Over the last two months or so, I’ve described here in Regs & Eggs how the Department of Health and Human Services (HHS) has been distributing the Provider Relief Fund—the $175 billion pot of funding appropriated by Congress to help cover health care providers’ increased expenses and lost revenues due to COVID-19.
ACEP has had numerous issues with the distribution of the Provider Relief Fund, none of which have been sufficiently resolved. Besides the confusing terms and conditions associated with the funding and the ever changing rules and guidance about how to apply for and use the funds, our primary concern has been that emergency physicians and the groups you work for have thus far only received a small fraction of the amount that you have lost due to your increased expenses fighting the virus and lower emergency department volumes. Unfortunately, despite our best efforts, HHS doesn’t seem to be listening to our message that you, as frontline clinicians, need additional support to preserve the vital safety net that all Americans rely on.
As a quick refresher, up until this week, HHS had distributed (or had planned on distributing) roughly $87.4 billion of the $175 billion in available funds (see my breakout here). Of that funding, all of you or your groups probably received a portion of the $50 billion General Distribution that HHS allocated to health care providers. In order to be eligible for the General Distribution you or your group must have billed Medicare in 2019. This covers most if not all of emergency physician groups. Even pediatric emergency physicians work in groups that see at least some Medicare patients.
Despite receiving payments from the $50 billion General Distribution (and perhaps having some of your uninsured claims paid through the Uninsured program), ACEP, along with the Emergency Department Practice Management Association (EDPMA), estimate that emergency physician groups have only received 7 to 15 percent of the amount we think would sufficiently cover your losses. ACEP has repeatedly requested that HHS provide $3.6 billion from the Provider Relief Fund to emergency physician groups and the emergency physicians who practice within them. We have written a total of four letters to HHS on the Provider Relief Fund, the most recent of which was on June 1—where we specifically asked for additional support to cover the difference between what you’ve received so far and our $3.6 billion request.
As you might imagine, emergency physicians are not the only ones requesting consideration for the funds. In fact, several members of Congress from both sides of the aisle recently asked HHS to distribute more funding to safety net and Medicaid providers. And earlier this week, the Department announced $35 billion in additional distributions -- allocated as follows:
- $15 billion for Medicaid Providers: HHS opened a portal yesterday 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 to Safety Net Hospitals: This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care.
- $10 billion in Additional Funding for Hospitals in Hot Spots: In May, $12 billion was distributed to 395 hospitals that had 100 or more COVID-19 admissions between January 1 and April 10. HHS now plans on distributing another round of funding to hospitals based on their COVID-19 admissions between January 1 and June 10.
The only new allocation of funding that physicians are eligible to receive is the first one targeted at “Medicaid providers” (the other two distributions are solely reserved for hospitals, which have already received the lion share of the Provider Relief Fund). It seems entirely appropriate for emergency physicians to be classified as Medicaid providers and receive this funding, given that according to the Center for Disease Control and Prevention (CDC), Medicaid patients represented over 40 percent of total emergency department visits in 2017. However, unfortunately, most, if not all, of you will NOT qualify for these funds due to the stipulation that you cannot have received any funding thus far from the Provider Relief Fund. ACEP fundamentally disagrees with HHS’ decision to exclude emergency physicians from this targeted distribution.
There is some hope though! According to my calculations, there is still over $50 billion left from the $175 billion Provider Relief Fund. Further, the HEROES Act, which passed the House of Representatives, included an additional $100 billion for the fund.
While we will continue to push HHS for more funding for emergency physicians, ACEP is also pursuing a concurrent legislative strategy and has already sent Congress a letter asking for additional support for emergency physician. We are also currently exploring other options and will keep you informed of any progress we make.
Lastly, please tune in today at 3pm ET during our live Capital (30) Minutes to hear more about our federal advocacy efforts and to get your questions answered!
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs.