Click here for a 1-page fact sheet on the Provider Relief Fund.
On May 4, ACEP's Regulatory Affairs Director, Jeffrey Davis, gave a presentation to a group of ED physician directors in Colorado highlighting the available financial support options for emergency physicians. Listen to Mr. Davis' presentation and download his presentation with links to helpful resources.
Major Updates on the Provider Relief Fund
December 14, 2021: HHS announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments to health care providers who have experienced revenue losses and expenses related to the COVID-19 pandemic. The average payment for small providers is $58,000, for medium providers is $289,000, and for large providers is $1.7 million. More than 69,000 providers in all 50 states, Washington, D.C., and eight territories will receive Phase 4 payments. These payments represent about half of the originally allocated $17 billion for PRF Phase 4. HHS is currently reviewing the remaining Phase 4 applications and will make the remainder of Phase 4 payments in 2022.
September 10, 2021: HHS announced that it is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. The application portal will open on September 29, 2021. To promote transparency, HHS is also releasing detailed information about the methodology utilized to calculate PRF Phase 3 payments. Additionally, HHS is announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. For more information about the new PRF payments, please click here.
July 1, 2021: The Provider Relief Fund (PRF) Reporting Portal is open for providers who need to report on the use of funds in Reporting Period 1. Providers who are required to report during Reporting Period 1 have until September 30, 2021 to enter the Portal and submit their information. To get started, review the updated Reporting Requirements Notice (June 11) and enter the PRF Reporting Portal. Portal registration is the first required step (if not already completed). You can also register to attend the technical assistance webinar on July 8, 2021 at 3:00pm ET. Reporting resources like user guides, a data entry worksheet, updated Frequently Asked Questions, and more can found on the PRF Reporting web page.
June 11, 2021: HHS released revised reporting requirements for recipients of Provider Relief Fund payments. Key updates include:
For more information, click here.
March 31, 2021: HHS issued a revised set of frequently asked questions (FAQs). Of note, HHS stated that providers must use Provider Relief Funds to cover allowable expenses or lost revenues attributable to COVID-19 no later than June 30, 2021, adding that the Department will provide information in the future on how to return unused funds. HHS also indicated that 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 expenses attributable to COVID-19 meet or exceed their Provider Relief Fund payment. In addition, HHS provided details on how cost-based reimbursement affects the use of Provider Relief Funds, including stating that certain non-reimbursed costs are eligible for reimbursement under the Provider Relief Fund. Finally, HHS provided additional details on payment amounts that applicants should expect to receive from Phase 3 of the General Distribution.
January 15, 2021: HHS released revised reporting requirements for individuals or groups that received over $10,000 from the Provider Relief Fund. The new requirements take into account changes from the Coronavirus Response and Relief Supplemental Appropriations Act (passed in late December), which added another $3 billion in funding to the PRF program and included language specific to reporting requirements. Previously, the due date for submitting required information related to the use of funds was February 21, 2021. However, with these changes, HHS has extended the deadline, and will announce a new one in the coming weeks. In the meantime, HHS has opened up a reporting portal, and requests that all individuals or groups register. Registration takes around 20 minutes to complete. For more information, please visit the Provider Relief Fund website.
December 27, 2020: President Trump signed into law the “Consolidated Appropriations Act, 2021,” which among other provisions, included an additional $3 billion for the Provider Relief Fund and the following stipulations: 1) a clarification that a parent organization can transfer provider relief funds to a subsidiary; 2) a description of how a provider may calculate lost revenues; and (3) a requirement that not less than 85 percent of the unobligated balances of the Provider Relief Fund available as of December 27 must be paid out to health care providers (beyond the Phase 3 distribution) based lost revenues and increased expenses occurring in the third or fourth quarter of 2020 or the first quarter of 2021.
December 16, 2020: HHS announced that it has completed review of Phase 3 applications from the Provider Relief Fund and will distribute $24.5 billion to over 70,000 providers-- up from the $20 billion originally planned. The addition of another $4.5 billion in funding is being used to satisfy close to 90 percent of each applicant’s reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020.
October 22, 2020: HHS announced expanded eligibility for the Phase 3 General Distribution of the Provider Relief Fund (PRF), along with revisions to the reporting requirements. The expanded list of eligible providers is extremely long, thereby decreasing the chance that emergency physicians will be receive additional funds beyond what they have already received from previous distributions. HHS also changed PRF reporting requirements to now allow providers to apply PRF payments against all lost revenues without limitation. HHS had received pushback for initially limiting funds to an amount that would prevent most providers from being more profitable in 2020 than in 2019. All providers receiving more than $10,000 are subject to key reporting requirements, with the first deadline for reporting February 15, 2021. In addition, all providers who expend more than $750,000 in Federal funds (including PRF and the Paycheck Protection Program funds) will be subject to additional audit requirements. For additional information, visit the Reporting Requirements and Auditing page and read the Auditing and Reporting Requirements FAQs. More information related to this program can be found on the Provider Relief Fund website.
October 5, 2020: You can now start applying for the $20 billion “Phase 3” general distribution from the Provider Relief Fund. Applications are due on November 6, 2020, but HHS urges you to submit an application as soon as possible. HHS provides the following clarifying information about this general distribution:
Eligibility – HHS states that providers that did not deposit a check from the Phase 1 General Distribution are eligible to apply for the Phase 3 General Distribution. In addition, HHS clarifies that receiving funds from the Payroll Protection Program or certain other COVID-19 relief payments does not preclude a provider who meets the eligibility criteria from applying for the Phase 3 General Distribution.
On October 1, 2020, HHS announced another general distribution from the Provider Relief Fund—a $175 billion fund appropriated by Congress that helps cover health care providers’ lost revenues and increased expenses due to COVID-19. The $20 billion distribution is open to health care providers and groups, including emergency physicians and emergency medicine group practices, who have already received funding from the Provider Relief Fund.
As a reminder, you or your group have thus far been eligible to receive up to 2 percent of your 2018 total revenue from the Provider Relief Fund. HHS is now allowing you or your group to potentially receive additional funding on top of that. You or your group will be required to submit financial information in order to help HHS determine your or your group’s share of the funds.
Specifically, HHS will ask you or your group to review and confirm that you or your group have already received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue. If you or your group have not yet received Provider Relief Fund payments of 2 percent of patient revenue, you or your group will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
HHS will determine these payments first. With the remaining balance of the $20 billion budget, HHS will then calculate an equitable add-on payment that considers:
You or your group will have from October 5, 2020 through November 6, 2020 to apply for this funding. Since HHS is allocating this funding equitably to everyone who applies, it is urging everyone to apply early and not to wait until the last day or week of the application period. Applying early will help to expedite HHS’s review process and payment calculations, and ultimately accelerate the distribution of all payments.
All payment recipients will be required to attest to receiving this funding and will have to accept the associated Terms and Conditions. HHS will continue to host webinars to assist providers through the application process
On September 19, 2020, HHS released updated guidance on how to report lost revenues and increased expenses due to COVID-19. The guidance applies generally to PRF recipients that received one or more PRF payments exceeding $10,000 in the aggregate, but does not apply to payments received from the HRSA Uninsured Program. The guidance outlines specific data elements that must reported, and includes additional requirements for providers who received more than $500,000. Recipients who spend all their funds prior to the end of 2020 will be required to report this information by the February 15, 2021. Recipients with funds still unexpended after December 31, 2020, must submit a second and final report no later than July 31, 2021. The reporting system will become available to recipients for reporting on October 1, 2020, although that could be delayed.
HHS announced an additional $1.4 billion in targeted distribution funding to almost 80 free-standing children’s hospitals nationwide. According to HHS, this distribution will help to ensure children’s hospitals receive relief proportional to other hospitals across the nation and providers caring for children are able to continue operating safely in some of our most vulnerable communities.
HHS has updated its frequently-asked questions (FAQs) document to include more information about auditing and reporting requirements. HHS clarifies that reports on the use of Provider Relief Fund money must be submitted no later than July 31, 2021, and accordingly, HHS expects that providers will fully expend their payments by that date.
HHS has extended the deadline for Medicaid and dental providers to apply for funds. HHS also plans to allow certain Medicare providers who experienced challenges in the “General Distribution” application period a second opportunity to receive funding. Both groups will have until Sunday, September 13, 2020 to apply. Most emergency medicine groups are eligible to receive funding from the Medicare General Distribution. The original deadline for this funding was June 3rd. If you missed this deadline, you may be eligible to apply now. You can apply here. Note that this does not represent an additional allocation for emergency physicians. If you already received funding from the “General Distribution,” you cannot reapply for additional funding. The cap in funding is still 2 percent of your annual patient revenues.
On July 22, HHS announced that it would allocate $5 billion of the Provider Relief Fund to Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control. This new funding is in addition to the $4.9 billion previously provided to nursing homes to offset revenue losses and cover increased expenses due to COVID-19.
HHS released a notification informing Provider Relief Fund recipients who received one or more payments exceeding $10,000 in the aggregate that they will be required to report information showing how they complied with the Terms and Conditions (including how they used the funds). Additional detailed instructions regarding the reporting requirements will be released soon. HHS plans on opening up a reporting system where you are to submit the required information on October 1, 2020.
On July 22, HHS announced that it would allocate $5 billion of the Provider Relief Fund to Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”), to build nursing home skills and enhance nursing homes’ response to COVID-19, including enhanced infection control. This new funding is in addition to the $4.9 billion previously provided to nursing homes to offset revenue losses and cover increased expenses due to COVID-19
On July 10, HHS announced new allocations of the Provider Relief Fund— approximately $3 billion in funding to hospitals serving a large percentage of vulnerable populations on thin margins and approximately $1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas. HHS is also opening the provider portal to allow dentists to apply for relief. Dentists and Medicaid providers (discussed below) have until August 28, 2020 to apply for the funds. Approximately $50 billion remains unallocated of the $175 billion Provider Relief Fund.
In June, HHS had announced additional allocations of the Provider Relief Fund—none of which is going to emergency physicians
Most of you or your groups have already received payments from the Provider Relief Fund. Therefore, you will not be eligible for this funding. However, ACEP believes that the funds you have received thus far have not been sufficient and we will continue to advocate for additional support.
This payment is being sent directly to these hospitals via direct deposit. Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.
Background on the Provider Relief Fund
The major stimulus bill that was signed into law (the CARES Act) included a $100 billion fund that the U.S. Department of Health and Human services (HHS) has been distributing to health care providers, including physicians, in the form of grants and direct payments. Further, the Paycheck Protection Program and Health Care Enhancement Act (the COVID 3.5 package) added $75 billion to the fund on top of the initial $100 billion. Health care providers are not required to repay any of this funding.
On April 10, HHS distributed $30 billion of the $100 billion CARES Act funding to Medicare “providers” (physicians, hospitals, and other facilities and health professionals that bill Medicare) and on April 22, HHS announced additional, future allocations.
With respect to the $30 billion, the amount was distributed in direct proportion to providers’ total 2019 Medicare fee-for-service (FFS) reimbursement. You or your group should have received approximately 6.2 percent of their Medicare FFS payments. Some of you, depending on where you practice and your patient mix, will receive more or less than others, since again, the amount you receive is simply based on your Medicare payments from last year.
There is also a catch that goes along with the funding. Within 45 days, you must agree to certain terms and conditions. These terms and conditions include the following statement:
“The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that 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 Recipient.”
ACEP sought clarification on exactly what this condition means and how this may impact you and your patients. HHS has provided some clarification, but more is needed. Specifically, HHS defines a “presumptive case of COVID-19” as a case where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record. HHS also has stated that there are no limitations on the ability of a provider to submit a claim for payment to the patient’s insurance company and that “most health insurers have publicly stated their commitment to reimbursing out-of-network providers that treat health plan members for COVID-19-related care at the insurer’s prevailing in-network rate.”
On June 1, ACEP sent another letter to HHS Secretary Alex Azar about the distribution of the Provider Relief Fund, the $175 billion pot of funding appropriated by Congress to cover health care providers’ lost revenues and increased expenses due to COVID-19. This letter follows up on previous letters we sent on March 27, April 3, and April 14 to the HHS Secretary. In the most recent letter, we reiterate our previous request for $3.6 billion from the Provider Relief Fund to be specifically allocated towards emergency medicine groups and to the emergency physicians who practice within them. Thus far, we estimate that emergency physician groups have received approximately 7 to 15 percent of the initial $3.6 billion request. We ask that HHS reserve a portion of the $75 billion that Congress provided in the Paycheck Protection Program and Health Care Enhancement Act to cover the remaining balance of the $3.6 billion request.
$20 billion General Allocation: HHS is allocating another $20 billion to all health care providers (“Tranche 2”). The total you or your group receives—both from the initial $30 billion and the new $20 billion—will be based on your 2018 total net revenue.
To estimate how much a provider will receive in total from both the initial $30 billion and additional $20 billion general allocation, HHS provides this formula: (Individual Provider 2018 Revenue/$2.5 Trillion) X $50 Billion = Expected General Distribution.
Note: Total revenues of Medicare facilities and providers in 2018 is estimated to be $2.5 trillion.
This calculation comes out to be around 2 percent of your 2018 provider revenue. HHS has stated that the total you are expected to receive from tranche 1 and tranche 2 combined is the lesser of 2% of your 2018 patient revenue or the sum of incurred losses for March and April. If you received equal to or more than 2 percent of your total 2018 revenue in tranche 1, you will not receive additional funding in tranche 2.
There are numerous steps you will need to take to receive a portion of this additional $20 billion.
If you received funding from the first $30 billion, you are required to attest to the required terms and conditions. You must attest to the terms and conditions associated with the first $30 billion in order to receive funding from this second $20 billion tranche.
You must log into the General Distribution Portal to provide revenue information. Detailed instructions on what information you need to provide are included in a frequently asked questions (FAQ) document HHS has produced, but overall include:
HHS provides the following table highlighting exactly what revenue to report from your tax returns based on what type of group/organization you are:
You will also need your W-9 and Medicare or Medicaid ID number.
HHS will use this information to calculate your payment, which as stated above, is based on 2018 net revenue. Like your first payment, HHS will deposit the money electronically into the account that you have on file with Medicare. The goal is to deposit the funds within 10 days of submitting the required information. Although the fund is limited to $20 billion (and, as of April 24, HHS has stated that $10 billion has already been distributed), HHS claims that the remainder will not be distributed on a first come first serve basis. HHS will be processing applications in batches every Wednesday at 12:00 noon EST. HHS has stated that you must submit information at attest to the Terms and Conditions by June 3rd.
After you receive the funds, you must log back into the CARES Act Provider Relief Fund attestation portal to confirm receipt and agree to ANOTHER set of terms and conditions. This second set of terms and conditions is similar to the first, but not identical. Both sets of terms and conditions (both for the initial $30 billion and the subsequent $20 billion) can be found here.
IMPORTANT NOTE: ACEP strongly recommends that a financial expert in your group and/or your accountant review all the instructions extremely carefully, enter the information into the portal, and review and attest to both sets of terms and conditions.
Here are some useful sources of information to review:
If you have questions, please reach out to Jeffrey Davis, ACEP’s Director of Regulatory Affairs. You may also call the provider relief hotline at (866) 569-3522.
$32 billion for Providers in Hot Spots and Rural Health Providers: On May 1, HHS announced that it had started the process of distributing $12 billion of the funding to hospitals in areas that have been particularly impacted by the COVID-19 and $10 billion to rural health clinics and hospitals. None of this funding was distributed directly to physician groups. For more information about this announcement, please go here.
On June 8, HHS announced that $10 billion in additional funds will be distributed to hospitals in COVID-19 hotspots. To receive this second round of funding, hospitals must provide updated information to HHS by June 15 on their COVID-19 positive-inpatient admissions for the period January 1 through June 10.
$500 million for Indian Health Service (IHS) Facilities: $500 million has been distributed to the IHS and tribal hospitals, clinics, and urban health centers to support the tribal response to COVID-19.
$4.9 billion for Skilled Nursing Facilities: HHS provided nearly $4.9 billion in additional relief funds to skilled nursing facilities (SNFs).
$15 billion for Medicaid Providers: HHS is opening up a portal on June 10 that will allow clinicians who participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations to submit their annual patient revenue information and receive a distribution equal to at least 2 percent of reported gross revenues from patient care. To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either 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. Examples of providers possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities and other home and community-based services providers.
$10 billion for Safety Net Hospitals: This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:
This payment is being sent directly to these hospitals via direct deposit. Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.
Reimbursement for Providers Treating Uninsured COVID-19 Patients:
Every health care provider who has provided treatment for uninsured suspected or confirmed COVID-19 patients on or after February 4, 2020 can request claims reimbursement at Medicare rates, subject to available funding. Approximately $12 billion has been allocated to this program, although more could be added in the future.
Providers can register NOW for the program here and begin submitting claims. ACEP encourages you to review the information in this registration portal. Emergency department visits that lead to an order of or administration of a test (i.e. testing related services) are covered under this program, as long as the claim includes one of three diagnosis codes: Z03.818, Z11.59, or Z20.828. These codes can appear in any position on the claim. In other words, you have the flexibility to submit a testing-related visit claim for reimbursement that includes another diagnosis code as the primary diagnosis instead of one of the three required codes.
However, for any treatment of COVID-19 positive patients, you will only receive reimbursement if the primary diagnosis on the claim is COVID-19 (diagnosis codes B97.29 and U07.1). The billing codes are found here.
Finally, it is important to note that there are two sets of terms and conditions associated with this program:
On April 30, the Health Resources & Services Administration (HRSA) held a webinar to discuss the program. A summary of the webinar can be found here.
HHS also announced that some providers will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid. Finally, HHS has not made any decisions about how the additional $75 billion included in the Paycheck Protection Program and Health Care Enhancement Act will be allocated.
In March 2020, the Centers for Medicare & Medicaid Services (CMS) expanded a Medicare advanced payment program that was meant to help health care practitioners with their cash flow during the COVID-19 public health emergency. CMS paid out $106 billion before suspending the program in April, in part because of the unfavorable terms associated with these payments. Under the original terms, the payments had to be paid back to CMS starting in August. Unpaid loans were eventually subject to an extremely high interest rate of 10.25 percent.
The Continuing Appropriations Act, 2021 and Other Extensions Act, which was enacted on October 1, 2020, included some favorable changes to the program. On October 8, 2020, CMS announced that it was implementing the changes included in the Act. Under the new law, repayment of the advance payments will now begin one year from when hospitals or health care practitioners received them (instead of in August). After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the health care practitioner for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the health care practitioners is unable to repay the total amount of the advance payment during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent (instead of 10.25 percent).
Health care practitioners can also request an Extended Repayment Schedule (ERS) if they are experiencing financial hardships. An ERS is a debt installment payment plan that allows a health care practitioner to pay debts over the course of three years, or up to five years in the case of extreme hardship.
The CARES Act provides loan forgiveness for certain qualifying Small Business Administration (SBA) loans. The details of one such program, the Payroll Protection Program (PPP) are found below:
To find out more information about the SBA’s loan forgiveness programs, please click here.
On May 22, the SBA, in conjunction with the Department of Treasury, issued an interim final reg that includes some important clarifications on how to calculate certain costs for the purposes of figuring out your loan forgiveness amount.
Here are some other useful links:
The original $349 billion allocated to the Payroll Protection Program ran out, and Congress approved an additional $321 billion in the Paycheck Protection Program and Health Care Enhancement Act.