Source of funds

• CARES Act and Consolidated Appropriations Act, 2021
• Consolidated Appropriations Act, 2021
• H.R. 1868 (Public Law No: 117-7)

Category

• Delayed payment cuts

Funding status

• Currently funded

Description

• The CARES Act temporarily suspended the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration effective May 1, 2020, through December 31, 2020.
• The Consolidated Appropriations Act, 2021, extended the suspension from December 31, 2020, through March 31, 2021.
• The subsequent H.R. 1868 bill was signed into law on April 14, 2021, extending the suspension of the Medicare sequestration through December 31, 2021.

Eligibility

• Medicare providers who bill fee-for-service are eligible.

Restrictions

• N/A

Amount

• Health care providers can expect to receive an increase in fee-for-service Medicare payments by approximately 2% as compared to what they would have otherwise received during this period. There will also be a 20% increase in the weighting factor that would otherwise apply to the diagnosis-related group (DRG) for Medicare patients discharged with a diagnosis of Covid-19.

Purpose

• Boost fee-for-service reimbursement for providers affected by Covid-19.

Timeline

• Effective May 1, 2020, through the end of the public health emergency, which is expected to run through December 31, 2021.

Process to get money

• Automatic increase in reimbursement payments.

Governing authority

• CMS

Repayment terms

• N/A

Additional considerations

• In exchange for this temporary suspension, the CARES Act also postpones the sunset of sequestration as it applies to Medicare from the end of 2029 to the end of 2030. Medicare Advantage plans will benefit from both the temporary suspension and the increased DRG payment.
• H.R. 1868 further postpones the sunset of sequestration from 2030 to the year 2031 to pay for the cuts.

Source: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Source of funds

• CARES Act

Category

• Reimbursement

Funding status

• Currently funded

Repayment terms

• N/A

Description

• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can furnish and bill for distant site telehealth services to Medicare beneficiaries during the emergency period.

Eligibility

• RHCs and FQHCs

Restrictions

• There are no restrictions on where the telehealth service is provided, meaning physicians or practitioners may provide the service from their homes. Providers must use audio and video telecommunications technology during the telehealth visits.

Amount

• Total amount unspecified. CMS will pay RHCs and FQHCs $92 for each telehealth service provided by physicians or practitioners.

Purpose

• To support telehealth with greater flexibility for RHCs and FQHCs to reach their patients during the Covid-19 emergency period as margins have drastically narrowed.

Timeline

• The program is effective March 1, 2020, through the duration of the public health emergency.

Process to get money

• Telehealth key takeaways and fact sheet.

Governing authority

• CMS

Source: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Source of funds

• CARES Act

Category

• Reimbursement

Funding status

• Automatic add on

Description

• Provides for a 20% add-on to the inpatient prospective payment system diagnosis-related group (DRG) rate for inpatient hospital Covid-19 patients.

Eligibility

• Both rural and urban hospitals providing inpatient care of a patient diagnosed with Covid-19.

Restrictions

• Restricted to payments associated with ICD-10 diagnosis codes:
  • U07.1 (Covid-19) for discharges occurring on or after April 1, 2020
  • B97.29 (Other coronavirus as the cause of diseases classified elsewhere) for discharges occurring on or after January 27, 2020, and on or before March 31, 2020
• For admissions on or after September 1, 2020, a positive Covid-19 laboratory test must be documented in the patient’s medical record to receive the 20% increase. More information can be found here.

Amount

• Total amount unspecified. 20% add-on payment.

Purpose

• Support health care-related expenses or lost revenue attributable to Covid-19.

Timeline

• This add-on payment is retroactively effective January 27, 2020, through the duration of the public health emergency.

Process to get money

• Automatic increase in reimbursement payments from normal claims processing.

Governing authority

• CMS

Repayment terms

• N/A

Additional considerations

• This provision is also an amendment to the Social Security Act.

Source: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Source of funds

• CARES Act
• Consolidated Appropriations Act, 2021

Category

• Delayed payment cuts

Funding status

• Automatic

Description

• The CARES Act eliminated the fiscal year 2020 Medicaid DSH allotment reductions and the Consolidated Appropriations Act, 2021, further delays scheduled payment cuts through fiscal year 2023.

Eligibility

• Disproportionate Share Hospitals are eligible.

Restrictions

• N/A

Amount

• Eliminates $4 billion in Medicaid DSH allotment reductions that were scheduled to go into effect in 2021 and further eliminates the $8 billion allotment reductions scheduled to take place in 2022 and 2023.

Purpose

• Originating from the Affordable Care Act (ACA), which sought to reduce payments to safety-net hospitals, as the country in general has observed a declining trend in the number of uninsured Americans. The delayed payment cuts are intended to offset hospitals’ uncompensated care costs attributable to Covid-19.

Timeline

• On December 27, 2020, the Consolidated Appropriations Act, 2021, was signed into law, delaying payment reductions through fiscal year 2023.

Process to get money

• Automatic delay in payment cuts.

Governing authority

• CMS

Repayment terms

• N/A

Additional considerations

• The original postponement of Medicaid DSH payment cuts was May 22, 2020, but was subsequently extended by applicable passed bills to December 1, 2020, December 11, 2020, and finally through the fiscal year 2023.

Source: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Source of funds

• CARES Act
• Consolidated Appropriations Act, 2021

Category

• Reimbursement

Funding status

• Currently exhausted

Description

• The telehealth program will provide immediate support to eligible health care providers responding to the Covid-19 pandemic by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services until the program’s funds have been expended or the Covid-19 pandemic has ended.

Eligibility

• Nonprofit and public health care providers that fall into the following categories:
  • Post-secondary educational institutions offering health care instruction, teaching hospitals and medical schools
  • Community health centers or health centers providing health care to migrants
  • Local health departments or agencies
  • Community mental health centers
  • Not-for-profit hospitals
  • Rural health clinics
  • Skilled nursing facilities
  • A consortia of health care providers consisting of one or more entities falling into the first seven categories

Restrictions

• Funds may be used to purchase services and connected devices to provide connected care services in response to Covid-19.

Amount

• $200 million in the first round of funding from the CARES Act
• $249.95 million in the second round of funding from the Consolidated Appropriations Act, 2021

Purpose

• Support efforts of health care providers by providing telecommunications services, information services, and devices necessary for telehealth services to connect patients in response to Covid-19.

Timeline

• On June 25, 2020, the program stopped accepting new applications. On July 8, 2020, the FCC approved the final set of telehealth program applications. Funding determinations will be made on a rolling basis until program’s funds have been expended or the federal state of emergency declaration has ended.
• On December 27, 2020, the Consolidated Appropriations Act, 2021, was passed, providing an additional $249.95 million to the Covid-19 telehealth program. The application window for round two of funding opened on April 29th, 2021, and closed on May 6, 2021.

Process to get money

• Providers must submit an application through the FCC website.

Governing authority

• Federal Communications Commission (FCC)

Repayment terms

• N/A

Additional considerations

• The FCC Covid-19 Telehealth Program is not a grant program. To receive disbursements, eligible health care providers that are approved for funding will be required to submit an invoicing form and supporting documentation in order to receive reimbursement for eligible expenses and services. Applicants who receive funding will be required to comply with all program rules and requirements, including applicable reporting requirements, and may be subject to compliance audits.

Source: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html

Source of funds

• CARES Act
• Consolidated Appropriations Act, 2021
• American Rescue Plan Act of 2021

Category

• Loan

Funding status

• Currently exhausted

Description

• The Paycheck Protection Program provides loans to small businesses to help them pay for payroll costs, mortgage interest, rent, utilities, worker protections related to Covid-19, property damage caused by looting or vandalism, and certain operational expenses. The Flexibility Act amended the PPP to be more flexible including:
  • Extends the loan forgiveness use period of PPP loan proceeds from 8 weeks following funding to 24 weeks following funding or December 31, 2020, whichever is earlier.
  • Rehire and restoration of salary date in order to avoid proportional reduction of loan forgiveness extended from June 20, 2020, to December 31, 2020.
  • Portion of PPP loan proceeds required to be applied to payroll costs in order to qualify for loan forgiveness decreased from 75% to 60% of loan proceeds.
  • Increase repayment period for non-forgiven portion of loans from 2 years to 5 years, but only for loans approved on or after June 5, 2020.
• The SBA initially stopped accepting applications for PPP loans on August 8, 2020. On December 27, 2020, the Consolidated Appropriations Act, 2021, reopened the Paycheck Protection Program for First Draw and Second Draw Loans beginning the week of January 11, 2021. Certain borrowers that previously received a PPP loan are eligible to apply for a Second Draw Loan and borrowers that haven’t received a PPP loan may be eligible to apply for a First Draw Loan.
• The American Rescue Plan Act of 2021 allocated an additional $7.25 billion to the Paycheck Protection Program.

Eligibility

• To receive a First Draw PPP Loan, borrowers must have 500 or fewer employees. Eligible entities include nonprofits, veterans’ organizations, tribal concerns, self-employed individuals, sole proprietorships, and independent contractors. Borrowers with more than 500 employees in certain industries are also eligible to apply.
• To receive a Second Draw PPP Loan borrowers must have previously received a First Draw PPP Loan and used, or will use, the full amount, have 300 or fewer employees, and demonstrate a 25% or greater reduction in gross revenue between comparable quarters in 2019 and 2020.
• On March 11, 2021, the American Rescue Plan Act of 2021 was signed into law, expanding the loan eligibility to include larger nonprofits by counting employees per physical location of the organization. It also expanded the eligibility to include digital news services providing public health guidance during the pandemic with 500 or fewer employees per physical location of the organization.

Restrictions

• Companies must have already been in business as of February 15, 2020. Per treasury guidance issued on April 3, 2020, many companies funded by private equity or venture capital may be ineligible for loans due to SBA affiliation rules. Bankrupt hospitals or hospitals in bankruptcy proceedings are not eligible.
• The maximum amount of a Second Draw PPP Loan is 2.5 times the borrower’s average monthly 2019 or 2020 payroll costs or up to $2 million.

Amount

• CARES Act - $321 billion
• Consolidated Appropriations Act - $284 billion
• American Rescue Plan Act of 2021 - $7.25 billion

Purpose

• To incentivize employers to maintain payroll during the Covid-19 crisis, the SBA is providing 100% federally-backed loans for certain payroll expenses.

Timeline