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HHS Provider Relief Funds Reporting Requirements: Important Updates Every Provider Should Know

HHS continues to revise its reporting requirements for the use of the Provider Relief Funds. Providers with more than $10,000 in Provider Relief Fund payments must report on the use of the funds through December 31, 2020. The reporting window will begin on January 15, 2021 and providers must complete reporting obligations for FY 2020 by February 15, 2021 through a portal designed by HHS. However, providers that have unexpended funds as of December 31, 2020, will have an additional 6 months to use the remaining funds through June 30, 2021. These providers must submit a second and final report no later than July 31, 2021.  

Providers must use the Provider Relief Funds for increased healthcare related expenses attributable to COVID-19 or lost revenues due to COVID-19. HHS has made clear that providers that do not have or do not anticipate that they will have eligible expenses or lost revenue in excess of the Provider Relief Funds must return the funds by July 31, 2021. Providers must carefully calculate increased expenses attributable to COVID-19 and lost revenue due to COVID-19 in accordance with the new guidance issued by HHS through a 2-step analysis.  

Step 1:  Calculate Healthcare Expenses Attributable to COVID-19

First, providers must calculate healthcare expenses that are (1) attributable to COVID-19, and (2) not reimbursed by another source or not obligated to be reimbursed by another source. The healthcare expenses are divided into two categories: General and Administrative (G&A expenses) and healthcare-related operating expenses. The intent of the Provider Relief Funds is to reimburse marginal increased expenses due to COVID-19. Providers that received between $10,000 and $499,999 in aggregate Provider Relief Funds will only need to report healthcare related expenses attributable to COVID-19 less other sources of reimbursement (insurance payments, government assistance, etc.) separately in the two categories of G&A expense and healthcare-related operating expenses. Providers that received $500,000 or more in Provider Relief Funds will be required to report more detailed expense information using worksheets that will be in the portal.  

G&A expenses include expenses such as mortgage/rent, insurance costs, personnel and fringe benefits, lease payments, utilities and operations, etc. Provider Relief Funds can only be used to cover G&A expenses over and above amounts that have been reimbursed from other sources such as insurance payments and funds received from government sources (such as PPP, EIDL, etc.).  HHS has issued detailed FAQs regarding the definition of G&A expenses, but we expect more guidance to be issued regarding how increased expenses are calculated and offset by other monies received by the provider.  

The FAQs outline a few methodologies from which a provider can choose, based on the provider’s accounting methodology and record-keeping. The provider can net G&A expenses against insurance payments and other funds received (such as PPP, EIDL, etc.). The provider can also calculate the increased incremental cost to provide services, such as an office visit, due to incremental expense. However, the provider must offset the incremental cost by any increased reimbursement received by the provider to compensate for the increased costs. Providers can also calculate incremental expenses separately such as additional security personnel, increased hazard pay, increased utility costs of temporary facilities, etc. However, if the provider applied any funding or grants, such as PPP funds, the provider cannot apply these expenses to the Provider Relief Funds. 

Healthcare-related operating expenses include expenses such a supplies, equipment, IT, facilities, employees, and other similar expenses. The Provider Relief Funds can only be used for costs attributable to COVID-19. Providers can compare costs and expenses from 2019 to the same costs and expense from 2020 in order to determine the incremental increase due to COVID-19. For example, providers should calculate the increased costs in PPE supplies in 2019 compared to PPE supplies in 2020 (less any grant or funding received by the provider for such items). 

Step 2:  Calculate Lost Revenues Attributable to COVID-19

If providers still have unused Provider Relief Funds, the provider must allocate the Provider Relief Funds to lost revenues due to COVID-19. The updated reporting instructions reverse initial instructions that allowed providers to calculate lost revenues based on a reasonable accounting methodology through a snapshot of March and April 2020 losses and budgeted versus actual revenues. The new reporting requirements require providers to compare 2019 patient care revenues to 2020 patient care revenues and the year-over-year net change in patient care revenues from 2019 to 2020.  

Lost Revenues Equation:

     2019 Patient Care Revenues

-    2020 Patient Care Revenues

  = Net Change (maximum amount to which Provider Relief Funds can be applied)

Providers must report patient revenues by payor source (Medicare Part A+B, Medicare Part C, Medicaid/CHIP, commercial insurance, self-pay) as well as other income. Other income would include amounts received from other sources for patient care services (e.g. deductibles, copayments, coinsurance amounts).   

If the Provider Relief Funds are not fully expended by December 31, 2020, the provider can use the 6-month period from January 1, 2021-June 30, 2021 and compare patient care revenues to the same 6-month period in 2019.  

Other Reporting Requirements

Providers must also report other assistance received in 2020 such as Coronavirus Relief Funds from the Treasury, IRS, SBA, CARES Act/PPP, etc.; FEMA CARES Act; CARES Act testing; local, state, and tribal government assistance; business insurance (e.g. business interruption); and other assistance (which includes interest earned on the Provider Relief Funds). Interest must be added to the total Provider Relief Fund amount and expended towards the appropriate use of the funds. 

Providers must also provide quarterly data on non-financial information. Providers must report personnel metrics by category (full-time, part-time, contract, etc.) as well as total re-hires, total new hires, and total personnel separations – all by category. Providers must report certain patient metrics including in-person and telehealth visits, as well as total number of admissions and resident patients. In addition, providers must report on facility metrics including staffed beds for medical/surgical, critical care, and other beds. 

Finally, providers that underwent changes of ownership or certain divestitures will be required to report the change in ownership.

Providers should continue to be cognizant of their record-keeping obligations as well as balance-billing prohibitions. For more information on the HHS Provider Relief Fund Reporting Requirements, please visit our website at www.bmdllc.com. For more information on the HHS Provider Relief Funds, please contact Amanda Waesch at alwaesch@bmdllc.com or 330-253-9185.

Vaccination Considerations for Employers

Today, three Covid-19 vaccines have tested as highly effective (90%+ efficacy) and are advancing in the process for emergency use. This is especially welcome news in Ohio, which has skyrocketing cases and our strategic response has been to turn the entire state into the small town of Bomont with strict curfews and bans on social gatherings.

Did You Receive More than $750,000 in Provider Relief Funds?

The Provider Relief Funds (“PRF”) - authorized under the CARES Act - has been a vital tool for health care providers during the COVID-19 public health emergency. These funds have allowed providers to stay open and continue to offer care during these pressing times. While helpful, these funds do come with several important obligations. First, fund recipients are required to comply with certain record-keeping requirements as well as comply with certain balance billing prohibitions. See our Client Alert. Second, fund recipients are required to report their intent, use of funds, and other data elements, which helps promote transparency to the federal government. Please see our Client Alert on provider relief fund reporting requirements. Third, and perhaps a new concept for many providers, fund recipients of more than $750,000 must undergo a “single audit” to ensure program compliance and appropriate use of funds.

Important Updates Every Provider Should Know: Information Blocking

In December 2016, Congress passed the 21st Century Cures Act (“Cures Act”) which: (1) authorized funding for the National Institutes of Health to promote medical research and drug development, (2) implemented provisions aimed at addressing the prevention and treatment of mental illness and substance abuse, and (3) reformed certain standards of the Medicare program and federal tax laws to foster healthcare access and quality improvement.

PPP Update: Loan Necessity Questionnaires

On October 26, 2020, the Small Business Administration (“SBA”) published a notice in the Federal Register which foreshadowed the release of two new forms seeking information from for-profit and nonprofit organizations that received Paycheck Protection Program (“PPP”) loans of $2 million or more. If approved, the SBA would use information from these forms to evaluate and determine whether economic uncertainty made a PPP loan request necessary.

Exposure to COVID-19 Flow Chart

Exposure to COVID-19 Flow Chart