On Friday, April 10, 2020, the U.S. Department of Health and Human Services (HHS) announced it will begin disbursing $30 billion of the $100 billion of the Public Health and Social Services Emergency Fund recently allocated by the Coronavirus Aid, Relief, and Economics Security Act (CARES Act), signed March 27, 2020. Inclusive of the $30 billion, the $100 billion funding will be used to reimburse healthcare providers and facilities:
(i) for healthcare-related expenses;
(ii) for lost revenue attributable to coronavirus; and
(iii) to ensure uninsured Americans have access to testing and treatment.
The initial $30 billion distributed is intended to provide relief to providers in areas heavily impacted by the COVID-19 pandemic and to providers struggling to stay open due to cancelled elective services and/or other healthy patients delaying care. While it is not entirely clear, it appears all suppliers and providers will receive a portion of the $30 billion disbursement in accordance with the methodology outlined below. As further described below, if a provider or supplier is unable to agree to the Terms and Conditions of Payment, it must contact HHS within 30 days of receipt and remit the full payment.
Any amount awarded under the $30 billion disbursement will not require repayment and should not be considered a loan. Facilities and providers will be allotted a portion of the $30 billion based on their share of 2019 Medicare fee-for-service (FFS) reimbursements (not including Medicare Advantage). Providers may estimate their payments using the following formula:
This can also be calculated by multiplying the provider’s 2019 Medicare FFS payments received (not including from Medicare Advantage) by 0.06198.
The $30 billion distribution will be delivered in partnership with UnitedHealth Group (UHG). Providers will be paid via the Automated Clearing House account information on file with UHG, UnitedHealthcare, or Optum Bank, or the Centers for Medicare & Medicaid Services (CMS). Providers who typically receive a paper check for reimbursement will receive this payment by check. All relief payments will be made to the billing organization according to its Taxpayer Identification Number (TIN). Payments to practices that are part of larger medical groups will be sent to the group’s central billing office.
Large Organizations and Health Systems will receive payments for each of their billing TINs that bill Medicare.
Employed physicians should not expect to receive an individual payment directly. Rather, as the billing organization, the employer organization will receive the payment.
Individual physicians and providers in a group practice are unlikely to receive individual payments directly. As the billing organization, the group practice will receive the payment.
Solo practitioners will receive a payment under the TIN they use to bill Medicare.
Providers began receiving deposits starting April 10, 2020. Within 30 days of receipt of payment, providers must sign an attestation found here (available April 13, 2020) confirming receipt and agreeing to the Terms and Conditions of Payment. If a provider does not agree, the provider must contact HHS within 30 days of receipt and remit the full payment. The terms and conditions include, but are not limited to, the following:
- An agreement not to collect or seek to collect out-of-pocket payments from a COVID-19 patient if the payments are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider (i.e. “balance billing”);
- Certification that the payment will only be used to prevent, prepare for, and respond to COVID-19, and will reimburse the recipient only for healthcare-related expenses or lost revenues that are attributable to the COVID-19 pandemic;
- Certification that the recipient is currently providing diagnoses, testing, or care for individuals with possible or actual cases of COVID‐19;
- An agreement to not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse;
- A certification that the recipient billed Medicare in 2019, is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs and that its Medicare billing privileges are not currently revoked; and
- Additional reports must be submitted by entities receiving more than $150,000 in funds under the CARES Act, the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, or any other Act primarily making appropriations for the COVID-19 pandemic response and related activities.
For the remaining $70 billion, additional targeted distributions will likely focus on providers in areas affected by the COVID-19 outbreak, rural providers, and providers of services with lower shares of Medicare FFS reimbursement or who predominantly serve the Medicaid population.
Distributions will also be used to reimburse providers for COVID-19 care for uninsured Americans. In particular, the following actions have, are, or will be taken:
(i) A portion of the $100 billion will be used to reimburse healthcare providers at Medicare rates for COVID-related treatment of the uninsured.
(ii) Pursuant to the Families First Coronavirus Response Act signed into law on March 18, 2020, private insurers are now required to cover an insurance plan member's cost-sharing payments for COVID-19 testing.
(iii) The Trump Administration has secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system to waive cost-sharing payments for treatment related to COVID-19 for plan members.
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