New Provider Relief Fund Details Released
On June 11, the Department of Health & Human Services (HHS) released (more) revisions to the Provider Relief Fund (PRF). Today’s blog provides a high-level look at the key changes only. The portal is supposed to open July 1, 2021. At that point we anticipate far more detailed guidance on how the reporting elements and process will work since the revised guidance creates new questions that need to be answered.
New Time Periods, Deadlines Created
One key change to be aware of is a series of new dates and timelines. HHS has established four “Periods,” which are dependent on the actual date a PRF distribution was received. Based on that Period, a deadline is then established to use those specific PRF distribution dollars. This is also referred to as the “period of availability.” Finally, once the period of availability ends, providers will have 90 days to complete reporting on the PRF they received in that period.
Our graphic below provides the new dates and timelines.
Example 1: A critical access hospital (CAH) received General Distribution Phase 1 payments on April 10, 2020 and also received the Targeted Rural Distribution on May 6, 2020. Because both distributions were received during Period 1, the deadline to use those dollars is June 30, 2021. The CAH will be able to report on these dollars for 90 days (July 1, 2021-September 30, 2021).
Example 2: A skilled nursing facility (SNF) received General Distribution Phase 1 payments on April 10, 2020, the SNF Targeted Distribution on May 22, 2020 and the SNF Infection Control Payments (including incentive payments) in August and November 2020. Because the SNF received PRF money in Period 1 and Period 2, it will be required to follow the deadlines and timelines on use/reporting for both Period 1 and 2. As you can see in our example, HHS is now requiring providers to report on the SNF Infection Control Payments.
Example 3: A physician practice received a Phase 2 General Distribution in December 2020 and a Phase 3 General Distribution in March 2021. Their deadline to use Phase 2 PRF will be December 31, 2021 with corresponding reporting beginning January 1, 2022. Their deadline to use Phase 3 PRF will be June 30, 2022 with corresponding reporting beginning July 1, 2022.
Reporting entities will report on their use of funds using their normal basis of accounting (e.g. cash basis, accrual basis) and these reporting requirements apply to all past and future PRF payments.
One note, while the reporting requirements now apply to the SNF infection control distributions, HHS indicates that the reporting requirements do not apply to the Rural Health Clinic COVID-19 Testing Program, the Uninsured COVID Testing/Treatment reimbursements, the COVID-19 Coverage Assistance Fund, or those that received less than $10,000 in one or more payments during a reporting period.
Unanswered Questions
Because HHS created four rolling time periods, as you can see in our visual below, there is significant overlap. What remains unclear is how these different time periods interact with one another. For example, are lost revenues still on a calendar year basis, are they aggregated across the period of availability or looked at quarter by quarter, and, will they roll over from time period to time period?
Again, HHS indicates detailed guidance and instructions will be provided when the portal opens on July. We await those important clarifications.
HHS Outlines Process
HHS provides a snapshot of the six steps providers will take (in order) when in the reporting portal. Those include details on:
- Interest earned on PRF
- Other assistance received
- Use of SNF Infection Control Distribution payments
- Use of General and Targeted Distributions (on COVID expenses)
- Net unreimbursed expenses attributable to COVID
- Lost revenues
When reporting, HHS also indicates PRF recipients will provide information on 12 data elements. There are some adjustments to the previously required data elements plus HHS added new data elements on the use of SNF Infection Control Payments, subsidiary information, net unreimbursed expenses attributable to COVID and survey questions.
New, Modified FAQs
At the same time it released the revised reporting requirements, HHS also released some changes to the PRF FAQs. HHS states in one newly added FAQs that the “burden of proof is on the Reporting Entity to ensure that adequate documentation is maintained.” HHS also clarifies that for-profit entities are subject to a single or program audit when they “expend $750,000 or more in annual awards” [emphasis added]. A previous FAQ stated this requirement was when for-profits “received” those dollars.
With respect to using PRF on expenses, HHS restates that COVID expenses are to be incremental/marginal in nature:
“…Provider Relief Fund payments may be applied to the remaining expenses or costs, after netting the other funds received or obligated to be received which offset those expenses. The Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus provided those expenses have not been reimbursed from other sources or that other sources are not obligated to reimburse.” [emphasis added]
What To Do Next
The changes from June 11 are important. We encourage everyone to review the revised reporting requirements, the revised FAQs and other information in detail. Consider these next steps:
- Double-check the dates you received each PRF distribution. Make sure you know the exact dates you received those by ACH transfer (or the date the check cashed). These dates dictate which time periods you will have to follow. If you fail to report on PRF for that time period, HHS will consider you to be out of compliance and you may be subject to recoupment.
- If you received any PRF distributions between April 10, 2020 and June 30, 2020, your deadline to use those dollars is June 30, 2021 – less than two weeks away.
- Review the revised registration guide and FAQs and prepare to register on the portal if you have not done so yet.
- Contact CLA for our advisory services/assistance. We are here to help.
Resources
- HHS PRF Revised Post-Payment Notice of Reporting Requirements: Reporting Requirements and Auditing
- HHS PRF Revised FAQs: CARES Act Provider Relief Fund Frequently Asked Questions (hhs.gov)
- HHS Reporting Portal (Revised FAQs): Revised PRF Portal FAQs
- HHS Reporting Portal (Revised Registration Guide): Revised PRF Registration Guide
- HHS PRF Reporting Portal (Main website): HHS PRF Reporting Portal Website
Jennifer Boese is the Director of Health Care Policy at CLA. She is a highly successful public policy, legislative, advocacy and political affairs leader, including working in both the state and federal government as well as the private sector. She brings over 20 years of government relations and public policy knowledge with her to CLA. Well over half of her career has been spent dedicated to health care policy and the health care industry, affording her a deep understanding of the health care market and environment, health care organizations and health care stakeholders. Her role at CLA is to provide thought leadership, policy analysis and strategic insights to health care providers across the continuum related to the industry's ongoing transformation towards value. A key focus of that work is on market innovations and emerging payment models. Her goal is to help CLA clients navigate and thrive in an increasingly dynamic health care environment.
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