CMS Stakeholder Call on Medicaid and CHIP Access

The Centers for Medicare & Medicaid Services (CMS) is seeking feedback on topics related to health care access in the Medicaid program. Specifically, CMS is interested in hearing from a broad array of stakeholders on topics relating to: enrolling in and maintaining coverage, accessing health care services and supports, and ensuring adequate provider payment rates…

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…

HHS Announces $25.5 Billion in COVID-19 Provider Funding

  • Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29

The Biden Administration announced Friday, September 10, that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.

“Home health and hospice will have an opportunity to tap these new funds,” says NAHC President William A. Dombi. “Our concern is that non-Medicare, non-Medicaid home care is still not included. We have been pushing for their inclusion for months, but have seen no movement on such. These are primarily the home care companies that do home care aide services that are private pay along with VA or Area Agency on Aging  funded.”

“This funding critically helps health care providers who have endured demanding workloads and significant financial strains amidst the pandemic,” said HHS Secretary Xavier Becerra. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.”

Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021. PRF Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers.

 Who Is Eligible To Apply and How Will Payments Be Calculated?

Phase 4 General Distribution: Consistent with the requirements included in the December appropriations bill, PRF Phase 4 payments will be based on providers’ lost revenues and increased expenditures between July 1, 2020 and March 31, 2021. Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers, and bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patient.

  • 75% of the Phase 4 allocation will calculated based on revenue losses and COVID-related expenses.
    • Large providers will receive a minimum payment amount that is based on a percentage of their lost revenues and COVID-related expenses.
    • Medium and small providers will receive a base payment plus a supplement, with small providers receiving the highest supplement, as smaller providers tend to operate on thin margins and often serve vulnerable or isolated communities.
    • HHS will determine the exact amount of the base payments and supplements after analyzing data from all the applications received to ensure we stay within our budget and funds are distributed equitably.
    • No provider will receive a Phase 4 payment that exceeds 100% of their losses and expenses.
    • HHS will continue to use risk mitigation and cost containment measures in Phase 4 to protect program integrity and preserve taxpayer dollars.
  • 25% of the Phase 4 allocation will be put towards bonus payments that are based on the amount and type of services provided to Medicaid, CHIP, and Medicare patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

ARP Rural Distribution: Providers who serve Medicaid, CHIP, and Medicare patients who live in rural communities are eligible for the ARP Rural payments.

  • HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) services provided to rural patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

Terms and Conditions: To help ensure that these provider funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with or acquisition of another healthcare provider during their Payment Received Period. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.

Similarly, HRSA will make ARP rural payments to providers based on the amount of Medicaid, CHIP and/or Medicare services they provide to patients who live in rural areas as defined by the HHS Federal Office of Rural Health Policy. As rural providers serve a disproportionate number of Medicaid and CHIP patients who often have disproportionately greater and more complex medical needs, many rural communities have been hit particularly hard by the pandemic. Accordingly, ARP rural payments will also generally be based on Medicare reimbursement rates.

In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. HRSA will use existing Medicaid, CHIP and Medicare claims data in calculating payments. The application portal will open on September 29, 2021. To help ensure that these provider relief funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with, or acquisition of, another health care provider during the period in which they can use the payments. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

“We know that this funding is critical for health care providers across the country, especially as they confront new coronavirus-related challenges and respond to natural disasters,” said Acting HRSA Administrator Diana Espinosa. “We are committed to distributing this funding as equitably and transparently as possible to help providers respond to and ultimately defeat this pandemic.”

To promote transparency in the PRF program, HHS is also releasing detailed information – PDF (PDF – 175 KB) about the methodology utilized to calculate PRF Phase 3 payments. Providers who believe their PRF Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on the PRF Phase 3 reconsideration process are forthcoming.

Additionally, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.

For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.

HHS Announces $25.5 Billion in COVID-19 Provider Funding

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Reports: Biden to Nominate Chiquita Brooks-LaSure as CMS Admin

According to reports, President Joe Biden will select Chiquita Brooks-LaSure to be the next administrator of the Centers for Medicare & Medicaid Services (CMS), the largest component of the Department of Health & Human Services (HHS), with ten offices around the country, more than 6000 employees, and over $1 trillion in annual expenditures. CMS has…

CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and Providers

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Thursday, December 10, intended to improve the electronic exchange of health care data among payers, providers, and patients, and streamline processes related to prior authorization to reduce burden on providers and patients. According to CMS, the proposed rule aims to improve data sharing…