HHS Issues Updated Guidance on Provider Relief Fund

The Big Picture

The Department of Health and Human Services (HHS) updated the Provider Relief Fund (PRF) reporting requirements and FAQs on June 11, establishing new deadlines for the use of funds based on the date the payment was received, extending the time period for recipients to report on the use of PRF payments, and requiring recipients of the Skilled Nursing Facility and Nursing Home Infection Control Distribution to report on the use of PRF payments. Most notably, in response to widespread requests from the health care industry, the updates extend the deadline for recipients to use PRF payments, but only for those payments received after June 30, 2020, and now give recipients 90 days (rather than 30) to complete reporting on the use of PRF payments. The FAQs also further clarify what constitutes an expense attributable to COVID-19.

Payment Received Periods

The updated guidance establishes new “Payment Received Periods” in which the date PRF payments were received by a recipient establishes both (1) the time period in which the PRF payments can be used (“period of availability”) and (2) the deadline for reporting on the use of those funds. The guidance states that PRF recipients “must only use payments for eligible expenses including services rendered and lost revenues” during the newly established period of availability. For payments received prior to June 30, 2020, which generally encompass the PRF payments made in Phase 1, the period of availability for the use of funds is limited to the period between the date the funds were received and June 30, 2021. Providers are required to follow their normal basis of accounting (now clarified as either cash or accrual) for determining the date the expense is incurred. For PRF payments received prior to June 30, 2020, this requirement prohibits PRF recipients from using payments for expenses or lost revenue occurring after the period of availability (June 30, 2021) and requires that any remaining payments that have not been spent on eligible expenses or lost revenue incurred prior to June 30, 2021, be returned to HHS by September 30, 2021, through the PRF Reporting Portal. While these new rules respond to some concerns raised by stakeholders about their inability to spend PRF funds by the original June 30, 2021 deadline, some providers have expressed ongoing concerns about their ability to fully expend previously allocated funds as rapidly as still required under the new guidance.

Recipients are now required to report for each Payment Received Period in which they received one or more payments exceeding, in the aggregate, $10,000 (rather than $10,000 cumulatively across all PRF payments). Recipients that do not report within the applicable Reporting Time Period will be considered out of compliance with payment Terms and Conditions, and the relevant PRF payments may be subject to recoupment. Under the new requirements, recipients who received multiple PRF payments that occurred in different Payment Received Periods will be required to submit reports for each applicable reporting time period; the new requirements limit the ability of recipients who have used all of the PRF payments they received from submitting a single report in the July–September 2021 reporting period.

The following Summary of Deadline and Reporting Requirements outlines the deadlines for the use of funds and the reporting period for funds received within the applicable period:

Updated Reporting Requirements

In addition to including new information on reporting and reporting data elements, the updated guidance contains a revision to the January 15, 2021 Reporting Requirements related to reporting lost revenues attributable to COVID-19. Under the updated guidance, recipients using PRF payments for lost revenues will provide information used to calculate lost revenues attributable to COVID-19 depending on the method they choose: (i) the difference between actual patient care revenues, (ii) the difference between budgeted (prior to March 27, 2020) and actual patient care revenues, or (iii) another method of estimating revenues. For options (i) and (ii), HHS revised the previous requirement that recipients submit revenues/net charges from patient care for 2020, and now requires that recipients submit revenues/net charges from patient care by payer mix by quarter for each quarter during the period of availability.

The PRF reporting portal will open for recipients on July 1, 2021, and all recipients that received a PRF payment between April 10, 2020, and June 30, 2020 (now identified as Period 1) will be required to submit a report on the use of funds received in Period 1 and return any unused funds by September 30, 2021. HHS is encouraging recipients to complete their user registrations in advance of the portal opening and anticipates issuing a “comprehensive user guide” and supporting worksheets to assist recipients with the reporting requirements.

Outstanding Issues

Notably absent from the recently issued updates is the status of future distributions by HHS. An estimated $24 billion that has yet to be allocated remains in the PRF, and HHS previously indicated that any returned PRF payments will be reallocated for further distribution. Also, an additional $8.5 billion was allocated by the American Rescue Plan solely for rural health providers. HHS has not yet announced when, or how, these funds will be distributed.