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 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 Begins Phase 4 Payments & Payment Reconsideration Updates Begins Phase 4 Payments & Payment Reconsideration Updates12/14/2021 5:00:00 AM<p></p><div><span style="font-size:14.6667px;">The Health Resources and Services Administration (HRSA) today announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments to health care providers who have experienced revenue losses and expenses related to the COVID-19 pandemic. HRSA reports a total of $17 billion for release in Phase 4.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">Of the $9 billion released today, HRSA states the average payment for small providers is $58,000, $289,000 for medium providers, and $1.7 million for large providers. More than 69,000 providers in all 50 states, Washington, D.C., and eight territories will receive Phase 4 payments. Payments will start to be made later this week, and the Phase 4 payment methodology is available <a href="" data-feathr-click-track="true" target="_blank">here</a>.   </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">The PRF Phase 4 payments are in addition to the $7.5 billion in American Rescue Plan (ARP) Rural payments to providers and suppliers who serve rural Medicaid, Children's Health Insurance Program, and Medicare beneficiaries.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">HRSA will make Phase 4 awards on a rolling basis. More details on HRSA’s recent update on Phase 4 roll out, status of outstanding ARP Rural Payments, and how to complete Period 1 Reporting if you were unable to report were shared in a recent <a href="/News-and-Communications/Blog/Pages/Important-HRSA-Updates.aspx" data-feathr-click-track="true" target="_blank">AHCA/NCAL update</a>.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">Additional HRSA resources are available, including the <a href="" data-feathr-click-track="true" target="_blank">HHS press release</a> and a <a href="" data-feathr-click-track="true" target="_blank">state-by-state breakdown</a> of Phase 4 payments. AHCA/NCAL will continue to provide updates as more information becomes available. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>Payment Reconsideration Updates</strong> </span></div><div>HRSA has also updated its <a href="" data-feathr-click-track="true" target="_blank">payment reconsideration webpage</a>, a process intended for providers who believe their payment was not correctly calculated. The update provides preliminary information on how to request a Phase 4 or ARP Rural Reconsideration. <br></div><div><ul><li>​Providers will not have an opportunity to submit an application if they missed a deadline. </li><li>Providers will not be able to revise or correct their original application - e.g., elect to be considered for ARP Rural payment after their Phase 4/ARP Rural application was submitted. </li><li>HRSA will not consider reconsideration requests that would require a change to payment methodology or policy. </li></ul></div><div>HRSA notes providers may appeal their awards, but the payment methodology will not change.  <br></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;"></span></div><div><span style="font-size:14.6667px;"></span>Updates by payments include:  </div><div><ul><li><span style="font-size:14.6667px;">​</span><strong><em>ARP Rural and Phase 4 Payment Reconsideration</em></strong>: The reconsideration window for ARP Rural and Phase 4 payments will open February 1, 2022. Providers will be able to request reconsideration of their ARP Rural and/or Phase 4 payments. Details regarding the application process will be provided on this website by February 1, 2022. At a minimum, providers will need to provide in their reconsideration application information confirming their eligibility for ARP Rural and/or Phase 4 payment reconsideration, as well as information necessary to enable HRSA to link the reconsideration request with the original ARP Rural and Phase 4 application. This information is expected to include: a copy of the email or letter the provider received from HRSA communicating the ARP Rural and/or Phase 4 payment determination the provider would like HRSA to reconsider, as well as the taxpayer identification number, DocuSign envelope ID for the ARP Rural/Phase 4 application, and contact information from the original application.  The PRF Phase 4 and ARP Rural Reconsiderations FAQ is available <a href="" data-feathr-click-track="true" target="_blank">here</a>.  <br></li><li><strong><em>Phase 3 Payment Reconsideration</em></strong>: The Phase 3 Payment Reconsideration period closed on November 12, 2021. HRSA is processing the requests that were received, including reviewing providers’ original submitted applications again based on the established <a href="" data-feathr-click-track="true" target="_blank">PRF Phase 3 Payment Methodology</a>. Given the volume of requests received and the complexity of the reviews, HRSA anticipates that review of requests will occur over an extended period of time. </li></ul></div><div><span style="font-size:14.6667px;"></span><strong>If you have questions about a Phase 3 Reconsideration Request, contact the Provider Support Line at 866-569-3522 (for TTY, dial 711) for assistance</strong>. Providers should have the following information available when calling: <br></div><div><ul><li><span style="font-size:14.6667px;">The recipient's or applicant's Tax Identification Number (TIN). </span></li><li><span style="font-size:14.6667px;">The name of the recipient or applicant as it appears on the most recent tax filing. </span></li><li><span style="font-size:14.6667px;">The mailing address for the recipient or applicant as it appears on the most recent tax filing. </span>​</li></ul></div>HRSA today announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments.
Important HRSA Updates HRSA Updates12/13/2021 5:00:00 AM<div>The Health Resources and Services Administration (HRSA) shared an updated status of delayed American Rescue Plan (ARP) Rural payments and suggestions for provider action steps, overview of Phase 4, and action steps for Period 1 Reporting if providers missed the November 30 deadline.   <br></div><div><br></div><div><strong>ARP Rural Payments</strong> </div><div>Some applications are still in process due to the size of award, Optum Account ID challenges, and pending denial letters or HRSA’s term, No Pay Letters. If a provider disagrees with the award amount, they will have the ability to request a reconciliation review. <br></div><div><br></div><div>In terms of Optum Account ID challenges, providers waiting for their ARP Rural applications’ determination should confirm they have an active Optum Pay Account for the TIN that they anticipate receiving funds, if determined eligible. One to two weeks are needed to process an ID request. If providers submit the ID request after November 30, they will likely receive ARP Rural payments in January. HRSA noted that a particularly common error is use of a non-payment TIN rather than the payment account application.   </div><div><br></div><div>HRSA recommended that providers check the three-digit TIN on the initial HRSA ARP Rural notification letter to determine whether the payment account number is being used, or, in HRSA terms, “active.” If not, this could be the payment release challenge. HRSA may send an email regarding the need to <a href="" data-feathr-click-track="true" target="_blank">set-up an Optum account</a> from <em></em>. This email address should be added to a provider’s email “safe” list to ensure it does not go to a “junk” email folder.  <br></div><div><br></div><div>Other ARP Rural payment challenges, which require<a href="" data-feathr-click-track="true" target="_blank"> manual review</a>, include:  </div><div><br></div><div><ul><li><em>Duplications</em>: HRSA noted it is reviewing provider accounts with a parent or holding company to ensure there were no duplicate submissions (e.g., a parent/holding company submission as well as subsidiary submissions). The HRSA Factsheet on complex organization structures and related guidance is available <a href="" data-feathr-click-track="true" target="_blank">here</a>.  </li><li><em>Calculation Errors</em>: As previously noted, the Agency continues to work through calculation errors. No additional information is needed from providers. While HRSA will not be contacting providers for additional information, they should contact HRSA via the Provider Support Line at (866) 569-3522 to request an application status update if they still have not received their ARP Rural payment in early to mid-January.    </li></ul></div><div></div><div><br></div><div><strong>PRF Phase 4</strong> <br></div><div>The Phase 4 process should be simpler because much of the background analysis was completed for ARP Rural payments. In terms of the TIN validation step in the Phase 4 application, providers may not edit the data submitted after submitting this information for IRS validation. <br></div><div><br></div><div>For the Tax and Financial Information submission step in DocuSign, providers can resubmit the entire application. That means if a provider wishes to edit the information in DocuSign, they must re-enter all the financial information and re-upload supporting documentation. If providers submit multiple applications, HRSA will review the last application submitted before the deadline - and this will lead to delays in Phase 4 payments. </div><div><br></div><div><strong>Phase 4 and ARP Rural Payments</strong> </div><div>For both Phase 4 and ARP Rural payments, while delays in funding are problematic, HRSA offered two helpful points.  <br></div><div>​​<br></div><div><ol><li>​​<em>Additional Time for Use</em>: Phase 4 and Phase IV/Rural awards received after January 2 will offer providers six months more to use the funds due to how the reporting periods are set up. </li><li><em>Reconciliation Requests</em>: Providers may request reconciliation reviews if they believe their awards are incorrect.   <br></li></ol></div><div>HRSA noted such requests may begin to be submitted after January 22, 2022.   <br></div><div><br></div><div><strong>​PRF Reporting Period 1 </strong>  <br></div><div>Information has been posted at HRSA’s <a href="" data-feathr-click-track="true" target="_blank">reporting portal</a> for report completion, and the portal has been re-opened. Providers will have until <strong>Monday, December 20 at 11:59 PM ET</strong> to file. Providers who contacted the Support Center to alert HRSA about reporting challenges will receive an email notifying them the reporting portal is open. However, all providers - including those who did not notify HRSA of a reporting issue - may go to the portal and complete their reports with no penalty.   <br></div><div><br></div><div>PRF recipients who submitted a Reporting Period 1 report, but need to correct an error, must contact the Provider Support Line at (866) 569-3522 to gain access to their submitted report. Resubmitted reports must also be received by Monday, December 20 at 11:59 PM ET. Providers can easily access the <a href="" data-feathr-click-track="true" target="_blank">PRF reporting portal​</a>, as well as <a href="" data-feathr-click-track="true" target="_blank">additional information</a>. </div><div><br></div><div>For assistance with reporting or portal questions, please contact the Provider Support Line at (866) 569-3522. </div><div>​<br></div><div><strong>ARP and Phase 4 Award Challenges </strong></div><div>​HRSA is unable to address provider-specific payment issues until mid-January. Providers should contact HRSA at the Provider Support Line at (866) 569-3522. The Agency has asked AHCA to collect information on challenge trends with awards so it can make national corrections. In early January, AHCA will provide contact information to submit awards challenge issues so we may share trend information with HRSA. <span style="font-size:11pt;">​</span></div>HRSA shared an updated status of delayed ARP Rural payments and suggestions for provider action steps, overview of Phase 4, and action steps for Period 1 Reporting if providers missed the November 30 deadline.
HRSA Updates on Rural Payments and Period 1 Reporting Updates on Rural Payments and Period 1 Reporting12/3/2021 5:00:00 AM<div><span style="font-size:14.6667px;">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.   </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">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: </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">​68 percent to acute care hospitals; </span></li><li><span style="font-size:14.6667px;"></span>11 percent to nursing homes; </li><li>4 percent to multi-specialty practices; and </li><li>17 percent to mix of other provider times in smaller portions.  <br></li></ul></div><div><span style="font-size:14.6667px;"></span>In total, 43,759 providers of all types have received an average payment of $170,700.   </div><div><span style="font-size:14.6667px;"></span></div><div><strong><br></strong></div><div><span style="font-size:14.6667px;"></span><strong>Pending Rural Payments</strong>  </div><div>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:  <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><ol><li><span style="font-size:14.6667px;">​Errors in calculations requiring corrections and possible requests for additional information from providers;  </span></li><li>Large awards which require additional review as noted above; or  </li><li>Complex corporate arrangements.  </li></ol></div><div>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.   <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>Next Steps for Providers </strong></span></div><div>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.  <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">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.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">Other action steps include:  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">​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. </span></li><li>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. </li></ul></div><div>Questions about attestation and funds return should be directed to Provider Support at 866-569-3522; TTY dial 711.   <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>Payment Methodology Review</strong>  </span></div><div>HRSA also reviewed the data points used for <a href="" data-feathr-click-track="true" target="_blank">payment calculatio</a>n:  <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">​Medicaid, Medicare, and CHIP claims were paid at Medicare rates. </span></li><li>Calculated claims determined by subsidiary TIN/ billing. </li><li>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. </li><li>Aggregated billing payments to the filing TIN. </li></ul></div><div><span style="font-size:14.6667px;"></span><strong>Reporting Requirements and Use of Funds</strong> </div><div>HRSA noted additional guidance on ARP Rural Payments will be released including key considerations:   <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">​Is this expense necessary and reasonable to support patient or client care efforts to prevent, prepare for, or respond to COVID? </span></li><li><span style="font-size:14.6667px;"></span>Is this expense incurred consistent with our organizations policies and procedures?  </li></ul></div><div>HRSA is working to process Phase 4 applications and anticipates first Phase 4 payment in mid-to-late December 2021.  <br></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>Guidance for Providers with Delayed Report Submission </strong></span></div><div>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. <br></div>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 Releases ARP Rural Distribution Releases ARP Rural Distribution11/23/2021 5:00:00 AM<div>​The Health Resources and Services Administration (HRSA) began releasing the $7.5 billion American Rescue Plan (ARP) Rural Distribution this week. ARP Rural payments are being made to providers and suppliers who have served rural Medicaid, Children's Health Insurance Program (CHIP), and Medicare beneficiaries from January 1, 2019 through September 30, 2020. <br></div><div><br></div><div>Every eligible provider that served at least one rural Medicare, Medicaid, or CHIP beneficiary will receive funding. Eligibility for the Rural Distribution is based on the number of beneficiaries whose residency is designated as rural rather than the physical location of the provider. </div><div><br></div><div>Approximately 40,000 providers in 50 states, Washington, D.C., and six territories will receive ARP Rural payments. HRSA will begin distributing the Phase 4 $17 billion in mid-December.  </div><div><br></div><div><strong>ARP Rural Distribution Update </strong></div><div><strong><br></strong></div><div>HRSA is releasing the Rural Awards on a rolling basis. State-by-state total awards for all health care providers are available <a href="" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">here</a>. The data is currently organized by total provider awards. Provider type (e.g., SNF and AL) specific amounts are not yet available. Provider specific awards may be <a href="" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">located</a> by provider name and zip code. <br></div><div><br></div><div>As with other awards, within 90 days of receiving a payment, recipients must sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions of payment by re-entering the <a href="" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Provider Relief Fund (PRF) Application and Attestation Portal</a>. If a recipient chooses to reject the funds, they must also complete the attestation to indicate this and return the funds within 15 calendar days.</div><div><br></div><div>If providers believe their Rural Award was made in error, HRSA’s calculation methodology is <a href="" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">available for review</a>. Questions about ARP Rural Awards should be directed to the Provider Support Line at 866-569-3522 (for TTY dial 711).<br></div><div><br></div><div><strong>Phase 4 Distribution Update</strong></div><div><strong><br></strong></div><div>HRSA continues to indicate it will begin releasing the $17 billion in Phase 4 awards on a rolling basis in mid-December. Many ARP Rural payment recipients will also be eligible for additional funding through the <a href="" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">$17 billion PRF Phase 4</a> opportunity that was also made available during the same time period. Providers could apply for both opportunities through a single application.<br></div><div>​<br></div><div>HRSA expects to begin releasing PRF Phase 4 payments in December 2021. Similar to the ARP Rural payments, HRSA plans to send individual communications to providers when final payment determinations are made. Providers with questions about the Phase 4 and ARP Rural application process should contact the Provider Support Line at 866-569-3522 (for TTY dial 711).<br></div><div><br><br></div><p>​</p>The Health Resources and Services Administration (HRSA) began releasing the $7.5 billion American Rescue Plan (ARP) Rural Distribution today.