If a provider rejects a payment and the associated Terms and Conditions in the attestation portal but decides to keep the funds after rejecting it in the attestation portal, what should the provider do in order to report on the use of funds kept? (Added 6/30/2022)
Providers who rejected one or more Provider Relief Fund payments exceeding $10,000, in aggregate, and kept the funds are required to report on these funds during the applicable reporting period per the Terms and Conditions associated with the payment(s). In order to be able to report on the use of funds, a provider must contact the Provider Support Line at (866) 569-3522 (for TTY, dial 711) to request a change to their attestation from “rejected” to “accepted.” Once the attestation status has been updated in the attestation portal, the Provider Relief Fund Reporting Portal will subsequently be updated to accurately reflect the kept payment that the provider is required to report on during the applicable reporting period.
Why would a provider not be eligible for a General or Targeted Distribution Provider Relief Fund payment? (Modified 6/30/2022)
In order to be eligible for a payment under the Provider Relief Fund, a provider must meet the eligibility criteria for the distribution and must be in compliance with the Terms and Conditions for any previously received Provider Relief Fund payments. Additionally, a provider must not be currently terminated from participation in Medicare or precluded from receiving payment through Medicare Advantage or Part D; must not be currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and must not currently have Medicare billing privileges revoked as determined by either the Centers for Medicare & Medicaid Services or the HHS Office of Inspector General in order to be eligible to receive a payment under the Provider Relief Fund.
How do I appeal or dispute a payment decision? (Modified 6/30/2022)
In the event that you would like to appeal or dispute a payment decision, first review Phase 4 and/or ARP Rural payment methodology available at https://www.hrsa.gov/providerrelief/future-payments/phase-4-arp-rural/payment-methodology. If you believe your payment was calculated incorrectly, submit a completed PRF Reconsideration Request Form available at https://powerforms.docusign.net/034c7d84-45d9-40c2-9d0bc4648f225bc3?env=na3&acct=dd54316c-1c18-48c9-8864- 0c38b91a6291&accountId=dd54316c-1c18-48c9-8864-0c38b91a6291. HRSA is only reconsidering Phase 4 General Distribution and ARP Rural applications and payments at this time. For more information, please review HRSA’s Phase 4 and ARP Rural Reconsiderations page, available at https://www.hrsa.gov/provider-relief/paymentreconsideration. Any changes to payment determinations are subject to the availability of funds.
How do I know if I am eligible for a Phase 4 – General Distribution payment? (Modified 6/30/2022)
You must meet all of the five eligibility requirements for the Phase 4 – General Distribution, which include
- Falling into one of the following categories:
- Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, their state/territory Medicaid program (fee-for service or managed care) or Children’s Health Insurance Program (CHIP) for health care-related services during the period of January 1, 2019 to December 31, 2020;
- Must be a dental service provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for oral health care-related services during the period of January 1, 2019 to December 31, 2020;
- Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, Medicare fee-for-service (Parts A and/or B) or Medicare Advantage (Part C) for health care-related services during the period of January 1, 2019 to December 31, 2020;
- Must be a state-licensed/certified assisted living facility on or before December 31, 2020;
- Must be a behavioral health provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for health care-related services during the period of January 1, 2019 to December 31, 2020; or
- Must have received a prior Targeted Distribution payment.
- Having either (i) filed a federal income tax return for fiscal years 2018, 2019, or 2020, or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (e.g. a state-owned hospital or health care clinic); and
- Having provided patient care after January 31, 2020; and
- Having not permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
- If the applicant is an individual that was providing patient care, having gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.
You also:
- Must not be currently terminated from participation in Medicare or precluded from receiving payment through Medicare Advantage or Part D;
- Must not be currently excluded from participation in Medicare, Medicaid, and other Federal health care programs;
- Must not currently have Medicare billing privileges revoked; and
- Must be in compliance with the Terms and Conditions for any previously received Provider Relief Fund payments.
In addition, your billing or filing TIN must be included in the list of providers that HRSA has determined to be eligible or your application must pass additional validation by HRSA. Some providers may be eligible for a payment but the payment calculation will be $0 due to risk mitigation and cost containment safeguards.