion of the $12 billion pool for those providers. It’s also requiring qualifying hospitals to have a profit margin of 3 percent or less, based on their Medicare cost report.

Questions remain: Some home care pro­viders that do a small amount of Medicare business have seen a low Provider Relief Fund payment under the General Allocation rounds. Now they are wondering if they should return that money so they may be eligible to apply for a larger payment under this Medicaid dispersal.

“I don’t know if I’d give money back,” says Dave Macke with VonLehman & Co. in Fort Wright, Kentucky. Many factors, including how exactly CMS will calculate “at least” 2 percent of gross revenue form patient care, remain to be seen, Macke points out.

The adage “a bird in the hand is worth two in the bush” comes to mind, he adds.

After its general distribution of $50 billion in Provider Relief Funds, HHS earmarked $12 billion for 395 “high impact” hospitals; $10 billion for rural distribution (see Eli’s HCW, Vol. XXIX, No. 16); $4.9 billion for about 13,000 skilled nursing facilities; and $500 million for Tribal hospitals, clinics, and urban health centers. Now HHS is planning on about $15 billion for Medicaid/CHIP and $10 billion for “safety net” hospitals, the agency says.

That leaves about $85 billion of the Provider Relief Fund’s $175 billion still up for grabs.

HHS also says it’s “working on an additional allocation to distribute relief broadly to dentists.”

Note: The release is at www.hhs.gov/about/news/2020/06/09/hhs-announces-enhanced-provider-portal-relief-fund-payments-for-safety-net-hospitals-medicaid-chip-providers.html.