Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

The application is now open for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments. The application will close on October 26, 2021.

How Will Payments Be Calculated?
Read the Phase 4 and ARP Rural – Payment Calculation Methodologies to understand how payments will be calculated and how the Department of Health and Human Services (HHS) will continue to use risk mitigation and cost containment measures to protect program integrity and preserve taxpayer dollars.

Phase 4 General Distribution: Consistent with the requirements included in the December appropriations bill, PRF 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/Children’s Health Insurance Program (CHIP) and Medicare beneficiaries.

Approximately 75% of the Phase 4 allocation will be used for Base Payments, which are a percentage of a provider’s change in quarterly operating revenues and expenses.

• Provider size categories (Small, Medium, and Large) will be based on annual net patient care revenues, and will be established after the close of the Phase 4 application.
• Large providers will receive a Base Payment amount that is a percentage of the change in their quarterly operating revenues and expenses.
• Base Payments for medium and small providers will include the same percentage of the change in their quarterly operating revenues and expenses plus a scaled supplement, with small providers receiving the greatest amount.
• No provider will receive a Base Payment that exceeds 100% of their change in quarterly operating revenues and expenses.

Approximately 25% of the Phase 4 allocation will be put towards bonus payments.

• Bonus payments will be based on the amount and type of services provided to Medicaid, CHIP, and Medicare beneficiaries from January 1, 2019 through September 30, 2020.
• HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.

ARP Rural Distribution: HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and CHIP services provided to rural beneficiaries from January 1, 2019 through September 30, 2020.

• HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
• Eligible billing TINs that have at least one Medicaid, CHIP, or Medicare claim for a rural beneficiary will receive a minimum payment to be determined based on applications.

For more information, click here or contact your Somerset advisor at 317.472.2200 or with any questions.