Below are some of the key topics addressed in the latest version of the HHS FAQ: 

Eligible expenses: The CARES Act outlines eligible expenses for which the payments can be used:

• • building or construction of temporary structures
  • Leasing of properties
  • medical supplies and equipment including Personal protective equipment and testing supplies
  • increased workforce and training
  • emergency operation centers
  • retrofitting facilities
  • surge capacity.

HHS as part of its June 4 posted FAQs augments the CARES Act definition:“The term “health care related expenses attributable to coronavirus” is a broad term that may cover a range of items and services purchased to prevent, prepare for, and respond to coronavirus, including:

• • supplies used to provide healthcare services for possible or actual COVID-19 patients;

  • equipment used to provide healthcare services for possible or actual COVID-19 patients;

  • workforce training;

  • developing and staffing emergency operation centers;

  • reporting COVID-19 test results to federal, state, or local governments;

  • building or constructing temporary structures to expand capacity for COVID-19 patient care or to provide healthcare services to non-COVID-19 patients in a separate area from where COVID-19 patients are being treated; and

  • acquiring additional resources, including facilities, equipment, supplies, healthcare practices, staffing, and technology to expand or preserve care delivery.”

HHS also clarifies the timeframe during which eligible expenses will apply: “Providers may have incurred eligible health care related expenses attributable to coronavirus prior to the date on which they received their payment. Providers can use their Provider Relief Fund payment for such expenses incurred on any date, so long as those expenses were attributable to coronavirus and were used to prevent, prepare for, and respond to coronavirus. HHS expects that it would be highly unusual for providers to have incurred eligible expenses prior to January 1, 2020.”

Lost Revenues: LeadingAge has been asking HHS on behalf of members for some time to provide additional information about which lost revenues a provider can report when they have multiple lines of business under the Tax Identification Number(TIN) such as a life plan community. HHS does provide new information on how it is approaching the definition of lost revenues but still leaves the answer to our original question up to a little interpretation.

In its recent FAQs, HHS provides the following information on lost revenue: “The term ‘lost revenues that are attributable to coronavirus’ means any revenue that you as a healthcare provider lost due to coronavirus. This may include revenue losses associated with fewer outpatient visits, canceled elective procedures or services, or increased uncompensated care. Providers can use Provider Relief Fund payments to cover any cost that the lost revenue otherwise would have covered, so long as that cost prevents, prepares for, or responds to coronavirus.” HHS also clarifies, “these costs do not need to be specific to providing care for possible or actual coronavirus patients, but the lost revenue that the Provider Relief Fund payment covers must have been lost due to coronavirus.” This definition would seem to imply lost revenues for healthcare-related business lines could be reported but for example, independent living expenses could not.  

In addition, “HHS encourages the use of funds to cover lost revenue so that providers can respond to the coronavirus public health emergency by maintaining healthcare delivery capacity, such as using Provider Relief Fund payments to cover:

• Employee or contractor payroll

• Employee health insurance

• Rent or mortgage payments

• Equipment lease payments

• Electronic health record licensing fees”

Reporting

HHS does not provide new information yet on what must be reported or the format of those reports but merely reiterates that “All providers receiving Provider Relief Fund payments will be required to comply with the reporting requirements described in the Terms and Conditions and specified in future directions issued by the Secretary. HHS will provide guidance in the future about the type of documentation we expect recipients to submit. Additional guidance will be posted at https://www.hhs.gov/provider-relief/index.html.

”  The first report is due by law on July 10 for the second calendar quarter (April – June 2020).

Resubmitting Data

It appears that HHS is reaching out to some providers who submitted their financial/revenue information through the portal but were flagged for data verification. These providers “may require additional follow-up and communication prior to receiving funds.” Some of the reasons for being flagged include: “information entered not matching tax documentation, providers with significantly lower than expected Medicare revenue, and apparent data entry errors.”  These providers will need to resubmit their revenue information through the same General Distribution Portal as they did initially. This resubmission will not impact the potential payment your organization receives. Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April 2020. If after further review of your resubmitted revenue information, the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual net patient revenue, you may not receive additional General Distribution payments.

Attestation Deadlines

HHS confirmed, in writing, on June 4 that the June 3 deadline for attesting to Terms and Conditions and submitting financial data to HHS only applied to those providers who were still seeking a second General Distribution payment from the Provider Relief Fund. Providers who already received a second General Distribution payment by 5 p.m.. April 24 are the only ones who can and must still attest within 90 days of receipt of payment that the payments were receive and to the corresponding Terms & Conditions, and provide their additional revenue information through the General Distribution Portal.  For those who received a first payment on April 10, they have until July 10 to attest for that payment and for those receiving a second payment on April 24, you must attest by July 23 (barring any further changes to the deadlines).

Second Thoughts

According to the HHS FAQs, “if you affirmatively attested to a Provider Relief Fund payment already received and later wish to reject those funds and retract your attestation, you may do so by calling the provider support line at (866) 569-3522; for TTY dial 711. Note, HHS is posting a public list of providers and their payments once they attest to receiving the payment and agree to the Terms and Conditions.” In other words, if you have already attested and now read the new information from HHS on eligible expenses and lost revenues or feel you cannot abide by the Terms & Conditions, or for any other reason, you can return the payments received to date.

Key Dates

• July 9: 90-day attestation deadline for those with General Distribution payments who have not yet attested and received their payment on April 10.
• July 10: First quarterly report due based upon second quarter (April – June 2020)
• July 23: 90-day attestation deadline for those with General Distribution payments who have not yet attested and received their payment on April 24.
• August 20: Attestation deadline for Provider Relief Payments such as the targeted SNF-only distribution received on May 22