Health and Human Services (HHS) Provider Relief Fund Distributions

Announcing good news for pediatricians!

Strong advocacy by many pediatric leaders led to HHS announcing Relief Fund Distributions for Safety Net Hospitals, Medicaid & CHIP Providers. The information in this article is not meant to be specific to any particular practice or to provide accounting or legal advice. It is a compilation of other resources to assist practices with appropriate action. Check back periodically for updates!

Deadline to submit an application: September 13, 2020.

These funds are not first-come, first-served, so you don't need to apply right away, but it's best to start preparing now to make sure you can take advantage of the opportunity.

How much money can you expect?

HHS has indicated that providers should expect to receive an initial payment of at least 2% of the reported annual patient care revenue, including all payers. AAP FAQs can be found here and will also be updated as information becomes available. 

All information is housed on the HHS CARES Act Provider Relief Fund page.

We encourage you to download the PDF to review who is eligible for relief fund payments.

These are payment monies, not loans and there is no expectation of repayment provided you qualify according to the terms of the program. Those terms include the following:

  • Your organization must not have received any money from the Medicare direct relief program. 
  • You must participate in Medicaid or CHIP and billed for services for Medicaid or CHIP patients during the period of January 1, 2018, to December 31, 2019. 
  • You must have filed a federal income tax return for fiscal years 2017, 2018 or 2019 or are exempt from doing so.

There are several other mandatory requirements that must be met and outlined on the link above.

How to Apply

The portal is now accepting applications. However, before applying through the portal, applicants should:

  1. Read the Medicaid provider Distribution Instructions. This contains information including what each of the fields are looking for on the application itself.
  2. Download the Medicaid Provider Distribution Application Form (PDF). This is a PDF form for you to record your answers prior to logging on the portal so you can be prepared with the appropriate information.

You will need to upload the following documents as part of your application:

  1. Your most recent federal income tax return for 2017, 2018 or 2019 or a written statement explaining why the applicant is exempt from filing a federal income tax return (e.g. a state-owned hospital or healthcare clinic).
  2. The applicant’s Employer’s Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, Employer's Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement explaining why the applicant is not required to submit either form (e.g. no employees).
  3. An HHS completed Provider FTE (Excel) Worksheet available here. Note: These are independent Providers. If your NPs or PAs need direct supervision based on state law, they should not be included here.
  4. If required by Field 15, the Gross Revenue (Excel) Worksheet, provided by HHS.
Need help getting started? Click here to view a recorded discussion between OP's Medical Director, Dr. Sue Kressly, and OP's Assistant Medical Director, Dr. Suzanne Berman as they offer guidance on preparing your CARES Act Medicaid Distribution Application!

OP Specific Q&A

  Can OP write an SQL to determine our percentage of the payer mix?

Unfortunately, no. This is not your patient mix by active patient count, this is your mix by revenue. You may have P4P monies or other valued based incentives for a certain payer that are not reflected in OP.

  Can OP run a report to determine our gross revenue or lost revenue?

Unfortunately, no. Again, you must consider all revenues related to patient care including capitation checks, insurance P4P bonus payments, etc. which are not always captured in OP.

From the HHS Website

Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance

HHS expects to distribute $15 billion to eligible Medicaid and CHIP providers. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.