On July 10, 2020, the US Division of Well being and Human Providers (HHS) introduced the allocation of $Four billion in further focused funding via the Supplier Aid Fund (PRF) to security internet hospitals, specialty rural hospitals, city hospitals with sure rural Medicare designations and hospitals in small metropolitan areas. HHS additionally introduced a brand new PRF utility course of and portal for dentists who had been ineligible for earlier PRF distributions.
The Coronavirus Support, Aid, and Financial Safety (CARES) Act (P.L. 116-136) established the PRF to supply $100 billion to help healthcare suppliers affected by the Coronavirus (COVID-19) pandemic. The Paycheck Safety Program and Well being Care Enhancement Act (P.L. 116-139) supplied a further $75 billion to the PRF. To this point, HHS has allotted $116.75 billion of the $175 billion supplied via the PRF.
HHS expects to distribute roughly $Three billion in focused funding to security internet hospitals by increasing the preliminary profitability qualifying standards.
HHS expects to distribute a further $1 billion in focused funding for sure hospitals serving rural populations.
HHS introduced an utility portal and course of for dentists who had been beforehand ineligible for the Medicaid basic distribution and Medicaid PRF distributions.
With its July 10, 2020, announcement, HHS has now distributed or dedicated to distribute roughly $116.75 billion in funds. This determine contains $50 billion basically distributions for Medicare fee-for-service suppliers, and focused distributions for Medicaid suppliers; security internet hospitals; hospitals in excessive COVID-19 influence areas (hotspots); rural suppliers; expert nursing amenities; and tribal hospitals, clinics and concrete well being facilities. HHS additionally distributes funding from the PRF on a rolling foundation for the therapy and testing of uninsured COVID-19 sufferers. Suppliers submit claims, and HHS approves reimbursement. Whereas no set allocation is devoted for uninsured sufferers, as of July 13, 2020, roughly $350 million has been distributed to suppliers for the therapy and testing of uninsured COVID-19 sufferers, in keeping with HHS.
Additionally on July 10, HHS introduced a PRF portal for dentists who had been beforehand ineligible to obtain PRF funding. There is no such thing as a particular allocation quantity put aside for the dentists. The allocation quantity can be decided by the purposes submitted via the dental portal.
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Security Web Hospital Growth
On June 9, 2020, HHS introduced a focused distribution to security internet hospitals. At the moment, HHS dedicated $10 billion to qualifying hospitals that had 1) a Medicare disproportionate cost share of 20.2% or higher; 2) a mean uncompensated care per mattress of $25,000 or extra (for instance, a hospital with 100 beds would want to supply $2.5 million in uncompensated care in a yr to satisfy this requirement); and three) profitability of three% or much less, as reported to the Facilities for Medicare and Medicaid Providers within the hospital’s most not too long ago filed price report.
On July 10, HHS introduced a complement by increasing the profitability margin criterion beneath the protection internet hospital distribution. Now, acute care hospitals assembly the opposite two standards are eligible for this distribution in the event that they meet the revised profitability margin threshold of lower than 3% averaged consecutively over two or extra of the final 5 price reporting durations. HHS distributed roughly $Three billion to hospitals that meet the brand new profitability commonplace.
761 hospitals certified for the primary security internet distribution. HHS reported that one other 214 hospitals qualify for the extra $Three billion in funding beneath the revised standards. A listing of the precise hospitals that obtained this funding isn’t but accessible.
As we’ve got beforehand famous, hospital profitability can fluctuate considerably from yr to yr. Subsequently, the yr HHS makes use of to find out eligibility dramatically impacts who receives funds from the protection internet hospital distribution. HHS sought to deal with this variability challenge with this profitability criterion enlargement. Nonetheless, a hospital’s quantity of uncompensated care may fluctuate considerably by yr, and due to this fact the uncompensated care criterion nonetheless renders many security internet hospitals ineligible for the protection internet hospital distribution.
Extra Rural Suppliers and Different Suppliers from Small Metropolitan Areas
In Might 2020, HHS distributed $10 billion in funding to rural healthcare suppliers, together with hospitals, well being clinics and well being facilities. On July 10, HHS introduced the enlargement of the preliminary rural healthcare cost method “to incorporate sure particular rural Medicare designation hospitals in city areas in addition to others who present care in smaller non-rural communities.” HHS famous that these could embrace “some suburban hospitals that aren’t thought-about rural however serve rural populations and function with smaller revenue margins and restricted assets as in comparison with bigger hospitals.” In response to HHS, these further funds are directed to hospitals in small cities and rural areas that didn’t obtain cost within the preliminary supplemental rural focused distribution. In complete, these new funds equal roughly $1 billion.
HHS studies that 479 hospitals obtained this new cost. Funds vary from $100,000 to $4.5 million for rural designated suppliers and $100,000 to $2 million for the opposite suppliers. The cost method varies relying on hospital location and Medicare designation.
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Together with the protection internet and rural hospital funding expansions, HHS introduced a PRF utility course of and portal for dentists who had been beforehand ineligible to obtain funding via the Medicare basic distribution or Medicaid PRF. Which means that dentists who don’t take part in Medicare or Medicaid may have entry to PRF funding. That is the primary time a PRF distribution has been made accessible to suppliers that don’t take part in both federal program.
HHS is counting on knowledge sources exterior of Medicare and Medicaid to find out which dentists are eligible for this funding. HHS has developed a curated record of dental follow tax identification numbers from third-party sources and HHS datasets. Just like the method for the Medicaid portal, dentists on the curated record will have the ability to proceed the appliance via the portal, whereas dentists not on the record will be unable to finish the appliance course of. Dentists not on the record can work with HHS to validate that they’re eligible for funding.
Eligible dentists will obtain a reimbursement of two% of their annual reported affected person income. Dentists have till July 24, 2020, to use utilizing the similar portal that’s presently open to Medicaid suppliers. The dental distribution has been added to the Medicaid Phrases and Situations doc, however it’s presently unclear whether or not dentists may have the identical reporting necessities as outlined for Medicaid suppliers. Suppliers receiving future distributions, together with the dental distributions, possible can be required to report knowledge to HHS.
This newest funding announcement would possibly supply perception into how HHS could deal with future distributions. For instance, the supply of the Medicaid portal to dentists could show a bellwether: if HHS is profitable in gathering knowledge from suppliers, and the expertise is profitable in permitting two supplier teams to enter data concurrently, HHS could also be extra comfy including different suppliers to utility portal extra rapidly. Equally, though HHS has not but confirmed if dentists will submit the identical worksheet or knowledge that’s required by Medicaid suppliers, what dentists do undergo portal possible can be indicative of the data required by future distribution recipients.
Stakeholders have speculated about which teams would possibly obtain funds in future distributions. Youngsters’s hospitals have been pushing for a focused distribution, and so they could also be subsequent in line. Some studies have instructed that HHS will create a brand new portal for suppliers that missed the chance to achieve funding via the second tranche of the overall distribution and aren’t eligible for the Medicaid distribution. With any new PRF allocation, suppliers possible can be required to submit vital knowledge to HHS with the intention to obtain the funding.