Charles H. Newman
April 14, 2020
The United States Department of Health and Human Services (HHS) has announced that $30 billion of the $100 billion Public Health and Social Services Emergency Fund provided for under the CARES Act, in relief funds to hospitals and health care providers to support health care related expenses or lost revenue attributable to COVID-19, will be distributed automatically to all providers who are enrolled in Medicare. Payments will be made via direct deposit to the same account in which a provider ordinarily receives Medicare Fee for Service (FFS) reimbursement payments. Any provider who normally receives payment via paper check is expected to receive payment within the next few weeks. Each provider will receive a share of the $30 billion fund based on the provider’s proportionate share of total Medicare FFS payments in 2019. Reimbursements from Medicare Advantage plans are not included. Total 2019 Medicare payments are estimated by HHS to be $484 billion. For example, a provider that received $1 million in FFS Medicare reimbursements in 2019 can expect to receive:
$1 million/$484 billion x $30 billion = $61,983
The money will be distributed without the need to submit an application, however, that does not mean that there are no strings attached. Within 30 days after receipt of payment, the provider must accept HHS’s Relief Fund Payment Terms and Conditions. A portal is expected to be created this week for signing an attestation agreeing to these terms and conditions. Failure to return the funds within thirty (30) days will be considered acceptance of the terms and conditions.
Key elements of these Terms and Conditions include the following:
- After January 31, 2020, the recipient provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.
- The payment will only be used to prevent, prepare for, and respond to coronavirus, and will reimburse the provider solely for health care related expenses or lost revenue attributable to coronavirus.
- The payment will not be used to reimburse expenses or losses for which it received reimbursement from other sources, or for which other sources are obligated to provide reimbursement.
- The provider will submit reports to HHS to ensure compliance with the conditions imposed on the payment. The form and content of the reports have not yet been released.
- Providers who receive more than $150,000 in total funds from any federal Act making appropriations primarily for coronavirus response and related activities will be required to submit detailed reports of the funds received and how the funds were expended.
- Any provider who receives a payment agrees that, if any care is provided to an out-of-network patient for a possible or actual case of COVID-19, the provider will not seek to collect an amount from the patient that is greater than the amount the patient would have paid if the provider had been in-network with the patient’s health plan.
This program is separate from other recently enacted relief programs, including the CMS Accelerated and Advance Payment Program, the Economic Injury Disaster Loan program, and the Payment Protection Plan loan program.
Additional information and a link to a complete copy of the Relief Fund Payment Terms and Conditions may be found at https://www.hhs.gov/provider-relief/index.html
. This link is also expected to include a link to the portal for signing the required attestation when it becomes available.
This Client Alert has been prepared by Sills Cummis & Gross P.C. for informational purposes only and does not constitute advertising or solicitation and should not be used or taken as legal advice. Those seeking legal advice should contact a member of the Firm or legal counsel licensed in their state. Transmission of this information is not intended to create, and receipt does not constitute, an attorney-client relationship. Confidential information should not be sent to Sills Cummis & Gross without first communicating directly with a member of the Firm about establishing an attorney-client relationship.