$2.5 billion Arrives in Nursing Home Bank Accounts with Restrictions

Regulation | August 28, 2020 | by Nicole Fallon

Medicare and Medicaid certified nursing homes began receiving Provider Relief Fund payments Thursday, August 27 that totaled roughly $2.5 billion. 

Medicare and Medicaid certified nursing homes began receiving Provider Relief Fund payments Thursday, August 27 that totaled roughly $2.5 billion. This is the initial payment from the $5 billion distribution to nursing homes announced by the administration in late July. HHS issued its announcement on the funds around 11 a.m. ET, which also highlighted two voluntary training resources being made available to nursing homes in their fight against COVID-19.  UPDATE: Funds can only be used for limited list of "infection control expenses" outlined in the new Terms & Conditions.

The formula for this latest nursing home distribution was not mentioned in the announcement but posted on the HHS CARES Act  Provider Relief Fund website, indicating that each nursing home with 6 beds or more received $10,000 base amount plus $1,450 for each bed. Nowhere does the announcement indicate that providers are required to participate in either of the two training programs it has made available. The training two training resources mentioned include:

  1. The AHRQ National Nursing Home COVID Action Network offering “an interactive, small-group, problem-based training and customized mentorship through an existing network of academic medical centers, health centers and community organizations.” It is described as guiding “nursing homes through best practice care and treatment for patients who test positive for COVID-19; and protect staff from infection through evidence-based safety measures…”. This program is based on the Project ECHO pilot. HHS notes that participation is voluntary but participating nursing homes will be compensated for the costs of staff training time. No other specifics were provided. Sign up for this program is expected to begin in the coming weeks with training to start in September.
  2. CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management" that CMS announced earlier this week that has 15 online modules covering topics such as basic infection control practices, cohorting strategies, vaccine distribution and various other topics.

An HHS email sent by UnitedHealth Group to nursing home providers who received funds indicated the funds were, “to support facilities’ COVID-19 infection control efforts, including by conducting appropriate testing, acquiring necessary personal protective equipment (PPE), investing in staff and establishing COVID-19 isolation facilities.” 

UPDATE (8/28):Like other PRF payments, providers will have 90 days from receipt of payment to attest to the associated terms & conditions.  As of this publication(8/28), it appears that HHS listed the wrong set of terms and condition under the link for the $2.5 billion SNF distribution. The applicable terms and conditions appear to limit how the $2.5 billion can be used to: 

" The Recipient certifies that the Payment will only be used to reimburse the Recipient for costs associated with the following items and services (“Infection Control Expenses”):

  • Costs associated with administering COVID-19 testing, which means an in vitro diagnostic test defined in section 809.3 of title 21, Code of Federal Regulations (or successor regulations) for the detection of SARS– CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such a test, that—
    • Is approved, cleared, or authorized under section 510(k), 513, 515, or 564 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, 360bbb–3);
    • The developer has requested, or intends to request, emergency use authorization under section 564 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–3), unless and until the emergency use authorization request under such section 564 has been denied or the developer of such test does not submit a request under such section within a reasonable timeframe;
    • Is developed in and authorized by a State that has notified the Secretary of Health and Human Services of its intention to review tests intended to diagnose COVID-19; or
    • Other test that the Secretary determines appropriate in guidance
  • Reporting COVID-19 test results to local, state, or federal governments
  • Hiring staff, whether employees or independent contractors, to provide patient care or administrative support
  • Expenses incurred to improve infection control, including activities such as implementing infection control “mentorship” programs with subject matter experts or changes made to physical facilities
  • Providing additional services to residents, such as technology that permits residents to connect with their families if the families are not able to visit in person."

Finally, HHS noted that an additional $2 billion will be distributed "later this fall based on certain performance indicators that will be shared in the future. " The terms and conditions speak to this next round of funds stating, "The Recipient acknowledges that the Secretary may distribute additional payments based on the Recipient’s successful infection control outcomes. The Recipient agrees that it will not take any actions inconsistent with the best interests of its patients in order to increase any such future outcomes-based distribution."