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.

 

 

HRSA Releases Additional Phase 4 and Rural Distribution Detailshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/HRSA-Releases-Additional-Phase-4-and-Rural-Distribution-Details.aspxHRSA Releases Additional Phase 4 and Rural Distribution Details9/15/2021 4:00:00 AM<p style="text-align:center;"><strong>Portal Opens on September 29​</strong><br></p><div>Yesterday, September 15 the Health Resources and Services Administration (HRSA) released additional details on the $25 billion September 10th announcement composed of the $17 billion Phase 4 distribution and the $8.5 billion rural distribution.   <br></div><div>​<br></div><div><strong>HRSA Updates & ​New Details </strong></div><div>The Administration provided context for the size of the distribution and the parameters for award, eligibility, and use. HRSA noted the Provider Relief Fund (PRF) has approximately $39 billion. HRSA indicated the $39 billion will be reduced by the Phase 4 $17 billion to $22 billion. However, it is likely the $8.5 billion will also reduce the unobligated to $14 billion. The unobligated remaining amount of $22 or $14 billion is impacted by the ongoing availability of payments to providers who deliver care to the uninsured. Of note, HRSA also confirmed that virtually all skilled nursing facilities (SNFs) and assisted living communities (ALCs) (including private pay) are eligible for Phase 4.  ​<br></div><div><br></div><div><strong>Phase 4 Distribution</strong></div><div>Based upon parameters in the <a href="https://www.congress.gov/bill/116th-congress/house-bill/133/text" data-feathr-click-track="true" target="_blank">Consolidated Appropriations Act</a>, Phase 4 is modeled on Phase 3 and aimed at reimbursing providers for lost revenues and expenses related to COVID-19 based on Q3-4 of 2020 and Q1 of 2021.  Phase 4 is open to all providers, including new providers – “any provider or supplier of health care, services, and support in a medical setting, at home, or in the community” is eligible to apply.  Unlike the rural portion of funds, providers will not be excluded based on geography. To view a list of eligible providers, click <a href="https://akastage-www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">here</a>.  <br></div><div><br></div><div>HRSA made clear that the new methodology implemented in this distribution is intended to support the Administration’s broader goals around health equity:</div><div><ul><li><strong>More generous for smaller providers </strong>– the new methodology is intended to better support smaller providers. Specifically, HHS indicates its goals for the distribution is “reimbursing smaller providers….at a higher rate compared to larger providers.” HRSA is defining “small, medium and large” providers by the volume of Medicaid and Medicare patients served during the performance period.  Additional details on these delineations will be provided by HRSA next week.  <br></li><li><strong>Bonus payments based on services to Medicaid/Medicare payments </strong>– the methodology is also intended to reward those providers serving Medicare and Medicaid patients at a higher rate (vs. commercially insured). </li></ul></div><div><br></div><div>HRSA also views Phase 4 as two allocations and Phase 4 awards will be calculated based on two different methodologies:</div><div><br></div><div><ul><li>75% calculated based on revenue losses and COVID-related expenses ($12.75 billion).<br></li><li>25% put towards bonus payments that are based on the amount and type of service provided to Medicaid, CHIP, and Medicare patients ($4.25 billion).<br></li></ul></div><div></div><div>For more details on the sub-allocations, click <a href="https://akastage-www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">here</a>.  </div><div><br></div><div><strong>Rural Distribution </strong></div><div>Of the $25 billion, $8.5 billion is specified by the <a href="https://www.congress.gov/bill/117th-congress/house-bill/1319/text" data-feathr-click-track="true" target="_blank">American Rescue Plan Act</a> – the large, COVID-19 relief package Congress passed in March – for “rural providers.”  HRSA noted that “rural provider” means providers who meet their definition of rural as well as providers who deliver care to rural patients as well as an additional bonus payment based upon the number of Medicaid and Medicare patients.  Providers may determine whether their locations are considered rural by inputting their address into HRSA’ <a href="https://data.hrsa.gov/tools/rural-health?tab=Address" data-feathr-click-track="true" target="_blank">Rural Provider Validator</a>. Payments to providers who serve rural patients will be based upon the number of rural patients served during the performance period.  SNFs that provide Medicaid or Medicare financed care and ALCs who provide Medicaid financed care are eligible.  HRSA indicated that due to the heavy emphasis on the number of Medicaid and Medicare beneficiaries served during the performance period, it is unlikely private ALC will be eligible.  </div><div><br></div><div><strong>Applying for Funding & Award Timing </strong></div><div>Though the funding opportunities are separate and distinct, HHS will use a single application portal for providers to apply for funding.  HRSA plans to release application guidance (including more detail on the award methodology) the week of September 20 with the <strong>application portal opening on September 29.  </strong>The portal will remain open for four weeks, or until November 20.  HRSA anticipates releasing Rural Distribution awards by mid-November and Phase 4 distribution awards by mid-December.  </div><div> </div><div><strong>Other PRF Information</strong><strong></strong></div><div><em>Phase 3 Reconsideration</em></div><div>As part of the September 10 announcement, HRSA noted it will reconsider Phase 3 awards.  While the reconsideration process and materials are not yet available, providers may email HRSA, now, at <a href="mailto:prfreconsideration@hrsa.gov" data-feathr-click-track="true" target="_blank">prfreconsideration@hrsa.gov</a> to indicate they will be requesting reconsideration and to be included in a reconsideration email distribution list.  <br></div><div><br></div><div><em>Grace Period for Reporting  </em></div><div>Provider Relief Fund awardees <a href="https://www.hrsa.gov/provider-relief/reporting-auditing" data-feathr-click-track="true" target="_blank">are required to submit reports</a> to HHS that documents whether a provider’s lost revenue and expenses match the awards received.  Technically, reports still are due on September 30.  HRSA is providing a penalty-free grace period until November 30.  However, providers are encouraged to submit reports if they are ready to do so.  </div><p>​<br></p>
HHS Distributes Phase 4 Provider Relief Fundhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/HHS-Distributes-Phase-4-Provider-Relief-Fund.aspxHHS Distributes Phase 4 Provider Relief Fund9/10/2021 4:00:00 AM<p><br></p><div>Today, the U.S. Department of Health and Human Services (HHS) announced it​ will be releasing Phase 4 of the Provider Relief Fund (PRF). Phase 4 consists of $17 billion for providers who can document revenue loss and expenses associated with the pandemic. HHS has also created an option for reconsideration of Phase 3 awards and extended the due date for the first PRF Reports, formerly due on September 30, 2021, by 60 days. It is also possible rural SNFs and assisted living communitie​s may be eligible for the $8.5 for rural providers.​ </div><div><br></div><div>Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will: </div><div><ul><li>​Be based on providers’ lost revenues and coronavirus-related expenditures between July 1, 2020, and March 31, 2021. </li><li>Reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers. </li><li>Also include bonus payments for providers who serve Medicaid, CHIP and Medicare patients, who tend to be lower income and have greater and more complex medical needs. </li><ul><li>HRSA will price these bonus payments at the generally higher Medicare rates for Medicaid and CHIP patients to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.​<br></li></ul></ul></div><div>Similarly, HRSA will make American Rescue Plan (ARP) rural payments to providers based on the amount of Medicaid, CHIP and Medicare services they provide to patients who live in rural areas as defined by the <a href="https://data.hrsa.gov/tools/rural-health?tab=Address" data-feathr-click-track="true" target="_blank">HHS Federal Office of Rural Health Policy</a>. Accordingly, ARP rural payments will also generally be based on Medicare reimbursement rates.</div><div><br></div><div><strong>Applications</strong></div><div><br>The application portal will open on September 29, 2021. Virtually, all health care providers should be eligible to apply for funding in this distribution. Even providers who received funding previously may be newly eligible for consideration. In order to expedite and streamline the application process, <strong>providers will apply for both programs in a single application</strong>. HRSA will use existing Medicaid, CHIP, and Medicare claims data in calculating payments. To help ensure that these provider relief funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with or acquisition of another health care provider during the period in which they can use the payments. Providers who report a merger or acquisition may more likely be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.</div><div><br></div><div>To promote transparency in the PRF program, HHS is also releasing <a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase-3-methodology-overview.pdf" data-feathr-click-track="true" target="_blank">detailed information</a> about the methodology utilized to calculate PRF Phase 3 payments. Providers who believe their PRF Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on PRF Phase 3 reconsideration process are forthcoming.</div><div><br></div><div><strong>September 30 Report Due Date Delayed </strong></div><div><br></div><div>In light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS announced today a 60-day grace period to help providers come into compliance with their PRF <a href="https://www.hrsa.gov/provider-relief/reporting-auditing" data-feathr-click-track="true" target="_blank">reporting obligations</a> if they fail to meet the September 30, 2021 deadline for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate recoupment or similar enforcement actions for noncompliant providers during this grace period.</div><div><br></div><div><strong>Additional Phase 4 Information</strong></div><div><br></div><div>AHCA will have more detail on the Phase 4 award methodology available next week, including possible rural SNF and ALC eligibility for the $8.5 billion aimed at rural providers. For now, additional resources and information can be found at the PRF Phase 4 announcement <a href="https://www.hhs.gov/about/news/2021/09/10/hhs-announces-the-availability-of-25-point-5-billion-in-covid-19-provider-funding.html" data-feathr-click-track="true" target="_blank">webpage</a>, at the PRF Reporting <a href="https://www.hrsa.gov/provider-relief/reporting-auditing" data-feathr-click-track="true" target="_blank">webpage​</a>, or by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8 AM to 10 PM CT, Monday through Friday.<br></div>Today, HHS announced they will be releasing Phase 4 of the PRF.
AHCA/NCAL Praises the Biden Administration for Allocating Federal Funds to Long Term Care and Other Health Care Facilitieshttps://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/AHCANCAL-Praises-the-Biden-Administration-for-Allocating-Federal-Funds-to-Long-Term-Care-and-Other-Health-Care-Facilities.aspxAHCA/NCAL Praises the Biden Administration for Allocating Federal Funds to Long Term Care and Other Health Care Facilities9/10/2021 4:00:00 AM<p><br></p><div><strong>WASHINGTON, D.C.</strong> – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released the following statement today in reaction to the U.S. Department of Health and Human Services making $25.5 billion available to health care providers, including nursing homes and assisted living communities, affected by the COVID-19 pandemic through the American Rescue Plan and Provider Relief Fund.</div><div><br></div><div>The statement is attributable to Mark Parkinson, president and CEO of AHCA/NCAL.</div><div><br></div><div>“This financial aid is long overdue, but greatly appreciated by the long term care sector. Nursing homes and assisted living communities continue to spend billions of dollars to fight COVID while grappling with an economic and workforce crisis spurred by the pandemic.</div><div><br></div><div>“These federal funds are critical in helping providers acquire the ongoing staff support, personal protective equipment, and testing they need to protect our residents and staff members as well as prevent facility closures. We hope to see this aid delivered swiftly to the frontlines, so our nation’s most vulnerable continue to receive the high quality, long term care they deserve.”</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" data-feathr-click-track="true" target="_blank">www.ahcancal.org​</a>.<br></div>AHCA/NCAL released the following statement today in reaction to HHS making $25.5 billion available to health care providers, including nursing homes and assisted living communities, affected by the COVID-19 pandemic through the ARP and PRF.
Growing Number Of U.S. Senators Urge HHS To Distribute Provider Relief Fund Resources To Health Care Providershttps://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Growing-Number-Of-U-S--Senators-Urge-HHS-To-Distribute-Provider-Relief-Fund-Resources-To-Health-Care-Providers.aspxGrowing Number Of U.S. Senators Urge HHS To Distribute Provider Relief Fund Resources To Health Care Providers9/7/2021 4:00:00 AM<p>​​<span style="font-size:11pt;">Members of Congress on both sides of the aisle are asking the U.S. Department of Health and Human Services (HHS) to release the remainder of the Provider Relief Fund (PRF) to health care providers – including nursing homes – as they continue to battle COVID-19. No PRF funding has been distributed to the health care sector this year, even as the pandemic lingers.<br></span><span style="font-size:11pt;"><br>Last week, Senate Republican Leader Mitch McConnell (R-KY), and Senators Roy Blunt (R-MO), Richard Burr (R-NC), Richard Shelby (R-AL) and Mike Crapo (R-ID) sent a <a href="https://www.blunt.senate.gov/imo/media/doc/prf_letter_9-2-21.pdf" data-feathr-click-track="true" target="_blank">letter</a> to HHS Secretary Xavier Becerra, noting that it has been 11 months since the last PRF distribution was announced:</span></p><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div>“The nation is currently experiencing the ‘fourth wave’ of COVID-19 infections, with hospitals and health care providers around the country stretched to breaking points not seen since the earliest days of the pandemic. Some states have asked hospitals to stop elective procedures, others lack health care staffing resources. As many hospitals run out of bed space and staffing resources wear thin, facilities located in COVID-19 hotspots are diverting acute care patients requiring non-COVID related procedures out of state. Additionally, intensive care unit beds are at capacity in many regions, and nursing home infections have increased once again after a June low …</div></blockquote><div><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div>​“It has been eleven months since the last PRF distribution was announced. We believe it is imperative for the Administration to continue to fight the pandemic with all available means, including by swiftly disbursing PRF funds to providers buckling under the weight of surging COVID-19 cases.”</div></blockquote><div><br></div><div>A bipartisan group of more than 40 U.S. Senators, led by Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH), also sent a <a href="https://www.collins.senate.gov/sites/default/files/Collins-Shaheen%20PRF%20Letter%202021-08-26.pdf" data-feathr-click-track="true" target="_blank">letter</a> to Secretary Becerra, asking that the funding in the PRF be distributed right away so that health care providers can weather the financial challenges of the pandemic: <br><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div>“Over the course of the pandemic, Congress has appropriated $178 billion for the Provider Relief Fund as well as an additional $8.5 billion for rural providers. Hospitals, nursing homes, assisted living providers, health clinics, and other health care providers need these funds to help weather the financial difficulties created by the pandemic. In rural areas in particular, the PRF has prevented facilities that struggled before and during the pandemic from falling into bankruptcy or closing entirely …</div></blockquote><div><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div>“On July 19, the Government Accountability Office reported that about 25 percent of Provider Relief Fund appropriations and all of the rural provider funding remained unobligated as of May 31, 2021 … GAO recommended that HHS communicate information about, and facilitate oversight of, the department’s use of COVID-19 relief funds by providing projected time frames for its planned distributions in the spend plans it submits to Congress.</div></blockquote><div><br></div><blockquote style="margin:0px 0px 0px 40px;border:none;padding:0px;"><div>​“We fully agree with GAO’s assessment and ask that HHS announce and implement its plans for additional disbursement of provider relief funds. As the health care provider community continues to respond to the challenges posed by the pandemic, this funding should be released without any further delay.”</div></blockquote><div><br></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has <a href="/News-and-Communications/Fact-Sheets/Letters/Letter-HHS-PRF-8.9.21.pdf" data-feathr-click-track="true" target="_blank">stressed to HHS</a> that immediate aid from the PRF is critical, as long term care facilities continue to face a severe economic crisis due to chronic Medicaid underfunding and ongoing pandemic-related costs. Without government assistance, nearly 2,000 long term care facilities are at risk of closing during the pandemic.</div><div><br></div><div>Federal officials must act now. The pandemic is not over, and long term care providers need help to keep our nation’s most vulnerable safe. Immediate funding from the PRF will help safeguard our nursing homes and assisted living communities and ensure providers can keep delivering quality care to their residents.</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" data-feathr-click-track="true" target="_blank">www.ahcancal.org</a>.<br><br><br></div>Members of Congress on both sides of the aisle are asking HHS to release the remainder of the PRF to health care providers – including nursing homes – as they continue to battle COVID-19.