HHS has published additional Terms and Conditions associated with the acceptance of payments made from the $100 Billion Provider Relief Fund established pursuant to the Coronavirus Aid, Relief, and Economics Security Act (P.L. 116-136) (the CARES Act), as well as payments made for COVID-19 testing of uninsured individuals made pursuant to the Families First Coronavirus Response Act (P.L. 116-127) (FFCRA). The published Terms and Conditions apply to the initial $30 Billion general distribution based on net patient revenue that was made beginning April 10; the additional $20 Billion allocated to the general distribution and made beginning April 24; reimbursement from the Relief Fund for COVID-related treatment of the uninsured; and FFCRA payments for testing of uninsured individuals.

All of the Terms of Conditions relating to these distributions and service payments include the following agreements, acknowledgements and certifications by the provider receiving the funds (the Recipient):

• Eligibility. The Recipient certifies is not currently terminated from participation in Medicare or precluded from receiving payment through Medicare Advantage or Part D; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.
• Non-Permitted Uses of Funds. The payment will not be used to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. In addition, Recipients of payments for treatment or testing of uninsured patients agree not to include costs for which the payment was received in cost reports or otherwise seek uncompensated care reimbursement through federal or state programs for items or services for which the payment was received.
• Reports. All Recipient are required to submit reports as specified by the Secretary in future program instructions. In addition, Recipients that receive more than $150,000 total in funds under the CARES Act, FFCRA, or any other Act primarily making appropriations for the coronavirus response and related activities, are required to submit detailed quarterly reports to the Secretary and the Pandemic Response Accountability Committee.
• Recordkeeping and Audits. To substantiate the reimbursement of costs, Recipients are required to maintain appropriate records and cost documentation including, as applicable, documentation described in HHS grant rules relating to Financial Management and Record Retention and Access (45 CFR §§ 75.302, 75.361 - 75.365), and other information required by future program instructions. Recipients agree to submit copies of records and cost documentation upon the request of the Secretary, and to cooperate fully in all audits by the Secretary, Inspector General, or Pandemic Response Accountability Committee.
• Balance Billing. Recipients of the $50 Billion general distribution funds certify that they will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient. Recipients of funds for COVID- related treatment or COVID-19 testing of uninsured patients agree to accept the payment as payment in full, and not to charge the patient any type of cost-sharing.
• Accuracy of Information. The Recipient certifies that all information submitted as part of its application, as well as all information and reports provided in the future at the request of the Secretary or Inspector General, “are true, accurate and complete, to the best of its knowledge.” The Recipient further acknowledges the penalties that may apply if this certification is false. (This provision was not included in the original published version of the Terms and Conditions applicable to the initial $30 Billion general distribution but does appear in the current version of the Terms and Conditions applicable to that distribution.)
• General Conditions of 2020 Appropriations. A number of restrictions on use of the funds that apply to all 2020 appropriations are also incorporated in all of these Terms and Conditions. These general appropriation terms include limitations on use of the funds for executive pay above a specified level, or for certain lobbying activities. The general appropriations conditions also prohibit requiring employees or contractors seeking to report fraud, waste or abuse to sign internal confidentiality agreements prohibiting the lawful reporting of such matters to a Federal department or agency authorized to receive such information.

Additional Terms and Conditions that apply to Recipients of the initial $30 Billion and more recent $20 Billion general distribution from the Relief Fund include the following:

• The Recipient certifies that it billed Medicare in 2019, and provides (or provided after January 31, 2020) diagnoses, testing or care for individuals with possible or actual cases of COVID-19.
• The Relief Fund payment will only to used to prevent, prepare for, and respond to coronavirus, and reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.
• In addition, the Terms and Conditions associated with the $20 Billion general distribution specify that the Recipient consents to HHS publicly disclosing the payment Recipient may receive from the Relief Fund, and acknowledges that “such disclosure may allow some third parties to estimate the Recipient’s gross receipts or sales, program service revenue, or other equivalent information.”

Recipients submitting claims for treatment or testing of uninsured patients also agree to the following Terms and Conditions:

• The Recipient certifies that the items and services reflected on the claims form were provided to the uninsured individual identified in the claim; that the dates of service occurred on or after February 4, 2020; that all items and services were medically necessary; and that the individual was a qualifying “Uninsured Individual” (as defined under the applicable program) at the time of service.
• The Recipient agrees that all claims will be full and complete (i.e., no interim or corrected claims) and all payments are final.
• Payment will be “generally” be made at 100% of the Medicare fee schedule. A calculated average rate will be used if there is no Medicare standard rate.
• HHS may publicly disclose the payment made to the Recipient from the Relief Fund.

The Terms and Conditions can be found here. Additional information is available on the HHS website here.