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Andres Sanchez
Written by: Andres Sanchez

On April 10, 2020, the United States Department of Health & Human Services (“HHS”) commenced “Provider Relief Fund” distributions to Medicare providers (“Recipients”). The initial distributions totaled $30 Billion out of a total $100 Billion appropriated by the CARES Act for a Public Health and Social Services Emergency Fund.  The initial grant distributions went to each Recipient based on the Recipient’s share of the total Medicare fee-for-service reimbursements (excluding Medicare Advantage payments) in 2019.

Distributions are being direct deposited to eligible Recipients via Optum Bank. Within 30 days of receiving a payment, a Recipient is required to sign an attestation confirming that they have received the funds and agreeing to the Relief Fund Payment Terms and Conditions. The full text of the Term and Conditions is located here.

The Terms and Conditions impose the following requirements and restrictions:

  • The grant funds can only be used for the prevention, preparation and response to the coronavirus. A Recipient can only be reimbursed for healthcare related expenses or lost revenues attributable to the coronavirus.
  • The Recipient cannot use the grant funds to reimburse expenses or losses that are reimbursed from other sources, or that other sources are obliged to reimburse.
  • The Recipient is required to submit reports to ensure compliance with all Terms and Conditions. The form and requirements of the reports will be specified at a future time by the HHS Secretary.
  • Any Recipient that receives more than $150,000 total in funds from any act primarily making appropriations for the coronavirus response will also be required to submit a report to the HHS Secretary and the Pandemic Response Accountability Committee detailing, among other things, the total amount of funds received; a list of all projects or activities for which funds were expended, including the name, description, and the estimated number of jobs created or retained; as well as information on all sub-contracts or subgrants awarded by the recipient, its subcontractors or subgrantees.
  • All Recipients are required to keep records and cost documentations for the award, to be submitted at the request of the HHS Secretary, and to cooperate in all audits to ensure compliance with the Terms and Conditions.
  • A Recipient agrees that for all care for a possible or actual case of COVID-19, they will not seek to collect from patient’s out-of-pocket expenses greater than what the patient would have been required to pay if the care had been provided by an in-network recipient.
  • Additional restrictions include a ban on the use of funds for executive pay at a rate in excess of Executive Level II of the Federal Executive Pay Scale, funding gun control advocacy, lobbying, abortions, embryo research, promotion of the legalization of controlled substances, etc.

HHS has announced the remaining $70 Billion will be used for targeted distributions focusing on “providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medical reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans.”