Cares Act Provider Relief Fund – Medicaid, CHIP & Dental Distribution

*NEW The application deadline for both non-Medicaid and Medicaid/CHIP providers has been extended to August 28, 2020.

Second Chance for Certain Medicare Providers – *ANNOUNCED JULY 31, 2020

Starting the week of August 10, HHS will allow Medicare providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution.

In April, to expedite providers getting money as quickly as possible, as they faced the financial hardships stemming from suspended elective procedures and other COVID-19 related impacts, HHS, utilizing the Centers for Medicare and Medicare Services (CMS) payment information, distributed $30 billion directly to Medicare providers proportionate to their share of 2019 Medicare fee-for-service reimbursements. This was part one of the $50 billion Phase 1 Medicare General Distribution which sought to offer providers financial relief equal to 2 percent of their annual revenues. Providers that do not submit comprehensive cost reports with CMS were asked to submit revenue information to a portal to receive the balance of their 2 percent payment of General Distribution funds. Some providers, including many Medicaid, CHIP, and dental providers with low Medicare revenues, did not complete an application by the deadline for this additional $20 billion round of funding. HHS, in its principle of ensuring fairness in the administration of the Provider Relief Fund program, is now giving those eligible providers another opportunity to apply for additional funding. They will have until August 28, 2020, to complete an application to be considered for the balance of their additional funding up to 2 percent of their annual patient revenues.

Medicaid, CHIP & Dental Distribution – Overview

On July 10, The U.S. Department of Health & Human Services (HHS) announced that the CARES Act Provider Relief Fund application would expand to include eligible, non-Medicaid dentists. To support payments to dental providers who may not bill Medicare or Medicaid, HHS has developed a curated list of dental practice TINs from third party sources and HHS datasets. Providers with TINs on the curated list must meet other eligibility requirements including operating in good standing and not be excluded from receiving federal payments.

If you are concerned you were not on the curated provider list, please ensure you have an active, verifiable dental provider TIN and submit your information to the Provider Relief Fund application portal. Any eligible dental providers not on the curated list will undergo additional review and if validated will be permitted to apply for funding.

Additionally, HHS is distributing Provider Relief Funds to assist providers and clinicians who treat our most vulnerable populations, including low-income and minority patients. Providers that participate in state Medicaid/CHIP programs or Medicaid managed care plans and have not yet received a payment from the Provider Relief Fund General Distribution may be eligible for Medicaid and CHIP Provider Distribution funds.

To be eligible to apply for the Medicaid, CHIP & Dental Distribution, a provider must have:

Received no payment from the Phase 1 $50B general distribution
Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan.1, 2018-Dec.31, 2019; or billed a health insurance company for oral healthcare-related services as a dental service provider; or be a licensed dental service provider who does not accept insurance and has billed patients for oral healthcare-related services
Filed a federal income tax return for fiscal years 2017, 2018, 2019; or be exempt from filing a return
Provided patient care after January 31, 2020
Did not permanently cease providing patient care directly or indirectly
For individuals, reported on Form 1040 (or other tax form) gross receipts or sales from providing patient care
Must not be declared ineligible by local, state or federal government

You may find more details related to eligibility and other information by viewing the list of HHS Medicaid, CHIP & Dental Distribution FAQs.

General Information/Resources

Payment to eligible providers for the Medicaid, CHIP & Dental Distribution will be approximately two percent of their annual reported patient care revenue. It is suggested to review all pertinent information on the HHS Provider Relief Fund website prior to applying.

Many resources, guidance and specific information can be found on the HHS Provider Relief Fund, Page for Providers, including:

Applying for Funds

To apply for funds, eligible providers must create an Optum ID through the Enhanced Provider Relief Payment Portal (if they do not already have one). The funding process consists of three steps:

Verify provider TIN
- This step must be initiated by the application deadline in order to be considered for funding.
Submit revenue and tax information
- This step will be made accessible once the provider’s TIN has been successfully validated.
- Information submitted in this step will be used to calculate payment to provider. Manually entered information must match that of tax documentation.
- Be sure to review all information provided and correct any errors before submitting. Applications may not be edited after they are submitted and will have to be resubmitted in full if errors are made.
Attest to Terms and Conditions
- This step will unlock once an application is successful, and a provider will then have 90 days to agree to the Terms and Conditions or return the funds.
- If no attestation is made within the portal after 90 days, it will be assumed that the provider has accepted all Terms and Conditions.

Terms and Conditions

Providers must agree to the Terms and Conditions in the Enhanced Provider Relief Payment Portal within 90 days of receiving payment or return funds. If no attestation is made within the portal after 90 days, it will be assumed that the provider has accepted all Terms and Conditions. Note that this is the final process of funding and does not need to be done to apply for funds.

One of the terms and conditions states a provider must have, "provided, on or after Jan. 31, 2020, diagnosis, testing or care for actual or possible COVID-19 patients." (p. 1) To clarify this requirement, HHS specified the following:

Unless the payment is associated with specific claims for reimbursement for COVID-19 testing or treatment provided on or after February 4, 2020 to uninsured patients, under the Terms and Conditions associated with payment, providers are eligible only if they provide or provided after January 31, 2020, diagnoses, testing or care for individuals with possible or actual cases of COVID-19. HHS broadly views every patient as a possible case of COVID-19.

Not every possible case of COVID-19 is a presumptive case of COVID-19. A presumptive case of COVID-19 is a case 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.

The only time "presumptive" is used in the Terms and Conditions is with the following term:

“The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.” (p. 2-3)

Therefore, the above term related to balance billing is only applicable for an out-of-network patient who is a presumptive or actual case of COVID-19 as defined by HHS and with supporting medical record documentation. If the patient does not fit this definition, the provider may collect all applicable out-of-network expenses, including those greater than what the patient would pay in-network.

If the patient does meet the definition of a presumptive or actual case of COVID-19 as defined by HHS:

Providers accepting the Provider Relief Fund payment should submit a claim to the patient's health insurer for their services. Most health insurers have publicly stated their commitment to reimbursing out-of-network providers that treat health plan members for COVID-19-related care at the insurer's prevailing in-network rate. If the health insurer is not willing to do so, the out-of-network 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.

Should providers choose to accept new, out-of-network patients, we recommend documenting all applicable information of the patient including any appropriate medical records. HHS will provide information related to the audit of Provider Relief Funds, so it is important to keep record of eligible expenses and proof of abiding by all Terms and Conditions. However, HHS suspects this term to rarely affect dental providers.

Funds may be used for as long as providers need to cover permissible expenses (i.e. if the pandemic ends and the provider still has remaining funds, HHS will issue guidance for returning these funds.) These payments do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

If you have general questions or inquiries related to this information, you may contact advocacy@agd.org or call the HHS Provider Support Line at (866) 569-3522.