|Type of PRF recipient(s)
|General Distribution recipient that received payment in Phase 1 only
||Entity that received Phase 1 General Distribution payments totaling more than $10,000 in aggregate
|General Distribution with no parent organization or subsidiaries except PRF recipients that received Phase 1 General Distributions only
||Entity (at the Tax Identification Number (TIN) level) that received one or more General Distribution payments totaling more than $10,000 in aggregate
|General Distribution recipient with one or more subsidiaries that received payments in Phases 1-3
||Entity that meets the following three criteria:
1. Is the parent of one or more subsidiary billing TINs that received General Distribution payments in Phases 1-3,
2. Has providers associated with it that were providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after January 31, 2020, and
3. Is an entity that can otherwise attest to the Terms and Conditions.
|Targeted Distribution recipient
||Entity (at the Tax Identification Number (TIN) level) that received Targeted Distribution payments totaling more than $10,000 in aggregate
*Parent entities may report on the use of General Distribution payments for their subsidiaries; however, parent entities may not report on the use of Targeted Distribution payments for their subsidiaries. The original Targeted Distribution recipient must report on the use of those funds, even if the payment was transferred to the parent or another subsidiary.
- Tax Identification Number (TIN)
- National Provider Number (NPI)
- Fiscal Year-End Date
- Federal Tax Classification
If the PRF payments were held in an interest-bearing account, the amount of interest earned on the payments must be reported. The interest should also be included in the use of the funds.
Healthcare Related Expenses
Expenses should be limited to the incremental costs incurred to prevent, prepare for and respond to the COVID-19 pandemic.
- A Reporting Entity that received between $10,001 and $499,999 in aggregated PRF payments are required to report healthcare-related expenses, net of other reimbursed sources, in two categories: G&A expenses and other healthcare-related expenses.
- A Reporting Entity that received more than $500,000 in aggregated PRF payments must break out the expenses into more detailed information within G&A expenses and healthcare-related expenses as described below:
- General and Administrative Expenses Attributable to Coronavirus
- Fringe Benefits
- Lease Payments
- Other G&A
- Healthcare Related Expenses Attributable to Coronavirus
- Information Technology
- Other Healthcare Related Expenses
Lost Revenue Attributable to Coronavirus
Providers are required to submit the following information used to calculate lost revenues. Even if all PRF payments were expended on healthcare-related expenses, Reporting Entities are still required to submit 2020 and 2019 actual patient care revenue.
- 2020 total revenue (net of uncollectible bad debts) from patient care related sources. Calendar year actual revenues will be entered by quarters.
- 2020 revenue from patient care by payer mix
- Additional revenue information based on the method of lost revenue calculation elected:
||Required Reporting Information
|Difference between 2019 and 2020 actual patient care revenue
||Revenue from patient care payer mix by quarter (similar to that provided for 2020)
|Difference between 2020 budgeted and 2020 actual patient care revenue
||1) Copy of the 2020 budget, which must have been approved before 3/27/2020
2) attestation of the Reporting Entity’s CEO, CFO or similar responsible individual attesting under 18 USC Section 1001 that the actual budget being submitted was established and approved prior to 3/27/2020
||1) Description of the methodology
2) Calculation using that methodology
3) Explanation of why it is reasonable
4) Description establishing how lost revenue was in fact a loss attributable to COVID-19 and not caused by any other source
- 2020 Facility, Staffing and Patient Care (by quarter)
- Personnel metrics (including personnel by labor category, re-hires, new hires and separations)
- Patient metrics (including total patient visits, admits, resident patients)
- Facility metrics (available staffed beds for medical/surgical, critical care and other beds)
- Change in Ownership – Reporting Entities that acquired or divested of related subsidiaries during 2020 must provide certain additional information related to the change in ownership
- Other Assistance Received during 2020
- Treasury, Small Business Administration (SBA) and Paycheck Protection Program (PPP) Assistance
- Federal Emergency Management Agency (FEMA) Assistance
- CARES Act Testing
- Local, State and Tribal Government Assistance
- Business Insurance
- Other Assistance
Transfer of Targeted Distributions
Parent organizations of a subsidiary that received Targeted Distribution payments may transfer the subsidiary’s Targeted Distribution to another subsidiary of the parent organization. As stated above, the subsidiary that originally received the Targeted Distribution remains the Reporting Entity for that payment and must indicate the amount of the Targeted Distributions that were transferred to the parent entity. HHS did clarify that transferred Targeted Distributions are at an increased likelihood of being audited by HRSA.
Single Audit Status
Reporting entities must indicate if they are subject to Single Audit requirements and indicate whether the auditors selected provider relief fund payments to be within the scope of the Single Audit (if known at the time of reporting).
These reporting requirements do not apply to Nursing Home Infection Control distribution recipients, Rural Health Clinic Testing distribution recipients, or HRSA’s Uninsured Program reimbursement recipients. Separate reporting requirements may be announced in the future.