While the release of Provider Relief Fund Frequently Asked Questions (FAQs) has dwindled in the last month, the Department of Health & Human Services (HHS) has continued to issue new FAQs on a more limited basis. On December 28, 2020, three new FAQs were released (see below), and they reflect the shifted focus of HHS as the relief fund reporting system nears its opening on January 15, 2021. The first two FAQs below address high-level reporting and auditing requirements. Interestingly, the first FAQ below also reflects a disconnect between state Medicaid programs and federal guidance dating back months (i.e., that provider relief funds can only be used for expenses or costs not reimbursed or reimbursable by other sources, such as Medicaid). As we continue to approach the first reporting period, providers should continue to look out for new FAQs. Since the beginning of the pandemic, providers have generally been able to expect a slew of new FAQs following significant events, such as the release of new distributions, updates to provider eligibility for disbursements, guidance on reporting requirements, or change of ownership information.
Auditing and Reporting Requirements – Use of Funds
My state or territorial Medicaid or Children’s Health Insurance Program (CHIP) agency has directed providers to use Provider Relief Fund dollars before applying Medicaid or CHIP reimbursement, as well as Medicaid COVID-19 supplemental payments, to cover healthcare-related expenses or lost revenues attributable to coronavirus. Is this permissible?
As it relates to expenses, providers identify their healthcare-related expenses and then apply any amounts received through other sources (e.g., direct patient billing, commercial insurance, Medicare/Medicaid/CHIP, reimbursement from the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured, or funds received from FEMA or SBA/Department of Treasury’s Paycheck Protection Program) that offset the healthcare-related expenses. Provider Relief Fund payments may be applied to the remaining expenses or cost, after netting the other funds received or obligated to be received which offset those expenses.
Provider Relief Fund Overview
Which sections of 45 CFR 75 – UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR HHS AWARDS are applicable to the General and Targeted Distributions of the Provider Relief Fund (PRF)?
Recipients (both non-federal entities and commercial organizations) of the General and Targeted Distributions of the Provider Relief Fund are subject to 45 CFR 75 Subpart A (Acronyms and Definitions) and B (General Provisions), subsections §§75.303 (Internal Controls), and 75.351-.353 (Subrecipient Monitoring and Management), and Subpart F (Audit Requirements). In addition, the terms and conditions of the PRF payments incorporate by reference the obligation of recipients to comply with the requirements to maintain appropriate financial systems at 75.302 (Financial Management and Standards for Financial Management Systems) and the requirements for record retention and access at 75.361 through 75.365 (Record Retention and Access).
Nursing Home Infection Control Distribution
How is the infection gateway calculated for determining eligibility for Quality Incentive Program payments under the Nursing Home Infection Control Distribution?
The infection gateway criterion specifically excludes facilities that are found to have an infection rate exceeding the estimated infection rate in their county during the performance period. County infection rates are measured using daily COVID-19 community profile reports (CPRs) disseminated under the HHS Protect data program. CPRs contain information on the rate of COVID-19 infections for all residents in each county. County infection rates are not the same as county positivity rates.
