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.

 

 

AHCA/NCAL Summary of HRSA Phase 4 and Rural Documentation Webinarhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/AHCANCAL-Summary-of-HRSA-Phase-4-and-Rural-Documentation-Webinar-.aspxAHCA/NCAL Summary of HRSA Phase 4 and Rural Documentation Webinar10/18/2021 4:00:00 AM<p></p><div>Last week, Health Resources & Services Administration (HRSA) held its third Phase 4 and Rural distribution webinar focusing on documentation needed for the single application. HRSA also released detailed guidance on submitting Phase 3 Reconsideration Applications. </div><div><br></div><div>Highlights from the October 13 webinar include: <br><br></div><div><ul><li>General application instructions, including documentation guidance, are located in the <a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-application-instructions.pdf?cm_ven=ExactTarget&cm_cat=COVID-19+Update+%23214&cm_pla=All+Subscribers&cm_ite=Phase+4+General+Distribution+and+ARP+Rural+Payments+Application+Instructions.&cm_lm=1343767647&cm_ainfo=&&&&&" data-feathr-click-track="true" target="_blank">Phase 4 General Distribution and ARP Rural Payments Application Instructions.</a> </li><li>HRSA emphasis on, <strong><em>“Failure to submit the correct supporting documentation may result in HRSA deeming your application ineligible for payment.” </em></strong></li><li>Review of five scenarios which health care providers have tax requirements, use financial documentation, and/or have organizational structures which fall outside of their standard application documentation requirements. </li></ul></div><div>As part of this discussion, HRSA noted guidance on <em><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/prf-parent-subsidiary-reporting-fact-sheet.pdf?cm_ven=ExactTarget&cm_cat=COVID-19+Update+%23214&cm_pla=All+Subscribers&cm_ite=parent-subsidiary+relationships&cm_lm=1343767647&cm_ainfo=&&&&&" data-feathr-click-track="true" target="_blank">parent-subsidiary relationships</a></em> contained in its reporting guidance. Additionally, in an October 15 transmittal, HRSA outlined Phase 3 Reconsideration Application key steps. Phase 3 Reconsideration detail is located <a href="https://www.hrsa.gov/provider-relief/payment-reconsideration?cm_ven=ExactTarget&cm_cat=COVID-19+Update+%23214&cm_pla=All+Subscribers&cm_ite=here.&cm_lm=1343767647&cm_ainfo=&&&&&" data-feathr-click-track="true" target="_blank">here</a>. </div><div><br></div><div>AHCA/NCAL has also provided a <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/MemberOnlyDocs/COVID19/Phase%204%20and%20Rural%20Distirubtion%20Documentation%20Webinar%20Summary%2010.18.21.pdf?cm_ven=ExactTarget&cm_cat=COVID-19+Update+%23214&cm_pla=All+Subscribers&cm_ite=summary&cm_lm=1343767647&cm_ainfo=&&&&&" data-feathr-click-track="true" target="_blank">summary</a> of last week's webinar for members to easily reference.</div><div><br><br></div><p>​</p>Last week, Health Resources & Services Administration (HRSA) held its third Phase 4 and Rural distribution webinar focusing on documentation needed for the single application.
PRF Phase 4 & Rural Distribution Application Openhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/PRF-Phase-4-&-Rural-Distribution-Application-Open.aspxPRF Phase 4 & Rural Distribution Application Open9/29/2021 4:00:00 AM<div>The Provider Relief Fund (PRF) Phase 4 and Rural Distributions application <a href="https://www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">webpage</a> is now live. It offers an array of guidance and new educational opportunities including additional webinar dates in October. Notable materials are: <br></div><div>​<br></div><div><ul><li>​The <a href="https://cares.linkhealth.com/#/" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Provider Relief Fund Application and Attestation Portal </a><br></li><li><a href="https://www.hrsa.gov/provider-relief/future-payments/phase-4-arp-rural" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Application Instructions Webpages</a></li><li>Terms and Conditions<br></li><ul><li style="text-decoration:underline;">​<a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/terms-and-conditions-phase-4-general-distribution-relief-fund.pdf" data-feathr-click-track="true" target="_blank">Phase 4 - Terms and Conditions </a></li><li><span style="text-decoration:underline;">​​</span><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/terms-and-conditions-ARP-rural.pdf" data-feathr-click-track="true" target="_blank"><span style="text-decoration:underline;">ARP Rural - Terms and Conditions</span> </a></li></ul></ul></div><div><strong>The application will close on October 26, 2021, at 11:59 p.m. ET</strong>. Applications must undergo a number of validation checks before financial information is submitted. <strong>Providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline</strong>. Information on the documents and information needed to apply can be found in the resources following.<br></div><div><br></div><div>In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. Health Resources & Services Administration (HRSA) will also use existing Medicaid, Children's Health Insurance Program, and Medicare claims data in calculating portions of these payments.<br></div><div><br></div><div>Other HRSA resources include: <br></div><div><ul><li><span style="text-decoration:underline;"><a href="https://www.hrsa.gov/provider-relief/future-payments/phase-4-arp-rural" data-feathr-click-track="true" target="_blank">Application Instructions</a></span> (<a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-application-instructions.pdf" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Download PDF file</a>)</li><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-sample-application-form.pdf" data-feathr-click-track="true" target="_blank"><span style="text-decoration:underline;">S</span><span style="font-size:11pt;text-decoration:underline;">ample </span><span style="font-size:11pt;text-decoration:underline;">Application F</span><span style="font-size:11pt;text-decoration:underline;">orm</span></a></li><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-sample-application-form.pdf" data-feathr-click-track="true" target="_blank"><span style="font-size:11pt;text-decoration:underline;"></span></a><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-application-visual.pdf" data-feathr-click-track="true" target="_blank" style="font-size:11pt;">“<span style="text-decoration:underline;">How to Apply” Flow Chart</span></a></li><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-application-visual.pdf" data-feathr-click-track="true" target="_blank" style="font-size:11pt;"><span style="text-decoration:underline;"></span></a><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/annual-revenues-worksheet.xlsx" data-feathr-click-track="true" target="_blank" style="font-size:11pt;text-decoration:underline;">Annual Revenues from Patient Care Worksheet</a></li><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/adjusted-revenues-worksheet.xlsx" data-feathr-click-track="true" target="_blank" style="font-size:11pt;text-decoration:underline;">​Annual Revenues Adjustment Worksheet</a></li></ul></div><div><strong>General Program Information</strong></div><div><ul><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-factsheet.pdf" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Fact Sheet - General</a></li><li><a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase4-arp-complex-factsheet.pdf" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Fact Sheet - Complex Organizational Structures</a><br></li></ul></div><div>HRSA also updated its <a href="https://www.hrsa.gov/provider-relief/faq/general-distribution" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">searchable FAQs</a> and the <a href="https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/provider-relief-fund-faq-complete.pdf" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">FAQ Document in PDF</a> adding Phase 4 and Rural Distribution eligibility ad application FAQs as well as new PRF Reporting FAQs. <br><br></div>
New PRF Phase 4 & Rural Distribution Application Information Releasedhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/New-PRF-Phase-4-&-Rural-Distribution-Application-Information-Released.aspxNew PRF Phase 4 & Rural Distribution Application Information Released9/27/2021 4:00:00 AM<p></p><div>Today, the Health Resources and Services Administration (HRSA) released additional information on the $17 Billion Phase 4 and the $8.5 Billion Rural Distribution application. Applicants will be able to apply for both <a href="https://www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments</a> during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). See a detailed list of eligible provider types <a href="https://www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">here</a>. </div><div><br>HRSA released information on:</div><div> </div><div><ul><li>​Required documentation for application</li><li>Creating an Application Account</li><li>An updated explanation of “rural” awards</li><li>How to apply for the Upcoming HRSA Phase 4 and Rural Distributions<br></li></ul></div><div><br><strong>Application Documentation Needed</strong></div><div><br></div><div>In HRSA’s announcement, the Agency notes supporting documentation and information needed to complete an application will include:</div><div><br></div><div><ul><li>​Applicant Tax Identification Number (TIN) and TINs for any subsidiaries</li><li>Internally-generated financial statements that substantiate operating revenues and expenses from patient care in 2019 Q1, Q3, and Q4; 2020 Q3 and Q4; and 2021 Q1 </li><li>Federal income tax return, audited financial statements, or internally-generated financial statements submitted in their entirety: </li></ul></div><div><br><img src="/News-and-Communications/Blog/PublishingImages/Pages/New-PRF-Phase-4-%26-Rural-Distribution-Application-Information-Released/Phase%204%20Table.jpg" alt="Phase 4 Table.jpg" style="margin:5px;" /><br><div>You can also continue to check the <a href="https://www.hrsa.gov/provider-relief/future-payments" data-feathr-click-track="true" target="_blank">PRF Future Payments</a> webpage for more updates as the application period approaches.</div><div><br></div><div><strong>Clarification on “Rural”</strong></div><div><br></div><div>ARP Rural payments will be determined based on the <strong>l</strong><strong>ocation of the patients, not the provider.</strong> You <strong>do not </strong>need to verify whether your patients live in an area that meets the definition of rural. Simply select whether your organization (including any subsidiaries) would like to be considered for ARP Rural payments during the application process. HRSA will base payments on data already available to us on the amount and type of Medicare, Medicaid, and CHIP services provided to rural patients. HRSA will use the Federal Office of Rural Health Policy <a href="https://www.hrsa.gov/rural-health/about-us/definition/index.html" data-feathr-click-track="true" target="_blank">definition of rural</a>.</div><div><br><strong>Portal Availability & Application Account Creation</strong></div><div><br></div><div><strong>The application will open on September 29, 2021 and close on October 26, 2021 at 11:59 PM ET.</strong> Providers who previously created an account in the <a href="https://cares.linkhealth.com/#/" data-feathr-click-track="true" target="_blank">Provider Relief Fund Application and Attestation Portal</a> and have not logged in for more than 90 days will need to first reset their password before starting a new application. In order to streamline the application process and minimize administrative burdens, <strong>providers will apply for both programs in a single application</strong>.</div><div><br></div><div><strong>Application Education and Resources </strong></div><div><br></div><div>HHS recently hosted a <a href="https://www.youtube.com/watch?v=RAlLfxWRDwU#t=00s" data-feathr-click-track="true" target="_blank">briefing session</a> to provide information about these upcoming funding opportunities. HRSA will also host webinar sessions featuring guidance on how to navigate the application portal. Register now using the links below.</div><div><br></div><div><ul><li><a href="https://webex.webcasts.com/starthere.jsp?ei=1498144&tp_key=a107a70478" data-feathr-click-track="true" target="_blank"><strong>Thursday, September 30</strong></a> from 3:00 – 4:00 PM ET </li><li><a href="https://webex.webcasts.com/starthere.jsp?ei=1497665&tp_key=df7fdbdc74" data-feathr-click-track="true" target="_blank"><strong>Tuesday, October 5</strong></a> from 3:00 – 4:00 PM ET </li><li>T<span style="font-size:11pt;">wo additional webinars the weeks of October 11 and 18 (dates, times, and registration forthcoming) </span></li></ul></div><div><br></div><div>AHCA/NCAL will make available a pre-recorded webinar on applying on October 5, 2021. The pre-recorded event will be located at ahcancalED and a link will be sent to members.  </div><div><br></div><div><strong>Additional Information <br><br></strong></div><div>For additional information, contact the HRSA 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></div>Today, HRSA released additional information on the $17 Billion Phase 4 and the $8.5 Billion Rural Distribution application.
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>