The Colorado Medical Society joined the American Medical Association (AMA) and other medical societies across the country in a successful advocacy push to get financial support for physician practices during the COVID-19 pandemic. On April 10, the Department of Health and Human Services (HHS) announced the immediate disbursement of the first $30 billion out of the $100 billion that Congress allocated to hospitals, physicians, and other health care providers in the Public Health and Social Services Emergency Fund in the Coronavirus Aid, Relief and Economic Security (CARES) Act. The CARES Act Provider Relief Fund distribution policy adopted by HHS reflects the recommendations from organized medicine made to Secretary Azar last week, although it is not exactly what we proposed. In part, the differences stem from the administration's approach of first disbursing $30 billion and later determining how the remainder of the funds will be allocated. Getting these funds flowing to help sustain many physician practices as the COVID-19 response continues is an important step that will pave the way for further disbursements in the near future.

The initial $30 billion distribution is being directed to hospitals and physician practices based on 2019 Medicare fee-for-service (“FFS”) Part A & B payments and should be approximately 6.2 percent of what a recipient’s payments were in 2019. These payments are different than the Centers for Medicare & Medicaid Services Accelerated and Advance Payment Program and, although HHS refers to the payments as grants and no advance request was needed nor will funds need to be repaid, the payments are not without subsequent conditions. 

Recipients must sign an attestation within 30 days of payment agreeing to 10 pages of terms and conditions, which should be carefully reviewed by recipients. These terms and conditions include a certification that the recipient "provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.” The AMA had several conversations with senior HHS officials about the fund and how crucial it is to include funding for all physician practices that are struggling financially, including those that are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services. Following these conversations, HHS clarified the language of that certification to make clear that providers don’t need to be currently diagnosing, testing, or caring for COVID-19 patients and added the explanation that, “If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.

The allocation procedures for this first $30 billion do not employ any methodology to pay physicians who may have no or few Medicare claims but rely significantly on Medicaid funding. However, at a White House Coronavirus Task Force briefing last week, Administrator Verma indicated that a subsequent distribution from the Provider Relief Fund will be directed to pediatricians, children's hospitals, and others who rely on Medicaid. Future distributions are also expected to focus on providers in “hot spots,” rural areas, and those who provide COVID-19 care to uninsured patients.

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. Note that the funds will go to each organization's TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with "HHSPAYMENT" as the payment description.

Categories: Communications, ASAP, Resources, COVID, Practice Management