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 program include:
- 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 as instructed.
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 population.
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 Accelerated Advanced 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 provider/supplier must:
- 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 balance.
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 automatic.
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.