Download a fact sheet on the Provider Relief Fund (PDF)
The Department of Health and Human 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.
Provider Relief Fund
The quick disbursal of relief funds through the Provider Relief Fund 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 payments and the Small Business Administration's Paycheck Protection Program, which are loans.
See answers to questions about the Provider Relief Fund.
Updated July 21, 2020
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.
- In June, HHS announced it would also distribute funds to providers who treat Medicaid and Children's Health Insurance Program patients through an Enhanced Provider Relief Fund. The deadline to apply has been extended to Aug. 3.
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 fee-for-service 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
Updated July 15, 2020
What to do if you are eligible to receive payment?
- HHS 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.
Updated July 21, 2020
Submitting financial documentation
Providers who automatically received their Provider Relief Fund payments before 5 p.m. Friday, April 24, must submit documentation of their annual revenues, including tax forms or financial statements, to the Department of Health and Human Services through the HHS General Distribution Portal. Although the deadline to apply for additional General Distribution funds was on June 3, data submission is required of all recipients and will also preserve eligibility for future payments.
The terms and conditions that recipients must sign to accept Relief Fund payments require those who received at least $150,000 through any CARES Act legislation to submit quarterly reports to HHS and the Pandemic Accountability Committee.
However, providers who received more than $150,000 in Recipients of Provider Relief Fund payments do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee. HHS will compile this information and post the names and payment amounts on its website of all providers who have attested to receiving a payment and agreed to the terms and conditions (or retain such a payment for more than 90 days). HHS is also working with the Department of Treasury to report the aggregate total of the Provider Relief Fund payments each recipient attested to on USAspending.gov. Posting the data meets the reporting requirements of the CARES Act.
However, the terms and conditions also require recipients of Provider Relief Fund payments to submit any reports requested by the HHS secretary. HHS will let recipients know about more details about these reports in coming weeks.
Updated July 15, 2020
Will more relief funds be available?
- Congress is currently considering whether more relief funds will be set aside for businesses suffering from the pandemic, including health care providers.
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.
Updated July 21, 2020
The U.S. Department of Health and Human Services guidance on the Provider Relief Fund changes frequently. Check answers to frequently asked questions on the HHS website: