HRSA Updates on Rural Payments and Period 1 Reporting

COVID-19; Provider Relief Fund
The Health Resources and Services Administration (HRSA) recently provided an update on Rural Allocation payment amounts, reasons for payment delays, and information on how to address delays in Period 1 reporting.   

HRSA reported 96 percent of Rural Payments have been processed, and 11 percent of payment dollars ($788M) issued last week were to nearly 8,300 SNFs. Understanding there is a wide range of award amounts, the average SNF payment to-date is $95,000 based on HRSA’s numbers. The full breakdown of payments to-date is: 

  • ​68 percent to acute care hospitals; 
  • 11 percent to nursing homes; 
  • 4 percent to multi-specialty practices; and 
  • 17 percent to mix of other provider times in smaller portions.  
In total, 43,759 providers of all types have received an average payment of $170,700.   

Pending Rural Payments  
For pending Rural Payments, HRSA will notify providers as it completes the review and processing of remaining applications. HRSA noted three broad possible reasons for delays:  

  1. ​Errors in calculations requiring corrections and possible requests for additional information from providers;  
  2. Large awards which require additional review as noted above; or  
  3. Complex corporate arrangements.  
Further, the agency reported that additional review for program integrity through a manual process requires additional time and distribution for the balance of funds. Providers should receive funds in the coming weeks on a rolling basis as applications are processed or a notification/reason for declined application(s). Larger allocations will receive more detailed instructions (over $100k+), and paper letters are going out for eligible subsidiary billing TINS included in their application.   

Next Steps for Providers 
Providers who signed up for Optum Pay Accounts by November 30 for all TINs, including qualifying subsidiary arrangements, should have received payments. HRSA indicated the agency sent instructions to providers who need to set up Optum Pay Accounts with their payment notification emails. If an Optum Pay Account has not yet been set up, the rural payment may not come until 2022.  

For providers with delays that do not appear to relate to Optum Pay Account set up, AHCA/NCAL is exploring strategies with HRSA to determine the reason for payment delays and offer members some predictability regarding payment timing.  

Other action steps include:  

  • ​Providers must reenter the PRF application and attestation portal and sign attestation confirming receipt of funds and terms and conditions within 90 days of receiving payment. 
  • Providers that reject payment must return funds within 15 days. Not returning funds within 90 days will be considered acceptance of the terms and conditions. 
Questions about attestation and funds return should be directed to Provider Support at 866-569-3522; TTY dial 711.   

Payment Methodology Review  
HRSA also reviewed the data points used for payment calculation:  

  • ​Medicaid, Medicare, and CHIP claims were paid at Medicare rates. 
  • Calculated claims determined by subsidiary TIN/ billing. 
  • Adjusted claims-based payments to the amount of available ARP Rural funding and ensures that eligible providers receive at least $500 per subsidiary billing TIN. 
  • Aggregated billing payments to the filing TIN. 
Reporting Requirements and Use of Funds 
HRSA noted additional guidance on ARP Rural Payments will be released including key considerations:   

  • ​Is this expense necessary and reasonable to support patient or client care efforts to prevent, prepare for, or respond to COVID? 
  • Is this expense incurred consistent with our organizations policies and procedures?  
HRSA is working to process Phase 4 applications and anticipates first Phase 4 payment in mid-to-late December 2021.  

Guidance for Providers with Delayed Report Submission 
If a provider was unable to complete the Period 1 Reporting by November 30, providers should contact the Provider Support Line at (866) 569-3522 to share they missed the deadline but would like an opportunity to complete their report. HRSA indicates the call will be transferred to a representative who will collect their business name, TIN, and POC info. HRSA is currently tracking providers who call in to report the missed the deadline and will contact them if an opportunity is available after the portal maintenance concludes on December 5.