September 20, 2020

HHS Issues PRF Reporting Guidance with Limits on Lost Revenue

BY Nicole Fallon

This document supplements previous reporting information issued in July and revised August. 14. 

As part of the required reports, providers must report certain data for 2019 and 2020:

  • Healthcare related expenses attributable to coronavirus: Providers will be expected to report expense in two categories: General and Administrative expenses; and healthcare related operating expenses. Providers are advised that only those expenses not reimbursed by other sources can be reported here.
    • Providers who received between $10,000 and $499,999 in aggregate PRF payments can report their expenses in aggregate by category. However, providers receiving $500,000 or more in PRF payments will report their expenses in detail within each of the categories. The guidance offers further examples for each expense catrogry; 
  • Lost revenues: This calculation becomes relevant if all PRF dollars received were not consumed by the COVID-19 healthcare related expenses. Lost revenues are defined as, “year-over-year net patient care operating income (i.e., patient care revenue less patient care related expenses for the Reporting Entity,…).” This approach is more limited than previous HHS guidance which permitted “any reasonable method of estimating lost revenue.” Previously, providers could compare budgeted to actual or use a year-over-year comparison. In addition, HHS appears to cap the application PRF payments toward lost revenues up to either:
    • the amount of a provider’s 2019 net gain from healthcare related sources or
    • up to a net zero gain/loss in 2020, if the provider reported negative net operating income in 2019.

LeadingAge is concerned about the potential impact of this approach for some providers.

  • Calendar year expenses and revenues for each of the years;
  • Other types of assistance received, such as Paycheck Protection Program funds, FEMA CARES Act dollars, state and local government assistance and other funds.
  • Personnel Metrics such as total personnel by labor category, hire/re-hires, separations
  • Patient Metrics including total number of admits, visits and residents.
  • Facility Metrics like total available staffed beds.

It should be noted that these reporting requirements do not apply to PRF dollars received as part of the Nursing Home Infection Control Distribution. HHS indicated it may issue separate reporting requirements for these payments as the associated terms and conditions for these funds limited their use to certain “infection control” expenses and explicitly prohibited their use for lost revenues.

Key dates

  • October 1, 2020: Previously announced date for opening the reporting system. HHS now has said this activity will not take place until early 2021.
  • February 15, 2021: Deadline by which to submit a first report due for PRF expenditures through December 31, 2020
  • July 31, 2021: Deadline by which to submit a second and final report for January 1 – June 30, 2021 revenues and expenditures.

The reporting guidance confirms that PRF payments can be used through June 2021. It is not clear if these timelines may shift should Congress appropriate additional dollars for the Provider Relief Fund or if the public health emergency (PHE) is extended beyond October 23, 2020. The reporting guidance notes that HRSA plans to offer webinars and issue related FAQs to assist in answering providers’ questions on the reporting requirements. Dates of these activities have not yet been announced. 

In addition to the reporting requirements, providers receiving more than $750,000 in federal awards, which include Provider Relief Funds, are subject to single audit requirements. According to HHS, “Provider Relief Fund General and Targeted Distribution payments (CFDA 93.498) and Uninsured Testing and Treatment reimbursement payments (CFDA 93.461) to non-Federal entities are Federal awards and must be included in determining whether an audit in accordance with 45 CFR Part 75, Subpart F is required (i.e., annual total federal awards expended are $750,000 or more). Audit reports must be submitted to the Federal Audit Clearinghouse …”

LeadingAge is interested in your feedback on how you believe these new requirements may impact your use of the PRF payments. Please contact Nicole Fallon with any questions, concerns or feedback about the new requirements.