Here is more detail on the issues covered by the updated and new FAQS:

• Nursing Home Infection Control Incentives: The FAQs confirmed that HHS would limit the incentives to four monthly performance payments eliminating the once proposed aggregate payment. HHS had a total of $1.2 billion to distribute for November and December infection control incentives. November payments were distributed to nursing homes the week of January 25 but we do not know the total amount distributed for November. Some members have reported larger than usual payments. HHS has yet to report on which nursing homes received payments and the amounts. We were told by the outgoing HHS staff that roughly 70% of nursing homes would receive these payments. We also await to hear when HHS will distribute the final December incentive payment, which covers performance from November 30 through December 27.

   

• Congress approved redistribution of targeted distributions within organizations: In December 2020, Congress changed the rules allowing parent organizations to allocate targeted distributions throughout their organizations and the latest FAQs provide additional details on the implications of this change. In essence, parent organizations can allocate targeted distributions (such as Nursing Home Infection Control(NHIC) payments) to other eligible health care provider subsidiaries. They can also attest to the payments even if the payment was received by the subsidiary. However, whichever entity receives the funds initially retains the responsibility to report on those funds, once reports can be submitted. Providers should keep in mind that regardless of where the money ends up, the FAQs do not absolve an organization from the terms and conditions associated with those funds. In most cases, the terms and conditions are similar with the exception of the Nursing Home Infection Control distribution and incentive payments, which can only be used for infection control expenses. Members for whom this parent/subsidiary organization situation is relevant should look closely at the new FAQs for further details.

   

• Reporting: HHS updated an FAQ indicating that reporting entities will be able to submit consolidated reports covering their general and targeted PRF payments. We believe this does not include NHIC payments, as the current reporting requirements maintain that there will be a separate reporting process for these payments. HHS has not yet issued reporting requirements for NHIC payments.

   

• Lost Revenue: Congress made changes permitting providers to use any reasonable method, including a budgeted to actual revenue comparison, to calculate lost revenues. HHS FAQs have followed up by clarifying that providers must report revenues on a calendar year basis and lost revenues must be calculated on an annual basis not quarterly or monthly. 

   

• Interest Earned on PRF: Another FAQ makes it clear that if providers have placed their PRF payments into an interest bearing account and earned interest, the interest earned can only be used for eligible expenses and lost revenues related to coronavirus as described by the terms and conditions. Just like the initial payments, if the provider does not have eligible expenses/lost revenues to offset the interest, the remaining funds will need to be returned.

   

• PRF Use for Vaccine Costs: The FAQs include a new section clarifies that providers can use of PRF for covering unreimbursed vaccine administration costs such as purchasing additional refrigerators or freezers, personnel costs to provide vaccines or transportation costs. In addition, PRF can cover the costs of vaccinating someone who does not have Medicare Part B coverage.