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July 20 is Important Deadline for HHS Fund Distributions to Medicaid and CHIP Providers

On June 10, 2020, the U.S. Department of Health and Human Services (“HHS”) released details on the distribution of more CARES Act Provider Relief Fund payments. After allocating $50 billion to Medicare providers through its General Distribution fund, HHS has now announced that it will distribute $15 billion to eligible Medicaid and CHIP providers who apply by the deadline through a Targeted Distribution. Applicants must apply through the Enhanced Provider Relief Fund Payment Portal. The application form itself can be found on the HHS website and is due by July 20, 2020.

In order to qualify for part of the Targeted Distribution for Medicaid and CHIP providers, practices and individual practitioners must meet all of the following requirements:

  1. Must not have received payment from the $50 billion General Distribution; and
  2. Must have directly billed Medicaid (or Medicaid Managed Care Plans) for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; and
  3. Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or healthcare clinic); and
  4. Must have provided patient care after January 31, 2020; and
  5. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  6. If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

Note that if a provider received a General Distribution payment and returned it, they will not be eligible for this Targeted Distribution.

The final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients the provider serves. Payments will be allocated based on this formula:

Payment Allocation = 2% (Gross Revenues x Percent of Gross Revenues from Patient Care)

The provider requesting an allocation will specify in their application whether they want to base this calculation on calendar year 2017, 2018 or 2019 revenues. Payments will be disbursed on a rolling basis, as information is validated by HHS. Providers who qualify should apply as soon as possible to ensure they meet the July 20th deadline and do not get stuck waiting for validation.

Once a provider is approved for and receives Targeted Distribution funds, they will have 90 days to accept the payment and attest to certain Terms & Conditions. The Terms & Conditions are very similar to the General Distribution attestations, but recipients of the Targeted Distribution funds should read through them carefully to ensure they can truthfully attest to each one. If a provider finds they cannot satisfy one of the Terms & Conditions they should return their payment back to HHS within the 90-day period following receipt of the payment.

Also like the General Distribution funds, the Targeted Distribution funds may only be used to reimburse the provider for health care expenses incurred in the prevention, preparation for, and response to coronavirus or for lost revenues attributable to coronavirus. Providers may not use the Targeted Distribution funds to pay for expenses or losses that have been reimbursed from other sources. Additionally, the Targeted Distributions Funds are characterized as federal grants, which require the provider to take the following steps:

  • Adopt a policy regarding the proper use of the funds, procedure for ensuring proper use of the funds, and appointment of a compliance officer.
  • Ensure proper maintenance of records and documentation of expenditures as HHS can audit over a 3-year lookback period.
  • If the provider has received Paycheck Protection Program or other coronavirus-related funds, the provider must submit separate reports and account for each pool of funds separately.

For those interested, HHS is hosting complimentary webcasts next week. Click here for more information.

If you need assistance in determining whether you qualify for a Targeted Distribution or have questions about the application, please contact BMD Health Law Attorney Ashley Watson at abwatson@bmdllc.com. If you received Provider Relief Funds from either the General Distribution or Targeted Distribution, please contact Amanda Waesch at alwaesch@bmdllc.com or 330-253-9185 for questions related to the HHS Provider Relief Fund Policy.

El Contrato Escrito: La Herramienta Predilecta

No existe mejor herramienta a una disputa contractual que un documento firmado por las partes en el cual se expongan las obligaciones y acuerdos entre éstas.

New State Budget Institutes Licensure Requirement for Ohio’s Hospitals

On July 1, 2021, Governor Mike DeWine signed Ohio’s final budget codified at Ohio Revised Code 3722.01 et seq., which includes a new licensing requirement for Ohio’s hospitals. For years, Ohio was the only state in the country that did not license its hospitals. This approach will now be replaced with new, detailed requirements that will require careful review and compliance. Here are some of the highlights concerning these new changes:

Healthcare Provisions in the Ohio FY 22-23 Budget

Governor Mike DeWine signed Ohio’s Fiscal Year 2022-2023 budget bill (HB 110) into law on July 1, 2021. At almost 1,000 pages and 74.1 billion dollars, the budget lays out the State’s spending for the next two years. Below are a few highlighted provisions from the budget that will be important for the healthcare industry in Ohio

Interim Final Rule for Surprise Billing

In an effort to implement the new bipartisan No Surprises Act, on July 1, 2021, the Department of Health and Human Services (HHS), along with the Departments of Labor and Treasury, issued an interim final rule to safeguard patients against unforeseen medical bills arising from out-of-network care.

President Biden Seeks to Limit Non-Compete Agreements

Today, President Biden announced he would issue an Executive Order that calls on the Federal Trade Commission (FTC) to adopt rules to curtail worker non-compete agreements. Interestingly, a week ago, the FTC approved changes to its Rules of Practice to modernize and expedite the way it issues Trade Regulation Rules. If you have followed our alerts, we predicted the elimination of non-competes would probably happen. In 2016, then-Vice President Biden was a vocal opponent against non-compete agreements. He led the Obama administration’s initiative seeking to limit or eliminate non-compete agreements. In his presidential campaign, Biden promised to “work with Congress to eliminate all non-compete agreements, except the very few that are absolutely necessary to protect a narrowly defined category of trade secrets . . ..”