CMS Releases Allocation Details, Conditions of Participation for Emergency Payments to Home Health Providers

Home health and hospice providers now have greater clarity on how much initial emergency assistance they’ll be getting from the CARES Act Provider Relief Fund, as well as when those direct deposits will hit their bank accounts.

While details of the disbursements were originally scarce, it seems the Centers for Medicare & Medicaid Services (CMS) started doling out payments to Medicare-reimbursed providers as of Friday, April 10.

The goal is to divide $30 billion in grant funding up between all program participants to help them maintain stability amid COVID-19. The money comes from a pool of $100 billion in relief set aside for health care providers under the CARES Act.

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While it’s unclear how long it will take CMS to send out all of the emergency funding, what’s become more predictable is how much of the $30 billion providers can expect to receive. At least some home health providers received their payments as of Friday, sources confirmed to HHCN.

Payment amounts will be proportional and based on 2019 Medicare revenue. As such, providers can use a relatively straight-forward formula to gain insight, according to the National Association for Home Care & Hospice (NAHC).

To find its estimated payment, a provider can divide its 2019 Medicare fee-for-service reimbursement total (excluding Medicare Advantage payments) by $484 billion, the total amount the program paid out last year. Then, multiply that ratio by $30 billion.

For example, if a provider billed Medicare $121 million last year, it can expect to receive an initial emergency payment from CMS of about $7.5 million — and that payment could come any day now in the form of a direct deposit.

While CMS Administration Seema Verma has said there are “no strings attached” to the funding and that it doesn’t have to be repaid, it does come with a few conditions.

First of all, providers have to have received Medicare FFS reimbursements last year.

On top of that, they have to agree not to ask for out-of-pocket payments from COVID-19 patients in excess of what a patient would be expected to pay if the care had been provided by an in-network provider.

Finally, providers must sign an attestation within 30 days of receiving the payment, confirming that they got the money and that they agree to the terms and conditions that come with it. 

While there has been some uncertainty among providers about exactly how the emergency funding may be used, legal sources told HHCN further clarification on that is likely to come soon.

Meanwhile, industry stakeholders such as LeadingAge and NAHC have lauded CMS for making the emergency relief process so quick and easy. 

“The infusion of emergency funds will very much help home health agencies and hospices as they struggle to meet the challenges of the pandemic,” NAHC President Bill Dombi told Home Health Care News in a statement. “We sincerely appreciate that the first wave of the funds are being distributed with speed and simplicity. While additional relief will be needed, this start is a solid one.”

Additional relief seems likely, considering the initial disbursements will only account for 30% of the $100 billion originally set aside for the CARE Act Provider Relief Fund.

“We look forward to future allocations from the still-to-be distributed $70 billion from the CARE Act Provider Relief Fund and hope these payments will continue to support key aging services providers, including those that participate in Medicaid (including Medicaid home and community-based services), Medicare Advantage, and PACE organizations,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement.

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