April 16 UPDATE: The CARES Act Provider Relief Fund

Published in Government Relations on April 16, 2020

As most DMEPOS suppliers are likely aware, the Department of Health and Human Services (HHS) continues its distribution of $30 billion in funds from the $100 billion Public Health and Social Services Emergency Fund established by the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. Many have received their payments. For those who have questions about their payments, please call 877-842-3210 and choose option 7. You will be asked to provide your Tax ID number, and a United Healthcare representative will be able to check on the status of your payment.

Commencing April 10, all health facilities that billed Medicare in 2019 will receive a grant from the Fund. Each TIN will receive approximately 6.2% of its 2019 Medicare fee-for-service payments (not including Medicare Advantage). For example, a provider or supplier that received $1 million in Medicare payments in 2019 will receive a relief payment of approximately $62,000.

This payment will not need to be repaid. Payments will be made automatically, without the need to file an application. Many provider/suppliers accounts have been paid. The exception: Those without Automated Clearing House (ACH) deposit capabilities. These entities will receive paper checks by mail in the next few weeks.

HHS partnered with UnitedHealth Group (UHG) to make payments via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). The automatic payments will come from Optum Bank with "HHSPAYMENT" as the payment description.

Within 30 days of receipt, a provider must sign an attestation confirming receipt of the funds and agreeing to specific terms and conditions. A portal for signing is now active. Please read – in its entirety – this page https://www.hhs.gov/provider-relief/index.html, which offers important information and directs users to the actual portal URL, https://covid19.linkhealth.com/#/step/1.

CARES

Providers do not need to sign the agreement before payments are made.

There is also a ten-page list of certain terms and conditions (available here https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions-04092020.pdf), and they include the following:

Certify that the provider currently provides diagnoses, testing, or care for individuals with possible or actual cases of COVID-19;
Certify that the provider is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.
Agree to use the funds for health care-related expenses or lost revenues attributable to coronavirus.
Agree not to use the funds to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.
Agree not to balance bill any out-of-network patient for COVID-19-related treatment.
Agree to maintain and to submit upon request appropriate records and cost documentation including, as applicable, documentation required by 45 CFR § 75.302 and 45 CFR § 75.361 through 75.365, as well as other information required by future program instructions.

Also, a provider must agree to submit any HHS-required reports needed to ensure the provider's compliance with conditions imposed on Relief Fund payments.

Specifically, any provider receiving more than $150,000 total in funds appropriated by any law relating to coronavirus response and related activities must submit a quarterly report to HHS and the Pandemic Response Accountability Committee (and independent oversight committee created under the CARES Act) including the following information:

the total amount of funds received from HHS under one of the foregoing enumerated Acts;
the amount of funds received that were expended or obligated for reach project or activity;
a detailed list of all projects or activities for which large covered funds were expended or obligated, including: the name and description of the project or activity, and the estimated number of jobs created or retained by the project or activity, where applicable;
and detailed information on any level of sub-contracts or subgrants awarded by the covered recipient or its subcontractors or subgrantees, to include the data elements required to comply with the Federal Funding Accountability and Transparency Act of 2006 allowing aggregate reporting on awards below $50,000 or to individuals, as prescribed by the Director of the Office of Management and Budget

If a provider is unwilling to accept the terms and conditions, it must contact HHS within 30 days of receipt and remit full payment to HHS as instructed. HHS will provide specific contact information soon.

Lastly, these payments are independent of the Medicare advance payments that CMS has already been making to Medicare providers. Read more below. Participation in the advance payment program has no bearing on payments from the Fund.

One day after the enactment of the CARES Act, CMS announced that it was implementing authority provided under the Act to make significant accelerated/advance payments to Medicare Part A providers (e.g., hospitals) and Part B suppliers (e.g., physician groups, DME suppliers, and others who provide outpatient care). This program is not limited to entities that treat COVID-19 patients. These advance payments may be vital to organizations suffering from liquidity shortages, particularly if they are not eligible for the $100 billion fund dedicated to hospitals and other providers that are treating, or planning to treat, COVID-19 patients. CMS has promised that these payments will be made quickly, so eligible providers and suppliers may wish to seek them as soon as practicable.

Among the key terms of CMS’ advance payment announcement are the following:

To qualify, a provider or supplier must have billed Medicare for claims within 180 days of a submission for advance/accelerated payments, must not be in bankruptcy, must not be under investigation by Medicare, and must not have any outstanding delinquent Medicare overpayments.
Qualified entities will be able to request a specific amount of advance payment—in an amount that is based on historic Medicare reimbursement levels—on a form found on the applicable Medicare Administrative Contractor’s (“MAC’s”) website.
The size of the advance/accelerated payment will depend on the type of entity making the request: (i) providers and suppliers may request 100% of the Medicare payment amount for a three-month period; (ii) inpatient acute care hospitals, children’s hospitals and certain cancer hospitals may request 100% of the Medicare payment for a six-month period; and (iii) “critical access hospitals” (i.e., certain types of rural hospitals) may seek 125% of the Medicare payment.
Each MAC should issue payments within seven days of receiving a valid request.
Repayment of these advance payments will typically be required beginning 120 days after the issuance of payments according to terms specified in its announcement.
The program will apply only for the duration of the COVID-19 emergency (as determined by the Department of Health and Human Services).

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