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COVID-19 Loan & Grant Programs - Provider Relief

Public Health and Social Services Emergency Fund – Provider Relief Fund

Update: On August 25, HHS announced that the deadline for Medicaid/CHIP providers and any other Medicare providers who have not yet had the opportunity to apply for funds has again been extended now to September 13, 2020. Read more

The Provider Relief Fund (PRF) includes $175 billion to bolster healthcare-related expenses and mitigate the impact of lost revenue caused by COVID-19. Totaling $50 billion in general distribution, these payments to healthcare providers are grants which will not need to be repaid at any time. The first tranche of the funds was distributed on April 10, 2020, via direct deposit and paid via Automated Clearing House account information on file with UnitedHealth Group or the Centers for Medicare and Medicaid Services (CMS). The remaining $20 billion was released on April 24, 2020.

On June 9, HHS announced that $15 billion from the Provider Relief Fund will be distributed in a Phase 2 General Distribution to Medicaid providers that participate in state Medicaid and Children's Health Insurance Program. The funds, which will be equal to approximately 2% of a provider’s reported gross revenue from patient care, will be distributed to those providers who have not received any payment from the General Distribution of the Provider Relief Fund. Once further data is submitted on the expanded Provider Relief Fund Portal, a final payment amount may be determined using data reflecting the number of Medicaid patients a provider serves. Read more about Medicaid funding

On July 10, HHS announced that the Provider Relief Fund will distribute an additional $4 billion through the Health Resources and Services Administration (HRSA). While $3 billion of this will go to hospitals serving a high proportion of vulnerable populations, the remaining $1 billion will go to urban hospitals with specific rural Medicare designations, specialty hospitals in rural areas, and hospitals in smaller metropolitan areas. Read more

The Department of Health and Human Services partnered with UnitedHealth Group (UHG) to deliver the stimulus payments, and physicians should contact UHG’s Provider Relations at 866-569-3522. Note, if a physician or practice did not already set up direct deposit through CMS or UHG’s Optum Pay, they will receive a check at a later date. Practices that would like to set up direct deposit now can call the UHG Provider Relations number.

General Distribution Terms

  • Payments for the first tranche ($30 billion) are based on an HHS-determined methodology, which can be estimated by providers as their individual 2019 Medicare FFS payments divided by total 2019 FFS payments ($484,000,000,000) and multiplied by $30,000,000,000.
  • Payments for the second tranche ($20 billion) is allocated proportional to a providers’ share of 2018 net patient revenue. Payments will be based on the lesser of either (1) 2% of a provider’s 2018, or most recent complete tax year, net patient revenue or (2) the sum of incurred losses for March and April.
    • This payment can be calculated as (Individual Provider Revenues/$2.5 trillion) x $50 billion = Expected Combined General Distribution.
  • A Phase 2 General Distribution of $15 billion is currently available to providers who participate in Medicaid/CHIP programs, Medicaid Managed Care plans, dental providers, and certain Medicare providers, including those who missed out on Phase 1 General Distribution payments equal to 2% of their total patient care revenue or had a change in ownership in 2019 or 2020.
  • Within 90 days of receipt of the funds, providers are required to sign an attestation confirming receipt and agreeing to the terms and conditions in the CARES Act PRF Payment Attestation Portal.
  • If there is evidence of grave misuse or illegal use of the funds, or if the provider balance bills for COVID-19 related treatment, HHS has the authority to require repayment of the grant.

Eligibility

  • All facilities and providers that received Medicare Fee-for-Service (FFS) reimbursement in 2019 will be eligible for these funds and provided diagnoses, testing, or care to individuals with possible or actual COVID-19 cases after January 31, 2020.
  • For practices that are members of larger medical systems, the payments will be sent to the system’s central billing office.
  • Even if normal operations have been postponed as a result of COVID-19, providers will still be eligible to receive the funds if they provide diagnoses, testing, or care for individuals with possible or confirmed cases of COVID-19.
  • The care provided does not need to be specific to COVID-19, and HHS is emphasizing that every patient may be considered as a possible case of COVID-19.
  • For payments prior to 5pm on April 24, all providers will be required to submit their revenue information for verification through the HHS General Distribution Portal. Submitting tax forms on the portal will act as an application for additional funding from the General Distribution.
  • For payments beginning on April 24, the funds will be distributed on a weekly, rolling basis as information is validated.

Questions

Call the provider support line at (866) 569-3522; for TTY dial 711.

Legal and Financial Disclaimer: The information on this page is meant to serve as an educational summary of federal loan and grant programs related to COVID-19. It does not constitute or substitute legal or financial advice. Interested parties should continue to consult their legal and financial professionals.

Note about AAOS Help and Services: Unfortunately, the Academy is unable to help with individual applications or paperwork required for obtaining relief funds. For related questions or comments about the programs, please email the Office of Government Relations at dc@aaos.org.