CMS Emergency Payments to Home Health Providers Aren’t ‘No Strings Attached’ 

When the Centers for Medicare & Medicaid Services (CMS) Administration Seema Verma first announced Medicare providers would be getting emergency assistance payments to help them maintain stability amid the coronavirus, she said the money would come with “no strings attached.”

But that’s not entirely true, home health and hospice providers have learned as they receive their chunks of the $30 billion in grant funding.

The funds come with terms and conditions, which were released by the Department of Health & Human Services (HHS) Friday alongside the first round of payments. Providers must agree to those and confirm receipt of the funds within 30 days of getting their direct deposits.

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If those terms are violated, it seems providers could be responsible for repaying the money.

Some of the conditions are straightforward: Providers must have received Medicare fee-for-service (FFS) reimbursements last year to qualify. Additionally, they must agree not to ask COVID-19 patients for out-of-pocket payments in excess of what they would have to pay if the care had been provided by an in-network provider.

Other terms are more ambiguous — and appear to be in direct opposition with what CMS told providers last week. For example, HHS is stipulating that providers must use the payments for coronavirus-specific expenses, though agencies do not have to be treating COVID-19 positive patients to be eligible.

“The recipient certifies that the payment will only be used to prevent, prepare for and respond to coronavirus, and shall reimburse the recipient only for health care related expenses or lost revenues that are attributable to coronavirus,” HHS’s terms and conditions say.

Plus, providers must document how they’re spending their payments, which are based on 2019 Medicare revenue. So while home health and hospice agencies may not necessarily be responsible for repaying the funds, they all must be accountable for it, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

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“These are not repayable emergency funds,” Dombi told members in a policy update posted to YouTube. “Instead, you will need to be accountable for them, tying them to your direct and indirect COVID-19 costs, as well as lost revenue.”

The terms and conditions of the payments came out just days after Verma explained the funding bumps would not have to be repaid and could be used at providers’ discretion.

“There are no strings attached,” she said during an April 7 White House press briefing. “So the health care providers that are receiving these dollars can essentially spend that in any way that they see fit.”

Instead, it seems that providers must agree to the aforementioned terms or return the grant funding in full. However, that could change going forward, according to attorneys at the law firm Arnall Golden Gregory.

“Given that there’s going to be quarterly reporting and other requirements, common sense tells me that there will be an accounting at the end of this,” Arnall Golden Gregory partner Hedy Silver Rubinger told HHCN’s sister site Skilled Nursing News.

That means providers could be allowed to keep some of the money, while later being asked for refunds for anything that CMS deems unrelated to COVID-19.

The $30 billion in grant funding being divided up between providers is part of $100 billion set aside for health care providers under the CARES Act. Verma has said the remaining $70 billion will be distributed more broadly across the health care system and that more details on disbursement are coming soon. 

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