CARES Act Relief for Health Care Providers
If you are a healthcare provider and have questions
about the CARES Act relief provisions, Sacks Tierney attorneys are
available to provide advice on these matters.
In addition to loan programs, tax credits, and other relief available to
small businesses in general, the Coronavirus Aid, Relief, and Economic
Security (CARES) Act has two important provisions for healthcare providers
during this ongoing COVID-19 pandemic: (1) a $100 billion healthcare
provider relief fund and (2) expansion of the Medicare accelerated payment
program. Details on these programs are below:
healthcare Provider Relief Fund
The CARES Act set up a $100 billion healthcare provider relief fund. As
explained by the Department of Health and Human Services (HHS), the will be
used to support healthcare-related expenses or lost revenue attributable to
coronavirus and to ensure uninsured Americans can get the testing and
treatment they need without receiving a surprise bill from a provider."
On April 10, 2020, HHS began delivery of the initial $30 billion of this
fund, and $26 billion was expected to hit providers' bank accounts that day.
If you receive your Medicare payments by direct deposit, you would have
received the payment from Optum Bank, marked "HHSPAYMENT." Details of this
Allocation of funding. The first $30
billion will be disbursed to health care providers proportionally, based on
the provider's share of total Medicare fee for service (FFS) payments in
2019. Total Medicare FFS payments in 2019 were $484 billion. A provider can
estimate its payment by dividing its 2019 Medicare FFS (not including
Medicare Advantage) payments it received by $484 billion, and then
multiplying that ratio by $30 billion.
Qualifications for funding. All facilities and
providers that received Medicare FFS reimbursements in 2019 are eligible for
this initial distribution.
Restrictions on use of funding. Providers that accept this funding are
banned from sending surprise balance bills to those they treat for the
coronavirus. Specifically, a provider must not 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. Additionally, providers that accept this
money to cover costs for treating the uninsured must accept Medicare rates.
What providers need to do after receiving funds. In order to officially
accept these funds, providers must sign an attestation confirming receipt of
funds and agree to the terms and conditions of payment within 30 days after
receipt of funds. They can do this through a provider portal that will open
up the week of April 13. As of April 14, the portal was not yet open; when
it is available, providers will be able to find it at
HHS Provider Relief.
If a provider does not want to accept the funds, the provider must contact HHS within 30 days of receipt of payment and remit the full payment to HHS
Future rounds of funding from the remaining $70 billion will have a more
formal application process, and those allocations could be targeted toward
providers that do not typically bill Medicare, such as pediatricians or
children's hospitals. Additionally, this future funding may focus on
providers in hotspot COVID areas, rural providers, and providers with lower
shares of Medicare reimbursement or that predominantly serve the Medicaid
Medicare Accelerated Payment Program
Acting pursuant to the CARES Act, the Centers for Medicare & Medicaid
Services (CMS) has expanded the current Accelerated and Advance Payment
Program to a broader group of Medicare Part A providers and Part B
suppliers. The expansion of the program is only for the duration of the
COVID-19 public health emergency. The CMS has explained an
"accelerated/advance payment" as:
An accelerated/advance payment is a payment intended to provide necessary
funds when there is a disruption in claims submission and/or claims
processing. These expedited payments can also be offered in circumstances
such as national emergencies, or natural disasters in order to accelerate
cash flow to the impacted health care providers and suppliers. CMS is
authorized to provide accelerated or advance payments during the period of
the public health emergency to any Medicare provider/supplier who submits a
request to the appropriate Medicare Administrative Contractor (MAC) and
meets the required qualifications.
Key details of this program can be found in the
Payments Fact Sheet, which includes information to help you locate your MAC
for application. Details of the program include the following:
Eligibility. To qualify for advance/accelerated payments the
have billed Medicare for claims within 180 days immediately prior to the
date of signature on the provider's/supplier's request form;
not be in bankruptcy;
not be under active medical review or program integrity investigation; and
not have any outstanding delinquent Medicare overpayments.
Amount of Payment. Qualified providers/suppliers will be asked to request a
specific amount using an Accelerated or Advance Payment Request form
provided on each MAC's website. Most providers and suppliers will be able to
request up to 100% of the Medicare payment amount for a three-month period.
Processing Time. Each MAC will work to review and issue payments within
seven calendar days of receiving the request. Already, CMS has received
over 25,000 requests from health care providers and suppliers for accelerated
and advance payments and has already approved over 17,000 of those requests
in the last week.
Repayment. CMS has extended the repayment of these accelerated/advance
payments to begin 120 days after the date of issuance of the payment. The
repayment timeline is broken out by provider type:
Inpatient acute care hospitals, children's hospitals, certain cancer
hospitals, and Critical Access Hospitals (CAH) have up to one year from the
date the accelerated payment was made to repay the balance.
All other Part A providers and Part B suppliers will have 210 days from
the date of the accelerated or advance payment was made to repay the
Recoupment and Reconciliation. The provider/supplier can continue to submit claims as usual after the
issuance of the accelerated or advance payment; however, recoupment will not
begin for 120 days. Providers/suppliers will receive full payments for
their claims during the 120-day delay period. At the end of the 120-day
period, the recoupment process will begin, and every claim submitted by the
provider/supplier will be offset from the new claims to repay the
accelerated/advanced payment. Thus, instead of receiving payment for newly
submitted claims, the provider's/supplier's outstanding accelerated/advance
payment balance is reduced by the claim payment amount. This process is
For most providers other than hospitals, repayment in full is required
within 210 days after the issuance of the accelerated payment. No interest
will accrue if paid within that time frame.
If a provider cannot pay in full by that time, it will receive a demand
letter from its MAC with a 30-day cure period, after which point interest
will begin to accrue. There is a process to obtain an extended payment plan
if a provider is unable to pay within that time frame.