U.S. Department of Health and Human Services (HHS) released long-awaited guidance on June 11, 2021, extending reporting timelines, revising deadlines for use of funds, and clarifying reporting requirements for recipients of Provider Relief Fund (PRF) recipients. Recipients will now have a 90-day period to complete reporting, which will be spilt into four reporting periods.
Requirements for utilization of funds via eligible expenses and lost revenues remain largely unchanged from prior guidance. HHS states: “The Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus provided those expenses have not been reimbursed from other sources or that other sources are not obligated to reimburse.”
The new reporting and use of funds deadlines are dependent upon when providers received the funding, referred to as the “period of availability”:
In addition to setting new “use date” and “reporting date” deadlines, the updated HHS guidance requires recipients of Skilled Nursing Facility and Nursing Home Infection Control payments to submit a consolidated report distinguishing the use of funds from other PRF General and Targeted Distribution payments. Recipients will be required to report for each period in which they received one or more payments exceeding, in the aggregate, $10,000.
HHS also redefined categories for classifying personnel and patient admission. The updated facility metrics accompany an additional survey reporting requirement in which providers will be reporting on the impact the funds had on the overall operations and services of the provider.
Providers will be able to begin submitting information through the PRF Reporting portal starting July 1, 2021.
While HHS has provided welcome flexibility for providers, there are some questions that remain unaddressed despite the guidance:
How do providers calculate lost revenue given the revised time periods for use and reporting?
Previously, HHS required providers to use funds and report under two time periods (1) CY 2020 and (2) 1/1/2021 – 6/30/2021. In a 1/28/2021 FAQ response, HHS clarified that any lost revenue calculation must “report revenue for the full calendar year 2020”. This was critical guidance because it confirmed providers must offset any months with large losses against any positive months in the same time period.
In this 6/11/2021 update, HHS both altered the reporting periods and deleted the 1/28/2021 FAQ on the lost revenue aligning with the reporting period. HHS must now clarify for providers how they must structure their lost revenue calculation under the new reporting guidance. Is it by month? By quarter? By year?
Under the “Data Elements” section of the revised reporting guidance, HHS does request patient care revenue “by quarter for each quarter during the period of availability” – but HHS does not specify whether this also controls the calculation and offsetting of funds for lost revenue.
Can providers carry forward unused lost revenue from one period of availability to the next?
HHS clearly states providers can carry forward eligible “pre-award” expenses incurred prior to the period availability. However, HHS does not clearly state providers have the same option for lost revenue. The key quote seemingly allowing such a carry-forward is now added to FAQs: “Provider Relief Fund recipients must only use . . . lost revenues attributable to coronavirus before the deadline that corresponds to the Payment Received Period, which is based on the date the payment is received.”
Along with clarifying how providers calculate lost revenue by time period, HHS should clarify whether lost revenues “carry forward” if in excess of funds received in the same period.
Must each recipient of PRF register and report in the portal, even if a parent entity will be also be reporting on its behalf?
HHS clarified that subsidiary recipient of Target Distributions must register and report in the portal. Where these recipients will also have a parent report on their behalf, they must separately report background entity information and indicate the amount of any distributions transferred to the parent entity for use. However, HHS does not address whether subsidiary recipients of only General Distributions need to do the same.
Who will audit PRF utilization and when will these audits occur?
The guidance also does not provide additional information on audit will occur and who providers can expect to conduct the audit. HHS continues to only note that these funds will be subject to federal Single Audit requirements on typical cycles for entities that received greater than $750,000 in distributions.
Advis plans to seek more detail on these questions from HHS. Advis is available to answer any questions and to assist with the Provider Relief Fund reporting process. Contact us online or at (708) 478-7030.