Download a fact sheet on the relief fund (PDF)
The Centers for Medicare & Medicaid Services on April 10 began distributing $30 billion in funds from the new $100 billion Public Health and Social Services Emergency Fund created by the CARES Act. Another $20 billion began going out to providers on April 24.
The quick dispersal of relief funds will aid providers in areas heavily impacted by the COVID-19 pandemic and those who are struggling to keep their doors open due to healthy patients delaying care and practices or patients canceling elective services.
These are payments, not loans, to health care providers and will not need to be repaid. This program is separate from the Medicare Advanced Payment initiative and the Small Business Administration's Paycheck Protection Program, which are loans.
Who is eligible for a payment?
- All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible.
- Payments will be made according to Taxpayer Identification Numbers (TIN).
- Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
- As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
There is no direct bar under the CARES Act to accepting a payment from the relief fund and other sources, so long as the payment from the relief fund is used only for permissible purposes and otherwise complies with the Terms and Conditions.
How are payment distributions determined?
- Provider payments will be based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were about $484 billion in 2019. Based on available information, the Academy believes the distribution will include Part B drug reimbursements.
- A provider can estimate their approximate payment by multiplying the 2019 Medicare FFS (not including Medicare Advantage) payments they received by 6.19% ($30 billion divided by $484 billion).
- Providers can obtain their 2019 Medicare FFS billings from their organization's revenue practice management system.
Example 1: A practice billed Medicare FFS $1 million under a single TIN in 2019. This is how much they would receive using the equation:
- $1,000,000 x 6.19% = $61,900
Example 2: A large practice billed Medicare FFS $25 million under a single TIN in 2019. This is how much they would receive using the equation:
- $25,000,000 x 6.19% = $1,547,500
What to do if you are eligible to receive payment?
- CMS is partnering with UnitedHealth Group (UHG) to provide automatic payments to providers eligible for the distribution of the initial $30 billion in funds.
- Providers will be paid via Automated Clearing House account information on file with UHG or CMS.
- The automatic payments will come to providers via Optum Bank with "HHS-STIMULUS" or "HHSPAYMENT" as the payment description.
- Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well within the next few weeks.
- Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13.
- Terms and Conditions (PDF). Payment of these relief funds is conditioned on the health care provider's acceptance of the Terms and Conditions, which must occur within 30 days of receiving payment. These terms and conditions include:
- Certifying that the payment reimburses the recipient only for COVID-19 health care-related expenses or lost revenues that are attributable to coronavirus
- Certifying that the payment will not be used for expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse
- Any recipient of more than $150,000 must submit a report to the Health and Human Services Secretary and the Pandemic Response Accountability Committee on how funds received were expended. These reports are due no later than 10 days after the end of each calendar quarter.
- If a provider receives payment and does not wish to comply with these Terms and Conditions, the provider must do the following: Contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed.
CMS will be providing details on the HHS webpage in the near future about how providers who can’t or don’t want to comply with the Terms and Conditions can return the money.
Providers must meet all Terms and Conditions. Note that one item in the Terms and Conditions refers to treating individuals with “possible or actual cases of COVID-19.” CMS has indicated that they view any patient as someone with a “possible” case of COVID-19.
Will more relief funds be available?
- There will be second round of payments focusing on providers in areas affected by COVID-19, providers of services with lower shares of Medicare FFS reimbursement or who predominantly serve Medicaid, and to providers for COVID-19 care for the uninsured.
- Trump administration officials said the fund would also help reimburse hospitals that treat uninsured patients.
How does this apply to different types of providers?
- All relief payments are being made to providers according to their tax identification number (TIN). For example:
- Large Organizations and Health Systems: Large Organizations will receive relief payments for each of their billing TINs that bill Medicare. Each organization should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
- Employed Physicians: Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
- Physicians in a Group Practice: Individual physicians and providers in a group practice are unlikely to receive individual payments directly, as the group practice will receive the relief fund payment as the billing organization. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
- Solo Practitioners: Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare.
- Definition of Executive Level II pay level. The salary limitation is based upon the Executive Level II of the Federal Executive Pay Scale. Effective Jan. 5, the Executive Level II salary is $197,300. For the purposes of the salary limitation, the direct salary is exclusive of fringe benefits and indirect costs. An individual’s direct salary is not constrained by the legislative provision for a limitation of salary. The rate limitation simply limits the amount that may be awarded and charged to the grant. A recipient may pay an individual’s salary amount in excess of the salary cap with nonfederal funds.
When will the portal be ready?
The portal is tentatively scheduled to be open the week of April 13 and will be linked from the HHS webpage.
Read more about the $30 billion relief on CMS' website.
Read the Academy's full coverage of the pandemic at aao.org/coronavirus.