HHS Clarifies Provider Relief Medicaid Distribution Application Items

Regulation | June 26, 2020 | by Nicole Fallon

The U.S. Department of Health and Human Services through its hosted webinars this week and updated FAQ document has further addressed eligibility concerns related to the new Medicaid Distribution application process as well as how providers should report revenue information.

Many LeadingAge members have inquired why they are not eligible to apply for the Medicaid Distribution when their General Distribution payment(s) were so small. This issue was also raised on the HHS June 25 webinar on applying for the Medicaid Distribution. Here HHS repeated that providers who received a General Distribution payment of any amount cannot apply for the Medicaid Distribution. It went on to say there should be parity between the two payments to providers. The reason for this may be a quietly-made change in mid-June to how HHS is now approaching the total General Distribution payments the providers receive.

Originally, the General Distribution allocation to providers was to reflect roughly 2% of net patient revenues as reported on the Medicare cost reports. However, in mid-June, HHS updated its FAQ with a new General Distribution formula that is now 2% of gross revenue/receipts based upon reported federal income tax information. So, the formula has changed in two key ways from net to gross and from using the Medicare cost report data to federal income tax information. HHS noted on the call that gross revenues include funding received from all sources. The Medicaid Distribution formula is also 2% of (gross revenues * percent of gross revenues from patient care) for CY 2017, or 2018 or 2019, as selected by the applicant and with accompanying submitted tax documentation. So, it would appear that there is more parity between the two payments. In addition, HHS updated another FAQ today highlighted that just because providers are not eligible for the Medicaid Distribution does not mean they won’t be eligible for a future distribution. Keep in mind, HHS has about $70 billion left unallocated in the Provider Relief Fund. What is not currently clear, is if providers who received two automatic General Distribution payments based off the old formula may receive an additional payment under the new formula. LeadingAge has an inquiry into HHS about this change and its implications.

Here is a summary of some other new information related to the Medicaid Distribution included in the most recent update of the HHS FAQs as of June 26. Providers are encouraged to consult these FAQs for further details about the items below:

  • Eligibility: HHS in its FAQs clarified that the following providers are eligible for the Medicaid Distribution: providers of self-directed home and community-based services, providers paid through a certified public expenditure(CPE) or an Organized Healthcare Delivery Systems(OHCDS). However, HHS clarifies that the payments must be applied for and will be distributed to the filing Tax Identification Number(TIN) entity, which maybe the fiscal management service, CPE, or OHCDS. Some self-directed providers who are included in the T-MSIS files or are in the curated HHS list of Medicaid providers may be able to apply directly. Additional details are in the HHS FAQs. 
  • Providers not on the curated HHS List of Medicaid Providers: If a provider applies and is not on the curated list of Medicaid/CHIP providers, HHS will flag them as invalid but conduct additional research to verify with the states if they should be on the list. Providers will be notified by HHS within 15 business days of its findings.
  • FTE data submission: HHS clarified that it would like all providers (not just facility-based providers) to submit FTE information through the application but providers need only include their W-2 employees.
  • State licensure not a requirement of application: Providers are not required to have a state license in order to apply but there is currently a glitch in the application system that is keeping those providers from completing their application. HHS is trying to resolve this issue as quickly as possible but providers who do not have a license may want to wait a little bit before applying to ensure the glitch is fixed..
  • SNF Resident Fees: SNFs can report resident fees that cover accommodation (sometimes referred to as rent) in its reported patient service revenue information as part of its application.
  • Inclusion of Independent Living revenue: In one question, HHS indicates that AL and MC communities that offer IL in the same community and the residents benefit from the services and supports offered in the community can report revenue from IL in the definition of patient care when applying for the Medicaid distribution.
  • TINs with Multiple Facilities: TINs with multiple facilities can report patient revenue for every facility that bills under the TIN according to the HHS FAQs

Those applying for the Medicaid Distribution are encouraged to consult the following HHS resources for more information about what information is needed to apply and the application process:

  • Enhanced Provider Relief Fund Payment Portal – this is where you apply and there is an application guide under the tab, “Resources and Support”
  • Medicaid Distribution Application Instructions: The instructions walk through what data is needed for each field on the form and should be reviewed prior to applying
  • Application Form – PDF
  • HHS FAQs: There is an entire, and growing, section on the Medicaid Distribution which explains aspects of the application, how HHS will calculate the payment, and specific provider scenarios regarding eligibility and reporting of revenue information.
  • Provider Support Relief Line: 866-569-3522.  If you run into questions as you are filling out the form or have a specific situation not addressed by the FAQs, you are encouraged to use this line to get your questions answered.