On December 27, 2020, President Trump signed into law the Coronavirus Response and Relief Supplemental Appropriations (“CRRSA”) Act which materially altered certain provisions of the CARES Act Provider Relief Fund (“PRF”) as well as appropriated additional funds to be distributed through the PRF.

The changes stimulated by the CRRSA were then translated by the U.S. Department of Health and Human Services (“HHS”) into January 15, 2021, version of the Post-Payment Notice of Reporting Requirements (the “Notice”), which supersedes all previous versions and can be found here – https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-january-2021.pdf. The Notice provides further clarification of the significant alterations discussed below as well as other changes and further guidance for reporting through the HHS portal which was scheduled to open on January 15, 2021. A summary of the Notice and current reporting requirements are included below, however, please also visit the link above for full details as described by HHS.

Details of the Significant Alterations

Targeted Distributions

Prior to the change in legislation, distributions referred to as “Targeted Distributions” were to be controlled and used by the entity that was eligible for the payment. The payment was not eligible to be transferred to another entity within a parent organization. However, the economic relief bill clarifies the allocation of reimbursements from the PRF as follows, “for any reimbursement by the Secretary from the Provider Relief Fund to an eligible health care provider that is a subsidiary of a parent organization, the parent organization may, allocate (through transfers or otherwise) all or any portion of such reimbursement among the subsidiary eligible health care providers of the parent organization, including reimbursements referred to by the Secretary as ‘‘Targeted Distribution’’ payments, among subsidiary eligible health care providers of the parent organization except that responsibility for reporting the reallocated reimbursement shall remain with the original recipient of such reimbursement…”.

Lost Revenues

Since the initial distributions from the PRF in April 2020, the guidelines that defined how to calculate lost revenues have changed numerous times. The economic relief bill reverts most of these changes back to the initial guidance by stating the following – “such provider may calculate such lost revenues using the Frequently Asked Questions guidance released by the Department of Health and Human Services in June 2020, 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…”

Updated Use of Funds as Defined by the Notice

Recipients of PRF’s may use the payments to cover incremental expenses or lost revenues due to the COVID-19 pandemic in the following order:

  1. Healthcare-related expenses attributable to coronavirus that has not been reimbursed by another source and is not obligated to be reimbursed by another source. These expenses may include general and administrative expenses and/or other healthcare-related expenses.
  2. Patient care lost revenues attributable to coronavirus calculated under one of the following methods:
    1. The difference in 2019 and 2020 actual patient care revenue.
    2. The difference in 2020 budgeted and 2020 actual patient care revenue based on a budget that was established and approved prior to March 27, 2020. Providers electing to use this method will be required to submit additional documentation at the time of reporting.
    3. Any reasonable method as determined by the provider. Providers electing to use this method will be required to submit a description of the methodology, an explanation as to why it is reasonable and support for why the revenue was lost due to the COVID-19 pandemic versus other possible reasons. Providers electing to use this method will also be subject to an increased likelihood of an audit by the Health Resources and Services Administration (“HRSA”).

Payments received by healthcare providers but not used during 2020 may be used during 2021 through June 30, 2021. Lost revenues for the 6-month period in 2021 should be calculated under one of the following methods: (a) 2021 actual revenue as compared to the same period in 2019 or (b) 2021 actual revenue compared to the 2020 budget for the same period.

Reporting Portal and Updated Reporting Deadlines

As stated above, the HHS PRF reporting portal was scheduled to open on January 15, 2021, with the first reporting deadline of February 15, 2021. On January 15, 2021, HHS released instructions for providers to register within the PRF reporting portal. However, there is currently no deadline to complete this registration. After registering, recipients will later receive a notification about when they should complete the next step of submitting the reporting requirements. This notification will be sent to the email address used during the registration process. The following information is required to register:

  • Tax ID number (or other number submitted during the application process)
  • Business name of the reporting entity
  • Contact information of the person responsible for submitting the report
  • Address of the reporting entity as it appears on a W-9
  • TIN(s) of subsidiaries
  • Payment information for any of the payments received (TIN, amount, mode of payment, check number of ACH settlement date)

HHS has also provided Reporting Portal FAQs that can be found here – https://hrsac19.my.salesforce.com/sfc/p/#t00000004XgP/a/t0000001FId8/wN.4dTa.NRiNhwh_0CBblH6gvvedhqOt7_.5OS7rP6U.

Healthcare entities should begin compiling the information above and complete the registration as soon as possible. This will ensure the follow-up information to be provided by HHS is received and the provider can submit the required reporting information further detailed below timely.

Reporting Instructions

Demographic Information

Type of PRF recipient(s) Definition
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

Interest Earned

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
      • Mortgage/Rent
      • Insurance
      • Personnel
      • Fringe Benefits
      • Lease Payments
      • Utilities/Operations
      • Other G&A
    • Healthcare Related Expenses Attributable to Coronavirus
      • Supplies
      • Equipment
      • Information Technology
      • Facilities
      • 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:
Calculation Method 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

Alternate methodology 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

Additional Data

  • 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.

Sources:

Provider Relief Fund Team

Link to Courtney Provider Relief Funds: The Changes We Have All Been Waiting On & The HHS Reporting Portal

Courtney Bach

Shareholder, Audit and Advisory

phone icon email icon Chattanooga Nashville
phone icon email icon Chattanooga Nashville
Link to Laura Provider Relief Funds: The Changes We Have All Been Waiting On & The HHS Reporting Portal

Laura McGregor

Senior Manager, Audit and Advisory

phone icon email icon Nashville
phone icon email icon Nashville