Update on Provider Relief Funding Phase 3
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Tag: Coronavirus Aid Relief and Economic Security Act (CARES Act)
AAA Sends letter to HHS supporting additional funding.
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2020 Post-Election Outlook
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New SBA Questionnaires Require Borrowers of over $2 Million to Provide Justification for Economic Necessity of Loans
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Savvik: Do you have federal grant or CARES money to spend? We have public bid awards!
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Alabama CARES Act Funds for EMS
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Tranche 3 Funding Update From Asbel Montes
Asbel Montes, AAA Payment Reform Chair, partnered with fellow member Solutions Group on this detailed HHS Tranche 3 funding video update.
Thank you to Asbel and Solutions Group for sharing!
HHS Funding Portal Open for Tranche 3
The online portal for ambulance service providers and suppliers to submit applications for additional funding under the HHS Provider Relief Fund is now open.
Apply Soon for Funds!
While providers and suppliers have until November 6 to apply for funding, we strongly recommend that AAA members submit applications as soon as you are prepared as funding is on a first-come, first-served basis. HHS allocated a total of $20 billion for this round of funding.
Attend Today’s AAA Funding Webinar
The AAA will be hosting a webinar today, Monday, October 5, at 11:00 am (eastern), on how to apply for the funds and what information you will need in applying.
Thank You AAA Members!
As reported by the AAA on October 1, the additional funds are a direct result of the efforts of the AAA and our members and we thank all of you who reached out to the White House or your members of Congress advocating for the funds.
U.S. House of Representatives Approves Continuing Resolution
On September 22, 2020, the U.S. House of Representatives approved a continuing resolution to keep the government funded through December 11, 2020. Under current law, government funding is set to expire at midnight on September 30, 2020.
The House resolution is a stopgap measure that would maintain funding for most government programs at their current Fiscal Year 2020 levels. However, the Continuing Resolution omits $30 billion in agricultural aid sought by the Trump Administration and Senate Republicans. As of last week, it appeared that a compromise had been struck between the Administration and Speaker Pelosi under which the agricultural aid would be tied to the extension of special food benefits to recipients of free or reduced-price school lunches authorized by the Families First Coronavirus Response Act. The Continuing Resolution also does not include new spending on economic aid for those impacted by the coronavirus.
The Continuing Resolution will now go to the U.S. Senate for consideration.
Impact on Repayment of Medicare Accelerated and Advance Payments
In response to the COVID-19 pandemic, CMS announced that it would be opening the Medicare Accelerated and Advance Payment Program (AAPP) to all health care providers and suppliers that were impacted financially by the pandemic. Under the AAPP, Medicare-enrolled providers and suppliers were eligible to receive an advance of up to three months of their historic Medicare payments. These advances were structured as “loans,” and were required to be repaid through the offset of future Medicare payments. CMS began accepting applications for Medicare advances in mid-March 2020, before ending the program in late April following the passage of the CARES Act. CMS ultimately approved more than 45,000 applications for advances totaling approximately $100 billion, before it suspended the program in late April 2020.
Under the existing terms of the AAPP, repayment through offset was required to commence on the 121st day following the provider or supplier’s receipt of the advance funds. The program also called for a 100% offset until all advanced funds had been repaid.
The American Ambulance Association, the American Hospital Association, the Association of American Medical Colleges, and numerous other advocacy groups have advocated that the AAPP be revised to give health care providers and suppliers greater flexibility to repay the advanced funds. The AAA and others argued that these changes were necessary to avoid a financial crisis when CMS began offsetting Medicare payments to repay the advanced funds. A copy of the AAA’s letter to CMS Administrator Seema Verma can be viewed by clicking here.
In the Continuing Resolution, the House addressed this issue by making the following changes to the AAPP:
- Hospitals and Other Part A Providers: Upon request of the hospital or other Part A provider: (1) provide for 1 year before claims are offset to recoup the advanced funds, (2) limit the offset to not more than 25% of the payment on a future claim for the first 11 months during which offsets are required, (3) limit the offset to not more than 50% during the next 6 months, (4) provide for up to 29 months (from the date the advanced payments were first received) before requiring that the outstanding balance be paid-in-full, and (5) limit the interest charged on the unpaid principal balance of any advanced funds to 4%.
- Part B Suppliers: Upon request of the supplier: (1) provide for 1 year before claims are offset to recoup the advanced funds, (2) limit the offset to not more than 25% of the payment on a future claim for the first 11 months during which offsets are required, (3) limit the offset to not more than 50% during the next 6 months, (4) provide for up to 29 months (from the date the advanced payments were first received) before requiring that the outstanding balance be paid-in-full, and (5) limit the interest charged on the unpaid principal balance of any advanced funds to 4%.
The Continuing Resolution would require the HHS Secretary to post within 2 weeks of enactment (and updated every 2 weeks thereafter) the following information related to the AAPP on the CMS website:
- The total amount of such payments under each part of the program, including the specific percentage of such payments made out of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Insurance Trust Fund;
- The total amount of payments under each part of the program, by industry type;
- The CMS identifier and the amounts received by each health care provider or supplier.
HHS would also be required to post periodic reports, starting in July 2021 and every six months thereafter until all AAPP amounts have been repaid, that contain the following:
- The total amounts yet to be repaid;
- The total amounts yet to be repaid, by industry type;
- The total amounts repaid under each program, including the specific percentage of such repayments deposited back to the Federal Hospital Insurance Trust Fund or the Federal Supplementary Insurance Trust Fund; and
- The total interest collected on all repayments
The Senate will most likely approve the House CR before the September 30, 2020 deadline.
CARES Act Reporting Requirements Released
All recipients of payments from the Department of Health and Human Services’ Provider Relief Fund (PRF) are required to comply with the reporting requirements described in the Terms and Conditions and specified in future directions issued by the Secretary.
Providers that received more than $10,000 in grants will have to report on how they spent funds on coronavirus-related expenses and lost revenue in 2020 by Feb. 15, 2021. If providers do not spend all their grant funds by the end of 2020, they will be required to submit a final report on the remaining funds by July 31, 2021.
Any recipient of PRF payments may be subject to auditing to ensure the accuracy of the data submitted to HHS for payment. Any recipients identified as having provided inaccurate information to HHS will be subject to payment recoupment and other legal action.
For more details, please refer to the Terms and Conditions associated with each payment distribution and the Reporting Requirements and Auditing FAQs.
Department of Health and Human Services Extends Deadline to Apply for Provider Relief Funds
The Department of Health and Human Services (HHS) recently announced that it would be extending the deadline for health care providers to apply to receive general distribution funding from the HHS Provider Relief Fund. The deadline to apply for these funds was previously June 3, 2020.
Relevant Background
On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). As part of that Act, Congress allocated $100 billion to the creation of a “CARES Act Provider Relief Fund,” which will be used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response. An additional $75 billion was allocated as part of the Paycheck Protection Program and Health Care Enhancement Act, bringing the total “Provider Relief Fund” up to $175 billion. This $175 billion will be distributed to health care providers and suppliers to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.
HHS ultimately elected to allocate these funds through a $50 billion “general allocation,” and multiple smaller “targeted allocations.”
Under its general allocation program, HHS intended to provide health care providers with funds roughly equal to 2% of the provider’s 2018 “net patient revenue,” i.e., the provider’s total revenues from patient care minus provisions for bad debt, contractual write-offs, and certain other adjustments. This general allocation was made in two tranches, with the first tranche being distributed to all providers in mid-April. This first tranche was made based on provider’s 2019 Medicare revenues. As a result, any provider that received payments from the Medicare Fee-for-Service Program in 2019 automatically received an initial relief payment. However, HHS required providers to submit an application to receive relief funding as part of the second tranche. The deadline for applying for the second tranche of relief funding was June 3, 2020.
Scope of New Extension
HHS indicated that the new extension is limited to health care providers that missed the June 3, 2020 deadline to apply for the second tranche of relief funding. The extension also applies to providers that were ineligible for the first tranche of relief funding due to a recent change of ownership. The specific situations that HHS indicated would meet the requirements for the extension include:
- Health care providers who were ineligible for the first tranche of relief funding because: (1) they underwent a change in ownership in calendar year 2019 or 2020 under Medicare Part A and (2) did not have Medicare Fee-for-Service revenues in calendar year 2019;
- Health care providers who received a payment in the first tranche of funding but: (1) missed the June 3, 2020 deadline to submit revenue information or (2) did not receive funds in the first tranche that total approximately 2% of their net patient revenue; or
- Health care providers who received a payment in the first tranche of funding, but who ultimately elected to refund that payment (e.g., because they did not believe they met the eligibility requirements), and who are now interested in reapplying.
Health care providers that meet one of the requirements listed above will have until August 28, 2020 to submit an application for additional relief funds. This deadline aligns with the extended deadline for other eligible Phase 2 providers, such as Medicaid, Medicaid Managed Care, CHIP, and dental providers.
Applications should be submitted through the CARES Provider Relief Fund webpage, which can be found at: https://cares.linkhealth.com/#/.
AAA Letter to Trump about Press Conference
On August 11, AAA President Aarron Reinert sent a letter to President Trump in follow up to the White House Press Conference last week in which President Trump engaged in dialogue with a reporter about the need for additional ambulance relief.
Read the Letter
AAA Sends Vaccine Prioritization Request Letter to President Trump
On July 13, the American Ambulance Association was joined by the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, National Fire Protection Association, and the National Volunteer Fire Council in sending a letter to President Donald Trump requesting that firefighters and emergency medical services (EMS) personnel are placed on the highest priority tier for receiving COVID-19 vaccinations when they are available.
IRS Guidance on Taxation of HHS Provider Relief Funds
On July 7, 2020, the Internal Revenue Service published a series of Frequently Asked Questions that address the taxation of payments to health care providers under the HHS Provider Relief Fund.
As part of the Coronavirus Aid, Relief and Economic Security Act (CARES Act), Congress appropriated $100 billion to reimburse eligible health care providers for health care-related expenses and/or lost revenue attributable to the COVID-19 pandemic. The Paycheck Protection Program and Health Care Enhancement Act appropriated an additional $75 billion to the Provider Relief Fund.
The first FAQ addressed the issue of taxation for for-profit health care providers. Specifically, the IRS was asked whether a for-profit health care provider is required to include HHS Provider Relief Fund payments in its calculation of “gross income” under Section 61 of the Internal Revenue Code (Code), or whether such payments were excluded from gross income as “qualified disaster relief payments” under Section 139 of the Code.
The IRS indicated that payment from the Provider Relief Fund do not qualify as qualified disaster relief payments under Section 139 of the Code. As a result, these payments are includible in the gross income of the entity. The IRS further indicated that this holds true even for businesses organized as sole proprietorships.
The second FAQ addressed the issue of taxation for tax-exempt organizations. The IRS indicated that health care providers that are exempt from federal income taxation under Section 501(a) would normally not be subject to tax on payments from the Provider Relief Fund. Notwithstanding this general rule, the IRS indicated that the payment may be subject to tax under Section 511 of the Code to the extent the payment is used to reimburse the provider for expenses or lost revenue attributable to an unrelated trade or business as defined in Section 513 of the Code.
The IRS FAQ can be viewed in its entirety by clicking here. Members are advised to discuss the issue of potential taxation of any relief funding they received with their tax professionals.
For-profit providers have to pay taxes on COVID-19 relief grants
From Modern Healthcare on July 13, 2020
The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.
The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.
HHS HRSA Provider Relief Fund Webinars
CARES Act Provider Relief Fund
The Provider Relief Funds supports American families, workers, and the heroic healthcare providers in the battle against the COVID-19 outbreak. HHS is distributing $175 billion to hospitals and healthcare providers on the front lines of the coronavirus response.
HHS expects to distribute $15 billion to eligible Medicaid and CHIP providers through the Provider Relief Fund. Join our webcast to learn more about the application process. Please pre-register to reserve a spot on your preferred date:
Wisconsin | Governor Evers Announces $100m in Relief
“MADISON — Gov. Tony Evers today announced a grant program funded by the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. Totaling $100 million dollars, the funding will support providers most at-risk for financial hardship during the COVID-19 pandemic. The providers targeted for financial assistance include emergency medical services, home and community-based services, and long-term care providers such as skilled nursing facilities and assisted living facilities.”
Critical Care Decontamination System (CCDS) for N95 Respirators
Prehospital Use of the Critical Care Decontamination System (CCDS) for
N95 Respirators
PURPOSE:
Use of personal protective equipment (PPE) during the COVID-19 pandemic response is at unprecedented levels. In order to slow usage rates and maintain supply chain stability, the U.S. Food and Drug Administration (FDA) has authorized an Emergency Use Authorization (EUA) for the emergency use of an N95 respirator decontamination system. This is one of several EUAs for decontamination technologies granted by the FDA. This document is intended to provide basic information on the Critical Care Decontamination System (CCDS) for pre-hospital use.
MANUFACTURER SYSTEM REQUIREMENTS
- Method: vapor phase hydrogen-peroxide (VPHP)
- For use in decontaminating N95 or N95-equivalent respirators
- Respirators can undergo up to 20 decontamination cycles with the CCDS.
- Due to incompatibility, the CCDS is not authorized for use with respirators containing cellulose-based materials.
- All compatible N95 respirators provided to CCDS must be free of any visual soiling or contamination (e.g., blood, bodily fluids, makeup).
- If N95 respirators are soiled or damaged, they will be disposed of and not returned after decontamination.
- Healthcare personnel should follow the instructions provided by the CCDS program in Instructions for Healthcare Personnel
- There is not a cost for use of the system
- First responders will have access to the system(s) in their region
- Healthcare facilities and first responder agencies need to request a Site Location Code from the CCDS program.
- The Site Location Code must be placed by the healthcare facility or first responder agency on each of their N-95 respirators.
- This is not a one-for-one exchange program –if the N95 cannot be disinfected, it will not be replaced. Decontaminated N95s will be returned to the healthcare facility with the designated facility code and chain-of-custody forms.
LOCATIONS
The CCDS location for your area can be found by contacting your state or local EMS agency/public health agency / Emergency Operations Center (EOC).
NOTE: If there is not one in your area, a request can be submitted through your local EOC to
utilize others.
Further information can be found on the CCDS Site
CMS Issues Additional Staffing and Licensing Waivers
On May 1, 2020, CMS updated its “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.” The full document can be viewed by clicking here.
In the updated FAQ, CMS answers three important questions related to ambulance vehicle and staffing requirements:
- Expired Ambulance Operating Licenses. CMS was asked whether a ground ambulance vehicle operating under an expired license could nevertheless satisfy the Medicare regulations related to vehicle licensing. CMS indicated that the ground ambulance would remain in compliance with Medicare Program rules to the extent it was permitted to operate without a renewed license under a valid state or local law, regulation, or legally adequate waiver. It is important to note that this is not a “waiver” of CMS rules per se. Rather, CMS correctly noted that additional flexibility being provided is based on the state waiving or relaxing its existing rules related to licensures.
- Modified Staffing Requirements. CMS was asked whether an ambulance service that staffs its vehicles with personnel that fall below the previously required levels of certification would be in compliance with Medicare Program rules. The Medicare regulations at 42 C.F.R. §410.41(b) set forth the requirements for vehicle staffing. These regulations largely defer to state and local laws. However, they do require a certain minimum level of staffing. Specifically, the Medicare regulations require that: (i) BLS vehicles be staffed with at least two people, at least one of whom must be certified as an EMT and (ii) ALS vehicles be staffed by at least two people, at least one of whom must be certified as a paramedic or an EMT that is permitted to perform one or more ALS services (e.g., an EMT-Intermediate). CMS is indicating that it is waiving this minimum staffing requirement under its 1135 Waiver Authority for the duration of the Public Health Emergency. Under this waiver, CMS will consider the vehicle staffing requirement to be met to the extent state or local law, regulation, or waiver permits an alternative staffing arrangement. CMS specifically cited examples where the state or locality would permit BLS vehicles to be staffed with EMRs instead of EMT-Basics, or ALS vehicles staffed with RNs instead of paramedics. Note: claims submitted in reliance upon this waiver should be submitted using the “CR” modifier after the origin/destination modifiers.
- Ambulance Services Rendered Across State Lines. CMS was asked whether an ambulance service that provides care across state lines, in a state where it is not certified to provider services or in which its personnel are not licensed, would be in compliance with Medicare Program rules. CMS indicated that it is using its 1135 Waiver Authority to waive the requirement under 42 C.F.R. 410.41(b) that vehicle personnel be licensed in the state in which they are furnishing services to the extent that: (i) they have an equivalent licensing or certification in another state and (ii) they are not affirmatively excluded from practicing in that state or any other state. Please note that this waiver only applies to the Medicare certification requirements. CMS lacks the authority to waive the licensing requirements of the other state or locality. Thus, for this waiver to apply, you must be permitted to operate in the other state pursuant to that state’s laws, regulations, and/or validly issued waiver. Note: claims submitted in reliance upon this waiver should be submitted using the “CR” modifier after the origin/destination modifiers.
COVID-19 Uninsured Program Now Includes Air, Water
HHS Updates Guidance on Provider Relief Funding for Uninsured to include Air and Water Ambulance
The Department of Health and Human Services recently updated its guidance on the disbursement of provider relief funds under the CARES Act for the testing and treatment of the uninsured. Previously, HHS indicated that this allocation was only available for the reimbursement of emergency and non-emergency ground ambulance transportation. However, in its most recent update, HHS has removed the restriction that limited participation to ground ambulance providers and suppliers. The new guidance indicates that the relief funds are now available for all emergency ambulance transportation and non-emergency patient transfers via ambulance.
Thus, it appears that air and water ambulance providers and suppliers are now eligible to receive funding for the treatment of COVID-19 patients.
Is there anything my air or water ambulance organization needs to do to claim reimbursement for treatment of uninsured COVID patients?
Yes. In order to be eligible for payments for the treatment of uninsured COVID patients, you must enroll as a participant in the program. Enrollment must be done through an online portal that can be accessed at: http://www.coviduninsuredclaim.hrsa.gov.
Once my organization enrolls, when can we start submitting claims for reimbursement for treatment of uninsured COVID patients?
HHS has indicated that it will begin to accept claims for reimbursement for treatment of the uninsured on May 6, 2020.
FUNDING FOR TREATMENT OF UNINSURED COVID PATIENTS IS SUBJECTED TO AVAILABLE FUNDING, AND IS THEREFORE ON A FIRST-COME, FIRST-SERVED BASIS. IT IS EXPECTED THAT THESE FUNDS WILL BE EXHAUSTED IN FAIRLY SHORT ORDER.