COVID-19 Funding

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The U.S. Department of Health and Human Services (HHS) has provided much-needed funding to many long term care facilities through the CARES Act Provider Relief Fund (PRF) and Quality Incentive Program (QIP). These funds support American families, workers, and the heroic health care providers in the battle against the COVID-19 outbreak.

AHCA/NCAL is helping our skilled nursing and assisted living​ member providers address PRF and QIP issues through work with Capitol Hill and the Administration. In partnership with our state affiliates, AHCA/NCAL is collecting outstanding funding concerns our members are facing. Contact COVID19@ahca.org with any questions.

UPDATE: HHS released​ updated reporting requirements for recipients of PRF payments. With this announcement, HHS expands the amount of time providers will have to report information, aims to reduce burdens on smaller providers, and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020. Read More​
 

 Provider Relief Fund

The Provider Relief Fund​ (PRF) supports health care providers in the battle against the COVID-19 pandemic. This funding is provided through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act.​

 PRF Resources

Update: Provider Relief Fund FAQs
HHS recently updated the ​Provider Relief Fund (PRF) FAQs to clarify Ownership Structures and Financial Relationships between “parent” and “subsidiary” entities that received PRF funding (General and Targeted).

Provider Relief Fund Questions
There are several resources to assist with PRF questions. Contact the CARES Act Fund Hotline at (866) 569-3522 (for TTY dial 711). You can also review the HHS Frequently Asked Questions, which includes information about using the PRF for vaccine administration​.​

WebEx: Provider Relief Fund Reporting Requirements
This WebEx recording includes registration details, registration FAQs, recommended terms and conditions compliance controls, and a PRF reporting update overview.

U.S. Government Accountability Office (GAO) Report
The January 28th GAO report – Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention (GAO-21-265) – made several recommendations (focused around areas like COVID-19 testing, vaccines and therapeutics, and the medical supply chain) to federal agencies to improve the ongoing response and recovery efforts in the areas of public health and the economy. It is important to note that there is a summary of the PRF allocations and disbursements as of 12/31/20 on page 54.

This document offers detail on u​se of funds for health care related expenses and transfer of funds to higher need buildings. 

 Quality Incentive Payments

AHCA/NCAL is advocating on behalf of our members to provide the necessary resources regarding the Quality Incentive Payments (QIP), as well as promoting a fairer incentive program. This step-by-step chart is available to help providers correct any previously made errors when filling out NHSN data. 

Entering this data is valuable in determining how cases are spreading throughout facilities.

With the distribution of December QIP payments on Friday, February 12, it appears that this will be the last payment that HHS will make for this program. Although HHS previously stated there would be an aggregate payment, the running total through December is $2 billion – which is the total allocated for the program.

The county population and county case rate are factored in the methodology, as well as the resident occupancy level and resident case rate. The vast majority of facilities with at least 1 infection will not receive payment. The number of facilities paid per month decreased from around 10,000 in September to 6,000 in December due to the increasing number of cases in the later months of the program. Additionally, since all of the factors varied in each month, the payment you may have received can also vary widely.

 

 

HHS Releases Updated PRF Reporting Requirementshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/HHS-Releases-Updated-PRF-Reporting-Requirements.aspxHHS Releases Updated PRF Reporting Requirements6/11/2021 4:00:00 AM<div><span style="font-size:14.6667px;">​The U.S. Department of Health and Human Services (HHS) <a href="https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf" target="_blank">released​</a> updated reporting requirements for recipients of Provider Relief Fund (PRF) payments. With this announcement, HHS expands the amount of time providers will have to report information, aims to reduce burdens on smaller providers, and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020. Some key updates include:</span></div><div><ul><li><span style="font-size:14.6667px;">The period of availability of funds is based on the date the payment is received (rather than requiring all payments be used by June 30, 2021, regardless of when they were received).</span></li><li><span style="font-size:14.6667px;">Recipients are required to report for each Payment Received Period in which they received one or more payments exceeding, in the aggregate, $10,000 (rather than $10,000 cumulatively across all PRF payments).</span></li><li><span style="font-size:14.6667px;">Recipients will have a 90-day period to complete reporting (rather than a 30-day reporting period).</span></li><li><span style="font-size:14.6667px;">​The PRF Reporting Portal will open for providers to start submitting information on July 1, 2021.</span></li></ul><div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>Summary of Reporting Requirement</strong>s</span></div><span style="font-size:11pt;">​</span><img src="/News-and-Communications/Blog/PublishingImages/Pages/HHS-Releases-Updated-PRF-Reporting-Requirements/PRF%20Chart.jpg" alt="PRF Chart.jpg" style="font-size:11pt;margin:5px;" /></div></div><p>​<br></p>HHS has released​ updated reporting requirements for recipients of PRF payments.
Long Term Care Industry Urges HHS to Provide Extension for Provider Relief Fund Reportinghttps://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Long-Term-Care-Industry-Urges-HHS-To-Provide-Extension-For-Provider-Relief-Fund-Reporting.aspxLong Term Care Industry Urges HHS to Provide Extension for Provider Relief Fund Reporting6/8/2021 4:00:00 AM<p></p><div>Long term care facilities have been at the epicenter of the COVID-19 pandemic from the very beginning. To help fight the virus, nursing homes and assisted living communities have received approximately $14 billion of the $178 billion in the Provider Relief Fund (PRF) established by the CARES Act. </div><div><br></div><div>These federal dollars have gone towards critical resources such as personal protective equipment (PPE), testing, hiring additional workers, and providing hero pay and overtime wages. With this significant increase in expenditures, support from the PRF has been essential for long term care providers to maintain operations and keep their doors open. </div><div><br></div><div>PRF recipients must report the to the U.S. Department of Health and Human Services (HHS) how their money was spent and return any unused funds by June 30, 2021. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a <a href="/News-and-Communications/Fact-Sheets/Letters/HHS-Letter-PRF.pdf" target="_blank">letter</a> to HHS Secretary Xavier Becerra in April, requesting that the reporting deadline be extended to December 30, 2022. In the letter, AHCA/NCAL explains why an extension is needed: <br><br></div><div><ul><li>Skilled nursing facilities (SNFs) and assisted living communities (ALCs) will experience ongoing higher operating costs while occupancy remains at record lows. The industry is expected to lose $94 billion over a two-year period (2020-2021) due to the skyrocketing costs to fight the pandemic. In 2020, nursing homes spent roughly $30 billion on PPE and additional staffing alone. Many SNFs and ALC providers faced financial struggles even before the pandemic, but the situation is becoming more dire with the industry anticipating record closures.</li></ul></div><div><br><ul><li>Declining occupancy has compounded financial challenges. SNF occupancy declined by 16.5 percent between January 2020 and January 2021. Occupancy rates for ALCs dropped to a record-low 77.7 percent in the fourth quarter of 2020. Our research estimates that more than 1,600 SNFs could close in 2021. A recent AHCA/NCAL member survey indicated that 56 percent of ALCs would not be able to maintain operations at current levels an additional 12 months without additional revenue or financial relief.</li></ul></div><div><br>Members of Congress also recognize the need for an extension. Congresswoman Terri Sewell (D-AL-07) sent a <a href="/Reimbursement/Documents/Congressional%20PRF%20Request%20to%20HHS.pdf" target="_blank">letter</a> to Secretary Becerra specifically regarding long term care, citing the low Medicaid reimbursement rates and pandemic-related financial hardships that have negatively impacted long term care providers. The letter, which was co-signed by more than 50 Democrat and Republican Members of Congress, asked that the reporting deadline be extended to December 2022, and that an additional $10 billion from the PRF be allocated to long term care facilities. Congresswoman Cindy Axne (D-IA-03) and Congresswoman Mariannette Miller-Meeks (R-IA-02) also <a href="https://axne.house.gov/sites/axne.house.gov/files/Axne%20and%20Miller-Meeks%20PRF%20Deadline%20Letter%20to%20HHS.pdf" target="_blank">sent</a> a bipartisan letter to Secretary Becerra with nearly 80 co-signatures, requesting the June 30 deadline be extended for health providers. The American Hospital Association <a href="https://www.aha.org/lettercomment/2021-05-10-letter-americas-hospitals-and-health-systems-urging-hhs-extend-deadline" target="_blank">requested</a> an extension until the end of the public health emergency. </div><div><br></div><div>Restaurants have until 2023 to use COVID relief funding, and the federal government should take a similar approach with aid to health care providers. Although we have turned a corner on the pandemic, COVID-related measures, and therefore, costs will continue in the long term. Federal support has been instrumental in helping protect our vulnerable seniors and frontline caregivers. We must continue to rally around them and give them the support they need.</div><div><br></div><div><strong>ABOUT AHCA/NCAL</strong></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.<br><br></div>To help fight the virus, nursing homes and assisted living communities have received approximately $14 billion of the $178 billion in the Provider Relief Fund (PRF) established by the CARES Act.
AHCA/NCAL Requests Extension for Provider Relief Fund Reportinghttps://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/AHCANCAL-Requests-Extension-for-Provider-Relief-Fund-Reporting.aspxAHCA/NCAL Requests Extension for Provider Relief Fund Reporting6/3/2021 4:00:00 AM<p></p><div>The Provider Relief Fund (PRF) established by the CARES Act has been an instrumental resource for health care providers amid the pandemic. Long term care facilities have received approximately $14 billion of the $178 billion in the PRF since the pandemic began, which has helped providers with the exorbitant costs associated with combating the virus. Personal protective equipment (PPE), testing, hiring additional workers and providing hero pay are just a few things the aid has helped pay for. For many providers, the funding was the difference between keeping their doors open or closing them for good. </div><div><br></div><div>Recipients of PRF funding are subject to reporting requirements set by the U.S. Department of Health and Human Services (HHS). HHS has set a deadline of June 30, 2021 for recipients to report how the PRF funds have been used and to return any unused funds. </div><div><br></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a <a href="/News-and-Communications/Fact-Sheets/Letters/HHS-Letter-PRF.pdf" target="_blank">letter</a> to HHS Secretary Xavier Becerra in April, requesting that the reporting deadline be extended to December 30, 2022. In the letter, AHCA/NCAL explains why the extension is needed: </div><div><br></div><div><ul><li>Skilled nursing facilities (SNFs) and assisted living communities (ALCs) will experience ongoing higher operating costs while occupancy remains at record lows. The industry is expected to lose $94 billion over a two-year period (2020-2021) due to the skyrocketing costs to fight the pandemic. In 2020, nursing homes spent roughly $30 billion on PPE and additional staffing alone. Many SNFs and ALC providers faced financial struggles even before the pandemic, but the situation is becoming more dire with the industry anticipating record closures.<br></li></ul></div><div><ul><li>Declining occupancy has compounded financial challenges. SNF occupancy declined by 16.5 percent between January 2020 and January 2021. Occupancy rates for ALCs dropped to a record-low 77.7 percent in the fourth quarter of 2020. Our research estimates that more than 1,600 SNFs could close in 2021. A recent AHCA/NCAL member survey indicated that 56 percent of ALCs would not be able to maintain operations at current levels an additional 12 months without additional revenue or financial relief.​<br></li></ul></div><div>AHCA/NCAL is not alone in requesting an extension. Congresswoman Cindy Axne (D-IA-03) and Congresswoman Mariannette Miller-Meeks (R-IA-02) also sent a <a href="https://axne.house.gov/sites/axne.house.gov/files/Axne%20and%20Miller-Meeks%20PRF%20Deadline%20Letter%20to%20HHS.pdf" target="_blank">letter</a> to Secretary Becerra – co-signed by nearly 80 Republican and Democrat Members – asking that the June 30 deadline be extended for health providers to use the funds, and that remaining PRF funding be distributed as soon as possible. The American Hospital Association <a href="https://www.aha.org/lettercomment/2021-05-10-letter-americas-hospitals-and-health-systems-urging-hhs-extend-deadline" target="_blank">requested</a> that the deadline be extended until the end of the public health emergency. </div><div><br></div><div>Restaurants, which also experienced significant hardships over the course of the pandemic, have until 2023 to use COVID relief funding. AHCA/NCAL hopes that HHS takes the same approach with the PRF for health care providers.   </div><div><br></div><div>Federal lawmakers rallied around long term care facilities and gave them some of the critical assistance they needed, but they still need support. COVID-related expenditures will remain constant for the foreseeable future. Extending the reporting deadline will help long term care providers maintain operations and continue to protect our most vulnerable citizens and frontline health care heroes. </div><div><br></div><div><strong>ABOUT AHCA/NCAL</strong><br></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.<br></div>The Provider Relief Fund established by the CARES Act has been an instrumental resource for health care providers amid the pandemic.
Important QIP HHS FAQshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Important-QIP-HHS-FAQs.aspxImportant QIP HHS FAQs4/12/2021 4:00:00 AM<div><span style="font-size:14.6667px;">​​​AHCA is flagging two ​U.S. Department of Health and Human Services (HHS) <a href="https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdf">FAQs</a> relating to the Quality Incentive Program (QIP). Be sure to also check out the AHCA/NCAL <a href="/Reimbursement/Pages/COVID-19-Funding.aspx">provider relief fund and QIP website</a> that has helpful information and resources.</span></div><div><span style="font-size:14.6667px;"> </span></div><div><ul><li><span style="font-size:14.6667px;"><strong>​Will HHS allow providers to make corrections to the data used to determine Targeted Distribution eligibility and payment amounts?</strong> (Added 10/28/2020) Going forward, HHS will allow providers that submitted data as part of the COVID-19 High Impact Area Distribution and/or the Nursing Home Infection Control/Quality Incentive Payment Distribution, a limited opportunity to submit corrected data for up to 5 business days after the submission deadline. HHS will only accept corrections within the 5-day time period that are accompanied by a justification for why the provider erred in the initial data submission. HHS will review each request for correction on a case-by-case basis and may determine that a previous payment be amended to align with the updated data. Providers who submit updated data may have their payments delayed for up to 90 days from the date of submission pending review and adjudication. All HHS decisions are final and there is no appeals process.<br><br></span></li><li><strong>​How is the infection gateway calculated for determining eligibility for Quality Incentive Program payments under the Nursing Home Infection Control Distribution? </strong>(Added 12/28/2020) The infection gateway criterion specifically excludes facilities that are found to have an infection rate exceeding the estimated infection rate in their county during the performance period. County infection rates are measured using daily COVID-19 community profile reports (CPRs) disseminated under the HHS Protect data program. CPRs contain information on the rate of COVID-19 infections for all residents in each county. <span style="text-decoration:underline;">County infection rates are not the same as county positivity rates.</span>​</li></ul></div>AHCA is flagging two HHS FAQs relating to the Quality Incentive Program.