Medicare Compliance & Reimbursement

Tip: Check HHS website daily.

If you’re flummoxed by all the CARES Act Provider Relief Fund particulars, you’re not alone. Much of the confusion is due to the many extensions the feds have released on accepting the payments. However, the most recent update gives you some extra time to make your decision — at least for now.

Backtrack: On March 27, President Trump signed the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) to help combat COVID-19 and help the nation. This “ambitious legislation to support our economy and bolster our pandemic response” also included “more than $100 billion for hospitals and healthcare providers,” according to Department of Health and Human Services (HHS) Secretary Alex Azar in a release.

Next: On April 7, during a Coronavirus Task Force press conference, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma mentioned that $30 billion in grant money with “no strings attached” would be put into the pockets of providers ASAP.

As HHS rolled out the CARES Act Provider Relief Fund payments, the agency also pushed out release after release updating funding disbursements while extending terms and conditions and attestation requirements. The evolving timelines have added more complications, especially as some of the announcements have been quietly released.

Pocket This CARES Act Provider Relief Fund Timeline

Here’s a brief review of the HHS’ disbursement rollout and attestation highlights:

April 10 to April 17: In its “first tranche,” HHS directly deposited $30 billion of the CARES Act funding into providers’ bank accounts — with no warning and without application. These payments were originally allocated based on providers’ shares of their 2019 Medicare fee-for-service (FFS) reimbursements, HHS declared in an April 10 release.

This caused massive confusion as many Medicare providers and suppliers were also receiving money through CMS’ Accelerated Payment Program (See Medicare Compliance & Reimbursement, Vol. 46, No. 8.)

“For most providers and suppliers, the CARES Act Relief Fund payments and any payments from the Accelerated Payment Program were deposited directly into the provider or supplier’s bank account. To add to the confusion, for many organizations, these payments may have been deposited within a few days of each other,” explains attorney Benjamin Fee with Hall, Render, Killian, Heath & Lyman, PC in the Denver office.

Important: On April 10, HHS set its first attestation deadline “within 30 days of receiving the payment,” informed the release. The “first tranche” guidance outlined two attestation requirements: confirm receipt of the funds and agree to the terms and conditions of payment.

April 22: In the “second tranche” of CARES Act Provider Relief payments, HHS deposited upwards of $20 billion into providers’ accounts. In this batch of disbursements — announced on April 22 and deposited on April 24 — hospitals received a large portion of the funding. This “remaining $20 billion of the general distribution” was issued to “augment their allocation so that the whole $50 billion general distribution is allocated proportional to providers’ share of 2018 net patient revenue,” HHS indicated in a release.

Of interest: “HHS refers to the combined first tranche and second tranche totaling $50 billion as the ‘General Distribution’ or ‘General Allocation’ portion of the Relief Fund,” explains law firm Hall Render in its Health Law News blog.

Targeted allocations: On April 22, HHS also announced several other CARES Act disbursements including the following:

High-impact: The agency mentioned another $10 billion in a “high-impact allocation” to go out to “395 hospitals who provided inpatient care for 100 or more COVID-19 patients,” said HHS guidance on the disbursement. Then on May 1, the agency added that it planned to allocate another “$2 billion to these hospitals based on their Medicare and Medicaid disproportionate share and uncompensated care payments,” HHS said.

Rural: Plus, HHS outlined a “rural distribution” plan to allocate “$10 billion to rural hospitals, including rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers located in rural areas,” noted online guidance.

Indian Health Service: At first, HHS planned to assist the Indian Health Service with a $400 million payout for operating expenses, but it upped the amount to $500 million in later releases.

Uninsured: With minimal details and guidance, the feds said that part of the $100 billion would be available for providers to apply for to cover uninsured patients starting on April 27.

April 28: HHS stated that providers who didn’t get Relief Fund payments or who needed more money could apply — but they had to “submit required revenue information for verification” and “attest to the terms and conditions of this additional distribution,” the agency mandated in a release on April 28.

May 7: In a short statement, HHS extended its 30-day deadline to 45 days for providers to accept terms and conditions of CARES Act Provider Relief Fund payments and submit attestations. In accordance with the extension, the agency warned that “not returning the payment within 45 days of receipt of payment” would automatically be “viewed as acceptance of the terms and conditions,” HHS warned.

May 20: In a quiet reminder, HHS nudged “all providers eligible for CARES Act Provider Relief Fund payments that they have until June 3, 2020 to accept the terms and conditions and submit revenue information to support the receipt of an additional payment from HHS’ $50 billion General Distribution of Provider Relief Fund payments,” clarifies attorney Conor Duffy with Robinson & Cole LLP in the law firm’s Health Law Diagnosis blog.

Moreover, “all providers who automatically received an additional General Distribution payment prior to 5:00 pm, Friday, April 24, must provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements,” the agency said in a release. “These providers must also agree to the program terms and conditions if they wish to keep the funds.”

May 22: HHS finally announced that it had begun disbursing CARES Act funding to skilled nursing facilities (SNFs). The $4.9 billion allocations were issued to supplement these healthcare facilities helping the most vulnerable patients, HHS said in a release.

HHS Issues a Last-Minute Update on May 22

In a 6:00 pm release on May 22 — the Friday before a national holiday — HHS sent out another change.

Now: HHS issued a “45-day deadline extension for providers who are receiving payments from the Provider Relief Fund to accept the terms and conditions for Provider Relief Fund payments,” the agency said in a May 22 release. “This announcement means providers have now been granted 90 days from the date they received a payment to accept HHS terms and conditions or return the funds.”

Reasoning: Reports suggest that the feds offered this extension to assist the hardest hit healthcare organizations. “HHS’ latest extension of the deadline comes in response to frontline providers’ request for additional time to review and agree to the terms and conditions,” acknowledges Chattanooga, Tennessee-based attorneys Mark Cunningham, Courtney J. Keehan, and Jed Roebuck with Chambliss, Bahner & Stophel, P.C. in online analysis.

“HHS references both the first and second tranches of the $50 billion General Distribution in its press release — as well as the targeted distributions for hospitals in high-impact areas, rural providers, tribal healthcare providers, and skilled nursing facilities — [so] it seems fairly clear that a provider receiving any distribution made pursuant to the Provider Relief Fund now has 90 days from the date payment was received to attest to the terms and conditions applicable to that payment,” Cunningham, Keehan, and Roebuck counsel.

Tip: A careful review of the CARES Act Provider Relief Fund terms and conditions is essential, for both the initial payment and any additional reimbursement you might apply for, implores Duffy. Why? “The HHS Office of Inspector General recently announced that it would incorporate an audit of the distribution of the Provider Relief Funds to its work plan for 2020,” he reminds.

Resource: Check out a chart of the various HHS allocations and reach the attestation portal at www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html.