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Overview of Payer Relief Fund Requirements and Disbursement Procedures

The Provider Relief Fund was established through the CARES Act that was signed into law on March 27, 2020 that allotted $100 billion for health care providers impacted by COVID-19 Public Health Emergency. In the month since the passage of the law, the Department of Health and Human Services has dispersed some of the funds and made several announcements on the remaining funds that are going to be dispersed. In addition, last week, Congress added $75 billion to the Provider Relief Fund.

Due to the continuous announcements on the Provider Relief Fund and the varying eligibility criteria and processes to retrieve relief payments, we have created a quick reference on the status of the funds and actions suppliers need to take to access the available funds. Below is the status of the $175 billion of the Provider Relief Fund as of April 29, 2020.

Status of the $100 Billion from CARES Act

A.    $30 Billion General Distribution (Tranche 1)

  • Based on Medicare 2019 payments.
  • Automatic payments distributed between April 10-17, 2020.
  • No action needed by suppliers.
  • If you have received payments from Medicare in 2019 but have not received a payment yet, please call the CARES Provider Relief line: (866) 569-3522
  •  You can find more information on eligibility and calculation on the Provider Relief Fund website and you can calculate your estimated relief amount with AAH Relief Fund Calculator

B.    $20 Billion General Distribution (Tranche 2)

  • Based on 2018 patient net revenue.
  • Automatic payments distributed to health care providers that submit cost reports to CMS beginning April 24, 2020. DMEPOS suppliers are not included in this group.
  • DMEPOS suppliers will need to apply to receive payments from this funding stream on the General Distribution Portal. Only suppliers who have received payments from the first $30 billion (Tranche 1) are eligible for this additional funding. We highly recommend suppliers thoroughly review the application guide and FAQ prior to starting the application process. Suppliers will need to have several pieces of information prepared prior to filling out the application such as, but not limited to:

o Taxpayer Identification Number(s)
o Estimate of lost revenue between March-April 2020 (reference FAQ for calculation)
o Most recent tax form you filed with IRS (most likely, 2017, 2018, or 2019)

C.    Treating Uninsured Patients (funding unspecified)

  • All health care providers (including DMEPOS suppliers) that serviced uninsured COVID-19 patients on or after February 4, 2020 are eligible for payment at Medicare allowables.
  • This program is subject to funding. As of today, HHS has not specified the funding amount for this program.
  •  Suppliers can register for this program beginning April 27 here.
  • Registered suppliers may begin submitting claims on May 6. Payments will be released beginning mid-May.
  • More information about this program and registration portal can be found here. We recommend suppliers learn more about this program prior to registration by signing up for the webcast Getting started with the HRSA COVID-19 Uninsured Program (next one scheduled for April 30 from 2-3PM ET).

DMEPOS suppliers are not eligible for the following allocated funding: $10 Billion to COVID-19 High Impact hospitals, $10 Billion to Rural Providers, and $400 Million to Indian Health Services. The remaining funds of <$30 billion will be distributed to health care providers that solely provide to Medicaid patients. There is no information on this yet, but we will keep membership posted if suppliers are included in this funding stream.

Status of the $75 Billion from Paycheck Protection Program and Health Care Enhancement Act

Companies seeking funding will need to submit an application demonstrating the need for funding. Per our summary of the provisions related to the $75 billion in healthcare provider relief, the purpose of the funds are as follows:

  • Funds are to prevent, prepare for, and respond to coronavirus, domestically or internationally.
  • Funds are for necessary expenses to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus.
  • Funds may not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.

Currently, we are still waiting on guidance on the application process. We will notify our membership when this becomes available.

(updated 4/29/2020)

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