Healthcare Provider Relief Fund Attestation and Related Risks

April 16, 2020 | Article

Delivery of the provider relief funds for healthcare organizations has begun. Once this payment has been received, an attestation confirming receipt of funds, as well as agreement to the terms and conditions of payment, is required within 30 days. The link to attest is now live.

To attest to the terms and conditions of the provider relief fund payments, go here.

What Is Needed to Complete the Attestation

  • Taxpayer Identification Number (TIN) (either Employer Identification Number or Social Security number) connected to the billing entity(ies) that are eligible. Multiple TINs may be entered.
  • For each TIN, the last six digits of the deposit account in which the funds were received and the amount of funds received in that account with “HHSPAYMENT” as the payment description.

Are Attestations Required for Each TIN?
Yes. The following are the attestations that will be required.

  1. I acknowledge receipt of _$(______)_ from the Public Health and Social Services Emergency Fund (“Relief Fund”), and accept the Terms & Conditions. If you received a payment from funds appropriated in the Relief Fund under Division B of Public Law 116-127 and retain that payment for at least 30 days without contacting HHS regarding remittance of those funds, you are deemed to have accepted the following Terms and Conditions. This is not an exhaustive list and you must comply with any other relevant statutes and regulations, as applicable. Your commitment to full compliance with all Terms and Conditions is material to the Secretary’s decision to disburse these funds to you. Non-compliance with any Term or Condition is grounds for the Secretary to recoup some or all of the payment made from the Relief Fund. These Terms and Conditions apply directly to the recipient of payment from the Relief Fund. In general the requirements that apply to the recipient, also apply to sub-recipients and contractors under grants, unless an exception is specified.
  2. By receiving and accepting Relief Fund payment, you attest that in accordance with the “Coronavirus Aid, Relief, and Economic Security Act” or the “CARES Act,” you are eligible for this payment. You acknowledge that you may be asked to submit to the review process established by the U.S. Department of Health and Human Services, including its contractor (collectively, “HHS”), to determine your eligibility for this payment. Additionally, upon request by HHS, you will provide any and all information related to the disposition or use of the funds received under the Relief Fund for auditing and/or reporting purposes. I attest that I have the legal authority to act on behalf of the provider group that has received payment under the Relief Fund. For Electronic Funds Transfer/ACH Payments, HHS or its contractor may make adjustments to the payment whenever a correction or change is required. For example, if there is an error, you agree that HHS may correct the error immediately and without notice. Such errors may include, but are not limited to, reversing an improper credit, and correcting calculation and input errors. The right to make adjustments are not subject to any limitations or time constraints, except as provided by law.

Types of Documentation Recommended to Ensure Compliance
Note that the attestations provide HHS the ability to recoup some or all of the payments for numerous reasons, including non-compliance with any term or condition or incorrect payment calculations. It is still unclear how HHS plans on enforcing this program. However, based on what has been released to date, we recommend the following:

  • Record the funds in a separate general ledger account.
  • Document the determination of eligibility under the program. HHS views all facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 as eligible. HHS also “broadly views every patient as a possible case of COVID-19.”
  • Consider recalculating or estimating the payment expected from HHS based on the formula provided by HHS and comparing to the actual funds received.
  • Review current policies and procedures and modify as necessary to ensure that patients receiving care for a possible or actual case of COVID-19 will not be billed out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network recipient. Develop a system to monitor compliance.
  • Ensure adequate internal controls are in place for the tracking of both the receipt of funds and the related expenditures associated with these funds.
  • Track and retain documentation for all expenditures incurred during this period that are not otherwise reimbursed through other sources or that other sources have an obligation to reimburse. Develop a system to monitor all programs and related expenditures to ensure there is no “double dipping” across programs.
    • For critical access hospitals, Medicare is obligated to reimburse for its portion of costs through the cost report, so a separate assessment will likely be needed.
    • For organizations receiving forgiveness under a CARES Act program, these are often directly related to specific expenditures.
    • The terms and conditions provide limitations for other expenditures, such as executive compensation.
  • Calculate the loss of revenue as a result of COVID-19, which likely includes matters indirect to COVID-19 itself, such as a decline in elective procedures and admissions or visits.
  • Identify projects or activities that HHS funds are being used to support and monitor the number of jobs created or retained by those projects or activities for reporting purposes.
  • Identify any potential sub-contracts or subgrants for reporting purposes and ensure that those organizations are also complying with the requirements of the program.
  • Create a reporting mechanism to ensure timely reporting to HHS in accordance with the terms and conditions.

If You Have Not Received Funds
If you have not yet received funds from this program, but were expecting them, it may be due to the timing of the release of the three tranches of funds:

  1. Active ACH on file with UHC – electronic transfer on April 10
  2. Active ACH on file with CMS – electronic transfer on April 17
  3. Providers that receive paper checks for Medicare FFS will receive checks in the mail and they are expected to be mailed out by April 17.

If funds still have not been received, HHS should have an online request available by Friday, April 17.

We broke down what you need to know about the provider relief funds.

How to Ensure Compliance
While these funds are much needed to support the health care community, it is clearly not “free money.” Ensuring compliance with the various provisions of this program will reduce any risk of repayment in the future. Some of the steps necessary above are more complex than others. It’s important to work with a trusted advisor to help navigate these programs and compliance requirements.

Contact Us

We can help answer questions and assist in the attestation process.

Please note that information continues to be released and the information above is based on guidance issued as of the date of publication. Eide Bailly will continue to provide updates as necessary.

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