This blog was co-authored by Melinda A. Gaboury, CEO and D. Mark Cannon, CFO. Changes and updates are occurring rapidly, this information is as best we understand on 05/14/20.
During this Public Health Emergency (PHE) there are several avenues of obtaining cash to keep your agency going. This article addresses two of those. The Accelerated and Advance Payments Program allows agencies to get an advance on Medicare payments and it must be repaid. The other is the CARES Act Provider Relief Fund that is being automatically disbursed. Agencies will not need to repay these funds, however, there are accountability requirements for accepting and using these funds.
CMS Accelerated and Advance Payments Program
This program was suspended on April 26, 2020 and no further Accelerated Payments are happening at this time.
Through the passage of the CARES Act (HR 748, Section 3719), Congress has expanded the Medicare Accelerated Payment Program during the Novel Coronavirus (COVID-19) pandemic.
Below is a summary of the highlights of the expansion, including links to the request forms and instructions of all three of the home health and hospice Medicare Administrative Contractors (MAC). This program is intended to provide necessary funds when there are disruptions in the submitting or processing of Medicare claims.
ELIGIBILITY
To qualify for the program, Providers must meet all of the following criteria:
- Have billed Medicare for claims within 180 days immediately prior to the date of the request
- Not be in bankruptcy
- Not be under an active medical review or program integrity investigation (UPIC or OIG)
- Not have any outstanding delinquent Medicare overpayments
FUNDS DISBURSEMENT AND REPAYMENT TERMS
Providers will be able to request up to 100% of the Medicare payment amount for a three-month period. CMS has made the calculation as to what each agency’s maximum allowed disbursement is. Agencies can either request the maximum or a calculated amount less than the maximum. Agencies can call the MAC to ask what the calculated maximum is. The MAC is working to meet the seven (7) calendar day expectation to review and issue payments after receiving the request. Agencies should proceed with caution in determining the amount to request, if you choose to request these funds. Repayment of the accelerated/advance payment will be automatically recouped beginning 120 days after the date of the issuance of the payment from normal claim submissions. 100% of Medicare payments will be withheld for 90 days. If the accelerated/advance payment has not been fully recovered 90 days after the recoupment process begins, the agency will be required to make payment arrangements with CMS and interest will be charged. Claims submitted from the date of the accelerated/advance payment up until 120 days will be processed as they normally would.
CMS & MAC INFORMATION
The CMS Fact Sheet gives details of the program, including Step-by-Step Guide on How to Request the Advance Payment. Request forms for the accelerated/advance payment and instructions for completion can be found at each of the MAC sites: Palmetto GBA CGS Medicare NGS Medicare
CARES Act Provider Relief Fund
Disbursement of the initial $30 Billion began on April 10, 2020. These funds should represent approximately 6.2% of your Medicare receipts from 2019. The Department of Health & Human Services (HHS) is partnering with UnitedHealth Group (UHG) to deliver the initial $30 billion distribution to providers as quickly as possible. Providers will be paid via Automated Clearing House account information on file with UHG, UnitedHealthcare, or Optum Bank, or used for reimbursements from the Centers for Medicare & Medicaid Services (CMS). Providers who normally receive a paper check for reimbursement from CMS will receive a paper check in the mail for this payment as well, within the next few weeks.
These funds are to be considered a grant, as the expectation is not that agencies will have to repay it. These funds do carry much accountability. Agencies will have to sign an attestation statement confirming that the agency agrees to the Terms & Conditions. The CARES Provider Relief Fund Attestation must be signed within 45 days of receipt of the funds.
Following is a recap of the Terms & Conditions:
The Medicare Learning Network Article Number SE20011, updated 03/20/20 outlines many of the 1135 waivers and specifically addresses the following:
- You must be an agency that received Medicare payments in 2019.
- The agency provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19;
- Certify that the provider is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.
- Agree to use the funds for health care-related expenses or lost revenues related to COVID-19
- Agree not to use the funds to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse. (this would NOT include loans or advanced payments that must be paid back)
- Agree not to balance bill any out-of-network patient for COVID-19-related treatment.
- Agree to maintain and to submit upon request appropriate records and cost documentation including, as applicable, documentation required by 45 CFR § 75.302 and 45 CFR § 75.361 through 75.365, as well as other information required by future program instructions
- Provider must agree to submit any HHS-required reports needed to ensure the provider’s compliance with conditions imposed on Relief Fund payments. Any provider receiving more than $150,000 total in funds, must submit a report no later than 10 days after each calendar quarter to HHS including the following information:
- The total amount of funds received from HHS under one of the foregoing enumerated Acts;
- The amount of funds received that were expended or obligated for reach project or activity;
- A detailed list of all projects or activities for which large covered funds were expended or obligated, including: the name and description of the project or activity, and the estimated number of jobs created or retained by the project or activity, where applicable; and detailed information on any level of sub-contracts or subgrants awarded by the covered recipient or its subcontractors or subgrantees, to include the data elements required to comply with the Federal Funding Accountability and Transparency Act of 2006. HHS guidance on specific reporting and submittal requirements will be forthcoming.
If a provider is unwilling to accept the terms and conditions, it must contact HHS within 30 days of receipt and remit full payment to HHS as instructed. HHS will provide specific contact information soon.
Anyone who has not yet received the funds can call the Hotline and they will verify whether you are eligible to receive and whether funds are set to be disbursed. United Healthcare at 1-866-569-3522
Healthcare Provider Solutions is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success. We are in this together, if we can help you during this trying time please don’t hesitate to contact us.