The Department of Health and Human Services (HHS) issued a press release detailing how the first $30 billion of the $100 billion Provider Relief Fund created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act will be allocated and disseminated. The administration states that “funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.”
Allocation: Facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for the rapid distribution. Providers will receive a portion of the initial $30 billion based on their share of the $484 billion Medicare FFS reimbursements in 2019. Providers can estimate their payments by dividing the 2019 Medicare FFS payments they received by $484,000,000,000, then multiplying that ratio by $30,000,000,000. HHS explained that, for example, a hospital which billed Medicare FFS $121 million in 2019 could expect to receive about $7.5 million.
Dissemination: Relief payments are being delivered immediately through direct deposit starting April 10, 2020. Payment will be made to the billing organization according to its Taxpayer Identification Number (TIN). Providers must abstain from balance billing any patient for COVID-related treatment as a condition of the funding. HHS is partnering with UnitedHealth Group (UHG) to distribute the funds. Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). Paper checks will be sent to providers who normally receive a paper check for reimbursement from CMS. Providers must sign an attestation (available the week of April 13, 2020 here) confirming receipt of the funds and agreeing to the terms and conditions within 30 days of receiving the payment.
While detailed information about the administration’s plan for the remaining $70 billion is not yet available, HHS noted it is working to develop targeted distributions that will focus on:
- Providers in areas particularly impacted by the COVID-19 outbreak;
- Rural providers;
- Providers who deliver services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population; and
- Providers requesting reimbursement for the treatment of uninsured Americans.
On the last point, the administration doubled down on its position that a portion of the $100 billion will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
Further, HHS explained that private insurers are required to cover its members’ cost-sharing payments for COVID-19 testing under the Families First Coronavirus Response Act. The administration also noted that President Trump has received 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.