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Medicaid, CHIP, and Dental Providers Distribution FAQs

<< Return to CARES Act Provider Relief Fund: FAQs


Overview and Eligibility

When a healthcare providers applies, the first step of the application process is to validate that their TIN is on a curated list of known Medicaid/CHIP providers that were supplied by each state or providers who appear in T-MSIS or who are on the filing TIN curated list of known dental providers created by HHS. Applicants that are not on that list will be validated through an additional process with the state to determine if the provider is a known Medicaid or CHIP provider that was not captured initially.  HRSA will be working directly with State/Territory Medicaid or CHIP agencies for validation and will not be reaching out to individual providers for validation.  Please note that it may take additional time to validate an applicant’s TIN.  If they receive the results of that validation after August 28, they will still be able to complete and submit their application.

Many dental providers have already successfully applied for funding under the Medicaid-focused General Distribution.  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.  As a next step, HHS will work with states and its vendors to authenticate dental providers not on the curated list.  Please note that it may take additional time to validate an applicant’s TIN.  If they receive the results of that validation after August 28, they will still be able to complete and submit their application.

Yes. Receipt of funds from SBA and FEMA for coronavirus recovery or of Medicaid HCBS retainer payments does not preclude a healthcare provider from being eligible for the Medicaid, CHIP, and Dental Providers Distribution if the healthcare provider otherwise meets the criteria for eligibility and can substantiate that the Provider Relief Fund payments were used for increased healthcare related expenses or lost revenue attributable to COVID-19, so long as they are not reimbursed from other sources and other sources were not obligated to reimburse them.

Yes. Healthcare providers that bill for services in Medicaid or CHIP that are covered under either a waiver or state plan, including disability service providers and other providers of Medicaid-funded home and community-based services (HCBS) (e.g., day habilitation, HCBS waiver program services), are eligible for the Medicaid, CHIP, and Dental Providers Distribution if they otherwise meet the other eligibility criteria.

The Medicaid, CHIP, and Dental Providers Distribution methodology will be based upon 2% of (revenues * percent of revenues from patient care) from the applicant’s most recent federal income tax return for 2017, 2018 or 2019  and with accompanying submitted tax documentation.  Payments will be made to applicant providers who are on the filing TIN curated list submitted by states to HHS or whose applications underwent additional validation by HHS.

To be eligible to apply, the applicant must meet all of the following requirements:

  1. Must not have received payment from the $50 billion General Distribution; and
  2. Either
    1. Must have either (i) directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services during the period of January 1, 2018, to December 31, 2019; or
    2. Must be a dental service provider who has either (i) directly billed health insurance companies for oral healthcare-related services, or (ii) owns (on the application date) an included subsidiary that has directly billed health insurance companies for oral healthcare-related services; or
    3. Must be a licensed dental service provider who does not accept insurance and has either (i) directly billed patients for oral healthcare-related services, or (ii) who owns (on the application date) an included subsidiary that does not accept insurance and has directly billed patients for oral healthcare-related services;
  3. Must have either (i)  filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or healthcare clinic); and
  4. must have provided patient care after January 31, 2020; and
  5. must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  6. if the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

CMS issued a data call to States that sought information on eligible Medicaid providers including Tax Identification Number (TIN).  HRSA used the TINs from this CMS-developed list, coupled with federal T-MSIS data to establish the “curated” list of potentially eligible providers who are permitted to submit a full Medicaid, CHIP, and Dental Providers Distribution payment application.  Providers with TINs on the “curated” list must meet other eligibility requirements including operating in good standing with States and CMS and  not be excluded from receiving Medicaid, Medicare, or federal payments.

No.  However, HHS is making payments to safety net hospitals that serve the nation’s most vulnerable citizens on the front lines in addition to the Medicaid, CHIP, and Dental Providers Distribution payments. These hospitals serve a disproportionate number of Medicaid recipients and provide large amounts of uncompensated care and operate on thin profit margins.  HHS may make further Provider Relief Fund payments to non-hospital safety net providers in the future.

HHS used third-party and HHS datasets to identify the eligible dental providers to populate the curated list of known dental providers.

No.  PACE organizations are not eligible to apply for the Medicaid, CHIP, and Dental Providers Distribution.  However, providers that participate in PACE may be eligible for this distribution if they meet the eligibility criteria and can attest to the Terms and Conditions.

HHS has not yet determined the methodology for future Provider Relief Fund distributions at this time, but will share additional information in the future.  Providers should not have the expectation that they will be advantaged by applying for funds from one distribution over another.  Providers should apply for a Provider Relief Fund payment in the first distribution in which they are eligible.

General Distribution payments were made between April 10 and April 17.  Payments were primarily sent via Automated Clearing House (ACH). The automatic payments were sent via Optum Bank with "HHSPAYMENT" in the payment description. Payments were sent to the group's central billing office.

Providers who are enrolled in Medicaid and did not receive an initial General Distribution payment may apply for a payment through the Enhanced Provider Relief Fund Payment Portal as long as they provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020.   HHS broadly views every patient as a possible case of COVID-19. Providers must meet all six eligibility criteria listed in the application guidance in order to be considered for a payment

No, providers that enrolled in Medicaid or CHIP after January 1, 2020 are not eligible to apply under this distribution.  Providers who began billing Medicaid/CHIP between January 1 and May 31, 2020 may be eligible for future allocations of the Provider Relief Fund.

HHS collected 2018 and 2019 Medicaid and CHIP provider data from state and federal sources, including corporate names, TINs, and payment amounts, and is using this data to validate Portal submissions.  Data is not yet available for new providers who submitted claims between January 1 and May 31, 2020.

While the self-directed providers are eligible to receive Provider Relief Fund money, payments from the Provider Relief Fund will be made to the filing TIN entity. If the FMS organization is the filing TIN entity, it will need to apply on behalf of the self-directed providers and distribute the funds as appropriate to the providers. If self-directed providers were included in the provider files submitted by CMS from states or are included T-MSIS files, they might be eligible to apply directly for payment. Where a FMS organization receives the Provider Relief Fund payment, it has discretion in allocating the Provider Relief Fund payments among self-directed providers, to support the providers' healthcare related expenses or lost revenue attributable to COVID-19, so long as the payment is used to prevent, prepare for, or respond to coronavirus and those expenses or lost revenue are not reimbursed from other sources or other sources were not obligated to reimburse them.

These mechanisms do not impact eligibility for the Provider Relief Fund.  Medicaid, CHIP, and Dental Providers Distribution payments will be paid to the filing TIN entity based on the entity’s percentage of total revenue attributable to patient service revenue.

Medicaid, CHIP, and Dental Providers Distribution payments will be made to the filing TIN entities.  If the OHCDS are the filing TIN entity, the payment will go to that entity, who has the sole discretion about how funds are distributed. The Provider Relief Fund payment recipient has discretion in allocating the Provider Relief funds to support its subsidiaries’ health care related expenses or lost revenue attributable to COVID-19, so long as the payment is used to prevent, prepare for, or respond to coronavirus and those expenses or lost revenue are not reimbursed from other sources or other sources were not obligated to reimburse them.

If applicants are not on the curated list provided by state, HHS is using additional data, to validate a provider's eligibility. We have accepted amended submissions from states as well.

Yes. Healthcare providers that bill for Medicaid or CHIP services through a county behavioral health provider network are eligible for the Medicaid, CHIP, and Dental Providers Distribution if they otherwise meet the other eligibility criteria.

No, if a healthcare provider was eligible for the first phase of the General Distribution payment, even if it rejected the payment, it is not eligible for a Medicaid, CHIP, and Dental Providers Distribution payment.  All providers that received an initial General Distribution payment needed to submit revenue information in to the Provider Portal by June 3, 2020, to be considered for an additional payment for a total distribution of at least 2% of gross receipts.  Providers that are not eligible for this distribution may be eligible for future allocations of the Provider Relief Fund.

Yes.  Providers who received payments in the prior $50 billion General Distribution payment are not eligible to receive payment in this current Medicaid, CHIP, and Dental Providers Distribution, regardless of the size of the payment received.  However, prior payment in a Provider Relief Fund Targeted Distribution (like the High Impact Area, Rural, Indian Health Service, and Skilled Nursing Facility Targeted Distributions) does not affect eligibility, i.e. providers who have received a Targeted Distribution may use this portal as long as they have not been paid in the $50 billion General Distribution.

No, if you were eligible for the initial General Distribution payment and rejected the payment, you cannot be eligible for Medicaid, CHIP, and Dental Providers Distribution payment.

You must meet the Medicaid, CHIP, and Dental Providers Distribution eligibility criteria described above.  You must not be currently terminated from participation in Medicare or precluded from receiving payment through Medicare Advantage or Part D; must not be currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and must not currently have Medicare billing privileges revoked. Your billing TIN must be included in the State-provided list of eligible Medicaid and CHIP providers or your application must pass additional validation by HHS.  You also must not have previously received a payment from the initial Provider Relief Fund $50 billion General Distribution.

Medicaid, CHIP, and Dental Providers Distribution payments will be paid to the Filing / Organizational TIN, and not directly to subsidiary TINs.  The Provider Relief Fund payment recipient has discretion in allocating the Provider Relief funds to support its subsidiaries’ health care related expenses or lost revenue attributable to COVID-19, so long as the payment is used to prevent, prepare for, or respond to coronavirus and those expenses or lost revenue are not reimbursed from other sources or other sources were not obligated to reimburse them.

As long as the Filing TIN or one of the Billing TINs was not eligible for the initial $50 billion General Distribution, but is a Medicaid or CHIP provider and is on the State-provided list of eligible Medicaid and CHIP providers, then they are eligible to apply. Medicaid or CHIP providers who are not on the State-provided list, their applications will undergo additional validation by HHS.

FQHCs are eligible for this distribution if they have not received a payment from the initial $50 billion General Distribution. Most FQHC providers are paid by the FQHC as salaried or contracted employees and do not independently bill for services. However, if a provider who works at an FQHC bills under his or her TIN for FQHC out-of-scope patient services, that provider may also be eligible for a distribution.

The deadline to submit an application for the Medicaid, CHIP, and Dental Providers Distribution is August 28, 2020.

Payments will be disbursed on a rolling basis, as information is validated. HHS may seek additional information from providers as necessary to complete its review.

HHS collected Medicaid and CHIP provider data from state and federal sources, including corporate names, TINs, and payment amounts, and is using this data to validate Portal submissions. The data collected from states was also used to help inform the overall payment methodology.

Providers that have been allocated a payment must sign an attestation confirming receipt of the funds and agree to the Terms and Conditions within 90 days of payment.

If a provider cannot meet the Terms and Conditions of the payment, they must reject the payment.  This can be done by going into the attestation portal within 90 days of receiving payment and indicating you are rejecting the funds. The CARES Act Provider Relief Fund Payment Attestation Portal will guide providers through the attestation process to reject the funds.

TTo return the money, the provider needs to contact their financial institution and ask the institution to refuse the received Automated Clearing House (ACH) credit by initiating an ACH return using the ACH return code of "R23 - Credit Entry Refused by Receiver." If a provider received the money via ACH they must return the money via ACH. If a provider was paid via paper check, after rejecting the payment in the attestation portal, the provider should destroy the check if not deposited or mail a paper check to UnitedHealth Group with notification of their request to return the funds.

If you affirmatively attested to a Provider Relief Fund payment already received and later wish to reject those funds and retract your attestation, you may do so by calling the Provider Support Line at (866) 569-3522; for TTY dial 711. Note, HHS is posting a public list of providers and their payments once they attest to receiving the payment and agree to the Terms and Conditions.

The Terms and Conditions for the Medicaid, CHIP, and Dental Providers Distribution can be found on the Provider Relief Fund: For Providers page.

HHS intends to make Provider Relief Fund payments in a fair, transparent, and fast manner.  HHS will distribute payments on a weekly basis according to submission date.

Yes. Indian healthcare providers are eligible to apply for a payment from the Medicaid, CHIP, and Dental Providers Distribution if they meet all of the eligibility criteria. Prior payment from the Indian Health Service Targeted Distribution (or another targeted distribution) does not affect eligibility for the Medicaid, CHIP, and Dental Providers Distribution, i.e., providers who have received a Targeted Distribution may use this portal as long as they have not been paid in the $50 billion General Distribution.

Yes. Healthcare providers that bill either fee-for-service or managed care in Medicaid or CHIP are eligible for the Medicaid, CHIP, and Dental Providers Distribution if they otherwise meet the other eligibility criteria.

HHS is currently posting payment information for providers who have attested to receiving a payment from the Provider Relief Fund and accepted the associated Terms and Conditions.

All providers eligible for the Medicaid and CHIP Distribution, including dentists, should apply in the Enhanced Provider Relief Fund Payment Portal by the deadline of August 3, 2020.  HHS has not determined the methodology for the dental allocation at this time, but will share additional information in the future.  Dental providers should not have the expectation that there will be advantaged by applying for funds from one distribution over another.  Dentists should apply for a Provider Relief Fund payment in the first distribution in which they are eligible.

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Enhanced Provider Relief Fund Payment Portal

The portal currently will say “Get Started” until a final determination has been made on provider payment. If and when a payment has been made, you will be able to move on in the portal to attest to the payment.

The FMS organization should include an individual provider in the FTE count if the individual is an employee and receives a W-2. Contracted providers that are not employees should not be included in the FTE count. If the provider works without physician supervision, they should be counted as a primary provider FTE in field 27. If the provider works under physician supervision, they should be counted as a non-primary provider FTE in field 28.

Yes, the FMS organization should calculate FTE status based on the number of hours billed unless the FMS or state has another method for counting FTEs.  A 1.0 FTE works whichever number of hours the applicant considers to be the minimum for a normal workweek, which could be 37.5, 40, 50 hours, or some other standard. To compute FTE of a part-time provider, divide the total hours worked by the provider by the total number of hours that your medical practice considers to be a normal workweek

In general, if the individual is being paid through an FMS organization, the organization is likely the filing and billing TIN and would be eligible to apply for the Medicaid, CHIP, and Dental Providers Distribution. In that situation, the self-directed provider should contact the FMS organization to confirm that the organization is submitting an application on their behalf or whether the provider should submit an application as an individual self-directed provider.

Yes. Applicants may include administrative fees provided by the state Medicaid program in the reported revenue, as well as in the percentage of revenue from patient care reported in field 12.

HCBS provider applicants, including FMS organizations applying on behalf of self-directed providers, should categorize personal care services as “Other,” code OT.

If your TIN cannot be validated within 15 days of submission, you will receive an email 13 days after submission notifying you that additional verification is required by the State/Territory Medicaid or CHIP agency. If you do not receive an email, please contact the Provider Support Line at (866) 569-3522 (for TTY, dial 711).  Please note that it may take additional time to validate your TIN in these instances, particularly when close to deadlines.  If you receive the results of that validation after August 28, you will still be able to complete and submit your application.

Payments will be made to applicant providers who are in the filing TIN curated list from CMS if they are a Medicaid or CHIP provider. If a TIN is not on the curated list of state-submitted eligible Medicaid/CHIP providers or T-MSIS, it will be flagged as invalid.   In these cases, HHS will work with the states to verify whether the TIN should be included as a valid Medicaid or CHIP provider in good standing.

If a TIN is not on the curated list of dental providers, HHS will conduct additional analysis related to the TIN and any active dental providers associated with the TIN. 

If the TIN is subsequently marked as valid, the provider will be notified to proceed submitting data into DocuSign even if validation occurs after the August 28, 2020 deadline. TINs that cannot be validated will not receive funding.  Please note, the additional TIN validation may result in a delay in processing the application.

If you are a provider that is not licensed by your state but otherwise meets the eligibility criteria for the second phase of the General Distribution, you should enter “not applicable” in the field. The field cannot be left blank.

No. The applicant may only include patient care revenue in its application for Provider Relief Fund payments, which is found in line 9 of Form 990 for tax-exempt organizations.

An Applicant Type Code is a two-character series of letters that generally summarizes an organization’s purpose. Enter the single code that best describes your organization from following list:

Applicant Type Code Description
AG Agencies (ex. foster care, PACE, developmental disabled services, etc.)
BE Behavioral Health (Outpatient)
CA Case Management
CL Clinic/Center
CO Community-based Social Support Providers
DE Dental Services
EM Emergency
HO Home Health
HS Hospital
NO Non-emergency Medical Transport
NU Nursing Service Providers
OB Obstetrics / Gynecology
OP Other Physician
PE Pediatrics
PP Primary Care Physician
RF Residential Facilities
RB Residential Facilities (Behavioral)
SA Substance Abuse (Rehabilitation)
OT Other

Home- and Community-Based Service (HCBS) provider applicants should categorize personal care services as “Other,” code OT. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) applicants should categorize their services as “Residential Facilities,” code RF

The applicant should insert the Group NPI that is best representative of the healthcare services delivered by the provider organization.  For applicants with multiple 941 forms, the applicant should upload all of the organization’s 941 forms.

If the parent organization does not have an NPI, the applicant should insert the subsidiary Group NPI that is best representative of the healthcare services delivered by the parent organization’s subsidiaries. The field cannot be left blank.

ACH payments are a secure and expeditious way to transfer money. The majority of payments will be made through bank transfer. Organizations with revenue greater than $5,000,000 will be required to set up ACH accounts to allow the Department of Health and Human Services (HHS) to most effectively and quickly deliver funds to providers, as well as maximize program integrity and fraud avoidance.

The first Provider Relief Fund Payment Portal was used for providers who received a General Distribution payment prior to Friday, April 24th.  These providers were required to submit financial information in order to receive approximately 2% of revenues derived from patient care.

HHS has developed the new Enhanced Provider Relief Fund Payment Portal for providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care, and behavioral health providers).

Applicants should enter the most recent revenues number from its federal tax return of 2017, 2018, or 2019.  If the applicant for tax purposes is a:

  • Sole proprietor or disregarded entity owned by an individual: Enter Line 3 from IRS Form 1040, Schedule C excluding any income reported on W-2.
  • Partnership: Enter Line 1c minus Line 12 from IRS Form 1065.
  • C corporation: Enter Line 1c minus Line 15 from IRS Form 1120.
  • S corporation: Enter Line 1c minus Line 10 from IRS Form 1120-S.
  • Tax-exempt organization: Enter Line 9 from IRS Form 990 minus any joint venture income, if included in Part VIII lines 2a – 2f.
  • Trust or estate: Enter Line 3 from IRS Form 1040, Schedule C.
  • Entity not required to file any of the previously mentioned IRS forms: Enter a “net patient service revenue” number or equivalent from the applicant’s most recent audited financial statements (or management-prepared financial statements)
  • Applicants with gross revenue adjustments should enter an adjusted gross revenues number as calculated using the Gross Revenues Worksheet in Field 15.

The amount reported in Field 10 should be net patient revenue plus other operating income. Net patient revenue is gross patient revenue less contractual adjustments, charity care/financial assistance, and bad debt expense. Other revenues, such as rental income, grants and contributions, joint venture income, and investment income, should be excluded from the amount reported in Field 10.

No, HHS will treat the amount entered as an absolute figure regardless of whether the applicant entered a positive or negative value.  This updates the previous instructions requiring applicants to enter a negative value to indicate a net loss.  If an applicant experienced a net gain due to COVID-19, the applicant should enter “0” (zero).

Yes. Providers may include staff that were furloughed as a result of the coronavirus in the counts of FTEs in fields 27-29. Applicants should count providers and staff that were furloughed as of 5/31/2020 as 0.0 FTEs.

Yes. A healthcare provider must submit their TIN for validation by end of day August 28, 2020. If they receive the results of that validation after August 28, they will still be able to complete and submit their application.

If a healthcare provider employs an individual that does not require physician supervision and can practice independently under their own license, e.g., a registered dietician, the provider applicant should include this FTE as a "primary provider" in Field 27 of the application.

HRSA is validating provider eligibility using State-provided lists of eligible Medicaid and CHIP providers. If you are not on those lists, HHS is taking additional steps to validate your eligibility using T-MSIS data. In most instances, HHS will respond within 15 business days; however, this process may take up to several weeks.

After your application is submitted through DocuSign, your information is passed to HRSA for evaluation.  The status will update/change once the evaluation is completed.

No.  Applicants must use the forms referenced in the Medicaid, CHIP, and Dental Providers Distribution application instructions that correspond to the applicant’s tax filer status.

Yes, in order to most effectively and quickly deliver funds to providers, HHS recommends that applicants sign up for ACH at the same time they submit a Provider Relief Fund application. This will prevent delays in issuing payment once an application has been approved.

State licensure is not an eligibility requirement for a Medicaid, CHIP, and Dental Providers Distribution payment from the Provider Relief Fund. HHS is currently assessing the system issue that is preventing eligible unlicensed providers from completing the application process and will resolve it as quickly as possible. We will share more information as it becomes available.

No. HHS would like to know the number of FTEs for all applicant organizations, whether the organization has facilities or not.

If an applicant healthcare provider bills for care under a single TIN that provides care across multiple different facilities, the parent organization may report patient revenue for every facility that bills underneath the TIN.

You can only submit one application.  You can edit the data on the application form, until the form is submitted. You cannot edit or resubmit the application form once it is submitted. You should not apply until you have available all of the information and documentation required by the application form.

The Enhanced Provider Relief Fund Payment Portalwill initially be used for new submissions from Medicaid and Children's Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund starting Wednesday, June 10, 2020.  At this time, this portal will serve as the point of entry for providers who have received Medicaid and CHIP payments in 2017, 2018, 2019 or 2020 and who have not already received any payments from the initial $50 billion Provider Relief Fund General Distribution.

No. The Enhanced Provider Relief Fund Payment Portal will not process applications from providers who have received payment from the previous $50 billion Provider Relief Fund General Distribution.

HHS is working to process all providers' submissions as quickly as possible. HHS may seek additional information from providers as necessary to complete its review.

  • The applicant's most recent federal income tax return for 2017, 2018 or 2019 or a written statement explaining why the applicant is exempt from filing a federal income tax return (e.g. a state-owned hospital or healthcare clinic).
  • The applicant's Employer's Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, Employer's Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement explaining why the applicant is not required to submit either form (e.g. no employees).
  • The applicant's FTE Worksheet (provided by HHS).
  • If required by Field 15, the applicant's Gross Revenue Worksheet (provided by HHS).

Upload a statement explaining why the entity is not required to file a federal tax form (note that non-profit entities should submit a Form 990) or is unable to provide the required information.  In addition, provide the most recent audited financial statements (or management prepared financial statements) for the TIN entity.  If the financial information of a TIN entity is reported as part of a parent organization, it may be necessary to provide consolidating audited financial statements that breakout the revenue and expenses for the TIN entity.

The healthcare provider should use the status that was included in the most recent tax filing when applying for Provider Relief Fund payments.  For example, if a practice was a C corporation in 2019 and is an S corporation in 2020, it should apply as a C corporation.

Patients' out-of-pocket costs are considered part of the revenue received from a payer, therefore, should be reported in the commercial payer amount or whichever category is applicable, not separated out into "other" field.

Lost revenue estimates should be based on budget-to-actual or year-over-year, and should include revenue from all sources that can be attributed to COVID-19.  This may include value-based payments, such as quality measure achievement payments.

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Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on July 31, 2020