Bottom line Recent class action settlement gives all out-of-network (“ONET”) physicians important – and often overlooked – rights under the Employee Retirement Income Security Act of 1974 (“ERISA”) in connection with repayment demands. What is this case about? After paying claims submitted…
The Department of Health and Human Services (HHS) announced how it plans to allocate the Public Health Emergency Fund authorized by the CARES Act to deliver financial relief to providers. Congress appropriated $100 billion for this fund, and until this week, had only announced how $30 billion would be spent. More information can be found here.
Congress just appropriated another $75 billion to this fund on April 23 and we will continue to monitor how these funds will be dispersed.
- General Allocation of $50 billion:
- The second tranche of these funds, $20 billion, will be distributed based on 2018 net patient revenue, not just Medicare fee-for-service reimbursements. The Centers for Medicare & Medicaid Services will distribute these funds based on cost reports, which are filed by hospitals and some other facilities. Providers without cost reports on file should attest to their net 2018 revenue through an online portal which is not yet active. Please check this website for the portal once it goes live. Disbursements of these funds will begin on April 24 and be made on a weekly, rolling basis, as information is validated.
- The first tranche of these funds, $30 billion, has already been allocated to clinicians and facilities based on their Medicare Part A and B fee-for-service reimbursements in 2019. Providers were not required to take any action to receive a portion of this funding.
- Allocation of $10 billion for Rural Providers: Rural health clinics and hospitals will receive a payment from this allocation proportional to their operating expenses. These payments will begin next week and HHS has not provided any additional information about actions these institutions must take to receive these funds.
- Other Allocations:
- $10 billion for High Impact Areas – Hospitals in areas that have been particularly impacted by COVID-19 can apply for a portion of this allocation here by Saturday, April 25 at 3 pm.
- $400 million for Indian Health Service facilities
- An unspecified amount for the treatment of the uninsured with COVID-19 – These funds may be claimed beginning April 27 at here and the reimbursement for the uninsured will be based on Medicare payment rates.
- An unspecified amount for providers including skilled nursing facilities, dentists, and providers who solely take Medicaid.