Last week, as reported in the December 21 Health Headlines, bipartisan congressional leaders announced they had reached an agreement on a COVID-19 relief package––which would be combined into one end of year legislative package with all 12 Fiscal Year 2021 federal spending bills, a surprise billing agreement, various health care policy provisions, as well as provisions related to the Paycheck Protection Program––and on December 27, 2020, the President signed the bill. The relief package includes important changes to the Provider Relief Fund, including additional funds, sharing targeted distributions, and calculating lost revenue. Furthermore, last week, the Office of Management and Budget (OMB) published its 2020 Compliance Supplement Addendum, which includes guidance on how to audit money received under the Provider Relief Fund.

COVID-19 Relief Package

The COVID-19 relief package includes the following changes and updates to the Provider Relief Fund:

• Additional Funds: The bill adds an additional $3 billion to the Provider Relief Fund.
• Sharing Targeted Funds: The bill allows parent organizations to allocate (through transfers or otherwise) targeted distribution payments among the parent organizations' eligible healthcare provider subsidiaries. Importantly, the bill states that “responsibility for reporting the reallocated reimbursement shall remain with the original recipient of such reimbursement.” This is a significant change from current HHS guidance that only allows for the transfer of general distributions and prohibits the transfer of targeted distributions.
• Calculating Lost Revenues: The bill allows providers to use any reasonable method to calculate lost revenue, including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved prior to March 27, 2020. This change reverts back to HHS’ previous guidance from June 2020 on how to calculate lost revenues.

The full text of the bill is available here.

OMB 2020 Compliance Supplement Addendum

On December 22, 2020, OMB published its 2020 Compliance Supplement Addendum, which now includes Provider Relief Fund compliance guidance. Importantly, the Addendum provides for an additional extension for single audits for an additional three months:

In light of the late issuance of audit guidance for the COVID-19 programs contained in this addendum, awarding agencies, in their capacity as cognizant or oversight agencies for audit, must allow recipients and subrecipients that received COVID-19 funding with original due dates from October 1, 2020, through June 30, 2021, an extension for up to three (3) months beyond the normal due date in the completion and submission of the Single Audit reporting package. No further action by awarding agencies is required to enact this extension.

The Addendum lists the allowed and unallowed activities for the general and targeted distributions as listed in each distribution’s terms and conditions. The Addendum also explains that it does not expect the Provider Relief Fund reporting requirements portal to be available before January 15, 2021:

At the time of issuance of this addendum, the report and reporting portal were under development and not expected to be available before January 15, 2021. By February 1, 2021, a notice will be placed on OMB’s Office of Federal Financial Management website (https://www.whitehouse.gov/omb/management/office-federal-financial-management/) providing key line items and other information from the report that are subject to audit for audits of fiscal years ending on or after December 31, 2020. Auditors performing audits of December 31, 2020 year-ends are expected to test this special reporting even though it will not be able to be submitted by recipients until early in the next fiscal year.

HHS has not published an official announcement that changes any reporting dates. Notwithstanding the quoted Addendum text above, as of now, the reporting requirements portal will open for providers on January 15, 2021. Important reporting dates include:

• January 15, 2021: reporting system opens for providers
• February 15, 2021: first reporting deadline for all providers on use of funds
• July 31, 2021: final reporting deadline for providers who did not fully expend Provider Relief Fund payments prior to December 31, 2020

The Addendum also includes compliance information on the COVID-19 Testing for the Uninsured program. Through this program, healthcare providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, can electronically request claims reimbursement through the program and will be reimbursed generally at Medicare rates, subject to available funding. The Addendum lists the allowed and unallowed activities as described in the program’s terms and conditions.

The Addendum is available here.