Relief for Medicaid Pediatricians is Finally Here (updated 6/10)
HHS Announces COVID-19 Relief Funds for Medicaid & CHIP Providers
Dear TPS Member,
After months of financial hardship, countless news stories highlighting pediatric practice viability, and tireless advocacy from TPS members like you, the U.S. Department of Health and Human Services announced today expanded Provider Relief Funding to eligible Medicaid and Children's Health Insurance Program (CHIP) providers in response to the COVID-19 pandemic. $15 billion will be distributed to Medicaid and CHIP providers via the bipartisan CARES Act which passed more than two months ago.
We have included the CMS News Release below with additional links to information about eligibility and the application process. Thank you to all those who made their voices heard so that children on Medicaid would not lose access to their pediatrician.
FOR IMMEDIATE RELEASE
Tuesday, June 9, 2020
HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers
Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.
“Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19,” said HHS Secretary Alex Azar. “HHS is using funds from Congress, secured by President Trump, to provide new targeted help for America’s safety-net providers and clinicians who treat millions of Medicaid beneficiaries.”
HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.
ENHANCED PROVIDER RELIEF FUND PORTAL
On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.
The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.
Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers serving Medicaid/CHIP beneficiaries possibly eligible for this funding, include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other home and community-based services providers.
To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.
More information about eligibility and the application process is available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html
$10 BILLION ALLOCATION FOR SAFETY NET HOSPITALS
HHS is announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens, recognizing the incredibly thin margins these hospitals operate on. This payment is being sent directly to these hospitals via direct deposit.
This payment is going to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. Qualifying hospitals will have:
- A Medicare Disproportionate Payment Percentage (DPP) of 20.2 percent or greater;
- Average Uncompensated Care per bed of $25,000 or more. For example, a hospital with 100 beds would need to provide $2,500,000 in Uncompensated Care in a year to meet this requirement;
- Profitability of 3 percent or less, as reported to CMS in its most recently filed Cost Report.
Recipients will receive a minimum distribution of $5 million and a maximum distribution of $50 million.
ADDITIONAL PROVIDER RELIEF FUND UPDATES
- On Monday, June 8, 2020, HHS sent communications to all hospitals asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020. This information will be used to determine a second round of funding to hospitals in COVID-19 hotspots to ensure they are equitably supported in the battle against this pandemic. To determine their eligibility for funding under this $10 billion distribution, hospitals must submit their information by June 15, 2020 at 9:00 PM ET.
- HHS is working on an additional allocation to distribute relief broadly to dentists.
Update: As of 6/10, the Enhanced Provider Relief Fund Payment Portal has been posted on the HHS website and appears to be active now. Please follow the link for additional information if you are interested in applying: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html
Visit the AAP webpage for helpful information: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/help-for-pediatricians/provider-relief-fund-information-and-resources/
Medicaid Resources in Light of COVID-19
Due to COVID-19, many families are facing job insecurity and may be losing access to health insurance for themselves and their children. Below are some helpful resources compiled by the TPS Medicaid, CHIP, and Uninsured Committee to help you and families enroll in Medicaid.
Outreach Materials (displayable posters for offices)
Links for Clients to Apply for Benefits
- General information website on all state benefits to include Medicaid/CHIP
- Website for the Community Partner Program which links Texans who need assistance applying for benefits with community-based organizations in their area who can help
Link for Physicians Wishing to Enroll as a Texas Medicaid Provider
Links for Dedicated COVID-19 Information
- HHSC website for clients
- HHSC website for providers
- HHSC website for providers (Medicaid/CHIP specific)
- DSHS COVID-19 website