On June 10, the U.S. Department of Health and Human Services (HHS) updated its Provider Relief Fund FAQs. The update provides information on the new web application portal for Medicaid providers other than SNF Medicaid providers. SNF Medicaid-only providers already should have received a Medicaid Allocation or will receive payments over the course of the week. The new Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund including assisted living communities (ALs), ICFs/IID, and home and community-based providers.

Ensuring accuracy of web portal data entry is critical because once an application is submitted, it may not be modified. To help ensure web portal submissions are complete and accurate, HHS has prepared instructions on how to complete the Medicaid Distribution and a downloadable PDF of the application. Questions on the instructions and worksheet should be directed to the CARES Act Fund Hotline at (866) 569-3522; for TTY dial 711.

Medicaid

Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19 may apply. Examples of Medicaid/CHIP providers possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living communities and other home and community-based services providers.

*Providers also must meet three requirements see “Other FAQ Updates,” below.

Providers who received General Distribution awards under Tranche 1, which was based on 2019 Medicare Fee-for-Service claims, or Tranche 2, which was based upon other revenue from 2018 Cost Reports, are not eligible for Medicaid Allocation payments. Providers who received a SNF or other Allocation outside of General Distribution are eligible for a Medicaid Allocation. HHS also goes into more detail on Medicaid Allocation eligibility on page 32 of the June 10 FAQs.

The Medicaid Targeted Distribution methodology will be based upon 2% of (gross revenues * percent of gross revenues from patient care) for CY 2017, or 2018 or 2019, as selected by the applicant and with accompanying submitted tax documentation. Payments will be made to applicant providers who are on the filing Tax Identification Number (TIN) list submitted by states to HHS or whose applications underwent additional validation by HHS. Read the Medicaid Allocation press release.

Yes – you must attest to Terms and Conditions.

No. There are no differences between the SNF Allocation Terms and Conditions and the Medicaid Terms and Conditions.

No. The new Targeted Distribution portal will not process applications from providers who have received payment from the previous $50 billion Provider Relief Fund General Distribution.

You can only submit one application. You can edit the data on the application form, until the form is submitted. You cannot edit or resubmit the application form once it is submitted. You should not apply until you have available all of the information and documentation required by the application form.

No, if you were eligible for the General Distribution payment and rejected the payment, you cannot be eligible for Medicaid Targeted Distribution payment.

Payments will be made to applicant providers who are in the filing TIN curated list from CMS. If applicants are not on that list, HHS will establish an additional process to validate eligibility.

As long as the Filing TIN or one of the Billing TINs was not eligible for the $50B General Distribution, but is a Medicaid provider and is on the State-provided list of eligible Medicaid and CHIP providers, then they are eligible to apply. Medicaid providers who are not on the State-provided list, their applications will undergo additional validation by HHS.

The deadline to submit an application for the Medicaid Targeted Distribution is July 3, 2020.

No. HHS will review submissions through the application portal and make determinations as quickly as possible. Providers should be prepared for additional information requests from HHS.

Other FAQ Updates

1. Must not have received payment from the $50 billion General Distribution; and
2. Must have directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; and
3. Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or healthcare clinic); and 4. must have provided patient care after January 31, 2020; and 5. must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and 6. if the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

[AHCA Note: DHHS has indicated the provision above allows current owners who participated in a change in ownership (CHOW) and have not receive any funds under Tranches 1 and 2 due to the CHOW may use the Payment Portal as long as they meet all three requirements above. AHCA/NCAL will continue to work on a solution for Medicare-only CHOWs.] 

Additional General Distribution payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) gross receipts or the sum of incurred losses for March and April. HHS is collecting the “gross receipt or sales” or “program service revenue” data to have an understanding of a provider’s usual operations; the revenue loss information to have an understanding of COVID impact; and, tax forms to verify the self- reported information. Cost reports made up one of several data elements that HHS used to determine payments.

No. Providers do not need to be able to prove, at the time they accept a Provider Relief Fund payment, that prior and/or future lost revenues and increased expenses attributable to COVID-19 (excluding those covered by other sources of reimbursement) meet or exceed their Provider Relief Fund payment. Instead, HHS expects that providers will only use Provider Relief Fund payments for permissible purposes and if, at the conclusion of the pandemic, providers have leftover Provider Relief Fund money that they cannot expend on permissible expenses or losses, then they will return this money to HHS. HHS will provide directions in the future about how to return unused funds. HHS reserves the right to audit Provider Relief Fund recipients in the future and collect any Relief Fund amounts that were used inappropriately.

Payments from the Provider Relief Fund shall not be subject to the claims of the provider’s creditors and providers are limited in their ability to transfer Provider Relief Fund payments to their creditors. A provider may utilize Provider Relief Fund payments to satisfy creditors’ claims, but only to the extent that such claims constitute eligible health care related expenses and lost revenues attributable to coronavirus and are made to prevent, prepare for, and respond to coronavirus, as set forth under the Terms and Conditions.

For skilled nursing facility patients with insurance, an out-of-network skilled nursing provider delivering care to a presumptive or actual COVID-19 patient may not seek to collect from the patient out-of-pocket expenses, including deductibles, copayments, or balance billing, 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.

Through-out the FAQs, DHHS has replaced net revenue with gross receipts.