HHS Releases Phase 4 Application Process for Provider Relief
Sep 29, 2021
On September 29, 2021, health care providers will be able to apply for $25.5 billion in relief funds, including $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) and $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers with changes in operating revenues and expenses.
The application will be open for a period of four weeks. Providers must submit their completed application by the final deadline of October 26 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application.
- Phase 4 General Distribution — $17 billion based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021.
- To promote equity and to support providers with the most need, HRSA will:
- Reimburse smaller providers for changes in operating revenues and expenditures at a higher percentage compared to larger providers.
- Provide “bonus” payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates. (HRSA will use existing Medicaid, CHIP, and Medicare claims data in calculating portions of these payments.)
What Documentation Do I Need?
- Supporting documentation and information needed to complete an application will include:
- Applicant TIN and TINs for any subsidiaries included in the applicant TINs IRS tax filing.
- Internally-generated financial statements that substantiate operating revenues and expenses from patient care in 2019 Q1, Q3, and Q4; 2020 Q3 and Q4; and 2021 Q1.
- Federal income tax return, audited financial statements, or if neither then, internally-generated financial statements submitted in their entirety
Who Is Eligible To Apply and How Will Payments Be Calculated?
Phase 4 General Distribution: Phase 4 payments will be based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021. Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their changes in operating revenues and 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 be calculated based on changes in operating revenues and expenses.
- Large providers will receive a minimum payment amount that is based on a percentage of their changes in operating revenues and 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.
- 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.
- Who is potentially eligible?
- Providers or suppliers who bill Medicare fee-for-service (Parts A and/or B) or Medicare Advantage, Medicaid (fee-for service or managed care) or CHIP as well as:
- Dental service providers
- State-licensed or certified assisted living facilities
- Behavioral health providers
Provider Relief Fund Reporting: We Can Help