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HHS COVID-19 Provider Relief Fund

Summary of the Public Health Emergency relief payments that have been issued to health care providers by the U.S. Department of Health and Human Services.

Overview

As a result of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Department of Health and Human Services (HHS) began issuing payments to health care providers in early April 2020 to address expenses and revenue losses related to the novel coronavirus (COVID-19).

The following chart details each relief fund allocation to indicate when it was issued, how much was issued, who received it, and the methodology behind the distribution.

Relief Fund Allocation Date Issued/Announced Total Payment Amount Recipients Distribution Methodology
General Distribution (First Round) April 10, 2020 $30 billion Entities that billed Medicare in 2019 Share of 2019 Medicare FFS revenues
General Distribution (Second Round) April 24, 2020 $20 billion Entities that billed Medicare in 2019 (Most Recent Tax Year Annual Gross Receipts x $50 billion) / $2.5 trillion – Initial General Distribution Payment to Provider Equates to approximately 2 percent of net patient revenues per each eligible provider*
Rural Provider Distribution (First Round) May 6, 2020 $10 billion Rural acute general hospitals, CAHs, RHCs, and rural community health centers (CHCs)

Hospital = graduated base payment + (1.97 percent x operating expenses)

RHC = $100,000 per site + (3.6 percent x operating expenses) CHC = $100,000 per site

High Impact Distribution (First Round) May 7, 2020 $12 billion Hospitals with at least 100 inpatient COVID-19 admissions as of April 10, 2020

$10 billion: $76,975 x number of COVID-19 admissions

$2 billion: add-on payment based on Medicare DSH

Skilled Nursing Facilities Distribution May 22, 2020 $4.9 billion Medicare and Medicaid certified SNFs with at least six beds Fixed payment of $50,000 + $2,500 per certified bed
Indian Health Service (IHS) Facilities May 29, 2020 $500 million Tribal hospitals, clinics, and urban health centers Per hospital = $2.81 million + 3 percent of total operating expenses per clinic/program = $187,000 + 5 percent (estimated service population x average cost per user) IHS Urban Programs = $181,000 + 6 percent (estimated service population x average cost per user)
Safety Net Hospital Distribution (First Round) June 9, 2020 $10 billion Hospitals with Medicare DPP of 20.2 percent or greater, average uncompensated care per bed of $25,000 or more, and profitability of 3 percent or less (Hospital's Facility Score / Cumulative Facility Scores across All Safety Net Hospitals) x $10 billion Facility Score = Number of facility beds x DPP
Medicaid and CHIP Distribution June 9, 2020 $15 billion (approximately) Providers that did not receive a General Distribution payment and billed Medicaid for health care-related services between January 1, 2018, and December 31, 2019 2 percent (Gross Revenues x Percent of Gross Revenues from Patient Care), using data from CY 2017 or 2018 or 2019 as selected by applicant
Rural Provider Distribution (Second Round) July 10, 2020 $1 billion Specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas

SCHs, Medicare Dependent Hospitals, and RRCs in small metro areas: 1 percent of operating expenses (minimum of $100,000, a supplement of $50 for each rural inpatient day, and a maximum of $4.5 million)

Ten isolated urban hospitals that are 40 or more miles away from another hospital open to the public: supplemental payment of $1 million

Small city hospitals (under 250,000 population) without a special Medicare designation: 1 percent of operating expenses (minimum of $100,000 and a maximum of $2 million)

Rural specialty hospitals (Psychiatric, Rehabilitation, and Long Term Acute Care): graduated base payment + approximately 2 percent of operating expenses (adjusted for rural patient share with a minimum payment of $100,000 and a maximum of $4.5 million)

Safety Net Hospital Distribution (Second Round) July 10, 2020 $3 billion Hospitals with Medicare DPP of 20.2 percent or greater, average uncompensated care per bed of $25,000 or more, and profitability of 3 percent or less averaged consecutively over two or more of the last five cost reporting periods Same formula as used for first round
High Impact Distribution (Second Round) July 17, 2020 $10 billion Hospitals with over 161 COVID-19 admissions between January 1 and June 10, 2020; or one admission per day; or that experienced a disproportionate intensity of COVID admissions (exceeding the average ratio of COVID admissions/bed) $50,000 per admission
Children's Hospital Distribution (part of Safety Net Hospital Distribution) August 14, 2020 $1.4 billion 80 free-standing children's hospitals either exempt hospital under the Medicare IPPS or a HRSA Children's Hospital Graduate Medical Education facility 2.5 percent of net revenue from patient care
Nursing Home and Infection Control Distribution August 27, 2020 $5 billion

$2.5 billion: all certified nursing homes with at least six certified beds

$2.0 billion: certified nursing homes with at least six certified beds that meet

$2.5 billion to support increased testing, staffing, and PPE needs: per-facility payment of $10,000, plus a per-bed payment of $1,450

$2.0 billion: $500 million issued in four performance periods (September, October, November, December) to nursing homes based

*HHS is applying this methodology across the total $50 billion distributed through the General Allocation. There continues to be confusion as to the methodology used to determine the total payment under the General Allocation, as HHS indicates in FAQs that payments are intended to pay "at least 2% of that provider's gross receipts…and are determined based on the lesser of 2% of a provider's 2018 (or most recent complete tax year) gross receipts or the sum of incurred losses for March and April."

Note that there are frequent changes to the FAQs published by HHS that in some cases update previously published information and may provide new details or instructions. They warrant monitoring.

As of 9/11/2020

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