On Friday April 10, 2020, the Department of Health and Human Services (“HHS”) began funding the first $30 billion of its $100 billion Public Health and Social Services Emergency Fund, as authorized by the CARES Act. In terms of what entities will receive this initial funding, HHS has determined that all facilities and providers who received Medicare Fee-For-Service (“FFS”) reimbursements in 2019 will be eligible to receive a pro rata share of the $30 billion allocation. In an effort to streamline this process, HHS is distributing these funds based on the broad assumption that every patient seen after Jan. 31, 2020 by these eligible healthcare providers were possible COVID-19 patients.

Based on HHS guidelines, providers should expect to receive 6.198 percent of its 2019 Medicare FFS reimbursements. These payments are being made to entities with Taxpayer Identification Numbers, which may correspond to larger practice units as opposed to individual providers. The method of payment is based on normal reimbursement protocol, whether the entity typically receives direct deposits or mailed checks.

Details on Accepting Funds

As for the obligations of each provider accepting these distributions, it is important to note that these funds are considered by HHS to be grants instead of loans and therefore will not be returned, unless the Medicare provider chooses not to agree to the program’s terms and conditions, which include the following:

  • The provider must not charge any patient for COVID-19 treatment above what they would pay for as an in-network provider, commonly referred to as “balanced billing;
  • The provider must certify that payments are to be used only for expenses and lost revenue related to COVID-19;
  • The provider must certify that services are being provided to actual/possible COVID-19 patients;
  • The provider must certify that it is not otherwise excluded/terminated from Medicare/Medicaid programs;
  • The provider must provide requested reporting on a quarterly basis, as requested by HHS, and;
  • The provider must maintain adequate records and cost documentation

As for the remaining $70 billion in authorized HHS reimbursements, HHS indicated that these funds will be subsequently distributed to various targeted providers, such as those in harder hit areas and rural communities, as well as providers with lower amounts of Medicare reimbursements, providers who predominantly treat Medicaid patients and providers who request reimbursement for treating uninsured Americans.

If you have any questions, please reach out to GHJ’s COVID-19 Response Team to assist with any aspects of the CARES Act or COVID-19-related questions.

Ben Sheppard Facts

Ben Sheppard

Ben Sheppard, CPA, is a managing director in GHJ’s Forensic Services Practice and has more than 35 years of experience. He has deep expertise in litigation support and expert witness services, as well as forensic investigations and valuations. Ben works closely with clients to helping them find…Learn More