Since early April 2020, the CARES Act Provider Relief Fund (PRF) has distributed $175 billion to healthcare entities impacted by the coronavirus. The eligibility and allocation parameters have evolved throughout the public health emergency, as federal agencies have had to quickly adapt to the legislation and its requirements.
There have been numerous rounds, phases, and targeted distributions rolled out including the most recent Phase 3 General Distribution set to close on November 6, 2020. Each designated distribution requires the applicant and recipient to attest to the Terms and Conditions for the specific funding. Terms and Conditions are detailed documents that stipulate the eligibility requirements, outline the permissible and impermissible uses of the funds, and define obligations for the recipient to participate in required reporting and recordkeeping as defined by the Secretary of Health and Human Services (HHS). The central purpose for the PRF funds is that recipients use the funds to cover expenses attributable to coronavirus and supplement lost revenues.
Recipients of PRF payments have 90 days to attest to the Terms and Conditions or return the funds. If the recipients fail to log in to the portal and attest and has not returned the monies, they are deemed to have accepted the Terms and Conditions by default. Numerous PRF recipients are receiving correspondence from Health Resources and Service Administration (HRSA) alerting them when there is not a confirmed attestation on record.
The recordkeeping and reporting obligations have evolved since the initiation of the CARES Act PRF. The attestation Terms and Conditions stipulate quarterly reporting and established the reporting threshold to be $150,000 in federal funds related to coronavirus, with the initial report due July 10, 2020. In mid-June, the FAQs on the CARES Act Provider Relief Fund website were updated to indicate healthcare entities did not need to prepare and submit a separate report by July 10th; rather HHS would develop a report to comply with the requirements. Publicly posting the recipient names and corresponding payment amounts on the Tracking Accountability in Government Grants System (TAGGS) and USASpending.gov websites fulfilled the immediate CARES Act reporting requirements.
In July 2020, HHS lowered the reporting threshold for all recipients who receive more than $10,000 in aggregate from the CARES Act PRF. HHS has also outlined a plan that included a template and detailed instructions which were due in mid-August, anticipating an October 1 reporting system. However, as the most recent September 19, 2020 guidance specifies, with the exception of specific nursing home and testing programs, the revised deadlines for PRF recipients are as follows:
- January 15, 2021: first day for reporting portal to be available
- February 15, 2021: first reporting deadline for providers on the use of PRF funds in 2020
- July 31, 2021: final reporting deadline for PRF funds expended after January 1, 2021
The purpose of the reporting is to assess if recipients properly use PRF proceeds in compliance with the agreed upon Terms and Conditions. The reporting requirements progressively increase with the aggregate of PRF funds: 1) $10,000 to $499,999; 2) > $500,000; 3) >$750,000. HHS has not elaborated on the process recipients with less than $10,000 will be expected to document to substantiate compliance with the Terms and Conditions.
A primary restriction on the PRF monies is the prohibition to pay expenses that have been reimbursed from other sources such as insurance payers, patients, grants, or similar proceeds. A reporting template has not yet been made available; however, reporting is expected to focus on net patient revenues, allowable expenses, and estimated lost revenues between 2019 and 2020. Revenue derived from patient care will include 340B pharmacy revenues. Allowable expenses will be attributable to coronavirus and include general and administrative expenses as well as healthcare-related expenses.
Data elements that are anticipated in the report include standard organizational demographics as well as specifics on other assistance received in 2020 such as Paycheck Protection Program, Alabama CARES Relief Fund grants, Small Business Administration - Economic Injury Disaster Loans, CARES Act Testing, business insurance proceeds and similar funds. The reporting requirements will also obtain non-financial information such as employee counts, patient encounters, and bed counts for facilities.
Based on the rapid deployment of the CARES Act PRF funds throughout public health emergency, the reporting requirements to assess compliant use of the funds have been in continual development. They will continue to be refined and defined throughout this last quarter of 2020. It is imperative for recipients to monitor changes in the reporting elements and requirements to utilize the funds permissibly and maintain proper recordkeeping. HRSA is expected to host webinars and provide further clarification on the reporting requirements. Please consistently reference the CARES Act Provider Relief website: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html
Margaret H. Cook, MBA, CMPE is a Healthcare Advisor with Kassouf & Co.