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CARES Act Provider Relief Fund: General Information

To find a list of Provider Relief Fund Payment Portals, visit the For Providers page.


$50 Billion General Distribution

$50 billion is allocated proportional to providers' share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider's gross patient revenue regardless of the provider's payer mix. Payments are determined based on the lesser of 2% of a provider's 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April.

Total Amount Recipients
Initial $30 billion Nearly 320,000 providers who bill for Medicare fee-for-service
Additional $20 billion Nearly 15,000 providers who bill for Medicare fee-for-service

Medicaid and CHIP Allocation

HHS expects to distribute $15 billion to eligible 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 allocation.

Total Amount Recipients
~$15 billion TBD

Targeted Allocations

HHS is allocating targeted distribution funding to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. The fast and transparent dispersal of funds gives relief to those providers who are struggling to keep their doors open.

Targeted Distribution Total Amount Recipients
High-Impact Distribution $12 billion 395 hospitals in high-impact areas
Rural Distribution $10 billion Almost 4,000 rural health care providers
$1 billion Close to 500 specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas
Allocation for Skilled Nursing Facilities (SNFs) $4.9 billion Over 13,000 skilled nursing facilities
Allocation for Tribal Hospitals, Clinics, and Urban Health Centers $500 million Around 300 Tribal Hospitals, Clinics, and Urban Health Centers
Allocation for Safety Net Hospitals $10 billion Eligible safety net hospitals
$3 billion 215 acute care facilities

A portion of the funds are also distributed to providers who serve uninsured individuals based on COVID-19-related testing and treatment provided on or after February 4, 2020.


Timeline

CARES Act Provider Relief Fund Distribution Timeline

April

April 10 - April 17 (General Distribution: First Round)
$30 Billion distributed to nearly 320,000 Medicare Fee-For-Service (MFFS) billing providers based on their portion of 2019 MFFS payments

April 24 (General Distribution: Second Round)
$9.1 Billion to almost 15,000 Medicare Fee-For-Service billing providers based on revenues from CMS cost report data

Starting April 24 (General Distribution: Second Round)
$10.9 Billion available to Medicare Fee-For-Service billing providers based on revenue submissions to the provider portal ($2.4 Billion distributed as of 6/15)


May


$10 Billion to almost 4,000 rural health care providers including hospitals, health clinics, and health centers


$12 Billion to 395 hospitals that had 100 or more COVID-19 admissions between Jan 1 and Apr 10


$4.9 Billion to over 13,000 certified Skilled Nursing Facilities

May 29 (Allocation for Tribal Hospitals, Clinics, and Urban Health Centers)
$500 Million to approximately 300 IHS programs


June

June 3 (General Distribution)
Deadline for providers to submit revenue information and apply for a portion of the additional $20 Billion General Distribution funding

June 8 (High-Impact Distribution: Second Round)
To be considered for a second round of funding, hospitals are allowed to update their number of COVID-19 positive inpatient admissions between January 1, 2020 and June 10, 2020. Deadline for submissions: June 15, 2020.

June 9 (Medicaid & CHIP & Safety Net Hospitals Distribution)
HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution and $10 billion to safety net hospitals.


July

July 10 (Safety Net Acute Care Hospitals, Certain Specialty Rural Providers)
HHS announces approximately $3 billion in funding to hospitals serving a large percentage of vulnerable populations on thin margins and approximately $1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas.


Eligibility & Methodology

Summary of Formulas Used to Determine Funds Allocated

Download the Summary of Payments and Methodologies

$50 Billion General Distribution
Distribution & Eligibility Formulas to Determine Allocation
Initial $30 billion
Automatic based on provider's share of Medicare fee-for-service reimbursements in 2019
Payment Allocation per Provider = (Provider's 2019 Medicare Fee-For-Service Payments / $453 Billion) x $30 Billion
Additional $20 billion
Based on CMS cost reports or incurred losses
Payment Allocation per Provider = ((Most Recent Tax Year Annual Gross Receipts x $50 Billion) / $2.5 Trillion) – Initial General Distribution Payment to Provider
Medicaid/CHIP Distribution
Distribution & Eligibility Formulas to Determine Allocation

~$15 billion

Providers who did not receive funds from the General Distribution and billed Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services from January 1 to May 31      

Payment Allocation per Provider = 2% (Gross Revenues x Percent of Gross Revenues from Patient Care)*

*For CY 2017 or 2018 or 2019 as selected by applicant

Targeted Distribution
Distribution & Eligibility Formulas to Determine Allocation
High-Impact Distribution (first round)
Hospitals with 100 or more COVID-19 admissions between January 1 and April 10

$10 Billion to 395 High-Impact Hospitals

  • Payment Allocation per Hospital = Number of COVID-19 Admissions* x $76,975

$2 Billion to 395 High-Impact Hospitals with Medicare Disproportionate Share

  • Additional Payment Allocation per Hospital = $2 Billion x (Hospital Medicare Funding / Sum of Medicare Funding for 395 Hospitals)
Rural Distribution
Based on operating expenses and type of facility
Rural Acute Care Hospitals and Critical Access Hospitals

Payment Allocation per Hospital = Graduated Base Payment* + 1.97% of the Hospital's Operating Expenses

*Base payments ranged between $1 million to $3 million.

Independent Rural Health Clinics (RHC)

Payment Allocation per Independent RHC = $100,000 per clinic site + 3.6% of the RHC's Operating Expenses

Community Health Centers (CHC)

Payment Allocation per CHC = $100,000 per rural clinic site
Allocation for Skilled Nursing Facilities (SNFs)
Certified SNFs with six or more certified beds
Payment Allocation per Facility = Fixed Payment of $50,000 + $2,500 per Certified Bed
Allocation for Indian Health Service (IHS)
Based on operating expenses
IHS and Tribal Hospitals

Payment Allocation per Hospital = $2.81 Million + 3% of Total Operating Expenses

IHS and Tribal Clinics and Programs

Payment Allocation per Clinic/Program = $187,000 + 5% (Estimated Service Population x Average Cost per User)

IHS Urban Programs

Payment Allocation per Program = $181,000 + 6% (Estimated Service Population x Average Cost per User)

Allocation for Safety Net Hospitals
Hospitals with Medicare Disproportionate Payment Percentage (DPP) of 20.2% or greater, average uncompensated care per bed of $25,000 or more, and profitability of 3% or less

Certain acute care hospitals serving a large percentage of vulnerable populations on thin margins

Payment Allocation per Hospital = (Hospital's Facility Score* / Cumulative Facility Scores across All Safety Net Hospitals) x $10 Billion

*Facility Score = Number of facility beds x DPP

Less than of 3 percent averaged consecutively over two or more of the last five cost reporting periods, as reported to the Centers for Medicare and Medicaid Services (CMS) in its Cost Report filings

Explanation of Eligibility and Methodology for Each Distributon

$50 Billion General Distribution

HHS is distributing $50 billion to providers who bill Medicare fee-for-service in order to provide relief during the coronavirus (COVID-19) pandemic. On April 10, 2020, HHS immediately distributed $30 billion to eligible providers throughout the American healthcare system.

Initial $30 Billion

Payment Allocation per Provider = (2019 Medicare Fee-For-Service Payments / $453 Billion**) x $30 Billion

**This is the total sum of Medicare Fee-For-Service Payments in 2019

Additional $20 Billion

Payment Allocation per Provider = ((Most Recent Tax Year Annual Gross Receipts x $50 Billion) / $2.5 Trillion) Initial General Distribution Payment to Provider

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.

  • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
  • Payments to practices that are part of larger medical groups will be sent to the group's central billing office.

If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment Medicaid and CHIP Distributionto providers eligible for the distribution of the initial $30 billion in funds.

  • Providers are paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
  • The automatic payments come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
  • Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well.

    Visit the For Providers page for information about the attestation process to accept or reject the funds.
  • Providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 45 days of receiving the payment.
  • Not returning the payment within 45 days of receipt will be viewed as acceptance of the Terms and Conditions.

High-Impact Distribution

HHS is allocating funding to hospitals that have a high number of confirmed COVID-19 positive inpatient admissions.

$10 Billion to 395 High-Impact Hospitals

  • Payment Allocation per Hospital = Number of COVID-19 Admissions* x $76,975

*Hospitals must have 100 or more COVID-19 admissions.

$2 Billion to 395 High-Impact Hospitals with Medicare Disproportionate Share

  • Additional Payment Allocation per Hospital = $2 Billion x (Hospital Medicare Funding / Sum of Medicare Funding for 395 Hospitals)

HHS is making COVID-19 High-Impact Area payments to hospitals that have a high number of confirmed COVID-19 positive inpatient admissions. Payments are made at the billing TIN level. Billing TINs that include one or more hospitals should enter the total count for all confirmed COVID-19 positive inpatient admissions across all of the billing TIN's hospital facilities (four walls).

$10 Billion High-Impact Distribution

Inpatient admissions are a primary driver of costs related to COVID-19. A portion of the Provider Relief Fund is being distributed to hospitals that have treated a large number of COVID inpatient admissions.

In response to an HHS request for information, 5,598 hospitals submitted the number of COVID-19 inpatient admissions they encountered through April 10, 2020. 184,037 COVID-19 inpatient admissions were reported.

From this data, HHS identified those facilities with 100 or more COVID-19 admissions. These facilities encountered 129,911 admissions, or over 70% of the total number of COVID-19 inpatient admissions reported. The number of admissions encountered by these hospitals was the used to determine the allocation of Relief Funds across the pool of eligible recipients. Each recipient received funding equal to $76,975 per admission.

Note: Payments to these facilities on this basis is not intended to reimburse the facilities for the specific cost of these admissions. Rather, COVID-19 admissions is being used as a proxy for the extent to which each facility experienced lost revenue and increased expenses associated with directly treating a substantial number of COVID-19 inpatient admission.

$2 Billion High-Impact Distribution to Facilities

HHS recognizes that not all facilities are equally prepared to withstand the impacts of the coronavirus. Facilities that serve large Medicare or uninsured populations often do not have the same level of financial resources as other facilities. In recognition of this fact, HHS distributed $2 billion in additional funding to these facilities in proportion to each facility's share of Medicare Disproportionate Share funding.


$10 Billion Rural Distribution

HHS is distributing $10 billion to rural hospitals, including rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers located in rural areas.

Rural Acute Care Hospitals and Critical Access Hospitals

Payment Allocation per Hospital = Graduated Base Payment* + 1.97% of the Hospital's Operating Expenses
*Base payments ranged between $1 million to $3 million.

Independent Rural Health Clinics (RHC)

Payment Allocation per Independent RHC = $100,000 per clinic site + 3.6% of the RHC's Operating Expenses

Community Health Centers (CHC)

Payment Allocation per CHC = $100,000 per rural clinic site

Providers eligible for the targeted Rural Health Relief Fund distribution must be located in a geography that meets the following rural definition:

  1. All non-Metro counties.
  2. All Census Tracts 1 within a Metropolitan county that have a Rural-Urban Commuting Area (RUCA) code of 4-10.  The RUCA codes allow the identification of rural Census Tracts in Metropolitan counties.
  3. 132 large area census tracts with RUCA codes 2 or 3. These tracts are at least 400 square miles in area with a population density of no more than 35 people per square mile.
  4. For independent Rural Health Clinics: the authorizing statute applies the Census Bureau definition, which defines a Rural Health Clinic as being located outside of an Urbanized Area as defined by the U.S. Census Bureau.
  5. For Critical Access Hospitals:  CAHs have a unique safety net role and statutory charge per Section 1820 of the Social Security Act.  That statute initially gave state governors the authority to designate necessary provider CAHs, a number of which did not make a distinction between rural and urban designations.

RUCA Codes

(Code Definitions: Version 2.0)

  1. Metropolitan area core: primary flow within an Urbanized Area (UA)
  2. Metropolitan area high commuting: primary flow 30% or more to a UA
  3. Metropolitan area low commuting: primary flow 10% to 30% to a UA
  4. Micropolitan* area core: primary flow within an Urban Cluster (UC) of 10,000 through 49,999 (large UC)
  5. Micropolitan* high commuting: primary flow 30% or more to a large UC
  6. Micropolitan* low commuting: primary flow 10% to 30% to a large UC
  7. Small town core: primary flow within an Urban Cluster of 2,500 through 9,999 (small UC)
  8. Small town high commuting: primary flow 30% or more to a small UC
  9. Small town low commuting: primary flow 10% through 29% to a small UC
  10. Rural areas: primary flow to a tract outside a UA or UC (including self)

This funding recognizes that rural hospitals, health clinics, and health centers function with lower operating margins than urban and suburban providers and thus are at greater risk of closure as a result of reduced volumes attributable to the coronavirus.  Targeted distributions to rural hospitals, health clinics, and health centers were made according to the following methodology.

Recipients fall into three categories:

  • Rural acute care general hospitals and Critical Access Hospitals (CAHs)
  • Rural Health Clinics (RHCs)
  • Community Health Center sites located in rural areas

Hospitals and RHCs will each receive a minimum base payment plus a percent of their annual expenses. This expense-based method accounts for operating cost and lost revenue incurred by rural hospitals for both inpatient and outpatient services. The base payment will account for RHCs with no reported Medicare claims, such as pediatric RHCs, and CHCs lacking expense data, by ensuring that all clinical, non-hospital sites receive a minimum level of support no less than $100,000, with additional payment based on operating expenses.

Rural acute care general hospitals and CAHs will receive a minimum level of support of no less than $1,000,000, with additional payment based on operating expenses.

Eligible providers will receive the funds via direct deposit, based on the physical address of the facilities as reported to the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), regardless of their affiliation with organizations based in urban areas.

Rural acute care hospitals and Critical Access Hospitals (CAHs):

The methodology provides hospitals with supplemental funds based on a graduated base amount plus an additional amount to account for a portion of their usual operating costs and the volume of care they regularly provide, according to the following formula. The most recent, publicly available Medicare hospital cost reports were used to identify operating costs:

  • Per Hospital $ Allocation = Graduated Base payment + 1.97%* of the hospital's operating expenses
  • The graduated base payment is calculated as:
  • 50% of the first $2 million of expenses (payment of up to $1,000,000)
  • 40% of the next $2 million of expenses (payment of up to $800,000)
  • 30% of the next $2 million of expenses (payment of up to $600,000)
  • 20% of the next $2 million of expenses (payment of up to $400,000)
  • 10% of the next $2 million of expenses (payment of up to $200,000)

Rural hospitals with annual operating expenses greater than $10,000,000 receive a base payment of $3,000,000.

Rural hospitals with no operating expense data receive a base payment of $1,000,000.

The total calculated amount was then multiplied by 1.03253231** to determine the actual payment per rural provider.

*The actual value used in the formula was 1.967728428%.

Rural Health Clinics (RHCs):

Provider-Based RHCs:  RHCs connected with rural hospitals have their allocations included with their hospital's allocation, and the hospital is responsible for allocating dollars to support its RHC services.

Independent RHCs:  A base amount plus a percentage of total operating costs were calculated for independent RHCs not associated with a hospital using RHC Cost Report data according to the following formula:

  • Per Independent RHC $ Allocation = $100,000 per clinic site + 3.6%  of the RHC's operating expenses

Community Health Centers:

Health Centers in rural areas: The allocation for health centers in rural areas was a flat payment amount per health center site of $100,000.  Funds are distributed to each FQHC organization based on the number of individual rural clinic sites it operates.

  • Per FQHC $ Allocation = $100,000 per rural clinic site

The total calculated amount for RHCs and health centers was then multiplied by 1.03253231** to determine the actual payment per rural provider.

**This adjustment was applied to ensure that the total value of distributions equaled $10 billion.


Allocation for Skilled Nursing Facilities

HHS is distributing $4.9 billion to skilled nursing facilities (SNFs) to help them combat the devastating effects of this pandemic.

Payment Allocation per Facility = Fixed Payment of $50,000 + $2,500 per Certified Bed*

*Facilities must have six or more certified beds to be eligible for a payment.


Safety Net Hospitals Distribution

HHS is allocating $10 billion in provider relief funds to safety net hospitals. This funding recognizes that there are a number of acute care and children's "safety net" hospitals that disproportionately care for vulnerable populations and those without insurance coverage. Many of these facilities operate at low or negative profit margins, and thus are at greater risk of closure as a result of reduced volumes attributable to the coronavirus. This Provider Relief Fund distribution provides targeted funding to hospitals that disproportionately provide care to the most vulnerable, and are themselves more vulnerable to the financial impacts of the coronavirus. HHS recently expanded the criterion for payment qualification with an additional $3 billion allocation so that certain acute care hospitals meeting the revised profitability threshold would qualify.

Payment Allocation per Hospital = (Hospital's Facility Score* / Cumulative Facility Scores across All Safety Net Hospitals) x $10 Billion

*Facility Score = Number of facility beds x Medicare Disproportionate Payment Percentage (DPP)

Qualifying hospitals will have:

  • A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater
  • Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement
  • Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report
  • Certain acute care hospitals meeting the revised profitability threshold of less than of 3 percent averaged consecutively over two or more of the last five cost reporting periods, as reported to the Centers for Medicare and Medicaid Services (CMS) in its Cost Report filings, will now be eligible for payment. HHS expects to distribute the additional $3 billion across 215 acute care facilities

HHS extracted information from CMS Hospital Cost Reports to identify acute care facilities and children's hospitals that met each of the following criteria, respectively:

Acute Care Facilities

  1. A Medicare Disproportionate Patient Percentage (DPP) of 20.2% or greater
  2. Annual uncompensated care (UCC) of at least $25,000 per bed
  3. Profit Margin of 3.0% or less

Children's Hospitals

  1. A Medicaid-Only Ratio of 20.2% or greater
  2. Profit Margin of 3.0% or less

HHS determined each acute care facility's bed-weighted DPP score by performing the following calculation: Acute Care DPP Score X Number of facility beds.

HHS determined each Children's Hospital's bed-weighted Medicaid-Only Days score by performing a similar calculation: Medicaid-Only Ratio X Number of facility beds. For children's hospitals, Medicaid-Only Ratios were used because these hospitals do not report DPP. Since a hospital's Medicaid-Only Ratio enters the DPP calculation for acute care hospitals, we used the Medicaid-Only Ratio for children's hospitals instead.

Each acute care or children's hospital's individual score was expressed as a percentage of the total sum of bed-weighted facility DPP scores and Medicaid-Only Ratios.

This percentage was multiplied by $10 billion.

A minimum Distribution value of $5,000,000 was applied to each facility with an unadjusted Distribution value less than $5,000,000, and a maximum Distribution value of $50,000,000 was applied to each facility with an unadjusted Distribution value greater than $50,000,000.

Definitions and Data Sources - Medicare Cost Report

DPP:
W/S E Part A Line 32, Column 1
UCC:
W/S S-10, Line 30, Column 1
Hospital Beds:
W/S S-3 Part I, Line 14, Column 2
Net Patient Revenue:
W/S G-3, Line 3, Column 1
Total Other Income:
W/S G-3, Line 25, Column 1
Total Revenue:
Net Patient Revenue + Total Other Income
Net Income:
W/S G-3, Line 29, Column 1
Profit Margin:
Net Income / Total Revenue
Medicaid-Only Days:
Worksheet S-3, Part I, Column 7, Line 14, plus Line 2 and Line 32, minus the sum of Lines 5 and 6.
Total Days:
Worksheet S-3, Part I, Column 8, Line 14; plus Line 32; minus the sum of Lines 5 and 6; plus employee discount days reported on Line 30.
Medicaid-Only Ratio:
Medicaid Only Days / Total Days

Medicaid and CHIP Distribution

HHS expects to distribute $15 billion to eligible 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 allocation.

The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

  1. Must not have received payment from the $50 billion General Distribution; and
  2. Must have directly billed 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 billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; and
  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.

Providers must submit their gross revenues from patient care for CY 2017, or 2018 or 2019 by July 20, 2020. Before applying through the Enhanced Provider Relief Fund Payment Portal applicants should:

Read the Medicaid Provider Distribution Instructions

Download the Medicaid Provider Distribution Application Form

To learn about the application process:


Allocation for Uninsured Patients

A portion of the funds will be distributed to healthcare providers who have provided treatment for uninsured COVID-19 patients on or after February 4, 2020. Providers can request claims reimbursement and will be reimbursed at Medicare rates, subject to available funding.


$500 Million Distribution to Tribal Hospitals, Clinics, and Urban Health Centers

HHS is distributing $500 Million Distribution to Tribal hospitals, clinics, and urban health centers, distributed on the basis of operating expenses. This funding complements other funding provided to expand Indian Health Service (IHS) capacity for telehealth and testing.

IHS and Tribal Hospitals

Payment Allocation per Hospital = $2.81 Million + 3% of Total Operating Expenses

IHS and Tribal Clinics and Programs

Payment Allocation per Clinic/Program = $187,000 + 5% (Estimated Service Population x Average Cost per User)

IHS Urban Programs

Payment Allocation per Program = $181,000 + 6% (Estimated Service Population x Average Cost per User)

IHS and Tribal Hospitals

  • IHS and tribal hospitals will receive a $2.81 million base payment plus three percent of their total operating expenses.

IHS and Tribal Clinics and Programs

  • IHS and tribal clinics and programs will receive a $187,000 base payments plus five percent of the estimated service population multiplied by the average cost per user.

IHS Urban Programs

  • IHS urban programs will receive a $181,000 base payment plus six percent of the estimated service population multiplied by the average cost per userHHS has allocated approximately 4% of available funding for Urban Indian Health Programs, consistent with the percent of patients served by Urban Indian Organizations (UIOs) in relation to the total IHS active user population, as well as prior allocations of IHS COVID-19 funding. The remaining funding will be divided equally between hospitals and clinics.
  • HHS has allocated approximately 4% of available funding for Urban Indian Health Programs, consistent with the percent of patients served by Urban Indian Organizations (UIOs) in relation to the total IHS active user population, as well as prior allocations of IHS COVID-19 funding. The remaining funding will be divided equally between hospitals and clinics.

Patient Protections

We are working to remove financial obstacles that might prevent people from getting the testing and treatment they need from COVID-19.

Protecting uninsured patients

Every health care provider who has provided for COVID-related treatment of uninsured patients on or after February 4, 2020, may request claims reimbursement and will be reimbursed at Medicare rates, subject to available funding.

Insurance protections

Private insurers must waive an insurance plan member's cost-sharing payments for COVID-19 testing.

  • Some private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system, have agreed to waive cost-sharing payments for COVID-19 treatment related for insured patients.

Providers/recipients must not seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

No surprise billing

Recipients/providers must not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

Recipients/providers must abstain from "balance billing" any COVID-related treatment/any uninsured patient for whom the provider seeks reimbursement for COVID-19-related treatment.

Preventing fraud and misuse of the funds

Recipients/providers must submit documents sufficient to ensure that these funds were used for healthcare-related expenses or lost revenue attributable to the coronavirus.

This content is in the process of Section 508 review. If you need immediate assistance accessing this content, please submit a request to digital@hhs.gov. Content will be updated pending the outcome of the Section 508 review.

Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on July 10, 2020