HHS Relief Fund: HHS Provides Further Details for General Distribution Fund and Obtaining Reimbursement for Uninsured COVID-19 Testing and Treatment

April 29, 2020
Firm Publication

Following the announcement of additional allocations from the $100 billion Public Health and Social Services Emergency Fund (PHSSEF) under the CARES Act, on April 24, the U.S. Department of Health and Human Services (HHS) updated the provider relief fund page to offer further details regarding the remaining $20 billion of the $50 billion general distribution. Specifically, HHS opened the General Distribution Portal for Medicare providers for whom HHS did not have adequate cost report data to submit their revenue information to be able to receive additional general distribution funds. HHS reminded providers who received their additional money automatically that they will still need to submit their revenue information via the portal so that it can be verified. HHS also provided a set of frequently asked questions (FAQs) and a CARES Act Provider Relief Fund Application Guide on the additional general distribution funds. HHS reiterated that Medicare providers will need to agree to a set of Terms and Conditions for the remaining $20 billion general distribution that includes additional requirements as compared to the Terms and Conditions for the initial $30 billion general distribution.

HHS subsequently announced the launch of the COVID-19 Uninsured Program Portal on April 27. Providers can now sign up to participate in receiving reimbursement for testing and treatment provided to uninsured COVID-19 patients on or after February 4. Reimbursements paid from the PHSSEF will generally be provided at Medicare rates. The fund includes $1 billion appropriated by the Families First Coronavirus Response Act (FFCRA) to reimburse providers for conducting COVID-19 testing for the uninsured and additional funds allocated by the CARES Act to support healthcare-related expenses attributable to the treatment of uninsured individuals with COVID-19. Providers will need to certify to separate terms and conditions for the FFCRA Relief Funds and Uninsured Relief Funds.

General Distribution Fund: FAQs on Applying for the Additional $20 Billion

HHS reminds, clarifies, and adds the following noteworthy guidance:

  • HHS is distributing $50 billion from the $100 billion PHSSEF via a “General Distribution.” HHS has stated that the allocation of the whole $50 billion General Distribution will be proportional to providers’ share of 2018 net patient revenue.
  • To be eligible for the General Distribution, a provider must have billed Medicare in 2019 and provide or provided after January 31 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19.
  • Medicare providers who have already received General Distribution payments from the first $30 billion tranche as of 5:00 PM ET Friday, April 24, and who have attested to receiving the payment via the Provider Attestation Portal and who have agreed to the terms and conditions on the attestation portal, can and should apply for “additional funds” from the remaining $20 billion general distribution by submitting data about their annual revenues and estimated COVID-19-related losses via the General Distribution Portal.
  • Providers who have “NOT yet received any payment” from the PHSSEF as of 5:00 PM ET Friday, April 24, should “NOT use the General Distribution Portal.” However, these providers may still be eligible for payments from the PHSSEF through other mechanisms, including the targeted allocations being made from the PHSSEF. HHS is performing an ongoing assessment of how to distribute relief to these providers and states its intention “to distribute relief funds as quickly as possible.”
  • Providers who are eligible to receive additional General Distribution funds will need to submit the following four pieces of information in the General Distribution Portal:
    • The provider’s “Gross Receipts or Sales” or “Program Service Revenue” as submitted on its federal income tax return to help HHS better understand the provider’s usual operations.
    • The provider’s estimated revenue losses in March 2020 and April 2020 due to COVID-19 to enable HHS to have a better understanding of COVID-19’s impact. Lost revenue can be estimated by comparing year-over-year revenue or by comparing budgeted revenue to actual revenue. For April 2020, an estimate of the total monthly loss based on data from the first few weeks in April or by extrapolation from March data is acceptable.
    • A copy of the provider’s most recently filed federal income tax return for HHS to verify the self-reported information.
    • A listing of the TINs of any of the provider’s subsidiary organizations that have received relief funds but that DO NOT file separate tax returns in order for HHS to ensure it does not overpay or underpay providers who file tax returns covering multiple legal entities (e.g., consolidated tax returns).

HHS may also use this information in allocating other PHSSEF distributions.

  • Providers meeting the following two criteria are required to submit a separate portal application:
    • Provider has received PHSSEF payments as of 5:00 PM ET Friday, April 24.
    • Provider has filed a federal income tax return for 2017, 2018, or 2019.

Accordingly, each entity that files a federal income tax return is required to file an application even if it is part of a provider group. However, a group of corporations that files one consolidated return will have only the tax return filer apply.

Each provider submitting an application is required to list the TINs of each subsidiary that (1) has received PHSSEF payments as of 5:00 PM ET Friday, April 24 and (2) has not filed federal income tax returns for 2017, 2018, or 2019.

Do not list any subsidiary’s TIN that has filed a federal income tax return, because such subsidiary is required to submit a separate application.

  • Further details on the steps to request additional General Distribution funds are provided in the CARES Act Provider Relief Fund Application Guide.
  • HHS will process applications in batches every Wednesday at 12:00 noon ET. Funds will NOT be disbursed on a first-come-first-served basis, so an applicant will be given equal consideration regardless of when it applies.
  • Providers should expect additional funds, if they are to receive any, within 10 business days of application. There is no appeals or dispute process.
  • General Distribution funds do not need to be repaid if providers meet certain terms and conditions.

General Distribution Fund: Terms and Conditions for the Remaining $20 Billion

While the Terms and Conditions for the remaining $20 billion general distribution largely mirror the Terms and Conditions for the initial $30 billion general distribution, the former includes the following additional requirements:

  • Recipients are required to submit general revenue data for the calendar year 2018 to the HHS Secretary when applying to receive a payment or within 30 days of having received a payment.
  • Recipients consent to HHS publicly disclosing the payment that recipients may receive from the PHSSEF. Recipients acknowledge that such disclosure may allow some third parties to estimate recipients’ gross receipts or sales, program service revenue, or other equivalent information.

In addition, HHS added a new certification to both sets of Terms and Condition applicable to the general distribution funds, in which the recipients certify as to the accuracy and completeness of all information it submits; and, acknowledges that any deliberate omission, misrepresentation or falsification of any information supplied to HHS may be punishable by criminal, civil or administrative penalties, including but not limited to revocation of Medicare billing privileges, exclusion from federal healthcare programs and/or the imposition of fines, civil damages, and/or imprisonment.

Interested parties should review the FAQs and the CARES Act Provider Relief Fund Application Guide in their entirety as they address other important issues related to requesting additional General Distribution funds.

Reimbursement for Uninsured: Patients’ COVID-19 Testing and Treatment

HHS is using part of the PHSSEF to provide reimbursement to healthcare providers for testing uninsured individuals for COVID-19 and for treating uninsured individuals with a COVID-19 diagnosis.

Under the program, reimbursement will be made for qualifying testing for COVID-19 and treatment services with a primary COVID-19 diagnosis, including:

  • Specimen collection, diagnostic and antibody testing.
  • Testing-related visits including in the following settings: office, urgent care or emergency room or via telehealth.
  • Treatment, including office visit (including via telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care (LTAC), acute inpatient rehab, home health, DME (e.g., oxygen, ventilator), emergency ground ambulance transportation, non-emergent patient transfers via ground ambulance, and FDA approved drugs as they become available for COVID-19 treatment and administered as part of an inpatient stay.
  • FDA-approved vaccine, when available.

Services not covered by traditional Medicare, hospice services, outpatient prescription drugs and treatment without a COVID-19 primary diagnosis, except for pregnancy when the COVID-19 code may be listed as secondary, are not covered under the program. Providers may submit claims for individuals in the U.S. without healthcare coverage and for dates of services or admittance on or after February 4.

Providers may sign-up for the program beginning on April 27 and may begin electronically submitting claims on May 6. The process for requesting reimbursement will involve: enrolling as a provider participant, checking patient eligibility, submitting patient information, submitting claims, and receiving payment via direct deposit. HRSA estimates that providers will begin receiving reimbursements in mid-May. Reimbursement under the program will generally be at Medicare rates and is subject to funding availability and Medicare timely filing requirements. In order to participate, providers are also required to certify to certain terms and conditions issued by HHS.

Reimbursement For Uninsured: Terms and Conditions

As detailed above, providers request reimbursement for testing and treatment provided to uninsured individuals through the same process. However, HHS issued separate terms and conditions for FFCRA Relief Funds and Uninsured Relief Funds. The FFCRA Relief Funds allow providers to receive reimbursement for providing “COVID-19 Testing” and “Testing-Related Items and Services,” to “FFCRA Uninsured Individuals,” as those terms are defined within the document. Meanwhile, the Uninsured Relief Funds allow providers to receive reimbursement for providing care or treatment related to positive diagnoses of COVID-19 for individuals who do not have any healthcare coverage at the time services are provided. The terms and conditions with which providers are required to comply and the process for requesting funding are otherwise identical.

The terms and conditions for FFCRA Relief Funds and Uninsured Relief Funds also largely mirror the terms and conditions for the $20 billion and $30 billion PHSSEF general distributions. However, because the funding is provided as reimbursement rather than as a general distribution, recipients are also required to stipulate to the following conditions:

  • Recipients are required to certify that they provided the items and services on the claim form to the uninsured individuals identified on the claim form; that the dates of service occurred on February 4, or later; and that all items for which payment is sought were medically necessary. Recipients are also required to certify that to the best of their knowledge, the patients identified on the claim form were uninsured individuals at the time the services were provided.
  • Recipients which subsequently receive reimbursement for any items or services for which payment was requested from the relief fund are required to return to HHS the portion of the payment which duplicates payment or reimbursement from another source. Recipients are prohibited from including costs for which payment was received in cost reports or otherwise seeking uncompensated care reimbursement through federal or state programs.
  • Recipients are required to agree that all submitted claims will be full and complete. All payments are final and there will be no adjustments.
  • Recipients will generally be reimbursed at 100% of Medicare rates (including any amounts that would have been due to the provider as patient cost-sharing). If there is no Medicare standard rate, a calculated average rate will be used.
  • Recipients must certify that they will not engage in “balance billing” or charge any type of cost-sharing for any items or services for which payment is received. Payment received shall be considered payment in full.
  • Recipients are required to communicate to any uninsured individuals whom they charged for any item or service in which payment is subsequently received that they do not owe any money for that care or treatment. If the uninsured individual already paid a recipient for any portion of the care or treatment, the recipient is required to timely return the payment to the uninsured individual.

We are continuing to monitor for additional guidance from HHS regarding the general and targeted allocations under the PHSSEF and their terms and conditions.

If you have any questions about the PHSSEF and guidance in the context of the COVID-19 pandemic, please contact the authors of this alert.