The Provider Relief Fund: Frequently Asked Questions

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The Provider Relief Fund:
September September 215, 2021 , 2021
Frequently Asked Questions
Elayne J. Heisler
The Provider Relief Fund (PRF) was established in the Coronavirus Aid, Relief, and Economic The Provider Relief Fund (PRF) was established in the Coronavirus Aid, Relief, and Economic
Specialist in Health Specialist in Health
Security Act (CARES Act, P.L. 116-136) to reimburse, through grants or other mechanisms, Security Act (CARES Act, P.L. 116-136) to reimburse, through grants or other mechanisms,
Services Services
eligible health care providers for increased expenses or lost revenue attributable to Coronavirus eligible health care providers for increased expenses or lost revenue attributable to Coronavirus

Disease 2019 (COVID-19). The CARES Act provided $100 billion to prevent, prepare for and Disease 2019 (COVID-19). The CARES Act provided $100 billion to prevent, prepare for and
respond to coronavirus, domestically and internationally. The amounts were subsequently respond to coronavirus, domestically and internationally. The amounts were subsequently

increased by $78 billion, with $75 billion added in the Paycheck Protection Program and Health increased by $78 billion, with $75 billion added in the Paycheck Protection Program and Health
Care Enhancement Act (PPPHCEA, P.L. 116-139) and $3 billion in the Consolidated Appropriations Act, 2021 (P.L. 116-Care Enhancement Act (PPPHCEA, P.L. 116-139) and $3 billion in the Consolidated Appropriations Act, 2021 (P.L. 116-
260). The latter was the first time the Provider Relief Fund was referred to in statute and required changes to the fund’s 260). The latter was the first time the Provider Relief Fund was referred to in statute and required changes to the fund’s
reporting requirements and requirements for future fund allocations. reporting requirements and requirements for future fund allocations.
The answers to the frequently asked questions (FAQs) in this report provide overview information on the The answers to the frequently asked questions (FAQs) in this report provide overview information on the ~~PRFPF~~PRF, how funds , how funds
have been allocated, and the fund’s requirements for provider reporting. In addition, this report describes the use of the PRF have been allocated, and the fund’s requirements for provider reporting. In addition, this report describes the use of the PRF
to pay providers for providing coronavirus testing, treatment, and vaccines to uninsured individuals and the use of the fund to to pay providers for providing coronavirus testing, treatment, and vaccines to uninsured individuals and the use of the fund to
pay providers for costs associated with vaccinating individuals who are underinsured (e.g., who do not have insurance that pay providers for costs associated with vaccinating individuals who are underinsured (e.g., who do not have insurance that
covers vaccine administration). covers vaccine administration).
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he Provider Relief Fund (PRF) was established in the Coronavirus Aid, Relief, and he Provider Relief Fund (PRF) was established in the Coronavirus Aid, Relief, and
Economic Security Act (CARES Act, P.L. 116-136), which provided $100 bil ion to Economic Security Act (CARES Act, P.L. 116-136), which provided $100 bil ion to
T reimburse health care providers for increased expenses or lost revenue attributable to T reimburse health care providers for increased expenses or lost revenue attributable to
Coronavirus Disease 2019 (COVID-19). The amounts were subsequently increased by $78 Coronavirus Disease 2019 (COVID-19). The amounts were subsequently increased by $78
bil ion, with $75 bil ion appropriated in the Paycheck Protection Program and Health Care bil ion, with $75 bil ion appropriated in the Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA, P.L. 116-139) and $3 bil ion appropriated in the Consolidated Enhancement Act (PPPHCEA, P.L. 116-139) and $3 bil ion appropriated in the Consolidated
Appropriations Act, 2021 (P.L. 116-260). The latter law was the first time the Provider Relief Appropriations Act, 2021 (P.L. 116-260). The latter law was the first time the Provider Relief
Fund was referred to in statute and required changes to the fund’s reporting requirements and Fund was referred to in statute and required changes to the fund’s reporting requirements and
requirements for future fund al ocations. requirements for future fund al ocations.
The answers to the frequently asked questions (FAQs) below provide overview information on The answers to the frequently asked questions (FAQs) below provide overview information on
the fund, how funds have been al ocated, and the fund’s requirements for provider reporting. Data the fund, how funds have been al ocated, and the fund’s requirements for provider reporting. Data
on the fund are publicly available and updated regularly as new funds are released or as entities on the fund are publicly available and updated regularly as new funds are released or as entities
return funds.1 Due to ongoing data updates, this report does not include information on amounts return funds.1 Due to ongoing data updates, this report does not include information on amounts
al ocated or remaining; however, al ocated or remaining; however, agency data are available for download and can be used to data are available for download and can be used to examine the examine the
amounts that remain in the fund and the amount that a particular entity or state amounts that remain in the fund and the amount that a particular entity or state received, among received, among
other things. other things.
Fund Overview Questions
What Is the Provider Relief Fund?
The CARES Act appropriated $100 bil ion to “to prevent, prepare for, and respond to The CARES Act appropriated $100 bil ion to “to prevent, prepare for, and respond to
coronavirus, domestical y or international y, for necessary expenses to reimburse, through grants coronavirus, domestical y or international y, for necessary expenses to reimburse, through grants
or other mechanisms, eligible health care providers for health care related expenses or lost or other mechanisms, eligible health care providers for health care related expenses or lost
revenues that are attributable to coronavirus.”2 These funds were appropriated to the Public revenues that are attributable to coronavirus.”2 These funds were appropriated to the Public
Health and Social Services Emergency Fund (PHSSEF), a flexible funding source within the Health and Social Services Emergency Fund (PHSSEF), a flexible funding source within the
Department of Health and Human Services (HHS). The fund was later termed the “Provider Department of Health and Human Services (HHS). The fund was later termed the “Provider
Relief Fund.” The language did not specify an administering entity for the fund. HHS elected to Relief Fund.” The language did not specify an administering entity for the fund. HHS elected to
have the fund administered by the Health Resources and Services Administration (HRSA). HRSA have the fund administered by the Health Resources and Services Administration (HRSA). HRSA
is also administering the Uninsured Fund and the Coverage Assistance Fund, both of which are is also administering the Uninsured Fund and the Coverage Assistance Fund, both of which are
using an unspecified amount of the PRF to pay providers (see using an unspecified amount of the PRF to pay providers (see “What Is the Relationship Between
the Provider Relief Fund, the Uninsured Fund, and the Coverage Assistance Fund?”). ).
Do Providers Have to Repay Their PRF Funds?
PRF funds are grants and do not have to be repaid.3 Providers must attest to receiving these funds PRF funds are grants and do not have to be repaid.3 Providers must attest to receiving these funds
and comply with the applicable terms and conditions of the PRF (see and comply with the applicable terms and conditions of the PRF (see “What Requirements Apply
to Providers Receiving PRF Funds?”). ).

1 U.S. Department of Health and Human Services (HHS), “CARES Act Provider Relief Fund: Data,” 1 U.S. Department of Health and Human Services (HHS), “CARES Act Provider Relief Fund: Data,”
https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/data/index.html#fifty-billion-targeted-allocations. Note https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/data/index.html#fifty-billion-targeted-allocations. Note
that these data include amounts appropriated to the Provider Relief Fund (PRF) inthat these data include amounts appropriated to the Provider Relief Fund (PRF) in the three laws. T o download these the three laws. T o download these
data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6. data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6.
2 P.L. 116-136, 134 ST AT . 563. 2 P.L. 116-136, 134 ST AT . 563.
3 T his contrasts with the Medicare Accelerated and Advance Payment Program, in which providers received Medicare 3 T his contrasts with the Medicare Accelerated and Advance Payment Program, in which providers received Medicare
payments in advance of providing and billing for these services to payments in advance of providing and billing for these services to ~~Medicare~~Medicar e beneficiaries. For more information, see beneficiaries. For more information, see
CRS Report R46698, CRS Report R46698, Medicare Accelerated and Advance Paym ents and COVID-19: Frequently Asked Questions. .
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What Type of Health Providers Are Eligible for the Fund?
The CARES Act provided funds for lost revenue and defined eligible providers as follows: The CARES Act provided funds for lost revenue and defined eligible providers as follows:
“public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit “public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit
entities and not-for-profit entities not otherwise described in this proviso as the Secretary may entities and not-for-profit entities not otherwise described in this proviso as the Secretary may
specify, within the United States (including territories), that provide diagnoses, testing, or care for specify, within the United States (including territories), that provide diagnoses, testing, or care for
individuals with possible or actual cases of COVID-19.”4 In these provisions, “the Secretary” individuals with possible or actual cases of COVID-19.”4 In these provisions, “the Secretary”
refers to the HHS Secretary. Al ocations from the fund have included both specific types of refers to the HHS Secretary. Al ocations from the fund have included both specific types of
providers (e.g., nursing homes) and providers that bil specific programs (e.g., Medicare Fee-for- providers (e.g., nursing homes) and providers that bil specific programs (e.g., Medicare Fee-for-
Service).5 Service).5
How Much Was Appropriated to the Fund?
A total of $178 bil ion was appropriated to the fund across three laws, as follows: A total of $178 bil ion was appropriated to the fund across three laws, as follows:
 $100 bil ion in the CARES Act,  $100 bil ion in the CARES Act,
 $75 bil ion in the Paycheck Protection Program and Health Care Enhancement  $75 bil ion in the Paycheck Protection Program and Health Care Enhancement
Act, and Act, and
 $3 bil ion in the Consolidated Appropriations Act, 2021.  $3 bil ion in the Consolidated Appropriations Act, 2021.
What Agency Administers the Fund?
The CARES Act did not specify an administering entity within HHS. HHS elected to have the The CARES Act did not specify an administering entity within HHS. HHS elected to have the
fund administered by HRSA. HRSA is also administering two companion funds: (1) the fund administered by HRSA. HRSA is also administering two companion funds: (1) the
Uninsured Program,6 which includes an unspecified amount al ocated from the CARES Uninsured Program,6 which includes an unspecified amount al ocated from the CARES
appropriation to the PRF (see appropriation to the PRF (see “What Is the Relationship Between the Provider Relief Fund, the
Uninsured Fund, and the Coverage Assistance Fund?”), and (2) the COVID-19 Coverage ”), and (2) the COVID-19 Coverage
Assistance Fund, which covers the administrative costs for patients who have insurance, but Assistance Fund, which covers the administrative costs for patients who have insurance, but
whose insurance does not cover vaccine administrative cost fees or has cost sharing for these whose insurance does not cover vaccine administrative cost fees or has cost sharing for these
fees.7 fees.7
What Data Are Available on the Fund?
HHS makes data on the fund publicly available and updates the data regularly as new funds are HHS makes data on the fund publicly available and updates the data regularly as new funds are
distributed or as entities return funds.8 Data are available for download and can be used to distributed or as entities return funds.8 Data are available for download and can be used to
examine the amounts that remain in the fund and the amount that a particular entity or state examine the amounts that remain in the fund and the amount that a particular entity or state
received, among other things. The data that HHS provide on payments are limited to provider received, among other things. The data that HHS provide on payments are limited to provider
name, state, city, and payment amount. This tends to limit the ability to analyze data by provider name, state, city, and payment amount. This tends to limit the ability to analyze data by provider
type (e.g., evaluate how much money hospitals received). Analysts may find that such data cannot type (e.g., evaluate how much money hospitals received). Analysts may find that such data cannot

4 P.L. 116-136, 134 ST AT . 563. 4 P.L. 116-136, 134 ST AT . 563.
5 See information about targeted distributions and general distributions at HHS, “CARES Act Provider Relief Fund: 5 See information about targeted distributions and general distributions at HHS, “CARES Act Provider Relief Fund:
General Information,” https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html. General Information,” https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html.
6 Formally, this is termed the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting, 6 Formally, this is termed the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting,
T reatment, and Vaccine Administration for the Uninsured,” HHS, Health Resources and Services Administration T reatment, and Vaccine Administration for the Uninsured,” HHS, Health Resources and Services Administration
(HRSA), “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting, T reatment, and (HRSA), “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for T esting, T reatment, and
Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim. Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim.
7 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance. 7 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance.
8 T o download these data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6. As of the 8 T o download these data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6. As of the
date of this report’s publication, new funds have not been distributed since the third general distribution in December date of this report’s publication, new funds have not been distributed since the third general distribution in December
2020. 2020.
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be reliably merged with other data sets (e.g., Medicare provider data) because the variation in be reliably merged with other data sets (e.g., Medicare provider data) because the variation in
entity names (e.g., capitalization) makes it difficult to accurately merge data. entity names (e.g., capitalization) makes it difficult to accurately merge data.
Fund Allocation Questions
How Has Funding Been Allocated?
In statute, the HHS Secretary had broad authority to determine how the PRF would be al ocated. In statute, the HHS Secretary had broad authority to determine how the PRF would be al ocated.
HHS has chosen to al ocate funds in two ways: (1) general, which are available to a broad group HHS has chosen to al ocate funds in two ways: (1) general, which are available to a broad group
of providers, and (2) targeted distributions, which have more restrictive eligibility general aimed of providers, and (2) targeted distributions, which have more restrictive eligibility general aimed
at providing funds to a facility type with high needs (e.g., nursing homes). The two types are at providing funds to a facility type with high needs (e.g., nursing homes). The two types are
described in more detail below. Readers may also be interested in a time line of fund al ocations, described in more detail below. Readers may also be interested in a time line of fund al ocations,
available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/
index.html#phase1. index.html#phase1.
General Distributions
HHS has made three general distributions. HHS has made three general distributions. Applications for a fourth general distribution are to begin on September 29, 2021.9 The first, Phase One, was a general al ocation of $50 The first, Phase One, was a general al ocation of $50
bil ionbil ion distributed to health providers that bil eddistributed to health providers that bil ed Medicare Fee-for-Service.Medicare Fee-for-Service.910 This distribution This distribution
occurred occurred because the federal government paid those providers directly and therefore had the because the federal government paid those providers directly and therefore had the
~~ability to~~ ability to provide funds quickly to those entities. The CARES Act, enacted on March 27, 2020, provide funds quickly to those entities. The CARES Act, enacted on March 27, 2020,
established the PRF; Phase One funding began on Aprilestablished the PRF; Phase One funding began on April 10, 2020. A provider’s Medicare Fee-for-10, 2020. A provider’s Medicare Fee-for-
Service patient revenues in 2018 determined the amounts al ocated; as such, some safety-net and Service patient revenues in 2018 determined the amounts al ocated; as such, some safety-net and
other provider types that serve Medicaid and uninsured populations were either ineligible for this other provider types that serve Medicaid and uninsured populations were either ineligible for this
al ocation or received lower amounts because of the methodology used. al ocation or received lower amounts because of the methodology used.
Phase 2 Phase 2 targeted Medicaid, CHIP, and dental providers and included assisted living facilities.targeted Medicaid, CHIP, and dental providers and included assisted living facilities.1011 It It
provided $18 bil ion to providers that were not included in Phase 1 of the general distribution. provided $18 bil ion to providers that were not included in Phase 1 of the general distribution.
These providers received an amount equal to 2% of the provider’s total patient care revenue. These providers received an amount equal to 2% of the provider’s total patient care revenue.
Phase 2 funds began in June and required that providers applying for funding include in their Phase 2 funds began in June and required that providers applying for funding include in their
applications certain financial information related to documenting revenue necessary to determine applications certain financial information related to documenting revenue necessary to determine
the amount that a facility would receive. the amount that a facility would receive.1112
Phase 3 Phase 3 targeted providers that had not received funding in prior distributions (i.e., because they targeted providers that had not received funding in prior distributions (i.e., because they
were new or because they were behavioral health providers not included in a prior al ocation). were new or because they were behavioral health providers not included in a prior al ocation).
Providers that had previously received funding but had not received the full 2% of patient Providers that had previously received funding but had not received the full 2% of patient
revenue in PRF assistance were revenue in PRF assistance were ~~invited~~eligible to apply for additional funds, and could receive up to 2% 9 HHS, “ HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 10, 2021, https://www.hhs.gov/about/news/2021/09/10/hhs-announces-the-availability-of-25-point-5-billion-in-covid-19-provider-funding.html. 10 ~~to apply for additional funds. A total of $24.5 bil ion was~~
~~available in this distribution, and HHS began distributing these funds in December 2020.~~

9 For more information about the various components of the Medicare program, see CRS Report R40425, For more information about the various components of the Medicare program, see CRS Report R40425, Medicare
Prim er. .
1011 Medicare Fee-for-Service does not include dental benefits. As such, dentists generally do not bill the Medicare Medicare Fee-for-Service does not include dental benefits. As such, dentists generally do not bill the Medicare
program. Some Medicare Advantage plans (i.e., managed care plans) may include these benefits as an optional service. program. Some Medicare Advantage plans (i.e., managed care plans) may include these benefits as an optional service.
Some assisted living facilities provide personal care Some assisted living facilities provide personal care ~~and~~an d other types of other types of ~~ser vices~~services not covered by Medicare. T hese not covered by Medicare. T hese
facilities, like other types of residential facilities, may have incurred additional expenses related to COVID -19 (e.g., for facilities, like other types of residential facilities, may have incurred additional expenses related to COVID -19 (e.g., for
enhanced cleaning and personal protective equipment for staff). enhanced cleaning and personal protective equipment for staff).
1112 See HHS, https://www.hhs.gov/sites/default/files/provider-distribution-instructions-phase-2.pdf. See HHS, https://www.hhs.gov/sites/default/files/provider-distribution-instructions-phase-2.pdf.
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~~Congress has enacted legislation providing for PRF funding beyond Phase 3. As of the date of~~
~~this report’s publication, HHS has not made subsequent distributions. Specifical y, the~~
~~Consolidated Appropriations Act required that~~
of patient revenue. This resulted in approximately one-third of providers who applied not receiving Phase 3 funds.13 A total of $24.5 bil ion was available in this distribution, and HHS began distributing these funds in November 2020 and distributed more than three-quarters of funding in 2020.14 Phase 4 wil provide $17 bil ion for providers lost revenue and COVID-19-related expenses incurred between July 1, 2020, and March 3, 2021.15 This is in accordance with the requirements in the Consolidated Appropriations Act, which required that not less than 85% of (i) the unobligated balances available as the date of enactment of this not less than 85% of (i) the unobligated balances available as the date of enactment of this
Act, and (ii) any funds recovered from health care providers after the date of enactment of Act, and (ii) any funds recovered from health care providers after the date of enactment of
this Act, shall be for any successor to the Phase 3 General Distribution allocation to make this Act, shall be for any successor to the Phase 3 General Distribution allocation to make
payments to eligible health care providers based on applications that consider financial payments to eligible health care providers based on applications that consider financial
losses and changes in operating expenses occurring in the third or fourth quarter of calendar losses and changes in operating expenses occurring in the third or fourth quarter of calendar
year 2020, or the first quarter of calendar year 2021, that are attributable to coronavirus.year 2020, or the first quarter of calendar year 2021, that are attributable to coronavirus.1216 Phase 4 wil also reimburse smal er providers that have lower operating margins and serve vulnerable communities at higher rates and wil provide bonus payments to providers that serve Medicaid, CHIP, or Medicare populations with lower incomes and more complex medical needs.17 Information on specific methodology used to award these payments is not available as the date of publication of this report.
Targeted Distributions
HHS also al ocated PRF funds to certain types of providers in 2020 that had high needs due to HHS also al ocated PRF funds to certain types of providers in 2020 that had high needs due to
COVID-19. These included the COVID-19. These included the ~~fol owing~~following: :
  Hospitals with large numbers of COVID-19 admissions. The PRF provided $12 The PRF provided $12
bil ion in May to 395 hospitals that had more than 100 COVID-19-related bil ion in May to 395 hospitals that had more than 100 COVID-19-related
admissions and $10 bil ion in July to 161 hospitals with one COVID-19 admissions and $10 bil ion in July to 161 hospitals with one COVID-19
admission per day or a disproportionate intensity of COVID admissions. admission per day or a disproportionate intensity of COVID admissions.
  Skilled nursing facilities and nursing homes. The fund provided funds to nursing The fund provided funds to nursing
homes at various points in 2020. It provided $4.9 bil ion in May to more than homes at various points in 2020. It provided $4.9 bil ion in May to more than
13,000 facilities. It provided an additional $2.5 bil ion in August for increased 13,000 facilities. It provided an additional $2.5 bil ion in August for increased
testing, staffing, and personal protective equipment (PPE) needs. These facilities testing, staffing, and personal protective equipment (PPE) needs. These facilities
were eligible to receive $2 bil ion in incentive payments in October and were eligible to receive $2 bil ion in incentive payments in October and
December of 2020. December of 2020.
13 HHS, “Provide Relief Fund Phase 3: Payment Calculation Methodology,” https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase-3-methodology-overview.pdf, p. 4. 14 HHS, “Provide Relief Fund Phase 3: Payment Calculation Methodology,” https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase-3-methodology-overview.pdf, p. 1. 15 HHS, "HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding," press release, September 10, 2021, https://www.hhs.gov/about/news/2021/09/10/hhs-announces-the-availability-of-25-point-5-billion-in-covid-19-provider-funding.html. 16 H.R. 133, see pp. 740 at https://www.congress.gov/116/bills/hr133/BILLS-116hr133enr.pdf. P.L. 116-260 was enacted on December 27, 2020. 17 HHS, “HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 10, 2021, https://www.hhs.gov/about/news/2021/09/10/hhs-announces-the-availability-of-25-point-5-billion-in-covid-19-provider-funding.html. Congressional Research Service 4 The Provider Relief Fund: Frequently Asked Questions   Facilities funded by the Indian Health Service (IHS, including those operated by
Indian Tribes, Tribal Organizations, and Urban Indian Organizations). The PRF The PRF
provided $500 mil ion in May to approximately 300 IHS-funded health facilities. provided $500 mil ion in May to approximately 300 IHS-funded health facilities.
  Safety Net Hospitals. The fund provided $10 bil ion in June to hospitals that met The fund provided $10 bil ion in June to hospitals that met
certain criteria based on their patient mix, the amount of uncompensated care certain criteria based on their patient mix, the amount of uncompensated care
they provided, or their profit margin. they provided, or their profit margin.
  Hospitals with thin margins. The fund provided $3 bil ion in July to hospitals . The fund provided $3 bil ion in July to hospitals
with less than 3% profitability threshold. with less than 3% profitability threshold.
  Rural hospitals, urban hospitals with certain rural Medicare designations, and
hospitals in small metropolitan areas. The fund provided $1 bil ion in July to . The fund provided $1 bil ion in July to
urban hospitals that were more than 40 miles away from another hospital and to urban hospitals that were more than 40 miles away from another hospital and to
certain Medicare designated rural hospitals (e.g., sole community hospitals and certain Medicare designated rural hospitals (e.g., sole community hospitals and
Medicare dependent hospitals).Medicare dependent hospitals).1318
  Children’s hospitals. The fund provided $1.4 bil ion in August to free-standing The fund provided $1.4 bil ion in August to free-standing
children hospitals as defined by Medicare or hospitals that were eligible for children hospitals as defined by Medicare or hospitals that were eligible for
HRSA’s Children’s Hospital GME program.HRSA’s Children’s Hospital GME program.1419 These hospitals general y have ~~These hospitals general y have~~

~~12 H.R. 133, see pp. 740 at https://www.congress.gov/116/bills/hr133/BILLS-116hr133enr.pdf. P.L. 116-260 was~~
~~enacted on December 27, 2020.~~
~~13 For information on these designations, see CRS Infographic IG10023,~~ ~~Medicare Payment for Rural or~~
~~Geographically Isolated Hospitals~~.
~~14 For information on this program, see CRS Report R45067,~~ ~~Children’s Hospitals Graduate Medical Education~~
~~(CHGME)~~.
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low Medicare FFS payments, so they may not have received funding as part of low Medicare FFS payments, so they may not have received funding as part of
the first general distribution. the first general distribution.
What Is the Difference Between General and Targeted
Distributions?
Al providers who meet the criteria (e.g., bil Medicare) are eligible for a general distribution. To Al providers who meet the criteria (e.g., bil Medicare) are eligible for a general distribution. To
be eligible for targeted distribution, providers have to meet additional criteria (e.g., have a high be eligible for targeted distribution, providers have to meet additional criteria (e.g., have a high
number of COVID-19 inpatients). HHS awarded funds in general al ocations to al types of health number of COVID-19 inpatients). HHS awarded funds in general al ocations to al types of health
providers, with the total amount intended to equal 2% of an entity’s patient revenues. HHS also providers, with the total amount intended to equal 2% of an entity’s patient revenues. HHS also
made awards to certain types of health providers that had high needs. Providers are eligible under made awards to certain types of health providers that had high needs. Providers are eligible under
both types of al ocations. both types of al ocations.
What Are Some Potential Drawbacks of the Methodology that HHS
Used to Distribute Funds?
HHS awarded PRF funds to providers in amounts that were equal to 2% of a provider’s patient HHS awarded PRF funds to providers in amounts that were equal to 2% of a provider’s patient
revenue. This amount was cumulative and could have been received through multiple revenue. This amount was cumulative and could have been received through multiple
distributions. The use of patient revenue as a metric has been critiqued by somedistributions. The use of patient revenue as a metric has been critiqued by some, because it may because it may
favor providers with a higher percentage of their revenue coming from privately insured favor providers with a higher percentage of their revenue coming from privately insured
patients—a result of private insurers paying providers higher rates than those paid by Medicare patients—a result of private insurers paying providers higher rates than those paid by Medicare
and Medicaid. and Medicaid.1520 For example, the Medicaid and CHIP Payment Access Commission (MACPAC) For example, the Medicaid and CHIP Payment Access Commission (MACPAC)
found that Medicaid and CHIP providers tend to receive less from the fund because Medicaid found that Medicaid and CHIP providers tend to receive less from the fund because Medicaid
18 For information on these designations, see CRS Infographic IG10023, Medicare Payment for Rural or Geographically Isolated Hospitals. 19 For information on this program, see CRS Report R45067, Children’s Hospitals Graduate Medical Education (CHGME). 20 Karyn Schwartz and T ricia Neuman, Funding for Health Care Providers During the Pandemic: An Update, Kaiser Family Foundation, Washington, DC, April 20, 2021, https://www.kff.org/policy-watch/funding-for-health-care-providers-during-the-pandemic-an-update/. Congressional Research Service 5 The Provider Relief Fund: Frequently Asked Questions providers general y had lower revenue. The commission also found that some providers that were providers general y had lower revenue. The commission also found that some providers that were
not Medicare providers did not receive payments from the PRF.not Medicare providers did not receive payments from the PRF.1621 In addition to these findings, In addition to these findings,
news articles have indicated that access to PRF grants has contributed to surpluses for some large news articles have indicated that access to PRF grants has contributed to surpluses for some large
hospital systems. hospital systems.1722 The fourth general distribution wil provide additional funding to smal er providers and to Medicaid/CHIP/Medicare providers that serve vulnerable populations. The Biden Administration stated that this methodology is part of its commitment to equity and to equity for providers that serve more vulnerable populations, such as low-income children.23
How Are Allocations Determined?
HHS determined the amount that it would al ocate to both targeted and general distributions. The HHS determined the amount that it would al ocate to both targeted and general distributions. The
initial statute that created the PRF (the CARES Act) and the subsequent statute that increased initial statute that created the PRF (the CARES Act) and the subsequent statute that increased
funding (PPPHCEA) did not require funds to be al ocated in a specific manner. The Consolidated funding (PPPHCEA) did not require funds to be al ocated in a specific manner. The Consolidated
Appropriations Act, 2021, enacted in December Appropriations Act, 2021, enacted in December of 2020, required that not less than 85% of the 2020, required that not less than 85% of the
unobligated balance of the PRF (including amounts that are returned to the PRF) be used for an unobligated balance of the PRF (including amounts that are returned to the PRF) be used for an
al ocation that follows the Phase 3 general al ocation. It also specified that for that al ocation, al ocation that follows the Phase 3 general al ocation. It also specified that for that al ocation,
revenue must be calculated considering financial losses in the last quarter of 2020 or the first revenue must be calculated considering financial losses in the last quarter of 2020 or the first
quarter of 2021 that are attributable to the coronavirus. quarter of 2021 that are attributable to the coronavirus. ~~As of the date of this report’s publication,~~
~~no new al ocations had been announced.~~

~~15 Karyn Schwartz and T ricia Neuman, Funding for Health Care Providers During the Pandemic: An Update, Kaiser~~
~~Family Foundation, Washington, DC, April 20, 2021, https://www.kff.org/policy-watch/funding-for-health-care-~~
~~providers-during-the-pandemic-an-update/.~~
~~16 MACPAC, COVID Relief Funding for Medicaid Providers, Washington, DC, January 2021,~~
~~https://www.macpac.gov/wp-content/uploads/2021/02/COVID-Relief-Funding-for-Medicaid-Providers.pdf.~~
~~17 Alexandra Ellerbeck, “T he Health 202: Pandemic Relief Funds Boosted Surpluses for Some Large Hospitals,” June~~
~~21, 2021, https://www.washingtonpost.com/politics/2021/06/21/health-202-pandemic-relief-funds-boosted-surpluses-~~
~~some-large-hospitals/.~~
~~Congressional Research Service~~

5

~~The Provider Relief Fund: Frequently Asked Questions~~
The Phase 4 distribution was announced on September 10, 2021, with the applicant portal available September 29, 2021.24
What Is the Relationship Between the Provider Relief Fund, the
Uninsured Fund, and the Coverage Assistance Fund?
HHS is using a portion of the PRF appropriation to pay providers for treatment provided to HHS is using a portion of the PRF appropriation to pay providers for treatment provided to
uninsured individuals because no other funding was appropriated for this purpose. The Uninsured uninsured individuals because no other funding was appropriated for this purpose. The Uninsured
Fund has two components: (1) a total of $2 bil ion appropriated in the Families First Coronavirus Fund has two components: (1) a total of $2 bil ion appropriated in the Families First Coronavirus
Response Act (P.L. 116-127)Response Act (P.L. 116-127)1825 and PPPHCEA for uninsured testing and (2) an al ocation from the and PPPHCEA for uninsured testing and (2) an al ocation from the
CARES al ocation to the PRF for uninsured treatment and coverage assistance for vaccines. PRF CARES al ocation to the PRF for uninsured treatment and coverage assistance for vaccines. PRF
funds were not specifical y appropriated for either purpose. Instead, in April 2020, the Trump funds were not specifical y appropriated for either purpose. Instead, in April 2020, the Trump
Administration announced that it would use an unspecified portion of the CARES al ocation to Administration announced that it would use an unspecified portion of the CARES al ocation to
the PRF to reimburse providers for COVID-19 treatment provided to uninsured patients.the PRF to reimburse providers for COVID-19 treatment provided to uninsured patients.1926
Subsequently, both the Trump Administration and the Biden Administration have clarified that Subsequently, both the Trump Administration and the Biden Administration have clarified that
this reimbursement wil include administrative costs incurred by providers when vaccinating this reimbursement wil include administrative costs incurred by providers when vaccinating
~~uninsured individuals. In addition, the Biden Administration is using the PRF for costs associated~~
~~with vaccinating underinsured individuals through the newly created Coverage Assistance Fund.20~~uninsured individuals. In addition, the Biden Administration is using the PRF for costs associated 21 MACPAC, COVID Relief Funding for Medicaid Providers, Washington, DC, January 2021, https://www.macpac.gov/wp-content/uploads/2021/02/COVID-Relief-Funding-for-Medicaid-Providers.pdf. 22 Alexandra Ellerbeck, “T he Health 202: Pandemic Relief Funds Boosted Surpluses for Some Large Hospitals,” June 21, 2021, https://www.washingtonpost.com/politics/2021/06/21/health-202-pandemic-relief-funds-boosted-surpluses-some-large-hospitals/. 23 HHS, “ HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 10, 2021, https://www.hhs.gov/about/news/2021/09/10/hhs-announces-the-availability-of-25-point-5-billion-in-covid-19-provider-funding.html. 24 Ibid. 25 CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116 -127. 26 CRS Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and Treatm ent. Congressional Research Service 6 The Provider Relief Fund: Frequently Asked Questions with vaccinating underinsured individuals through the newly created Coverage Assistance Fund.27
Though the COVID-19 vaccine is free, providers can charge a third party for administrative costs Though the COVID-19 vaccine is free, providers can charge a third party for administrative costs
related to provider time, storage, and record keeping, among others.related to provider time, storage, and record keeping, among others.2128 Some individuals may not Some individuals may not
have insurance coverage that includes vaccines or may face large out-of-pocket costs associated have insurance coverage that includes vaccines or may face large out-of-pocket costs associated
with their insurance plan’s cost sharing for vaccines. The fund reimburses providers for the with their insurance plan’s cost sharing for vaccines. The fund reimburses providers for the
administrative costs associated with vaccinating these individuals. administrative costs associated with vaccinating these individuals.
HHS has not specified amounts for the uninsured fund or for underinsured vaccine costs. The HHS has not specified amounts for the uninsured fund or for underinsured vaccine costs. The
Government Accountability Office (GAO) estimated that HHS al ocated $10 bil ion for this Government Accountability Office (GAO) estimated that HHS al ocated $10 bil ion for this
purpose in March 2021.purpose in March 2021.2229 GAO’s estimate was prior to the announcement of the Coverage GAO’s estimate was prior to the announcement of the Coverage
Assistance Fund, so the estimate did not include funds reserved for this purpose.Assistance Fund, so the estimate did not include funds reserved for this purpose.2330
Reimbursements are provided on a rolling basis, with eligible claims being paid to providers as Reimbursements are provided on a rolling basis, with eligible claims being paid to providers as
long as funds remain available. As such, should provider payments exceed $10 bil ion, HHS may long as funds remain available. As such, should provider payments exceed $10 bil ion, HHS may
choose to increase the amount al ocated for uninsured treatment and vaccines and the Coverage choose to increase the amount al ocated for uninsured treatment and vaccines and the Coverage
Assistance Fund. As stated above, $2 bil ion was explicitly appropriated for uninsured testing, Assistance Fund. As stated above, $2 bil ion was explicitly appropriated for uninsured testing,
and this amount has been expended.and this amount has been expended.2431 On May 25, 2021, the Biden Administration announced On May 25, 2021, the Biden Administration announced
that it was al ocating $4.8 bil ion from the American Rescue Plan Act (ARPA, P.L. 117-2) for that it was al ocating $4.8 bil ion from the American Rescue Plan Act (ARPA, P.L. 117-2) for
uninsured testing.uninsured testing.2532 These amounts are separate from the PRF; as such, PRF funds are not These amounts are separate from the PRF; as such, PRF funds are not
currently being used for uninsured testing. currently being used for uninsured testing.

~~18 CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116 -127.~~
~~19 CRS Insight IN11526,~~ ~~COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and~~
~~Treatm ent~~.
20 HHS is providing regularly updated information on amounts reimbursed from the Uninsured Fund at https://taggs.hhs.gov/Coronavirus/Uninsured. Data are also available about the providers that receive reimbursements from this fund at https://data.cdc.gov/Administrative/Claims- Reimbursement-to-Health-Care-Providers-and-/rksx-33p3. What Is the Relationship Between the PRF and the American Rescue Plan Funding for Rural Providers? Section 9911 of the American Rescue Plan Act appropriated $8.5 bil ion for rural providers that bil Medicare and Medicaid.33 This funding stream is to be administered in a number of ways that are similar to the PRF (e.g., reporting requirements) but is separate from the $178 bil ion appropriated for the PRF. 27 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance. HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance.
2128 CRS Insight IN11609, CRS Insight IN11609, COVID-19 Vaccine: Financing for Its Administration. .
2229 U.S. Government Accountability Office, U.S. Government Accountability Office, COVID-19 Sustained Federal Action is Crucial as Pandemic Enters Its
Second Year, 31-387, March 2021, p. 60, https://www.gao.gov/assets/gao-21-387.pdf. , 31-387, March 2021, p. 60, https://www.gao.gov/assets/gao-21-387.pdf.
23 30 GAO released a subsequent report that examined the obligations of the PRF, but this report did not include estimates GAO released a subsequent report that examined the obligations of the PRF, but this report did not include estimates
of amounts allocated for specific PRF purposes. See U.S. Government Accountability Office, of amounts allocated for specific PRF purposes. See U.S. Government Accountability Office, Continued Attention
Needed to Enhance Federal Preparedness, Response, Service Delivery, and Program Integrity , 21-551, July 2021, p. , 21-551, July 2021, p.
87 and p. 93. 87 and p. 93.
2431 HHS, “HHS COVID-19 Funding: T reatment & T esting of the Uninsured,” https://taggs.hhs.gov/Coronavirus/ HHS, “HHS COVID-19 Funding: T reatment & T esting of the Uninsured,” https://taggs.hhs.gov/Coronavirus/
Uninsured, and CRS Insight IN11526, Uninsured, and CRS Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay ~~P roviders~~Providers for
Testing and Treatm ent. .
2532 HHS, “HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 T esting for the Uninsured, ” press HHS, “HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 T esting for the Uninsured, ” press
release, May 25, 2021, https://www.hhs.gov/about/news/2021/05/25/hhs-to-dedicate-billions-from-the-american-release, May 25, 2021, https://www.hhs.gov/about/news/2021/05/25/hhs-to-dedicate-billions-from-the-american-
rescue-plan-for-the-uninsured.html. 33 For information about this funding source, see the “Health Care Infrastructure and Provider Support” section of CRS Report R46834, Am erican Rescue Plan Act of 2021 (P.L. 117 -2): Public Health, Medical Supply Chain, Health Services, and Related Provisions. Congressional Research Service 7 ~~Congressional Research Service~~

6

link to page 6 link to page 6 link to page 9 link to page 9 link to page 9 link to page 6 link to page 6 link to page 9 link to page 9 link to page 9 The Provider Relief Fund: Frequently Asked Questions

~~HHS is providing regularly updated information on amounts reimbursed from the Uninsured~~
~~Fund at https://taggs.hhs.gov/Coronavirus/Uninsured. Data are also available about the providers~~
~~that receive reimbursements from this fund at https://data.cdc.gov/Administrative/Claims-~~
~~Reimbursement-to-Health-Care-Providers-and-/rksx-33p3.~~
~~What Is the Relationship Between the PRF and the American~~
~~Rescue Plan Funding for Rural Providers?~~
~~Section 9911 of the American Rescue Plan appropriated $8.5 bil ion for~~An announcement about the release of these funds and the application procedures was included in the September 10, 2021, announcement about the PRF Phase 4 distribution. This distribution wil follow the same timeline, with the applicant portal available September 29, 2021.34 In accordance with statute, the funds wil be available to rural providers that bil rural providers that bil
~~Medicare and Medicaid.26 This funding stream is to be administered in a number of ways that are~~
~~similar to the PRF (e.g., reporting requirements) but is separate from the $178 bil ion~~
~~appropriated for the PRF. As of the date of this report’s publication, these funds have not been~~
~~released, nor have there been announcements about application processes for providers to seek~~
~~these funds.~~Medicare and Medicaid. The Biden Administration announced that this distribution wil use the Federal Office of Rural Health Policy definition of “rural.”35 Like the PRF and Uninsured Funds, the rural fund is administered by HRSA.36
What Other Purposes Have the PRF Funds Been Used For?
GAO examined PRF al ocations as of March 1, 2021, and found that $0.980 bil ion was being GAO examined PRF al ocations as of March 1, 2021, and found that $0.980 bil ion was being
used to administer the fund and that $9.970 bil ion was al ocated for “vaccine and therapeutic used to administer the fund and that $9.970 bil ion was al ocated for “vaccine and therapeutic
development and procurement activities.”development and procurement activities.”2737 As such, approximately $11 bil ion of the $178 bil ion As such, approximately $11 bil ion of the $178 bil ion
cannot be al ocated to provider payments. As discussed above (seecannot be al ocated to provider payments. As discussed above (see “How Has Funding Been
Al ocated?”), the majority of funds have been al ocated to providers through either general or , the majority of funds have been al ocated to providers through either general or
targeted distributions. In addition to these distributions, an unspecified amount of the PRF is targeted distributions. In addition to these distributions, an unspecified amount of the PRF is
being used to pay providers that provided uninsured testing, treatment, and vaccines and to pay being used to pay providers that provided uninsured testing, treatment, and vaccines and to pay
providers for vaccine administration costs for uninsured individuals who do not have vaccine providers for vaccine administration costs for uninsured individuals who do not have vaccine
coverage or who have cost sharing for vaccine administration costs (seecoverage or who have cost sharing for vaccine administration costs (see “What Is the
Relationship Between the Provider Relief Fund, the Uninsured Fund, and the Coverage
Assistance Fund?”). .
Provider Requirements
What Must Providers Do to Receive Funds?
Requirements to receive funds varied by distribution. The first general distribution (i.e., Phase Requirements to receive funds varied by distribution. The first general distribution (i.e., Phase
One) for Medicare Fee-for-Service Providers was automatic, as HHS had payment and revenue One) for Medicare Fee-for-Service Providers was automatic, as HHS had payment and revenue
information for these providers. Subsequent al ocations required that entities submit information for these providers. Subsequent al ocations required that entities submit
documentation to HHS to receive funds. For example, for targeted distributions related to having documentation to HHS to receive funds. For example, for targeted distributions related to having
provided care to a large number of COVID-19 patients, hospitals were required to submit provided care to a large number of COVID-19 patients, hospitals were required to submit
documentation of their COVID-19 patient caseloads. As another example, the Phase 3 general documentation of their COVID-19 patient caseloads. As another example, the Phase 3 general

~~rescue-plan-for-the-uninsured.html.~~
~~26 For information about this funding source, see the “Health Care Infrastructure and Provider Support” section of CRS~~
~~Report R46834,~~ ~~Am erican Rescue Plan Act of 2021 (P.L. 117 -2): Public Health, Medical Supply Chain, Health~~
~~Services, and Related Provisions~~.
27distribution permitted entities that had previously received funds to receive up to 2% of their patient revenue, which required submitting financial information to document patient revenue. What Requirements Apply to Providers Receiving PRF Funds? Providers were required to attest to certain terms and conditions to accept PRF funds. Each distribution of funds had specific terms and conditions associated with the distribution—for example, that the provider met the specific conditions of that distribution (e.g., was a Medicaid 34 Ibid. 35 HHS, HRSA, “Defining Rural Population,” https://www.hrsa.gov/rural-health/about-us/definition/index.html, and HHS, HRSA, “Rural Health Grants Eligibility Analyzer,” https://data.hrsa.gov/tools/rural-health?tab=Address. 36 Ibid. 37 U.S. Government Accountability Office, U.S. Government Accountability Office, COVID-19 Sustained Federal Action is Crucial as Pandemic Enters Its
Second Year, 31-387, March 2021, p. p. 60, https://www.gao.gov/assets/gao-21-387.pdf. For a discussion of , 31-387, March 2021, p. p. 60, https://www.gao.gov/assets/gao-21-387.pdf. For a discussion of ~~t he~~the
allocation of PRF funds for vaccines, see Rachel Cohrs, “T he T rump Administration Quietly Spent Billion in allocation of PRF funds for vaccines, see Rachel Cohrs, “T he T rump Administration Quietly Spent Billion in ~~Hospital~~Hosp ital
Funds on Operation Warp Speed,” Funds on Operation Warp Speed,” STAT, March 2, 2021. , March 2, 2021.
Congressional Research Service Congressional Research Service

78 The Provider Relief Fund: Frequently Asked Questions provider for the second general distribution).38 Some

~~The Provider Relief Fund: Frequently Asked Questions~~

~~distribution permitted entities that had previously received funds to receive up to 2% of their~~
~~patient revenue, which required submitting financial information to document patient revenue.~~
~~What Requirements Apply to Providers Receiving PRF Funds?~~
~~Providers were required to attest to certain terms and conditions to accept PRF funds. Each~~
~~distribution of funds had specific terms and conditions associated with the distribution—for~~
~~example, that the provider met the specific conditions of that distribution (e.g., was a Medicaid~~
~~provider for the second general distribution).28 There are, however, some terms and conditions~~
~~that~~ terms and conditions apply across al of the apply across al of the al ocations. These include certification that al ocations. These include certification that
 the entity provides or provided testing and care for actual or possible cases of  the entity provides or provided testing and care for actual or possible cases of
COVID-19; COVID-19;
 the entity is not terminated or excluded from participating in the Medicare  the entity is not terminated or excluded from participating in the Medicare
program or precluded from receiving payment from another federal health care program or precluded from receiving payment from another federal health care
program; program;
 that payment wil be used only to prevent, prepare for, or respond to the  that payment wil be used only to prevent, prepare for, or respond to the
coronavirus and wil be used only for health care expenses or lost revenue coronavirus and wil be used only for health care expenses or lost revenue
attributable to the virus; attributable to the virus;
 that payment wil not be used to reimburse expenses or losses that have been  that payment wil not be used to reimburse expenses or losses that have been
reimbursed by another source; reimbursed by another source;
 the entity wil comply, in the required timeframe, with HHS reporting  the entity wil comply, in the required timeframe, with HHS reporting
requirements associated with the fund and report truthfully, accurately, and requirements associated with the fund and report truthfully, accurately, and
completely; completely;
 the entity wil maintain appropriate records and cost documentation; and  the entity wil maintain appropriate records and cost documentation; and
 for al presumptive or actual cases of COVID-19, the entity wil not seek to  for al presumptive or actual cases of COVID-19, the entity wil not seek to
collect from the patient out-of-pocket expenses that are greater than what the collect from the patient out-of-pocket expenses that are greater than what the
patient would have otherwise been required to pay if the care had been provided patient would have otherwise been required to pay if the care had been provided
by an in-network provider for patients who have insurance plans with a specific by an in-network provider for patients who have insurance plans with a specific
provider network.provider network.2939
Entities are also required to comply with certain general provisions included in FY2020 Entities are also required to comply with certain general provisions included in FY2020
appropriations, such as those related to executive pay, lobbying, gun control advocacy, and appropriations, such as those related to executive pay, lobbying, gun control advocacy, and
abortion, among others. abortion, among others.3040
What Must Providers Report After Receiving Funds?
Entities that receive more than $10,000 (either one time or in the aggregate) are required to report Entities that receive more than $10,000 (either one time or in the aggregate) are required to report
the uses of their funds and to have expended al received funds within a year of receiving them, the uses of their funds and to have expended al received funds within a year of receiving them,
and to report al their expenditures within three months after the end of the expenditure period. and to report al their expenditures within three months after the end of the expenditure period.
For example, funds awarded between April 10 and June 30, 2020, must be expended by June 30, For example, funds awarded between April 10 and June 30, 2020, must be expended by June 30,
2021, and reported by September 30, 2021. In general, the usage deadline is a year from the end 2021, and reported by September 30, 2021. In general, the usage deadline is a year from the end

28of the awarding period, and the reporting period commences the day after and continues for three months.41 This CRS report discusses the requirements that were issued on June 11, 2021, which supersede prior reporting requirements and apply to al past and future PRF al ocations.42 Entities 38 For links to the terms and conditions associated with each distribution, see HHS, “CARES Act Provider Relief Fund: For links to the terms and conditions associated with each distribution, see HHS, “CARES Act Provider Relief Fund:
For Providers.” For Providers.”
2939 For more information on “in-network” and “out-of-network” coverage, see CRS Report R46116, For more information on “in-network” and “out-of-network” coverage, see CRS Report R46116, Surprise Billing in
Private Health Insurance: Overview and Federal Policy Considerations. .
3040 HHS, “Acceptance of T erms and Conditions,” https://www.hhs.gov/sites/default/files/terms-and-conditions-provider- HHS, “Acceptance of T erms and Conditions,” https://www.hhs.gov/sites/default/files/terms-and-conditions-provider-
relief-30-b.pdf, pp. 2-11. relief-30-b.pdf, pp. 2-11.
~~Congressional Research Service~~

8

~~The Provider Relief Fund: Frequently Asked Questions~~

~~of the awarding period, and the reporting period commences the day after and continues for three~~
~~months.31 This CRS report discusses the requirements that were issued on June 11, 2021, which~~
~~supersede prior reporting requirements and apply to al past and future PRF al ocations.32 Entities~~
41 See T ables 1 and 2 on page 2 in HHS, “Provider Relief Fund General and T argeted Distribut ion Post-Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf. 42 HHS, “Provider Relief Fund General and T argeted Distribution Post -Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june- Congressional Research Service 9 The Provider Relief Fund: Frequently Asked Questions are general y required to report using their normal basis of accounting. They are also required to are general y required to report using their normal basis of accounting. They are also required to
report on report on
 interest earned on PRF payments;  interest earned on PRF payments;
 other assistance received (e.g., Paycheck Protection Program); other assistance received (e.g., Paycheck Protection Program);3343
 use of Nursing Home Infection control payments, if applicable;  use of Nursing Home Infection control payments, if applicable;
 use of general or targeted distribution payments, which may be used only for  use of general or targeted distribution payments, which may be used only for
expenses that have not or wil not be reimbursed by another source; expenses that have not or wil not be reimbursed by another source;
 net unreimbursed expenses attributable to coronavirus (requirements specify that  net unreimbursed expenses attributable to coronavirus (requirements specify that
this is to be calculated quarterly, net after PRF and other assistance payments are this is to be calculated quarterly, net after PRF and other assistance payments are
applied and must be broken out quarterly by whether such expenses are general, applied and must be broken out quarterly by whether such expenses are general,
administrative, and/or health care related); and administrative, and/or health care related); and
 lost revenue reimbursement. Specifical y, lost revenue reimbursements may be  lost revenue reimbursement. Specifical y, lost revenue reimbursements may be
applied to remaining amounts that were not expended on health care-related applied to remaining amounts that were not expended on health care-related
expenses due to the coronavirus. HHS requires that entities submit documents to expenses due to the coronavirus. HHS requires that entities submit documents to
support their claims of lost revenue, which may be calculated by either of three support their claims of lost revenue, which may be calculated by either of three
options: (1) the difference between actual patient care revenue in 2019 and 2020, options: (1) the difference between actual patient care revenue in 2019 and 2020,
(2) the difference between the budgeted amount (prior to March 27, 2020) and (2) the difference between the budgeted amount (prior to March 27, 2020) and
actual patient care revenue, or (3) any reasonable method of estimating revenue.actual patient care revenue, or (3) any reasonable method of estimating revenue.3444
Who Is Responsible for Reporting on PRF Funds?
To receive funds from the PRF, an entity must have a Tax Identification Number (TIN). The To receive funds from the PRF, an entity must have a Tax Identification Number (TIN). The
entity then registers with that TIN and must report on al payments that meet the $10,000 entity then registers with that TIN and must report on al payments that meet the $10,000
reporting threshold for the TIN. Under the PRF reporting requirements, the entity that registered reporting threshold for the TIN. Under the PRF reporting requirements, the entity that registered
its TIN has the responsibility to report to HHS, regardless of whether payments were transferred its TIN has the responsibility to report to HHS, regardless of whether payments were transferred
to a subsidiary. However, if an entity received payments directly (under its own TIN), but also to a subsidiary. However, if an entity received payments directly (under its own TIN), but also
received funds transferred from a parent entity, it must also report the transferred payments. HHS received funds transferred from a parent entity, it must also report the transferred payments. HHS
says that transferred targeted distributions payments (i.e., payments for high COVID-19 inpatient says that transferred targeted distributions payments (i.e., payments for high COVID-19 inpatient
cases) are more likely to be audited by HRSA. cases) are more likely to be audited by HRSA.35

~~31 See T ables 1 and 2 on page 2 in HHS, “Provider Relief Fund General and T argeted Distribution Post -Payment Notice~~
~~of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-~~
~~reporting-requirements-june-2021.pdf.~~
~~32 HHS, “ Provider Relief Fund General and T argeted Distribution Post -Payment Notice of Reporting Requirements,”~~
~~June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-~~
~~2021.pdf.~~
3345 Can Providers Refuse or Return Funds? Providers must attest to certain terms and conditions after receiving funds. Providers may choose to return funds if they choose not to abide by the terms and conditions of the attestation. In addition, providers must expend funds by a certain date, which varies based on when providers 2021.pdf. 43 For more information on this program, see CRS Insight IN11324, For more information on this program, see CRS Insight IN11324, CARES Act Assistance for Employers and
Em ployees—The Paycheck Protection Program , Em ployee Retention Tax Credit, and Unem ploym ent Insurance
Benefits: Overview (Part 1), and CRS Insight IN11329, , and CRS Insight IN11329, CARES Act Assistance for Em ployers and Em ployees—The
Paycheck Protection Program , Em ployee Retention Tax Credit, and Unem ploym ent Insurance Benefits: Assessm ent of
Alternatives (Part 2). .
3444 For methodology to calculate lost revenue, see pages 10-11 of HHS, “Provider Relief Fund General and T argeted For methodology to calculate lost revenue, see pages 10-11 of HHS, “Provider Relief Fund General and T argeted
Distribution Post -Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/Distribution Post -Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/
provider-post -payment-notice-of-reporting-requirements-june-2021.pdf. provider-post -payment-notice-of-reporting-requirements-june-2021.pdf.
3545 HHS notes some entities may be subject to additional auditing to ensure payment accuracy. See HHS, “Reporting HHS notes some entities may be subject to additional auditing to ensure payment accuracy. See HHS, “Reporting
Requirements and Auditing,” https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/index.html. Congressional Research Service Congressional Research Service

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The Provider Relief Fund: Frequently Asked Questions

~~Can Providers Refuse or Return Funds?~~
~~Providers must attest to certain terms and conditions after receiving funds. Providers may choose~~
~~to return funds if they choose not to abide by the terms and conditions of the attestation. In~~
~~addition, providers must expend funds by a certain date, which varies based on when providers~~
~~received funding.36~~received funding.46 For example, the earliest deadline is June 30, 2021, which applies to providers For example, the earliest deadline is June 30, 2021, which applies to providers
that received funds in Phase 1 (between April 10, 2020 and June 30, 2020). Providers that did not that received funds in Phase 1 (between April 10, 2020 and June 30, 2020). Providers that did not
use their funds by the June 30, 2021, deadline associated with that distribution are required to use their funds by the June 30, 2021, deadline associated with that distribution are required to
return unexpended funds within 30 days after the end of the applicable reporting period. return unexpended funds within 30 days after the end of the applicable reporting period.3747
Agency Requirements
What Are HHS Reporting Requirements for the Fund?
The Consolidated Appropriations Act, 2021, required the HHS Office of Inspector General (OIG) The Consolidated Appropriations Act, 2021, required the HHS Office of Inspector General (OIG)
to submit a final report on its audit findings for the PRF not later than three years after the fund’s to submit a final report on its audit findings for the PRF not later than three years after the fund’s
final payments are made. The report is to be submitted to the House and Senate appropriations final payments are made. The report is to be submitted to the House and Senate appropriations
committees. The law also specified that the OIG may conduct audits of interim payments prior to committees. The law also specified that the OIG may conduct audits of interim payments prior to
the final report. Final y, the law required a report not later than 60 days after enactment of the the final report. Final y, the law required a report not later than 60 days after enactment of the
Consolidated Appropriations Act, 2021 (i.e., February 25, 2021), that included the obligations Consolidated Appropriations Act, 2021 (i.e., February 25, 2021), that included the obligations
made from the fund, summarized by state. It also required that these reports be updated every 60 made from the fund, summarized by state. It also required that these reports be updated every 60
days until the funds are expended. days until the funds are expended.

Author Information

Elayne J. Heisler Elayne J. Heisler

Specialist in Health Services Specialist in Health Services

~~Requirements and Auditing,” https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/~~
~~index.html.~~
~~36 For a time line, see HHS, HHS, “HHS Issues Revised Notice of Reporting Requirements and Reporting T imeline for~~
~~Recipients of Provider Relief Fund Payments,” press release, June 11, 2021, https://www.hhs.gov/about/news/2021/06/~~
~~11/hhs-issues-revised-reporting-requirements-timeline-for-provider-relief-fund-recipients.html.~~
~~37 HHS, HRSA, “Provider Relief Fund General Information,” see “T erms and Conditions,” at https://www.hrsa.gov/~~
~~provider-relief/faq/general.~~
~~Congressional Research Service~~

10

~~The Provider Relief Fund: Frequently Asked Questions~~

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
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46 For a time line, see HHS, HHS, “HHS Issues Revised Notice of Reporting Requirements and Reporting T imeline for Recipients of Provider Relief Fund Payments,” press release, June 11, 2021, https://www.hhs.gov/about/news/2021/06/11/hhs-issues-revised-reporting-requirements-timeline-for-provider-relief-fund-recipients.html. 47 HHS, HRSA, “Provider Relief Fund General Information,” see “T erms and Conditions,” at https://www.hrsa.gov/provider-relief/faq/general. Congressional Research Service R46897 · VERSION 3 · UPDATED ~~Congressional Research Service~~
~~R46897 · VERSION 1 · NEW~~
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