The CARES Act signed into law by President Trump on March 27, 2020, provides for $100 billion in funding for financial relief to Medicare health care providers impacted by COVID-19. On April 10, 2020, the Administration announced that $30 billion of this funding will be disbursed immediately to providers through direct deposit—these direct deposits will not be required to be repaid.

There are several important requirements for the relief that a provider needs to understand before certifying eligibility to retain the funds. First, the provider will be required to certify that since January 31, 2020, it has or had provided testing, diagnosis, or treatment of COVID-19 patients and that the relief will only be used to prevent, prepare for, and respond to coronavirus. Second, a provider receiving the funds will not be able to collect from a patient a copayment greater than the inpatient copayment amount charged by in-network providers. Third, there are quarterly reporting requirements for providers who receive more than $150,000 in funds.

The release addresses the provider eligibility, certification, and other requirements, as summarized below.

Provider Eligibility

Every facility and provider that was reimbursed through Medicare fee-for-service in 2019 is eligible for payments from the $30 billion of immediate relief funding. The provision of payments is dependent on provider type:

  • Solo Practitioners – Medicare-billing solo practitioners will receive their direct payments under the Tax Identification Number (TIN) used to bill Medicare.
  • Group Practices/Group Practice Physicians – Group practices will receive direct payments as the Medicare billing organization, and payments will generally not go to individual providers in the practice directly.
  • Employed Physicians – Physicians employed by another organization will generally not receive payments directly as their employer organization will receive the direct payment as the Medicare billing organization.
  • Health Systems and Large Organizations – These organizations will receive direct payments for each TIN used to bill Medicare.

Requirements for Participating Providers

  • As a condition to receiving CARES Act provider relief funds, providers must agree not to pursue collection of out-of-pocket patient payments from COVID-19 patients where the payments are greater than the amount such patient would have been required to pay if he/she had received care from an in-network provider.
  • Following the $30 billion of initial distributions, providers must sign an attestation confirming their receipt of funds and agreeing to the terms and conditions of payments within 30 days of receiving payment. A portal for executing such attestation will open the week of April 13, 2020.
  • The full terms and conditions can be found here. This document requires providers to certify to the following, among other conditions: 1) that the provider billed Medicare in 2019; 2) that the provider currently provides diagnoses, testing, or care for patients with COVID-19; 3) that the provider is not currently terminated from participation in Medicare; 4) that the provider is not currently excluded from participation in federal health care programs; and 5) that the provider does not currently have its Medicare billing privileges revoked.
  • Providers that do not wish to comply with the terms and conditions of payment but receive a payment must contact the Department of Health and Human Services (HHS) within 30 days of receiving payment and return the disbursed amount in full to HHS.

The CARES Act provider relief funding will provide much-needed assistance for health care providers struggling under the financial impact of COVID-19. However, providers receiving any amount of funding should carefully review the terms and conditions to which they will be subject to determine whether they are able to remain in full compliance.