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CARES Act Provider Relief Fund: General Information

On this page:

ANNOUNCEMENT: Starting October 5, 2020, providers may apply for funding from a new $20B Phase 3 General Distribution funding. Read the announcement.

For information about the application process and to find a list of Provider Relief Fund Payment Portals, visit the For Providers page.


Phase 1 General Distribution

HHS is distributing $50 billion to providers who bill Medicare fee-for-service in order to provide financial relief during the coronavirus (COVID-19) pandemic. These funds are allocated proportional to providers' share of 2018 patient revenue. On April 10, 2020, HHS immediately distributed $30 billion to eligible providers throughout the American healthcare system.

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

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 to 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 90 days of receiving the payment.
  • Not returning the payment within 90 days of receipt will be viewed as acceptance of the Terms and Conditions.

Phase 2 General Distribution

HHS has made available $18 billion in the Phase 2 General Distribution. Eligible providers include participants in state Medicaid/CHIP programs, Medicaid managed care plans, dentists, and certain Medicare providers, including those who missed Phase 1 General Distribution payment equal to 2% of their total patient care revenue or had a change in ownership in 2019 or 2020. Assisted living facilities are also eligible to apply.

Total Amount Recipients
$18 billion Applicant submission-based

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

  1. Either
    1. Must have either (i) directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-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 health care-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 health care-related services, or (ii) owns (on the application date) an included subsidiary that has directly billed health insurance companies for oral health care-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 health care-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 health care-related services;
    4. Must have billed Medicare fee-for-service during the period of January 1, 2019 and December 31, 2019; or
    5. Must be a Medicare Part A provider that experienced a change in ownership and billed Medicare fee-for-service in 2019 and 2020 that prevented the otherwise eligible provider from receiving a Phase 1 - General Distribution payment; or
    6. Must be a state-licensed/certified assisted living facility.
  2. 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 health care clinic); and
  3. Must have provided patient care after January 31, 2020; and
  4. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  5. 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 who have received a payment under Phase 1 General Distribution are no longer prohibited from submitting an application under Phase 2 General Distribution. Providers who received a previous Phase 1 General Distribution payment are eligible to apply and, if they have not yet received a payment that is approximately 2% of annual revenue from patient care, may receive additional funds.

  1. Read the instructions for how to fill out the application form for Phase 2 General Distribution
  2. Download the application form for Phase 2 General Distribution. For reference only. All applications must be submitted through the Provider Relief Application and Attestation Portal.

*The application period for Phase 2 General Distribution closed on September 13, 2020.


Phase 3 General Distribution

HHS has made $20 billion in new funding available for Phase 3 General Distribution allocation. Providers that have already received Provider Relief Fund payments will are invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers will also be eligible for relief payments.

Total Amount Recipients
$20 billion Applicant submission-based

All providers eligible for a previous PRF distribution, plus new 2020 providers and behavioral health providers may apply.

Providers may be eligible regardless of whether they were eligible for, applied for, received, accepted, or rejected payment from prior PRF distributions.

To be eligible to apply, the applicant must meet at least one of the following criteria:

  • Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan. 1, 2018-Mar. 31, 2020; or
  • Billed a health insurance company for oral healthcare-related services as a dental service provider as of Mar. 31, 2020; or
  • Be a licensed dental service provider as of Mar. 31, 2020 who does not accept insurance and has billed patients for oral healthcare-related services; or
  • Billed Medicare fee-for-service during the period of Jan. 1, 2019-Mar. 31, 2020; or
  • Be a Medicare Part A provider that experienced a CMS approved change in ownership prior to Aug. 10, 2020; or
  • Be a state-licensed / certified assisted living facility as of Mar. 31, 2020
  • Be a behavioral health provider as of Mar. 31, 2020 who has billed a health insurance company or who does not accept insurance and has billed patients for healthcare-related services as of Mar. 31, 2020

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

  • Filed a federal income tax return for fiscal years 2017, 2018, 2019 if in operation before Jan. 1, 2020; or be exempt from filing a return; and
  • Provided patient care after Jan. 31, 2020 (Note: patient care includes health care, services, and support, as provided in a medical setting, at home, or in the community); and
  • Did not permanently cease providing patient care directly or indirectly; and
  • For individuals providing care before Jan. 1, 2020, have gross receipts or sales from patient care reported on Form 1040 (or other tax form)

Note: 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.

  1. Read the instructions for how to fill out the application form for Phase 3 General Distribution
  2. Download the application form for Phase 3 General Distribution. For reference only. All applications must be submitted through the Provider Relief Application and Attestation Portal.

Targeted Distributions

HHS is allocating targeted distribution funding to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, 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
COVID-19 High-Impact Distribution $22 billion 395 hospitals in high-impact areas (first round)
695 hospitals in high-impact areas (second round)
Rural Distribution $10.2 billion Almost 4,000 rural health care providers
~$1.1 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
~$2.5 billion Over 15,000 skilled nursing facilities and nursing homes
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 ~$10.3 billion Eligible safety net hospitals
~$3 billion 215 acute care facilities
~$1.4 billion 80 free-standing children's hospitals

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.


COVID-19 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.

HHS made payments in this second round of COVID-19 High-Impact Area Targeted Distribution based on a formula for hospitals with a COVID-19 admission count over 160 between January 1 and June 10, 2020, or the facility experienced an above average intensity of COVID admission per bed (at least 0.54864). Hospitals were paid $50,000 per eligible admission from January 1 through June 10. HHS also took into account previous High Impact Area payments for those hospitals that received initial payments from this Targeted Distribution.


$11 Billion Rural Distribution

HHS is distributing $11 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.

Rural/Small Metropolitan Area:

The payment formula varied depending on hospital location and Medicare designation. For hospitals with a special Medicare payment designation of Sole Community Hospitals (SCH) or Medicare Dependent Hospitals (MDH), and for hospitals in small metro areas with a designation of Rural Referral Center (RRC), the payment amount was based on 1% of operating expenses (calculated based on their most recent Medicare Cost Report) with a minimum payment of $100,000, a supplement of $50 for each rural inpatient day, and a maximum payment of $4.5 million. HHS also provided a supplemental payment of $1,000,000 for 10 isolated urban hospitals that are 40 or more miles away from another hospital open to the public. HHS estimated the number of inpatient days provided by these hospitals to rural residents by calculating the proportion of patient days attributed to Medicare patients from rural zip codes using the Hospital Service Area File, calendar year 2018 (the most recent data available), multiplied by the total number of patient days as reported in the hospital's Medicare cost report.

For small city hospitals without a special Medicare designation, the payment amount was based on 1% of operating expenses (calculated based on their most recent Medicare cost report) with a minimum payment of $100,000 and a maximum of $2 million each.

The payment formula for rural specialty hospitals (Psychiatric, Rehabilitation, and Long Term Acute Care) used the previous Rural Targeted Distribution methodology (graduated base payment + approximately 2% of operating expenses) adjusted for the rural patient share (calculated as percent of inpatient days provided to rural patients) with a minimum payment of $100,000 and a maximum of $4.5 million. Operating expenses were determine based on the most recent Medicare Cost Report. Rural patient share was estimated using the proportion of patients from rural zip codes as reported in the Hospital Service Area File.

"Small metropolitan" was defined as a metro area with less than 250,000 in population as identified by the county-level Rural-Urban Continuum Codes developed by the U.S. Department of Agriculture.

Eligible rural specialty hospitals included Inpatient Psychiatric Facilities (IPFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Acute Care Hospitals (LTACHs) 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.


Allocation for Skilled Nursing Facilities and Nursing Homes

HHS is distributing a series of funding to nursing homes across the nation. The first distribution was $4.9 billion to skilled nursing facilities (SNFs) and a second distribution of almost $2.5 billion to skilled nursing facilities and nursing homes nationwide will help combat the devastating effects of this pandemic. Additionally, a separate $2 billion incentive payment structure is providing more funding to nursing homes and skilled nursing facilities based on certain performance measures.

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.

Eligible facilities received a per-facility payment of $10,000 plus a per-bed payment of $1,450. A facility has to have at least 6 certified beds to be deemed as eligible for payment.

In order for a facility to be eligible for payment, they must pass two initial gateway qualification tests on both their rate of infection and rate of mortality.

  • First, a facility must demonstrate a rate of COVID infections that is below the rate of infection in the county in which they are located. This benchmark requirement for infection rate reflects the goal of the incentive program to recognize and reward facilities that establish a safer environment than the community in which they are located.
  • Second, facilities must also have a COVID death rate that falls below a nationally established performance threshold for mortality among nursing home residents infected with COVID.
Performance Period Tentative Payment Date Tentative Audit Date
September 2020
October 2020
November 2020
December 2020
October 2020
November 2020
December 2020
January 2021
November 2020
December 2020
January 2021
February 2021
Aggregate February 2021 March 2021

Infection Measure Calculation

For facilities that meet the gateway criteria, their COVID infection performance will be measured by assessing two factors: the amount by which their own infection rate is lower than their county's infection rate and total patient volume, as measured by resident-weeks. In a given performance period, a facility's infection rate will be measured as their total number of COVID infections (not including COVID admissions) divided by their total count of resident-weeks reported in NHSN.

The difference between the facility's and county's infection rates is then scaled upward by the facility's patient volume, as measured by resident-weeks, which yields the facility's performance score on the infection measure.

Mortality Measure Calculation

Facilities are eligible for evaluation of their COVID mortality performance in a given performance period if they meet the gateway criteria and have at least one non-admission COVID infection. For these facilities, their mortality performance calculation will rely on two main pieces of information from NHSN data: the total number of COVID deaths resulting from in-facility infections and the total number of non-admission infections. Infected patients will be counted if they occur in an extended block of time, covering the performance period and several weeks preceding the performance period. These two pieces of information will be used to measure a preliminary COVID mortality rate for each facility. Direct outreach will be conducted to facilities that have at least one death in the performance period and have a mixture of COVID admissions and in-facility infections. The goal of this outreach will be to ascertain how many of their reported COVID deaths were due to in-facility infections versus COVID admissions.

These facility level characteristics will be incorporated with relevant health and demographic characteristics for each facility's resident population into a statistical model that will be used to estimate the expected number of deaths for each facility in the performance period.

  • Facilities with a mortality rate significantly exceeding expectations will become ineligible for any incentive program payments in the performance period.
  • Facilities with lower mortality than expected will be eligible for payment, which will be scaled up based on the amount by which they fall below the expected number of deaths.

Incentive Payment Calculation

For each performance period, the total available bonus payments will be determined based on aggregate performance on the infection measure. This total will then be split into separate payment pools for performance on the infection and mortality measures.

  • First, 80% of bonus payments will be available to providers that have positive performance on the infection measure. As discussed in previous sections, these payments will be made available to any facility that meets the gateway criteria.
  • Second, 20% of bonus payments will be available to providers that have positive performance on the mortality measure. Providers scoring below a threshold level of performance on the mortality measure will be deemed ineligible for payment in both the infection and mortality payment pools.

$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.

Safety Net Hospitals Distribution

HHS is allocating $14.4 billion in provider relief funds to safety net hospitals that disproportionately provide care to the most vulnerable, and operate on thin margins. Initially, HHS distributed $10 billion and then an additional $3 billion allocation so certain acute care hospitals meeting the revised profitability threshold would qualify. HHS is also distributing $1.4 billion to almost 80 free-standing children's hospitals facing financial hardships caused by the pandemic.

The distribution amount for an eligible safety net hospital is the proportion of the individual facility score (number of facility beds multiplied by DPP for an acute care facility or number of facility beds multiplied by Medicaid only ratio for a children's hospital) to the cumulative facility scores for all safety net hospitals, times the $10 billion safety net distribution.

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

Qualifying hospitals will have:

  • 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

Qualifying free-standing children's hospital must either be an exempt hospital under the Centers for Medicare and Medicaid Services (CMS) inpatient prospective payment system (IPPS) or be a HRSA Children's Hospital Graduate Medical Education facility. Eligible hospitals will receive 2.5 percent of their net revenue from patient care.


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.


CARES Act Provider Relief Fund Distribution Timeline

April

April 10 - April 17 First round of Phase 1 General Distribution
$30 Billion distributed to nearly 320,000 Medicare Fee-For-Service (MFFS) billing providers based on their portion of 2019 MFFS payments

April 24 Second round of Phase 1 General Distribution
$9.1 Billion to almost 15,000 Medicare Fee-For-Service billing providers based on revenues from CMS cost report data
$10.9 Billion available to Medicare Fee-For-Service billing providers based on revenue submissions to the provider portal


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 Center
$500 Million to approximately 300 IHS programs


June

June 3 Deadline for Phase 1 General Distribution
Deadline for providers to submit revenue information and apply for a portion of the additional $20 Billion General Distribution (Phase 1)

June 9 Phase 2 General Distribution & Distribution to Safety Net Hospitals
$15 billion to eligible Medicaid, CHIP, and Dental providers
$10 billion to Safety Net Hospitals

June 15 Second round of COVID-19 High-Impact Distribution
Deadline for hospitals to update their number of COVID-19 positive inpatient admissions between January 1, 2020 and June 10, 2020, to qualify for second round of funding.


July

July 10 Distribution to Safety Net Acute Care Hospitals, Certain Specialty Rural Providers
$3 billion to hospitals serving vulnerable populations on thin margins
~$1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas

July 17 Second round of COVID-19 High-Impact Distribution
$10 billion to hospitals with over 161 COVID-19 admissions between January 1 and June 10, 2020, one admission per day, or a disproportionate intensity of COVID admissions


August

August 7 Allocation for Nursing Homes
$2.5 billion to nursing homes mid-August to support increased testing, staffing, and PPE needs

August 14 Distribution to Certain Children's Hospitals
HHS to begin distributing $1.4 billion to 80 free-standing children's hospitals

August 27 Distribution to Nursing Homes
$2.5 billion to nursing homes to support increased testing, staffing, and PPE needs


September

September 1 Phase 2 General Distribution for Assisted Living Facilities
Assisted living facilities (ALFs) may now apply for funding under the Provider Relief Fund Phase 2 General Distribution allocation

September 3 Nursing Home Incentive Payment Plans
HHS announces details of $2 billion performance-based incentive payment distribution to nursing homes

October

October 1 Announcement of Phase 3 General Distribution
HHS announces $20 billion in new funding for providers on the frontlines of the coronavirus pandemic.



Summary of Eligibility & Methodology

Phase 1 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, submitted revenue information, 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
Phase 2 General Distribution
Distribution & Eligibility Formulas to Determine Allocation

$18 billion
Providers who participate in state Medicaid/CHIP programs, Medicaid managed care plans, or provide dental care, as well as certain Medicare providers, including those who missed Phase 1 General Distribution payment equal to 2% of their total patient care revenue or had a change in ownership in 2019 or 2020

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

*Most recent tax filings (CY2017, 2018, or 2019)

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

Second Round
Hospitals with over 160 COVID-19 admissions between January 1 and June 10, 2020, or the facility experienced an above average intensity of COVID admission per bed (at least 0.54864)
First Round

$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)
Second Round

$10 Billion to more than 1,000 High-Impact Hospitals

Payment Allocation per Hospital = Number of COVID-19 Admissions x $50,000

(HHS also took into account previous High Impact Area payments for those hospitals that received initial payments from this Targeted Distribution.)
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.

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

Sole Community Hospitals (SCH), Medicare Dependent Hospitals (MDH), & Rural Referral Center (RRC) Hospital in Small Metro Areas

Payment Allocation per Hospital = 1% of operating expenses*

* Minimum payment of $100,000, a supplement of $50 for each rural inpatient day, and a maximum payment of $4.5 million.

HHS also provided a supplemental payment of $1,000,000 for 10 isolated urban hospitals that are 40 or more miles away from another hospital open to the public.

Small Metro Area Hospitals without a special Medicare designation

Payment allocation per Hospital = 1% of operating expenses*

* Minimum payment of $100,000 and a maximum of $2 million each.

Rural Specialty Hospitals

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

*Minimum payment of $100,000 and a maximum of $4.5 million.
Allocation for Skilled Nursing Facilities (SNFs)
Certified SNFs with six or more beds
$4.9 Billion Distribution: Payment Allocation per facility = Fixed Payment of $50,000 + $2,500 per bed

$2.5 Billion distribution: Payment Allocation per-facility= Fixed payment of $10,000 + $1,450 per 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

Acute Care Facilities
A Medicare Disproportionate Payment Percentage (DPP) of 20.2% or greater, annual uncompensated care (UCC) per bed of $25,000 or more, and a profit margin of 3% or less

Certain acute care hospitals serving vulnerable populations with profit margins averaging less than 3% as reported to the Centers for Medicare and Medicaid Services (CMS)

Children's Hospitals 1
A Medicaid-only ratio of 20.2% or greater and a profit margin of 3% or less

Children's Hospitals 2
Qualifying free-standing children's hospital must either be an exempt hospital under the Centers for Medicare and Medicaid Services (CMS) inpatient prospective payment system (IPPS) or be a HRSA defined Children's Hospital Graduate Medical Education facility.

HHS expects most non-free-standing children's hospitals should have received financial support from their parent hospital systems as a share of General Distributions payments from the Provider Relief Fund program.

Acute Care Facilities and Children's Hospitals 1
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 for acute care facility or number of facility beds x Medicaid-only ratio for a children's hospital

Children's Hospitals 2
Payment Allocation per Hospital = 2.5% of Net Revenue from Patient Care


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.

For additional assistance applying, please call the provider support line at (866) 569-3522; for TTY dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday.


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Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on October 8, 2020