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Everything you need to know about BMD and the industry.

Important Items Every Provider Should Know if Accepting the HHS Provider Relief Funds

On April 10, 2020, the Department of Health and Human Services (HHS) issued $30 billion to healthcare providers as part of the Provider Relief Fund under the CARES Act.  Providers will have 30 days from the date of receipt to access the HHS portal, attest to the payment, and accept the Terms and Conditions. The Terms and Conditions require providers to take substantial steps to ensure compliance. Here is what every provider should know: 

  • Providers should ensure that they attest on the HHS portal to ensure that the money allocated by HHS is consistent with the amount they received, as HHS will certainly recoup any excess amount and the provider will have an obligation to repay such excess.
  • Providers are required to follow 45 CFR 75.302 with respect to financial record-keeping. Providers must adopt a written policy that includes a documented process for ensuring proper allowability of costs and expenses in furtherance of the Provider Relief Fund Terms and Conditions. 
  • Providers are required to comply with 45 CFR 75.361-365 with respect to record retention requirements. This affords HHS a 3-year lookback opportunity to audit providers’ compliance with the Provider Relief Fund Terms and Conditions. 
  • Providers cannot “balance bill” patients for any COVID-related treatment. All providers must bill patients as if the provider is an in-network provider even if the provider is out-of-network. 
  • The Provider Relief Fund Terms and Conditions contain whistleblower protections.

We anticipate that HHS will audit providers’ compliance. Therefore, we recommend the following: 

  • Identify a compliance officer or individual who will be responsible for these funds.
  • Adopt a written policy and procedure to ensure compliance with the Terms and Conditions. This policy should be incorporated into your Compliance Plan.
  • Adopt a written compliant financial record-keeping process.
  • Adopt a written billing policy and update your Patient Financial Responsibility Form. Under the FFCRA and the CARES Act, private insurance plans are required to waive patient co-sharing payment requirements. Providers should have a documented plan for compliance.
  • Providers that received money under another federal COVID-related program (PPP, EIDL, etc.) must separately account for such funds and maintain appropriate records.

Here are some other helpful tips:

  • Providers must ensure vendors and contractors meet certain requirements in order to allocate Provider Relief Funds to these vendor/contractor expenses.
  • Providers should carefully review Confidentiality Agreements, NDAs, and Severance and Settlement Agreements to ensure that language is compliant with the Terms and Conditions.
  • Providers should carefully allocate appropriate expenses as well as properly document “lost revenues.” 
  • Providers cannot allocated expenses twice to two different funding sources.
  • Providers must develop a strategy to use the Provider Relief Funds in accordance with other COVID-related funding (e.g. PPP, EIDL, etc.)

BMD can provide you with a written policy as well as review your agreements to ensure compliance with the Term and Conditions. For questions or more information, please contact Amanda Waesch at alwaesch@bmdllc.com or 330-253-9185.

Ohio State Dental Board Implements Teledentistry Rules

Ohio law defines “teledentistry” as the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization.[1] The law requires a dentist who desires to provide dental services through teledentistry to apply for a teledentistry permit from the Ohio State Dental Board (“OSDB”).[2] Pursuant to the mandate under Ohio Revised Code 4715.436, the OSDB is implementing the following teledentistry permit rules and requirements (to be set forth under Ohio Administrative Code Chapter 4715-23). These regulations, which were subject of a public hearing on February 19, 2020, are effective on May 30, 2020.

HHS Addresses Drug Manufacturer Coupons on Out-of-Pocket Limits

On May 7, 2020, the US Department of Health and Human Services (“HHS”) announced their Notice of Benefit Parameters for 2021 in which HHS addressed the application of prescription drug manufacturer copay coupons towards a patient’s out-of-pocket limit. Under this guidance, HHS will permit, but not require, plans and insurers to count direct support offered to enrollees by drug manufacturers (i.e., coupons) for specific prescription drugs toward the annual limits on cost-sharing, regardless of whether a generic equivalent is available.

Important Updates, Deadlines, and Clarifications for the HHS Provider Relief Funds

On May 20, 2020, HHS made important updates and clarifications regarding the General Distribution payments to providers. Between April 10, 2020 and April 24, 2020, HHS distributed an initial $30 billion to providers based on the provider’s 2019 Medicare fee-for-service receipts. These funds were distributed automatically and providers did not need to submit an application in order to receive these funds. The funds were originally touted as a “no strings attached” stimulus payment reserved for healthcare providers. But HHS issued a 10-page Terms and Conditions and required that providers sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions.

Reopening & Social Media: Tips for Businesses

As the country starts to reopen, businesses are under great pressure to keep employees and customers safe. Even if a business follows every reopening requirement, there will inevitably be scrutiny from within and outside the organization. And, in this world of social media, perception tends to become reality. Below are a few practical tips to avoid attracting negative press while restarting your business.

Back to Work: Employer Documents

The return of the workforce brings a renewed set of documentation requirements for employers, particularly those employers with fewer than 500 employees and any companies who received PPP funds. Back in March, employers needed a COVID-19 Leave Form and a Remote Work Policy, but things have changed.