CARES Act Provider Relief for COVID-19 | Practicing DPMs | APMA
CARES Act Provider Relief for COVID-19

Page last updated September 29, 2021.

Looking for information on past rounds of Provider Relief Funds?

4th Round of Provider Relief Funds - Application Opens on September 29, 2021, Closes on October 26, 2021

On September 29, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), will start accepting applications for Phase 4 of the Provider Relief Fund (PRF).

Included in this round is $25.5 billion in new funding for providers affected by the COVID-19 pandemic, specifically those who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, in addition to providers who are able to document revenue loss and increased operating expenses associated with the pandemic. Lost revenue and expenses will be calculated from the period of July 1, 2020, to March 31, 2021. To see if you qualify for areas deemed “rural,” view the Rural Health Grants Eligibility Analyzer on the HHS website. 

To prepare for this round, you will need a copy of your most recent tax returns as well as financial statements from the second half of calendar year (CY) 2020 and the first quarter of CY 2021. Providers must submit their completed application by the final deadline of October 26 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application.

Provider Relief Funds Reporting Requirements

Providers that received aggregated Provider Relief Fund (PRF) payments in excess of $10,000 in a single reporting period are required to report using the PRF Reporting Tool. Reporting is required if a provider received General or Targeted Distributions. The following table summarizes reporting requirements for payments received during each Payments Received Period. On June 11, 2021, HHS released revised reporting requirements for recipients of PRF payments, which maintained the lowered the threshold from the August 14, 2020 Notice – from $150,000 in the Terms and Conditions to $10,000. These forms provide complete, detailed information on provider reporting guidelines, including intent, use of funds, and data elements requestedThe PRF Reporting Portal opened for providers to start submitting information on July 1, 2021, with the first round of reporting due on September 30, 2021. Note that HHS has extended this deadline to November 30 as a grace period, and providers who do not report by September 30 will still be considered out of compliance. However, no collection activities or similar enforcement actions will be initiated during this 60-day grace period. Providers who are able to complete their report by September 30 are strongly encouraged to do so.

APMA has worked with Hart Health Strategies to create a webinar for members to assist in navigating reporting, as well as a detailed summary

Podiatrists who have gone through the reporting process recommend accessing the following documents and information prior to reporting:

  1. Any interest earned on the PRF payments
  2. Other sources of assistance received (e.g., SBA, FEMA, business insurance, local and tribal government assistance)
  3. PRF expenses totals for general and administrative expenses, as well as health-care-related expenses from Q1 2020 through Q2 2021
  4. Total revenues from 2019 and 2020
  5. Number of part-time, full-time, and contractor clinical and non-clinical employees from Q1 2019 through Q2 2021
  6. Number of furloughed, separated, and hired part-time, full-time, and contractor clinical and non-clinical employees from Q1 2019 thru Q2 2021
  7. Number of patient visits from Q1 2019 thru Q2 2021

Additional Key Dates

Payment Received Period
(Payments Exceeding $10,000 in Aggregate Received)
Deadline to Use Funds Reporting Time Period
Period 1 From April 10, 2020 to June 30, 2020 June 30, 2021 July 1 to September 30, 2021*
Period 2 From July 1, 2020 to December 31, 2020 December 31, 2021 January 1 to March 31, 2022
Period 3 From January 1, 2021 to June 30, 2021 June 30, 2022 July 1 to September 30, 2022
Period 4 From July 1, 2021 to December 31, 2021 December 31, 2022 January 1 to March 31, 2023

* Please note, HHS has extended this deadline to November 30 as a grace period, and providers who do not report by September 30 will still be considered out of compliance. However, no collection activities or similar enforcement actions will be initiated during this 60-day grace period.

Terms and Conditions

Recipients of Provider Relief Fund payments must agree to the Terms and Conditions specific to the distribution in which they received a payment or reimbursement.

Providers must attest to program Terms and Conditions in order to receive payment, such as:

  • Eligible providers may use funds to prevent, prepare for, and respond to coronavirus, and for related expenses or lost revenues attributable to coronavirus.
  • Funding cannot be used where another source has reimbursed or is obligated to reimburse those expenses or losses.
  • Payments can be pre-payments, prospective, or retrospective payments.
  • Provider and payment information for entities that have attested to at least one payment is posted to an HHS Public Use File (PUF)

General Distribution

Targeted Distribution

Rural Payments

  • Rural Targeted Distribution: The recipient has received payment from funds appropriated as part of the targeted allocations known as the Rural Targeted Distribution.

In reviewing the terms and conditions, there are a few key items for providers to consider, as detailed below.

Possible or actual cases. Providers must attest that they “[provide] or provided after January 31, 2020, diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.” The initial terms and conditions did not include the specific date. While this information is not included in the terms and conditions, HHS on its website further noted that “HHS broadly views every patient as a possible case of COVID-19.” With the addition of the date and the HHS clarification, providers may be able to attest to this requirement if they treated any patient after January 31, whether via telehealth or in person.

Reallocating funds. At this time, there is a not a process to allow an entity to reallocate the funds to different a TIN in light of changes in ownership or new providers. This situation is a particular issue given that the legacy TINs may not be able to attest to the ability to treat patients and, as such, may have difficulty in attesting to retain the funds.

Bans balanced billing. In essence, to retain the funds, a provider must not balance bill for “all care for a presumptive or actual case of COVID-19.” For those patients, the provider must not seek from the patient more than the patient would have been obligated to pay if the provider was an in-network provider. While it is still unclear which cases would be “presumptive or actual” cases, one could attest that this subset of patients is different from “possible or actual” (which is essentially all patients) but would still apply to all patients in that subset, regardless of payer. And, given that this language does not have a similar date qualifier (i.e., the January 31 date), it is unclear when HHS expects the balance billing requirement to be in effect. This situation is particularly troubling, given that, so far, there has been no discussion regarding the amount of payment required.

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

No other reimbursement. One additional requirement is that the “recipient certifies that it will not use the payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.” Unfortunately, HHS did not provide enough information for providers to easily untangle how to provide appropriate accounting for these items, especially given that many health-care services may be under additional obligations (e.g., Medicare payment for certain telehealth services), interactions with other government programs (e.g., the Paycheck Protection Program), etc.

Salary cap. The funds provided cannot be used to “pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” According to OPM, Executive Level II is $197,300 for 2020. On its website, HHS has stated that “these are payments, not loans” but has not clarified whether this is an “extramural mechanism” subject to this restriction.

Use of funds. Another key requirement is that the “recipient certifies that the payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the recipient only for health-care related expenses or lost revenues that are attributable to coronavirus.” This requirement is confusing at best, and it seems virtually impossible to use the fund at the same time for both care and lost revenue. Therefore, additional clarity is needed, especially in light of the extensive reporting requirements for the program.

Not an exhaustive list. The terms and conditions include a statement that “[t]his is not an exhaustive list and you must comply with any other relevant statutes and regulations, as applicable.” Further, the notice states that “[n]on-compliance with any term or condition is grounds for the secretary to recoup some or all of the payment made from the Relief Fund.”

Subcontractors. Another key statement is that “[t]hese terms and conditions apply directly to the recipient of payment from the Relief Fund. In general, the requirements that apply to the recipient, also apply to subrecipients and contractors, unless an exception is specified.”

Additional language from $20 billion allocation. The additional language in the terms and conditions for the second tranche (e.g., $20 billion allocation) is as follows: “The recipient shall also submit general revenue data for calendar year 2018 to the secretary when applying to receive a payment, or within 30 days of having received a payment. The recipient consents to the Department of Health and Human Services publicly disclosing the payment that recipient may receive from the Relief Fund. The recipient acknowledges that such disclosure may allow some third parties to estimate the recipient’s gross receipts or sales, program service revenue, or other equivalent information.”

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