Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance

As we shared earlier this week, HHS has announced a distribution of $15 Billion to eligible Medicaid and CHIP providers. 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.

This news is a major victory for pediatricians who have been largely left out of previous federal relief packages. You can read the full HHS announcement HERE.

Below you will find FAQs compiled by the American Academy of Pediatrics. Bookmark the FAQ page. As more details become available, they will be posted here. 

A few things to be aware of: 
1) All eligible providers will receive at least 2% of the reported annual patient care revenue, including all payers.
2) These funds are NOT first come, first served, so you don’t need to apply right away, but it’s best to start preparing now to make sure you can take advantage of the opportunity.
3) The deadline to apply through the portal for funds is July 20, 2020.
4) Once your information is submitted, you will not be allow to edit your submission. 

Before applying through the enhanced provider relief portal, the LA AAP recommends that providers should:

Read the Medicaid Provider Distribution Instructions – PDF, and Download the Medicaid Provider Distribution Application Form – PDF. We reccomend you complete the PDF application form to become familiar with what information is required and what documents you will be required to submit. As the chapter learns more, we will be sharing it with our members electronically.

From AAP’s Frequently Asked Questions page:

Where is the portal? The portal can be found at https://cares.linkhealth.com/#/. 
If you access the portal from the HHS Provider Relief Fund main page, be sure to choose the “Enhanced Provider Relief Payment Portal” that is currently open to Medicaid/CHIP providers.

Am I eligible? Any practice or clinician who has billed Medicaid and CHIP, including Medicaid/CHIP managed care plans, from January 2018-December 31, 2019, provided patient care after January 31, 2020, and who has not received any funding from the Provider Relief Fund general distribution, can apply. HHS has listed eligibility criteria here.

  • My practice received a PPP loan. Can I still apply?
    Yes. If you received a PPP loan or an EIDL loan, or a targeted allocation from the Provider Relief Fund, you can still be eligible for the Medicaid and CHIP targeted allocation. You cannot use payment from the Provider Relief Fund to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.
  • Is this different from the Provider Relief Fund general distribution? What is a “targeted allocation”?
    HHS has allocated different portions of the $175 billion Provider Relief Fund in a number of ways. $50 billion was allocated as the “general distribution” that was available to any provider with Medicare fee-for-service payments in 2019. If a provider was eligible for that general distribution, they are not eligible for the Medicaid and CHIP targeted allocation. HHS has also made targeted allocations for certain categories of providers to acknowledge financial needs beyond those addressed in the general distribution, including hospitals in high impact areas, rural hospitals and clinics, Indian Health Service hospitals and clinics, skilled nursing facilities, safety net hospitals, and Medicaid and CHIP providers excluded from the general distribution. The full descriptions of the Provider Relief Fund allocations are here.
  • My practice is part of a larger group that received a payment from the Provider Relief Fund general distribution, but those funds were not allocated to our pediatricians. Can I still apply? If the filing TIN or billing TIN has already received any amount of funding from the general distribution, you are not eligible to apply for the Medicaid and CHIP targeted allocation. If one of the billing TINs was not eligible for the general distribution but otherwise meets the eligibility criteria for the Medicaid and CHIP targeted allocation, then they are eligible to apply.
  • My practice received a small automatic payment from the Provider Relief Fund general distribution. Can I return those funds so I can apply for the Medicaid and CHIP targeted allocation?
    No. If you were eligible for the general distribution payment and rejected that payment, you are not eligible for the Medicaid and CHIP targeted allocation. Similarly, if you received a payment of any size from the general distribution, you are not eligible for the Medicaid and CHIP targeted allocation. AAP is deeply concerned about this policy and will continue to advocate for adequate financial relief for all pediatricians, including those who have been ineligible for relief thus far and those who have received inadequate relief to date.
  • I am employed by a large system that has implemented furloughs, layoffs, salary reductions, benefit cuts, etc. and I am facing financial hardship as a result. Can I apply?
    Targeted allocation payments will be made to filing/organizational TINs. If your filing TIN or billing TIN was eligible for a general distribution payment, you are not eligible for the Medicaid and CHIP targeted allocation. AAP is concerned about the implications of this policy for pediatricians and will continue to advocate for adequate financial relief for all pediatricians, including those who have been ineligible for relief thus far and those who have received inadequate support.
  • I do not see any Medicaid or CHIP patients. Can I apply?
    No. The Medicaid and CHIP targeted allocation is only available to providers who have billed their state Medicaid and CHIP program, or a Medicaid and CHIP managed care plan, between January 2018 and December 2019. The AAP is concerned about what this limitation will mean for pediatricians. AAP advocated to HHS for the funding to account for lost revenue and higher expenses attributable to COVID-19, with as few barriers as possible, and to go to all pediatricians, regardless of Medicaid participation and without cumbersome reporting requirements.

* Note: HHS has published conflicting information about dates for eligibility and AAP is working to clarify these dates. If you did not participate in Medicaid/CHIP between January 1, 2018 and December 31, 2019 and you enrolled in Medicaid/CHIP on or after January 1, 2020, your eligibility for the Medicaid/CHIP targeted allocation is uncertain.

How much funding can I expect? HHS has indicated that providers should expect to receive an initial payment of at least 2% of the reported annual patient care revenue, including all payers. Additional funds may be made available later to account for factors such as a high volume of Medicaid patients.

Is this a loan or a grant? Provider Relief Fund payments do not need to be repaid.

When do I need to apply? What if I can’t apply right away? HHS has confirmed that funding will not be allocated in a first-come, first-served way. Applications will be accepted through July 20, 2020.

What information do I need to prepare?

  • The applicant’s most recent federal income tax return for 2017, 2018 or 2019 or a written statement explaining why the applicant is exempt from filing a federal income tax return (e.g. a state-owned hospital or healthcare clinic).
  • The applicant’s Employer’s Quarterly Federal Tax Return on IRS Form 941 for Q1 2020, Employer’s Annual Federal Unemployment (FUTA) Tax Return on IRS Form 940, or a statement explaining why the applicant is not required to submit either form (e.g. no employees).
  • The applicant’s FTE Worksheet
  • Any applicant with gross revenue adjustments who enters an adjusted gross revenue number different from the applicable number shown on its tax return must upload the Gross Revenue Worksheet.

What are the obligations if I accept these funds? What do these Terms and Conditions require of me? The recipient certifies that all information it provides as part of any application are true, accurate, and complete. Recipients may have to submit reports to HHS to ensure compliance with conditions that are imposed. A full list of the terms and conditions can be found here.

I have run into a problem or have a question. Can you help? Please share any questions or concerns with AAP through covid-19@aap.org. You can also find HHS’s FAQs here, and call the Provider Relief Fund support line at (866) 569-3522; for TYY dial 711.

For More Information:

The AAP is closely monitoring the HHS website and will share detailed resources in the coming days.

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