In addition to general financial relief available to businesses impacted by the COVID-19 pandemic (Pandemic), plans for new funding streams, specifically for health care providers, are now becoming clearer.
When Congress passed the Coronavirus Aid, Relief and Economic Security Act (CARES Act) at the end of March to combat the economic impact of the Pandemic, providers celebrated the inclusion of $100 billion of relief funding earmarked for the health care industry, predominantly via the Public Health and Social Service Emergency Fund (Fund).
Nearly two weeks later, on April 10, 2020, the U.S. Department of Health and Human Services (HHS) announced the allocation of the first $30 billion of funding.
The funds, which are a cash payment and not a loan, will be distributed to Medicare providers based on their share of 2019 Medicare fee-for-service reimbursements via their typical automated clearing house or paper payments. Providers will receive payments based on their tax identification numbers so funds will be sent to billing organizations. For example, individual providers in a group practice will not receive individual payments directly; instead, the payment will go to the billing organization.
Providers will have to certify that they provide diagnoses, testing or care for individuals with actual or possible cases of COVID-19 and will use the funds to prevent, prepare for or respond to the Pandemic or to replace lost revenue attributable to the Pandemic.
Other restrictions on the funds include caps on employee salary reimbursement and prohibition of using funds for lobbying or most abortion care. Funds also cannot be used to reimburse expenses or losses that the provider has had reimbursed from other sources. The HHS has not clarified whether other sources include other federal relief programs, such as the Paycheck Protection Program. Providers are also required to abstain from “balance billing” any patient for coronavirus-related care.
If a provider receives more than $150,000 from the Fund or any other Pandemic-related relief package, there are additional reporting requirements. Within 10 days after the end of each calendar quarter, the provider must file a report about how the funds were spent with the Secretary of HHS.
Providers will also have to sign an online attestation, confirming that they received the payment.
Additional distributions of the CARES Act funds are forthcoming. The HHS indicated that at least some of the remaining money will be directed to providers in areas most impacted by the Pandemic, rural providers and providers who predominantly serve Medicaid populations.
In addition to CARES Act funding, the Centers for Medicare and Medicaid Services has expanded the existing Accelerated and Advanced Payment Program to a broader group of Medicare Part A providers and Part B suppliers for the duration of the Pandemic.
These advanced funds, which must be repaid, support providers when typical billing claims are disrupted or when a national emergency or natural disaster is taking place.
To receive funds, a provider must have billed Medicare within 180 days of requesting funds, be in good standing with the Medicare program and not in bankruptcy. Providers will request funding through the appropriate Medicare administrative contractor (MAC) and requests will be processed in seven calendar days.
Most providers can receive up to 100% of their Medicare funding for a three-month period, with certain hospitals types, including inpatient acute care hospitals, children’s hospitals and certain cancer hospitals receiving up to six months of funding. Critical access hospitals can request up to 125% of their payment amount for a six-month period.
MACs have been instructed to prioritize payments to providers in areas most impacted by COVID-19, which currently include California, New York and Washington.
Most providers will have 210 days from the receipt of funds to repay the money, while hospitals will have a year. Funds will be paid by automatically offsetting new provider claims submitted to Medicare against the outstanding balance once the repayment period begins.
Health care providers should expect additional guidance on more funding from the CARES Act in the coming weeks.
Please contact the Gordon Feinblatt Health Care team if you have questions about how the current status of any regulations, payment programs or executive orders impacts your practice.
Barry F. Rosen
410-576-4224 • firstname.lastname@example.org
Alexandria K. Montanio
410-576-4278 • email@example.com
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