HHS Begins Phase 4 Provider Relief Fund Distribution, Updates Reporting Requirements for Mergers

The Department of Health & Human Services (HHS) recently announced the distribution of approximately $9 billion in CARES Act Provider Relief Fund (PRF) Phase 4 payments to Medicare, Medicaid, and CHIP providers. The average payment for small providers from this distribution is $58,000, for medium providers is $289,000, and for large providers is $1.7 million. HHS has already started facilitating payments and will continue to do so in 2022.

As part of the announcement, HHS also indicated a new reporting requirement for providers involved in recent mergers or acquisitions that have received Phase 4 or American Rescue Plan (ARPA) Rural payment program funds. Specifically:

  • If the Recipient’s Phase 4/ARP Rural payment(s) exceeds $10,000, the Recipient agrees to notify HHS of a merger with or acquisition of any other healthcare provider during the Payment Received Period within the Reporting Time Period (as defined in the PRF Post Payment Notice of Reporting Requirements). Providers who report a merger/acquisition may be more likely to be audited, consistent with an overall risk-based audit strategy.”

HRSA (the HHS agency implementing the PRF program) considers changes in ownership, mergers/acquisitions, and consolidations to be reportable events under this new requirement. If a provider that received a Phase 4/ARP payment indicates when they report on the use of funds that they have undergone a merger or acquisition during the applicable Payment Received Period, this information will be a component that is factored into whether an entity is audited.

The PRF Frequently Asked Questions (FAQs) were also supplemented in conjunction with the Phase 4 distribution. The newly added items cover a wide range of topics, including mergers and acquisitions, tax credits, guidance for providers that file bankruptcy petitions, and more.

NAHC encourages our members who have received PRF or ARP Rural funds to review the FAQs and other related reporting guidance, to ensure timely and accurate compliance with all criteria. We will continue to monitor and analyze PRF modifications as they develop.

HHS Begins Phase 4 Provider Relief Fund Distribution, Updates Reporting Requirements for Mergers

The Department of Health & Human Services (HHS) recently announced the distribution of approximately $9 billion in CARES Act Provider Relief Fund (PRF) Phase 4 payments to Medicare, Medicaid, and CHIP providers. The average payment for small providers from this distribution is $58,000, for medium providers is $289,000, and for large providers is $1.7 million.…

New CMS Website Will Share Innovative State Actions to Expand Medicaid HCBS

  • CMS also approves earlier application for Alabama’s section 1115 demonstration to improve access to home and community-based services

The Centers for Medicare & Medicaid Services (CMS) has launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow people enrolled in Medicaid to receive services and supports in a preferred setting outside of an institution, such as in their own home. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).

Additionally, CMS has approved a new Medicaid section 1115 demonstration in Alabama, entitled the “Community Waiver Program,” to operate concurrently with a home and community-based services 1915(c) waiver. This new opportunity in the state’s Medicaid program will increase access to home and community-based services, and allow the state to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting.

“One-stop Shop” for Plans to Enhance, Expand, & Strengthen Home and Community-based Services

To encourage states to expand home and community-based services and strengthen their programs, the Biden-Harris Administration implemented a funding increase established by the ARP. The ARP provided states with a temporary 10 percentage point increase in federal Medicaid funding for certain Medicaid home and community-based services from April 1, 2021 through March 31, 2022, if they meet certain requirements. As the COVID-19 pandemic continues, the additional federal funding made available under the ARP allows those enrolled in Medicaid who need long-term services and supports to receive the assistance required to reside in the setting of their choice.

“The Biden-Harris Administration recognizes the value and dignity that come with access to home and community-based services,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, we can support states working to expand access to home and community-based services for Medicaid beneficiaries. With the launch of this new online hub, we’re making it easy for states to exchange ideas on how best to care for their residents.”

“The ability to access health care at home or in the community is essential for many low-income families, older adults, and individuals with disabilities who rely on Medicaid services — especially during this unprecedented public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “Thanks to the American Rescue Plan, CMS is providing state Medicaid agencies with the tools and funding needed to expand this important care. We welcome the opportunity to work with states to expand home and community-based services to meet the needs of their communities.”

The announcement issued today reinforces CMS’s commitment to assist states in response to the public health emergency. State administrators and stakeholders are encouraged to visit Medicaid.gov to view states’ programs and activities to identify innovative approaches that can support home and community-based services and improve capacity building and infrastructure in their area by drawing inspiration from other states.

For example, some states are delivering vaccines to people with disabilities and older adults through mobile COVID-19 vaccination programs. Other states are focusing on the potential of home and community-based services to help people with Medicaid coverage receive care outside a skilled nursing facility after a hospitalization, when aligned with the beneficiary’s goals. Other activities may include expanding and implementing new, community-based behavioral health crisis response services, ensuring that a qualified provider with training quickly and properly responds to mental health and substance use-related crisis situations. Many states are also providing recruitment and retention bonuses and increasing pay for direct support professionals, as well as implementing new training programs and other strategies to strengthen the direct support workforce. These actions allow Medicaid enrollees to receive care in the comfort of their own home or in a preferred community setting.

To view the home and community-based services webpage with states’ ARP section 9817 spending plans and narratives, letters issued to states on their spending plans and narratives, and other important information related to the implementation of ARP section 9817, please visit https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

For additional information on ARP funding for home and community-based services, see the guidance that CMS issued to states via a State Medicaid Director Letter in May of this year.

New Demonstration for Home and Community-based Services in Alabama

The Biden-Harris Administration is proud to help states that have long been at work to advance home and community-based services. Separate from the new website launched today, CMS has approved Alabama’s earlier application for a section 1115 demonstration, entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. Together, Alabama’s 1115 demonstration and 1915(c) waiver will increase access to home and community-based services for many Alabamans who are currently on a waiting list.

The state will now be able to redesign its home and community-based services delivery system to address concerns, such as long waiting lists, high use of residential services and out-of-home placements, and low integrated community employment rates among its residents. CMS will also provide the authority needed for Alabama to create a new program that supports individuals with intellectual disabilities who choose to work, live with family, or live independently.

“It is important we find ways to collaborate to help Alabamians in need, particularly those with intellectual disabilities. My Administration is pleased to offer the Community Waiver Program, which focuses on serving individuals with intellectual disabilities before they are in crisis,” said Alabama Governor Kay Ivey. “The partnership between the Alabama Department of Mental Health and the Alabama Medicaid Agency will help integrate these individuals in the community, giving them a better chance to develop skills to work and live independently.”

To view Alabama’s section 1115 demonstration approval and the new 1915(c) waiver, visit: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/101016.

New CMS Website Will Share Innovative State Actions to Expand Medicaid HCBS

CMS also approves earlier application for Alabama’s section 1115 demonstration to improve access to home and community-based services The Centers for Medicare & Medicaid Services (CMS) has launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow…

New CMS Website Will Share Innovative State Actions to Expand Medicaid HCBS

  • CMS also approves earlier application for Alabama’s section 1115 demonstration to improve access to home and community-based services

The Centers for Medicare & Medicaid Services (CMS) has launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow people enrolled in Medicaid to receive services and supports in a preferred setting outside of an institution, such as in their own home. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).

Additionally, CMS has approved a new Medicaid section 1115 demonstration in Alabama, entitled the “Community Waiver Program,” to operate concurrently with a home and community-based services 1915(c) waiver. This new opportunity in the state’s Medicaid program will increase access to home and community-based services, and allow the state to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting.

“One-stop Shop” for Plans to Enhance, Expand, & Strengthen Home and Community-based Services

To encourage states to expand home and community-based services and strengthen their programs, the Biden-Harris Administration implemented a funding increase established by the ARP. The ARP provided states with a temporary 10 percentage point increase in federal Medicaid funding for certain Medicaid home and community-based services from April 1, 2021 through March 31, 2022, if they meet certain requirements. As the COVID-19 pandemic continues, the additional federal funding made available under the ARP allows those enrolled in Medicaid who need long-term services and supports to receive the assistance required to reside in the setting of their choice.

“The Biden-Harris Administration recognizes the value and dignity that come with access to home and community-based services,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, we can support states working to expand access to home and community-based services for Medicaid beneficiaries. With the launch of this new online hub, we’re making it easy for states to exchange ideas on how best to care for their residents.”

“The ability to access health care at home or in the community is essential for many low-income families, older adults, and individuals with disabilities who rely on Medicaid services — especially during this unprecedented public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “Thanks to the American Rescue Plan, CMS is providing state Medicaid agencies with the tools and funding needed to expand this important care. We welcome the opportunity to work with states to expand home and community-based services to meet the needs of their communities.”

The announcement issued today reinforces CMS’s commitment to assist states in response to the public health emergency. State administrators and stakeholders are encouraged to visit Medicaid.gov to view states’ programs and activities to identify innovative approaches that can support home and community-based services and improve capacity building and infrastructure in their area by drawing inspiration from other states.

For example, some states are delivering vaccines to people with disabilities and older adults through mobile COVID-19 vaccination programs. Other states are focusing on the potential of home and community-based services to help people with Medicaid coverage receive care outside a skilled nursing facility after a hospitalization, when aligned with the beneficiary’s goals. Other activities may include expanding and implementing new, community-based behavioral health crisis response services, ensuring that a qualified provider with training quickly and properly responds to mental health and substance use-related crisis situations. Many states are also providing recruitment and retention bonuses and increasing pay for direct support professionals, as well as implementing new training programs and other strategies to strengthen the direct support workforce. These actions allow Medicaid enrollees to receive care in the comfort of their own home or in a preferred community setting.

To view the home and community-based services webpage with states’ ARP section 9817 spending plans and narratives, letters issued to states on their spending plans and narratives, and other important information related to the implementation of ARP section 9817, please visit https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

For additional information on ARP funding for home and community-based services, see the guidance that CMS issued to states via a State Medicaid Director Letter in May of this year.

New Demonstration for Home and Community-based Services in Alabama

The Biden-Harris Administration is proud to help states that have long been at work to advance home and community-based services. Separate from the new website launched today, CMS has approved Alabama’s earlier application for a section 1115 demonstration, entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. Together, Alabama’s 1115 demonstration and 1915(c) waiver will increase access to home and community-based services for many Alabamans who are currently on a waiting list.

The state will now be able to redesign its home and community-based services delivery system to address concerns, such as long waiting lists, high use of residential services and out-of-home placements, and low integrated community employment rates among its residents. CMS will also provide the authority needed for Alabama to create a new program that supports individuals with intellectual disabilities who choose to work, live with family, or live independently.

“It is important we find ways to collaborate to help Alabamians in need, particularly those with intellectual disabilities. My Administration is pleased to offer the Community Waiver Program, which focuses on serving individuals with intellectual disabilities before they are in crisis,” said Alabama Governor Kay Ivey. “The partnership between the Alabama Department of Mental Health and the Alabama Medicaid Agency will help integrate these individuals in the community, giving them a better chance to develop skills to work and live independently.”

To view Alabama’s section 1115 demonstration approval and the new 1915(c) waiver, visit: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/101016.

Administration Begins American Rescue Plan Rural Funding to Support Providers Impacted by Pandemic

Today, Tuesday, November 23, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), released the vast majority ($7.5 billion) of the $8.5 billion American Rescue Plan (ARP) Rural payments to providers and suppliers who served rural Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries from January 1, 2019 through September 30, 2020.

Hundreds of home health care and hospice agencies received this funding and we strongly encourage them to attend the stakeholder briefing mentioned below.

You’re Invited: Stakeholder Briefing

HRSA’s Provider Relief Bureau (PRB) will hold a stakeholder briefing on:

  • December 2, 2021
  • 1:00-1:30 p.m. ET

This briefing will provide key information, dates, and data about the payments. Stakeholders must register to attend.

Administration Begins American Rescue Plan Rural Funding to Support Providers Impacted by Pandemic

Tuesday, November 23, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), released the vast majority ($7.5 billion) of the $8.5 billion American Rescue Plan (ARP) Rural payments to providers and suppliers who served rural Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries from January 1, 2019 through September 30, 2020.

Hundreds of home health care and hospice agencies received this funding and we strongly encourage them to attend the stakeholder briefing mentioned below.

You’re Invited: Stakeholder Briefing

HRSA’s Provider Relief Bureau (PRB) will hold a stakeholder briefing on:

  • December 2, 2021
  • 1:00-1:30 p.m. ET

This briefing will provide key information, dates, and data about the payments. Stakeholders must register to attend.

Administration Begins American Rescue Plan Rural Funding to Support Providers Impacted by Pandemic

Today, Tuesday, November 23, the Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), released the vast majority ($7.5 billion) of the $8.5 billion American Rescue Plan (ARP) Rural payments to providers and suppliers who served rural Medicaid, Children’s Health Insurance Program (CHIP), and Medicare beneficiaries from January 1, 2019 through September…

Biden Admin Issues Guidance to States on Required Medicaid and CHIP Coverage for COVID-19-Related Treatment

The Centers for Medicare & Medicaid Services (CMS) issued guidance to states about the statutory requirement for states to cover COVID-19-related treatment without cost-sharing in Medicaid and CHIP for many seniors, low-income adults, pregnant women, children, and people with disabilities who receive health coverage through these programs. This life-saving health care coverage, supported through the American Rescue Plan (ARP), includes care for conditions that could complicate the treatment of COVID-19 in patients who are presumed positive for the virus or have been diagnosed with COVID-19.

In addition to issuing Medicaid and CHIP guidance, CMS recognizes and applauds the efforts that many private issuers have taken to waive cost sharing for COVID-19-related treatment in the commercial market. Along with today’s guidance, CMS encourages private health plans to continue to take steps to ensure consumers have coverage for treatment for COVID-19, including for long COVID, without cost barriers.

Continue reading “Biden Admin Issues Guidance to States on Required Medicaid and CHIP Coverage for COVID-19-Related Treatment”

Biden Admin Issues Guidance to States on Required Medicaid and CHIP Coverage for COVID-19-Related Treatment

The Centers for Medicare & Medicaid Services (CMS) issued guidance to states about the statutory requirement for states to cover COVID-19-related treatment without cost-sharing in Medicaid and CHIP for many seniors, low-income adults, pregnant women, children, and people with disabilities who receive health coverage through these programs. This life-saving health care coverage, supported through the…