The latest round of COVID-19 relief funds is intended to help providers who don't bill large amounts to Medicare, but qualifications are built on data that PTs typically don't provide to HHS. There may be a workaround.
The U.S. Department of Health and Human Services is distributing an additional $20 billion in health care provider relief funds, but the way HHS is determining distribution might make getting that money more complicated for many PTs — if PTs qualify in the first place.
HHS announced that beginning April 24, some providers will automatically be sent payment as part of a $100 billion provider relief effort that set aside $50 billion for "general allocation" to providers. Release of that $50 billion began with a $30 billion tranche on April 10.
While the initial $30 billion was based on Medicare fee-for-service reimbursement in 2019, the remaining $20 billion will be distributed according to 2018 net patient revenue based on cost reports submitted to CMS. Medicare-certified institutional providers are required to submit those reports annually.
The problem for some clinicians, including PTs, is that they don't submit cost report data to CMS — but they still may qualify for relief, according to HHS.
On its CARES Act Provider Relief Fund Webpage, the department seems to indicate that providers who didn't submit cost reports to CMS can use "a portal" that will be accessible through the relief fund webpage that would allow them to provide revenue information to possibly qualify for the money. As of the date of this report, that portal had not been established.
According to Kara Gainer, APTA director of regulatory affairs, the idea behind this cash infusion was to reach providers that didn't qualify for the first round of relief, such as pediatric health care facilities and clinicians who may have more Medicaid and Medicare Advantage patients. But, she adds, just as with the initial $30 billion relief package, the details of how the $20 billion will be disbursed — and who will receive it — aren't all in place.
"Obviously the issue for PTs is how they might qualify for these funds since they don't submit a cost report to CMS," Gainer said. "Physicians are generally in the same position as PTs in this regard, so we're trying to get more details from HHS about whether they qualify for the funds and, if so, how they might receive the relief."
Information will be shared through PT in Motion News and on the APTA website as it's made available. Providers also should continue to check the HHS CARES Act Provider Relief webpage for the opening of the portal.
With $50 billion of the $100 billion package allotted to the general allocations, that leaves another $50 billion. According to HHS, $10 billion of that will be used for a targeted distribution to hospitals in areas that have been particularly impacted by the COVID-19 outbreak, $10 billion will go to rural hospitals and rural health clinics based on their operating expenses, and $400 million is being directed to Indian Health Service facilities. Some part of the remaining funds is being used to cover the costs of caring for uninsured patients with COVID-19, and an unspecified portion will be used for clinicians.
HHS has not yet created a plan for disbursement of an additional $75 billion it received as part of a "phase 3.5" COVID-19 relief package signed into law on April 24.