HHS Provider Relief - Reporting Requirements Released!

By Amy Brisson, CLC Partner and Consultant

Revisions to the Reporting Requirements have been updated and released!  On June 11, HHS released updates that you can find here: https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf

The period to use the funds has been revised to be based on when the payment was received, which can extend the period to use into 2022.  Please refer to the HHS fund to see the “Deadline for Use of Funds” table.

Additionally, in the updated released, there is a “Reporting Time Periods” table that gives the updated reporting deadlines.

Any provider who received over $10,000 in the aggregate is required to report.

Here are some notes for utilizing the funds and important highlights from the FAQs in order to help aid you to utilize the funds within the respective deadline:

Use of Funds:

• Expenditures

  • Expenses attributable to COVID-19 and not obligated to be reimbursed by other sources are eligible:

    • G&A incurred over and above what has been reimbursed by other sources, e.g. Mortgage & Rent, Insurance, Personnel, Fringe Benefits, Lease Payments, Utilities/Operations, Other G&A – other costs as part of overhead

    • Healthcare Related Expenses used to prevent, prepare for or respond to COVID-19, e.g. Supplies (PPE, hand sanitizer, patient screening supplies), Equipment (ventilators, HVAC system updates, etc.), Information Technology (EHR fees, telehealth infrastructure, increased bandwidth, and teleworking).

    • Facilities – lease or purchase of permanent or temporary structures or to modify facilities to accommodate patient treatment practices.

    • Other Healthcare Related Expenses: other actual expenses not captured above

  • Staff Costs:

    • From FAQs: “Time spent by staff on COVID-19-specific matters may be an allowable cost attributable to coronavirus so long as it was not reimbursed or obligated to be reimbursed by other sources. If the personnel salaries are reimbursed by any other source of funding they cannot be also reimbursed by the Provider Relief Fund. In addition, no one individual may be allocated as greater than one full-time equivalent (FTE) across all sources of funding.  All costs must be tangible expenses (not opportunity costs) and must be supported by documentation.”

    • From FAQs: “expenses incurred by providers to secure and maintain adequate personnel, such as offering hiring bonuses and retention payments, child care, transportation, and temporary housing, are deemed to be COVID-19-related expenses if the activity generating the expense was newly incurred after the declaration of the Public Health Emergency and the expenses were necessary to secure and maintain adequate personnel.”

    • The Federal Salary Cap from 2020 - $197,300 applies to PRF and other Federal funds combined.

  • Capital Expenditures:

    • From FAQS: “Expenses for capital equipment and inventory may be fully expensed only in cases where the purchase was directly related to prevent, prepare for and respond to the coronavirus. Examples of these types of equipment and inventory expenses include:  Ventilators, computerized tomography scanners, and other intensive care unit- (ICU) related equipment put into immediate use or held in inventory; masks, face shields, gloves, gowns, biohazard suits; general personal protective equipment, disinfectant supplies”.

    • From FAQs: “Expenses for capital facilities may be fully expensed only in cases where the purchase was directly related to preventing, preparing for and responding to the coronavirus. Examples of these types of facilities projects include: Upgrading a heating, ventilation, and air conditioning (HVAC) system to support negative pressure units; retrofitting a COVID-19 unit; enhancing or reconfiguring ICU capabilities; leasing or purchasing a temporary structure to screen and/or treat patients; leasing a permanent facility to increase hospital or nursing home capacity”.

• Lost Revenues

  • “Unreimbursed expenses attributable to coronavirus are considered first in the overall use of funds calculation. Provider Relief Fund payment amounts not fully expended on unreimbursed healthcare related expenses attributable to coronavirus are then applied to lost revenues for 2020.”

  • Using budgeted revenues for lost revenue calculation – from FAQs: “When reporting use of Provider Relief Fund money toward lost revenues attributable to coronavirus, Reporting Entities may use budgeted revenues if the budget(s) and associated documents covering calendar year 2020 were established and approved on or before March 26, 2020.  To be considered an approved budget, the budget must have been ratified, certified, or adopted by the Reporting Entity’s financial executive or executive officer as of that date, and the Reporting Entity will be required to attest that the budget was established and approved on or before March 26, 2020.  Documents related to the budget, including the approval, must be maintained in accordance with the Terms and Conditions.”

  • What to include in the calculation:

    • From FAQs: Revenue from Patient Care Payer Mix (2019 and 2020, and for some recipients, 2021 where applicable).  Note: All sources of patient care revenue should be reported net of uncollectible patient service revenue recognized as bad debts.

    • Medicare Part A+B: The actual revenues/net charges received from Medicare Part A+B for patient care for the calendar year.

    • Medicare Part C: The actual revenues/net charges received from Medicare Part C for patient care for the calendar year.

    • Medicaid: The actual revenues/net charges received from Medicaid/Children's Health Insurance Program (CHIP) for patient care for the calendar year.

    • Commercial Insurance: The actual revenues/net charges received from commercial payers for patient care for the calendar year.

    • Self-Pay (No Insurance): The actual revenues/net charges received from self-pay patients, including the uninsured or individuals without insurance who bear the burden of paying for healthcare themselves, for the calendar year.

    • Other: The actual gross revenues/net charges from other sources received for patient care services and not included in the list above for the calendar year.”

  • From FAQs: “To calculate lost revenues attributable to coronavirus, providers are required to report revenues received from Medicare, Medicaid, commercial insurance, and other sources for patient care services.  Other sources include fundraising revenues, grants or donations if they contribute to funding patient care services.”

  • From FAQs: “Provider Relief Fund recipients shall exclude from the reporting of net patient revenue payments received or payments made to third parties relating to care not provided in 2019 or 2020.”

As you contemplate and evaluate the use of these funds, here are some important reminders:

• Any uses of funds should be documented including but not limited to invoice copies, payroll records, procurement document, memos explaining the necessity related to COVID, lost revenue calculations, etc.

• HHS can audit the use of funds in years to come.

• Effect of Cost Base Reimbursement from FAQs:

  • “Under cost-based reimbursement, the payer agrees to reimburse the provider for the costs incurred in providing services to the insured population. In these instances, if the full cost was reimbursed based upon this method, there is nothing eligible to report as an expense attributable to coronavirus because the expense was fully reimbursed by another source. Provider Relief Fund payments cannot be used to cover costs that are reimbursed from other sources or that other sources are obligated to reimburse.  Therefore, if Medicare or Medicaid makes a payment to a provider based on the provider’s Medicare or Medicaid cost, such payment generally is considered to fully reimburse the provider for the costs associated with providing care to Medicare or Medicaid patients and no money from the PRF would be available for those identified Medicare and Medicaid costs.  However, in cases where a ceiling is applied to the cost reimbursement or the costs are not reimbursed under cost-based reimbursement (such as costs for care to commercial payer patients) since the reimbursed amount by Medicare or Medicaid does not fully cover the actual cost, those non-reimbursed costs are eligible for reimbursement under the Provider Relief Fund.”

• Reportable interest on funds:

  • From FAQs: “if funds were held in an interest-bearing account, they would be considered reportable revenue. If interest is earned on Provider Relief Fund disbursements that the Reporting Entity expended in full, the interest amounts may be retained and applied toward a reportable use of funds. If interest is earned on funds that are only partially expended, the interest on remaining unused funds must be calculated, reported, and returned.”

• Documentation Retention: “Providers need to retain original documentation for three years after the date of submission of the final expenditure report, in accordance with 2 CFR 200.333.”

The FAQs posted by HHS are very helpful as you prepare to report on these funds: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/faqs/index.html

When the updates were released, several FAQs were added, specifically a new section related to the non-financial data that must be reported and others under the Miscellaneous category, especially regarding the returning of unused funds.

If you have questions or need support on the HHS Provider Relief Fund, please reach out to amyb@communitylinkconsulting.com