On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $100 billion to the United States Department of Health and Human Services (HHS) to provide financial relief for eligible health care providers.
The entire Provider Relief Fund will be divided in half: $50 billion will be allocated generally to eligible health care providers, and $50 billion will be allocated for targeted distributions. The first $30 billion of what is now known as the CARES Act Provider Relief Fund was released earlier in April. This initial wave was allocated among providers in proportion to their 2019 Medicare fee-for-service payments and later stated as a proportion to that provider’s share of 2018 net patient revenue. The following $20 billion was released after April 24. The first $30 billion and subsequent $20 billion was part of the $50 billion general allocations.
Skilled nursing facility (SNF) residents are the most vulnerable seniors due to age, chronic conditions, communal living, functional impairments, comorbidities, medications, and invasive devices. Unfortunately, according Forbes it has been estimated that as of May 22, approximately 42% of all COVID-19 deaths occurred among the residents of skilled nursing facilities and assisted living facilities.
On May 22, 2020, HHS announced in a press release that nearly $4.9 billion, as part of the remaining targeted distributions, would be distributed to nursing facilities impacted by COVID-19. HHS will make relief fund distributions to facilities based on both a fixed and variable basis.
“This funding secured by President Trump will help nursing homes keep the seniors they care for safe during the COVID-19 pandemic,” said HHS Secretary Alex Azar. “The Trump Administration is providing every resource we can, from funding and direct PPE shipments to regulatory flexibility and infection control consultations, to protect seniors in nursing homes and those who care for them.”
HHS acknowledged the financial stress that nursing home operators face while fighting COVID-19.
“Since the beginning of 2020, SNFs have experienced up to a 6 percent decline in their patient population as current and potential residents choose other care settings, or as current residents pass away. In addition to nursing home residents, many SNF employees have also been diagnosed with COVID-19,” the agency observed. “These additional funds may help nursing homes address critical needs such as labor, scaling up their testing capacity, acquiring personal protective equipment, and a range of other expenses directly linked to this pandemic.”
Each SNF will receive a fixed distribution of $50,000 plus a distribution of $2,500 per bed; however, to receive the funds nursing home recipients must:
- Attest that they will only use Provider Relief Fund payments for permissible purposes, as set forth in the terms and conditions.
- Agree to comply with future government audit and reporting requirements.
Failure by a provider that received a payment from the Provider Relief Fund to comply with any term or condition can subject the provider to recoupment of some or all of the payment. Per the terms and conditions, all recipients will be required to submit documents to substantiate that these funds were used for increased healthcare-related expenses or lost revenue attributable to coronavirus and that those expenses or losses were not reimbursed from other sources and other sources were not obligated to reimburse them. HHS will have significant anti-fraud monitoring of the funds distributed, and the Office of Inspector General (OIG) will provide oversight as required in the CARES Act to ensure that Federal dollars are used appropriately.
Providers generally are not required to repay the relief funds. HHS has said that the Provider Relief Fund payments are intended to reimburse health care providers that have been economically disadvantaged by incurring expenses as a result of caring for patients with COVID-19. If providers satisfy all of the terms and conditions of the attestations, they will not have to repay the funds. However, HHS has indicated their clear intent to vigorously monitor the use of these funds, including conducting audits. Providers should strictly adhere to all reporting, recordkeeping, and other requirements to ensure they are prepared to satisfy the audit requirements and avoid having to repay the funds (and other penalties).
LW Consulting, Inc. provides the following resources which are allowable expenses under the CARES Act:
- Training related to CARES Act.
- Survey readiness related to Infection Control Focus Survey.
- Infection control consultation regarding policies and procedures, observation of care and infection control practices, surveillance, review, and recommendations related to infection control committee and Quality Assurance and Performance Improvement (QAPI) efforts and tracking COVID-19.
- Minimum Data Set (MDS) support – mentoring, oversight, coding, remote MDS completion and waiver interpretation.
- Interim and permanent management staffing.
- Training related to infection control.
- Training and education on environmental cleaning, disinfecting, and Occupational Safety and Health Administration (OSHA) guidelines.
- Training related to tracking expenses relating to CARES Act dollars
In addition, if your facility received funds from the first two distributions from the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, your facility must agree to HHS program terms and conditions and provide HHS with an accounting of your annual revenues. Originally, this action was required by June 3, 2020, but the deadline has been extended to 90 days after receipt of funds.
LW Consulting, Inc. would like to answer any questions you may have. We can provide you with any of the above listed services to ensure your facility is complying with the HHS terms and conditions and are using the Provider Relief Funds for the betterment of your facility.
For more information, contact Patty Klinefelter at 540-686-1311 or email PKlinefelter@LW-Consult.com.