- April 15, 2020
- Alerts
Government Issues Provider Relief Payments
Approximately $30 billion of the $100 billion appropriated for healthcare providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act has been distributed to providers across the country. To many, it was a surprise payment – that came with terms and conditions which raise many questions. It is anticipated that additional guidance will follow from the Department of Health and Human Services (HHS), but here is some of what we know now (which remains subject to change):
Who is eligible?
Healthcare facilities and providers who received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for the initial relief funds. Funds are distributed based on the tax identification number used to bill Medicare claims.
How was my share of the funds determined?
Payments are based on a provider’s share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
I had to shut down my practice. Will I still get relief funds?
Yes, as long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020 you remain eligible to receive funds even if your practice is not currently operational. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.
What conditions are attached to keeping the relief funds?
Within 30 days of receiving the funds, providers must sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions of payment. If the funds are not returned within 30 days, the provider is deemed to have accepted the terms and conditions. In addition, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider. If a provider is unable or unwilling to comply with the terms and conditions, it must return the funds.
What can I use the money for?
The Terms and Conditions currently state, among other things, that the provider certify that the funds will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the provider only for health care related expenses or lost revenues that are attributable to coronavirus. In addition, the provider must certify that the funds cannot be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. It is recommended that the relief funds be segregated so that they can be properly accounted for. Providers are required to maintain records and documentation related to expenditure of the relief funds, and any provider that received $150,000 or more must provide quarterly reports to HHS. The terms and conditions include other restrictions regarding use of the funds that do not directly relate to COVID-19, which should be carefully reviewed.
Given that more guidance is anticipated, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.
Who is eligible?
Healthcare facilities and providers who received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for the initial relief funds. Funds are distributed based on the tax identification number used to bill Medicare claims.
How was my share of the funds determined?
Payments are based on a provider’s share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
I had to shut down my practice. Will I still get relief funds?
Yes, as long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020 you remain eligible to receive funds even if your practice is not currently operational. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.
What conditions are attached to keeping the relief funds?
Within 30 days of receiving the funds, providers must sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions of payment. If the funds are not returned within 30 days, the provider is deemed to have accepted the terms and conditions. In addition, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider. If a provider is unable or unwilling to comply with the terms and conditions, it must return the funds.
What can I use the money for?
The Terms and Conditions currently state, among other things, that the provider certify that the funds will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the provider only for health care related expenses or lost revenues that are attributable to coronavirus. In addition, the provider must certify that the funds cannot be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. It is recommended that the relief funds be segregated so that they can be properly accounted for. Providers are required to maintain records and documentation related to expenditure of the relief funds, and any provider that received $150,000 or more must provide quarterly reports to HHS. The terms and conditions include other restrictions regarding use of the funds that do not directly relate to COVID-19, which should be carefully reviewed.
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Given that more guidance is anticipated, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.