HHS Clarifies Rules for Receipt of Provider Relief Fund Payments

If like so many other providers trying to survive COVID-19 business disruption, your lab is getting federal CARES relief payments, you need to be aware of the recent rule changes announced by HHS. Here’s a quick debriefing.

The Provider Relief Fund
Created as part of the Coronavirus Aid, Relief, and Economic Security Act (CARES), the $50 billion Provider Relief Fund new (aka, Public Health and Social Services Emergency Fund), provides money to providers who furnish COVID-19-related treatment to the uninsured, rural health clinics and hospitals, Indian Health Service facilities, etc. Here are the X takeaways from CMS’ recent Relief Fund guidance.

1. 15-Day Extension of Attestation Deadline
As with any federal aid, there are strings attached. recipients must complete an online attestation posted on the HHS Attestation Portal to accept (or reject) each Provider Relief Fund payment agreeing to the Terms and Conditions governing the use of those funds within 30 days of receiving a payment. On May 7, HHS announced that it’s extending the attestation deadline to 45 days. Thus, labs that received the first general distribution payment on April 10 now have until May 24 rather than May 9 to complete the attestation and accept the Terms and Conditions. Labs that don’t return the payment within 45 days of the receipt date will be deemed to have accepted the Terms and Conditions.

2. No Need to Repay Relief Payments
One day earlier, HHS issued new guidance for relief fund recipients in the form of updated FAQs. The first takeaway from the guidance is that HHS isn’t going to ask providers to repay Provider Relief payments as long as the “provider’s lost revenue and increased expenses exceed the amount of Provider Relief funding a provider has received.” But HHS reserves the right to audit recipients and require repayment if the provider:

• Receives relief payments that exceed its COVID-19 revenue losses or expense increases;
• Receives relief payment amounts made in error; and/or
• Violates any of the Terms and Conditions.

3. How to Respond to Overpayments
If a provider thinks it’s received a Relief Fund overpayment (or erroneous payment), The new FAQs instruct it to reject the entire payment and submit appropriate documentation enabling HHS to determine the correct the payment via the General Distribution Portal. The provider should also tell its bank to refuse the Automated Clearinghouse (ACH) credit received by initiating an ACH return using the ACH return code of “R23 – Credit Entry Refused by Receiver.”

4. How to Respond to Underpayments
Providers who get less than they expected should accept the payment and submit their revenues in the General Distribution Portal to determine their correct payment, according to the FAQs.

5. Deadline for Quarterly Reports
Providers receiving more than $150,000 from the Provider Relief Fund must submit quarterly reports to the government explaining how they’re using the money. The FAQs confirm that the first quarterly reporting period will be for the “calendar quarter ending June 30” and the Terms and Conditions associated with the Provider Relief Funds indicate that reports will be due “[n]ot later than 10 days after the end of each calendar quarter.” Absent additional guidance, this appears to indicate that the first reports are due by July 10.

6. Clarification on When Ban on Balance Billing Applies
The Terms and Conditions ban balance billing and billing patients above in-network rates for “all care for a presumptive or actual case of COVID-19.” The FAQs clarify that a “presumptive case” is one “where a patient’s medical record documentation supports a diagnosis of COVID-19, even if the patient does not have a positive in vitro diagnostic test result in his or her medical record.”

Takeaway: Wiggle Room on Balance Billing
HHS also notes that most health insurers have publicly committed to reimbursing out-of-network providers treating health plan members for COVID-19-related care at the insurer’s prevailing in-network rate. But if the health insurer doesn’t meet that commitment, the FAQs say that the provider “may seek to collect from the patient out-of-pocket expenses, including deductibles, copayments, or balance billing, in an amount that is no greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.”