The Provider Relief Fund: Frequently Asked Questions

Changes from September 15, 2021 to February 7, 2022

This page shows textual changes in the document between the two versions indicated in the dates above. Textual matter removed in the later version is indicated with ~~red strikethrough~~ and textual matter added in the later version is indicated with blue.

The Provider Relief Fund:
~~September 15, 2021~~February 7, 2022
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) Security Act (CARES Act, P.L. 116-136) to reimburse, through grants or other mechanisms, 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). Disease 2019 (COVID-19). The CARES Act provided $100 billion to prevent, prepare for and 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)Care Enhancement Act (PPPHCEA, P.L. 116-139) and $3 billion in the Consolidated Appropriations Act, 2021 (P.L.and $3 billion in the Consolidated Appropriations Act, 2021 (P.L. 116-116-
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 PRF, how funds The answers to the frequently asked questions (FAQs) in this report provide overview information on the PRF, 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 Economic Security Act (CARES Act, P.L. 116-136), which provided $100 ~~bil ion~~billion to 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,~~ billion, with $75 with $75 ~~bil ion~~ billion appropriated in the Paycheck Protection Program and Health Care appropriated in the Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA, P.L. 116-139) and $3 Enhancement Act (PPPHCEA, P.L. 116-139) and $3 ~~bil ion~~ billion appropriated in the Consolidated 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 requirements for future fund ~~al ocations~~allocations. .
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 the fund, how funds have been ~~al ocated~~allocated, and the fund’s requirements for provider reporting. Data , and the fund’s requirements for provider reporting. Data
on the fund are publicly availableon the fund are publicly available and updated regularly as new funds are released or as entities 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;remaining;2 however, agency data are available for download and can be used to however, agency 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.received, among other things.
Fund Overview Questions
What Is the Provider Relief Fund?
The CARES Act appropriated $100 The CARES Act appropriated $100 ~~bil ion~~ billion to “to prevent, prepare for, and respond to to “to prevent, prepare for, and respond to
coronavirus, coronavirus, ~~domestical y or international y~~domestically or internationally, for necessary expenses to reimburse, through grants , 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.”revenues that are attributable to coronavirus.”23 These funds were appropriated to the Public These funds were appropriated to the Public
Health and Social Services Emergency Fund (PHSSEF), a flexible funding source within theHealth 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~~
~~and comply with the applicable terms and conditions of the PRF (see “What Requirements Apply~~
~~to Providers Receiving PRF Funds?”).~~

~~1 U.S.~~ ). 1 U.S. Department of Health and Human Services (HHS),Department of Health and Human Services (HHS), “CARES“CARES Act Provider Relief Fund:Act Provider Relief Fund: Data,” 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 Fundthat these data include amounts appropriated to the Provider Relief Fund (PRF) in(PRF) in the three laws.the three laws. ~~T o~~ To download these 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 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~~
~~payments in advance of providing and billing for these services to Medicar e beneficiaries. For more information, see~~
~~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:~~
One news report suggests that all PRF funds have been allocated; however, this information has not been confirmed. As discussed in this CRS report, PRF funds may be returned from earlier allocations and some payment amounts are being reconsidered. For the news report that all funds have been allocated, see Rachel Cohrs, “The Biden Administration Used Billions in Hospital COVID-19 Funds to Pay Drug Makers,” Stat, January 26, 2022, https://www.statnews.com/2022/01/26/the-biden-administration-used-billions-in-hospital-covid-19-funds-to-pay-drugmakers/. 3 P.L. 116-136, 134 STAT. 563. Congressional Research Service 1 link to page 14 link to page 14 link to page 12 link to page 12 The Provider Relief Fund: Frequently Asked Questions Do Providers Have to Repay Their PRF Funds? PRF funds are grants and do not have to be repaid.4 Providers must attest to receiving these funds and comply with the applicable terms and conditions of the PRF (see “What Requirements Apply to Providers Receiving PRF Funds?”). What Type of Health Providers Are Eligible for the Fund? 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
individualsindividuals with possible or actual cases of COVID-19.”with possible or actual cases of COVID-19.”45 In these provisions, “the Secretary” In these provisions, “the Secretary”
refers to the HHS Secretary. refers to the HHS Secretary. ~~Al ocations~~Allocations from the fund have included both specific types of from the fund have included both specific types of
providers (e.g., nursing homes) and providers that providers (e.g., nursing homes) and providers that ~~bil~~ bill specific programs (e.g., Medicare Fee-for-specific programs (e.g., Medicare Fee-for-
Service).Service).5
6 How Much Was Appropriated to the Fund?
A total of $178 A total of $178 ~~bil ion~~ billion was appropriated to the fund across three laws, as follows: was appropriated to the fund across three laws, as follows:
 $100  $100 ~~bil ion~~ billion in the CARES Act, in the CARES Act,
 $75  $75 ~~bil ion~~ billion in the Paycheck Protection Program and Health Care Enhancement in the Paycheck Protection Program and Health Care Enhancement
Act, and Act, and
 $3  $3 ~~bil ion~~ billion in the Consolidated Appropriations Act, 2021.in the Consolidated Appropriations Act, 2021.
These funds were appropriated through the Public Health and Social Services Emergency Fund as emergency-designated discretionary appropriations and remain available until they are expended. 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.fund administered by HRSA. HRSA is also administering two companion funds: (1) the HRSA is also administering two companion funds: (1) the
Uninsured Program,Uninsured Program,67 which includes an unspecified amount which includes an unspecified amount ~~al ocated~~allocated from the CARES 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~~
~~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~~
~~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~~
~~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~~
~~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.~~
~~5 See~~ 4 This 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 Medicare beneficiaries. For more information, see CRS Report R46698, Medicare Accelerated and Advance Payments and COVID-19: Frequently Asked Questions. 5 P.L. 116-136, 134 STAT. 563. 6 See information about targeted distributions and general distributions at HHS,information about targeted distributions and general distributions at HHS, “CARES“CARES Act Provider Relief Fund: 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.
67 Formally, this is termed the “COVID-19 Claims Formally, this is termed the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Reimbursement to Health Care Providers and Facilities for ~~T esting,~~
~~T reatment~~Testing, Treatment, and Vaccine Administration for the Uninsured, and Vaccine Administration for the Uninsured,””; see HHS, HHS, Health Resources andHealth Resources and Services Administration Services Administration
(HRSA),(HRSA), “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for ~~T esting, T reatment~~Testing, Treatment, and , and
VaccineVaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim. Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim.
~~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~~
~~date of this report’s publication, new funds have not been distributed since the third general distribution in December~~
~~2020.~~
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~~The Provider Relief Fund: Frequently Asked Questions~~

~~be reliably merged with other data sets (e.g., Medicare provider data) because the variation in~~
Congressional Research Service 2 The Provider Relief Fund: Frequently Asked Questions whose insurance does not cover vaccine administrative cost fees or has cost sharing for these fees.8 What Data Are Available on the Fund? HHS makes data on the fund publicly available and updates the data regularly as new funds are distributed or as entities return funds.9 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 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 type (e.g., evaluate how much money hospitals received). Analysts may find that such data cannot 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 In statute, the HHS Secretary had broad authority to determine how the PRF would be ~~al ocated.~~
allocated. HHS has chosen to HHS has chosen to ~~al ocate~~allocate funds in two ways: (1) general, which are available to a broad group funds in two ways: (1) general, which are available to a broad group
of providers, and (2) targeted distributions, which have more restrictive eligibilityof providers, and (2) targeted distributions, which have more restrictive eligibility general aimed 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 belowdescribed 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/~~
~~index.html#phase1~~. .
General Distributions
HHS has made HHS has made ~~three~~four general distributions. general distributions. ~~Applications for a~~Parts of the fourth general distribution fourth general distribution ~~are to~~
~~begin on September 29, 2021.9~~ were released in December 2021 and January 2022.10 Phase One The first, Phase One, was a general The first, Phase One, was a general ~~al ocation of $50 bil ion~~
allocation distributed to health distributed to health care providers that providers that ~~bil ed~~ billed Medicare Fee-for-Service.Medicare Fee-for-Service.1011 This distribution occurred This distribution occurred
because the federal government paid those providers directly and therefore had the ability to because the federal government paid those providers directly and therefore had the ability to
provide funds quickly to those entities. provide funds quickly to those entities. Entities did not need to apply for these funds. The CARES Act, enacted on March 27, 2020, established The CARES Act, enacted on March 27, 2020, established
~~the PRF; Phase One funding began on April 10, 2020. A provider’s Medicare Fee-for-Service~~
~~patient revenues in 2018 determined the amounts al ocated~~ 8 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance. 9 To download these data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6. 10 HHS, “HHS is Releasing $9 Billion Provider Relief Fund Payments to Support Health Care Providers Affected by the COVID-19 Pandemic,” press release, December 14, 2021, https://www.hhs.gov/about/news/2021/12/14/hhs-releasing-9-billion-in-prf-payments-to-support-providers-affected-by-covid-19.html, and HHS, “HHS is Distributing $2 Billion More in Provider Relief Fund Payments to Health Care providers Impacted by the COVID-19 Pandemic,” press release, January 25, 2022, https://www.hhs.gov/about/news/2022/01/25/hhs-distributing-2-billion-more-provider-relief-fund-payments-health-care-providers-impacted-covid-19-pandemic.html. 11 For more information about the various components of the Medicare program, see CRS Report R40425, Medicare Primer. For information about specific dollar amounts and where the distributions were drawn from, see HHS, HRSA, “Provider Relief Fund Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-relief/past-payments/general-distribution, and U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. Congressional Research Service 3 The Provider Relief Fund: Frequently Asked Questions the PRF; Phase One funding began on April 10, 2020. Initially, HRSA intended to provide $50 billion through this allocation; however, when accounting for returned funds, the total amount provided was $42.8 billion. For this allocation, HRSA allocated $30 billion to providers based on the provider’s Medicare Fee-for-Service payments in 2018 and allocated an additional $20 billion to these providers based on annual gross receipts in the most recent tax year available. The allocation of $20 billion took into account the amounts that providers had already received from the $30 billion allocation. Phase One payments were available only to providers that billed Medicare Fee-for-Service in 2018; as such, some safety-net and other ; as such, some safety-net and other
provider types that serve Medicaid and uninsured populations were either ineligibleprovider types that serve Medicaid and uninsured populations were either ineligible for this for this
~~al ocation~~allocation or received lower amounts because of or received lower amounts because of ~~the~~this methodology methodology ~~used.~~
. Phase Two Phase 2Phase 2 targeted Medicaid, CHIP, and dental providers and included assisted living facilities.targeted Medicaid, CHIP, and dental providers and included assisted living facilities.~~11 It~~
~~provided $18 bil ion~~ 12 The allocation as announced was to provide $18 billion to providers that were not included in Phase 1 of the general distribution. 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.12
13 Because HRSA did not receive sufficient eligible applicants, the full $18 billion was not allocated; instead, a total of $5.09 billion was allocated to 103,449 providers during this distribution.14 Phase Three Phase 3Phase 3 targeted providers that had targeted providers that had ~~not~~not received funding in prior distributions (i.e., because they received funding in prior distributions (i.e., because they
were new or because they were behavioral health providers not included in a prior were new or because they were behavioral health providers not included in a prior ~~al ocation~~allocation). ).
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 also eligible to apply for additional funds, and could receive up to eligible to apply for additional funds, and could receive up to 2% of patient revenue. This limit resulted in approximately one-third of providers who applied not receiving Phase 3 funds.15 A total of $24.5 billion was available in this distribution, and HHS began distributing these funds in November 2020 and distributed more than three-quarters of funding in 2020.16 As of November 22, 2021, HRSA had allocated $21.36 billion through this allocation to 65,367 providers.17 12 Medicare Fee-for-Service does 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 For more information about the various components of the Medicare program, see CRS Report R40425,~~ ~~Medicare~~
~~Prim er~~.
~~11 Medicare Fee-for-Service does~~ not include dental benefits. As such, dentists generally do not bill the Medicare not include dental benefits. As such, dentists generally do not bill the Medicare
program. Some Medicare Advantage plans (i.e., managed care plans) may includeprogram. Some Medicare Advantage plans (i.e., managed care plans) may include these benefits asthese benefits as an optional service. an optional service.
Some assistedSome assisted living facilities provide personal care living facilities provide personal care ~~an d~~ and other types of services not covered by Medicare. other types of services not covered by Medicare. ~~T hese~~These
facilities, like other types of residential facilities, may have incurred additional expenses related to COVIDfacilities, like other types of residential facilities, may have incurred additional expenses related to COVID -19 (e.g., for -19 (e.g., for
enhanced cleaning and personal protective equipment for staff). enhanced cleaning and personal protective equipment for staff).
1213 See See HHS,HHS, https://www.hhs.gov/sites/default/files/provider-distribution-instructions-phase-2.pdf. 14 Information on specific dollar values in given distributions were drawn from HHS, HRSA, “Provider Relief Fund Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-relief/past-payments/general-distribution, and U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 15 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. 16 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. 17 HHS, HRSA, “Provider Relief Fund Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-relief/past-payments/general-distribution. ~~https://www.hhs.gov/sites/default/files/provider-distribution-instructions-phase-2.pdf.~~
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The Provider Relief Fund: Frequently Asked Questions

~~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~~ HRSA also permitted entities to have the amounts they received in Phase 3 to be reconsidered in the fall of 2021. The agency announced a reconsideration process with applications that were due November 12, 2021.18 In its guidance for payment reconsideration, HRSA detailed the methodology used to distribute payments and how it identified entities that may have been outliers in terms of reporting lost revenue. The guidance directed providers to review this methodology and submit an online form if the entity believed its payment amount was incorrect.19 Phase Four Phase 4 will provide $17 billion for providers lost revenue and COVID-19-related expenses for providers lost revenue and COVID-19-related expenses
incurred between July 1, 2020, and March 3, 2021.incurred between July 1, 2020, and March 3, 2021.~~15 This is in~~ 20 HHS released an initial $9 billion of these payments in December 202121 and released an additional $2 billion in January 2022.22 HHS notes that it has processed more than 80% of the applications received for Phase 4. The remaining applications require additional review.23 Given outstanding applications that may be eligible for payment, additional Phase 4 funds may be released in the future. Payments are being provided in accordance with the requirements ~~accordance with the requirements~~
in the Consolidated Appropriations Act, which required thatin 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
paymentspayments ~~to eligible health care providers based on applications that consider~~ to eligible health care providers based on applications that consider financial 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.16
~~Phase 4 wil also reimburse smal er~~24 This distribution is providing less than the 85% required in the law. HHS is also using Phase 4 to reimburse smaller providers that have lower operating margins and serve providers that have lower operating margins and serve
vulnerable communities at higher ratesvulnerable communities at higher rates ~~and wil provide~~. It is also providing bonus payments to providers that serve bonus payments to providers that serve
Medicaid, CHIP, or Medicaid, CHIP, or Medicare populations with lower incomes and more complex medical needs.25 HHS announced that PRF Phase 4 payments have two components: a base payment and a bonus payment. The base payment will be allocated to providers based on their change in revenue and expenses from July 1, 2020, to March 31, 2021 (the third and fourth quarter 2020 and the first quarter of 2021). 18 HHS, “Provide Relief Fund: Phase 3 Payment Reconsideration,” https://www.hrsa.gov/provider-relief/payment-reconsideration. 19 HHS, “Provider Relief Fund ~~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~~
~~COVID-19. These included the following:~~
~~ Hospitals with large numbers of COVID-19 admissions. The PRF provided $12~~
~~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~~
~~admission per day or a disproportionate intensity of COVID admissions.~~
~~ Skilled nursing facilities and nursing homes. The fund provided funds to nursing~~
~~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~~
~~testing, staffing, and personal protective equipment (PPE) needs. These facilities~~
~~were eligible to receive $2 bil ion in incentive payments in October and~~
~~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,” Phase 3: Payment Calculation Methodology,”
https://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase-3-methodology-overview.pdfhttps://www.hrsa.gov/sites/default/files/hrsa/provider-relief/phase-3-methodology-overview.pdf~~, p. 1.~~
~~15 HHS, "HHS~~ . 20 HHS, “HHS Announces the Availability of $25.5 Billion in COVID-19Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,Provider Funding,"” press release, September 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-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. 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,”~~ 21 CRS Insight IN11609, COVID-19 Vaccine: Financing for Its Administration. 21 HHS, “HHS is Releasing $9 Billion Provider Relief Fund Payments to Support Health Care Providers Affected by the COVID-19 Pandemic,” press release, December 14, 2021, https://www.hhs.gov/about/news/2021/12/14/hhs-releasing-9-billion-in-prf-payments-to-support-providers-affected-by-covid-19.html. 22 HHS, “HHS is Distributing $2 Billion More in Provider Relief Fund Payments to Health Care providers Impacted by the COVID-19 Pandemic,” press release, January 25, 2022, https://www.hhs.gov/about/news/2022/01/25/hhs-distributing-2-billion-more-provider-relief-fund-payments-health-care-providers-impacted-covid-19-pandemic.html. 23 HHS, “Provider Relief Fund: Current and Future Payments: Phase 4 and APR Rural Distributions,” https://www.hrsa.gov/provider-relief/future-payments. 24 P.L. 116-260, 134 STAT. 1920. 25 HHS, “HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 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-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. 19-provider-funding.html.
Congressional Research Service Congressional Research Service

45 The Provider Relief Fund: Frequently Asked Questions HHS is allocating 75% of the Phase 4 allocation (i.e., $12.75 billion) as base payments and is to provide relatively higher percentages to small and medium size providers. The remaining 25% of the Phase 4 allocation (i.e., $4.25 billion) is being allocated as bonus payments based on provider’s Medicare, Medicaid, and CHIP participation.26 Applicants are required to verify their Tax ID Numbers (TIN) and use specified methodology to calculate their initial loss ratios. HRSA is calculating loss ratios by provider types and flagging outliers for additional review. It is also providing additional review to pharmacies and durable medical equipment suppliers.27 Targeted Distributions HHS also allocated PRF funds to certain types of providers in 2020 that had high needs due to COVID-19.28 These included the following:  Hospitals with large numbers of COVID-19 admissions (total of $20.69 billion in two rounds). In May 2020, the PRF provided $10 billion to 395 hospitals that had more than 100 COVID-19-related admissions and in July provided funds to 1,129 hospitals with one COVID-19 admission per day or a disproportionate intensity of COVID admissions.  Skilled nursing facilities and nursing homes. The fund provided funds to nursing homes at various points in 2020. It provided $5.0 billion in May to more than 15,000 facilities. It provided an additional $2.25 billion in August for increased testing, staffing, and personal protective equipment (PPE) needs. These facilities were also eligible to receive $2 billion in incentive payments in October and December of 2020.

~~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 $provided $~~500 mil ion in May to approximately 300~~520 million in May 2020 to 319 IHS-funded health facilities. IHS-funded health facilities.
  Safety Net Hospitals. The fund provided $The fund provided $~~10 bil ion~~13.07 billion in June to in June to ~~hospitals~~ 899 hospitals that met 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~~
~~with less than 3% profitability threshold.~~
 ~~Rural~~  Rural providers (including rural health clinics, rural community health centers, rural acute care hospitals, critical access hospitals, urban hospitals with certain rural Medicare designations,29 and
hospitals in small metropolitan areas~~. The fund provided $1 bil ion in July 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~~
~~Medicare dependent hospitals).18~~
~~ Children’s hospitals. The fund provided $1.4 bil ion in August to free-standing~~
~~children hospitals as defined by Medicare or hospitals that were eligible for~~
~~HRSA’s Children’s Hospital GME program.19 These hospitals general y have~~
. The PRF provided a total of $10.99 billion to 4,300 rural facilities in May 2020.  Children’s hospitals. The fund provided $1.06 billion in August to 66 free- standing children hospitals as defined by Medicare or hospitals that were eligible 26 HRSA, “HRSA Provider Relief Fund – Phase 4 and American Rescue Plan (ARP) Rural Distribution Revenue Application Instructions, Payment Methodology” https://www.hrsa.gov/provider-relief/future-payments/phase-4-arp-rural/payment-methodology. 27 Ibid. 28 For information on targeted distributions, see HHS, “Provider Relief Fund: Provider Relief Fund Past Payments, Past Targeted Distributions, https://www.hrsa.gov/provider-relief/past-payments/targeted-distribution and U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 29 For information on these designations, see CRS Infographic IG10023, Medicare Payment for Rural or Geographically Isolated Hospitals. Congressional Research Service 6 The Provider Relief Fund: Frequently Asked Questions for HRSA’s Children’s Hospital GME program.30 These hospitals generally have 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 All providers who meet the criteria (e.g., providers who meet the criteria (e.g., ~~bil~~ bill Medicare) are eligibleMedicare) are eligible for a general distribution. To for a general distribution. To
be eligiblebe eligible for targeted distribution, providers have to meet additional criteria (e.g., have a high for targeted distribution, providers have to meet additional criteria (e.g., have a high
number of COVID-19 inpatients). HHS awarded funds in general number of COVID-19 inpatients). HHS awarded funds in general ~~al ocations to al~~ allocations to all types of health 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 both types of ~~al ocations.~~
~~What Are Some Potential Drawbacks of the Methodology that HHS~~
~~Used to Distribute Funds?~~
allocations. What Information Is Known About Returned Funds? Providers generally have to register and submit the required information to receive PRF funds (with the exception of Phase 1, which was provided without application to Medicare Fee-for-Service providers). Providers, however, do not have to accept the funds they receive from the PRF. They can return funds for a variety of reasons. These include that funds were not needed or that the amount was incorrect and the entity returns the original amount while expecting the correct amount to be issued. HRSA’s data are not sufficient to determine a reason for return; however, HRSA estimated that $8.8 billion has been returned to agency.31 Nearly three-quarters of the funds returned were from the Phase One general allocation that was based on the provider’s Medicare fee-for-service payments.32 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 some, because it may distributions. The use of patient revenue as a metric has been critiqued by some, 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.2033 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~~.
19providers generally had lower revenue. The commission also found that some providers that were not Medicare providers did not receive payments from the PRF.34 In addition to these findings, 30 For information on this program, see CRS For information on this program, see CRS Report R45067, Report R45067, Children’s Hospitals Graduate Medical Education
(CHGME). .
~~20 Karyn Schwartz and T ricia Neuman,~~ ~~Funding for Health Care Providers~~ 31 This information was drawn from U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 32 Ibid. 33 Karyn Schwartz and Tricia Neuman, Funding for Health Care Providers During the Pandemic: An Update, Kaiser , Kaiser
Family Foundation, Washington, DC, April 20, 2021, https://www.kff.org/policy-watch/funding-for-health-care-Family Foundation, Washington, DC, April 20, 2021, https://www.kff.org/policy-watch/funding-for-health-care-
providers-during-the-pandemic-an-update/. providers-during-the-pandemic-an-update/.
34 MACPAC, COVID Relief Funding for Medicaid Providers, Washington, DC, January 2021, Congressional Research Service Congressional Research Service

57

The Provider Relief Fund: Frequently Asked Questions

~~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.21 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.22
35 The fourth general distribution The fourth general distribution ~~wil provide~~is providing additional funding to additional funding to ~~smal er~~smaller providers and to providers and to
Medicaid/CHIP/Medicare providers that serve vulnerable populations. The Biden Administration 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 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.serve more vulnerable populations, such as low-income children.23
36As noted above, providers that serve more vulnerable populations may have fewer privately insured patients, which may result in lower revenue for these facilities because private insurers generally pay providers at higher rates than do payers such as Medicaid and CHIP. These providers may also serve more people who are uninsured. How Are Allocations Determined?
HHS determined the amount that it would HHS determined the amount that it would ~~al ocate~~allocate to both targeted and general distributions. The to both targeted and general distributions. The
~~initial~~ initial statute that created the PRF (the CARES Act) and the subsequent statute that increased statute that created the PRF (the CARES Act) and the subsequent statute that increased
funding (PPPHCEA) did not require funds to be funding (PPPHCEA) did not require funds to be ~~al ocated~~allocated in a specific manner. The Consolidated in a specific manner. The Consolidated
Appropriations Act, 2021, enacted in December 2020, required that not less than 85% of the Appropriations Act, 2021, enacted in December 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~~allocation that follows the Phase 3 general that follows the Phase 3 general ~~al ocation~~allocation. It also specified that for that . It also specified that for that ~~al ocation,~~
allocation, 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. The Phase 4 distribution was announced quarter of 2021 that are attributable to the coronavirus. The Phase 4 distribution was announced
on September 10, 2021, with the applicant portal availableon September 10, 2021, with the applicant portal available September 29, 2021.37 The Phase 4 allocation was $17 billion; using the Government Accountability Office’s (GAO’s) estimates of PRF funds allocated as of August 31, 2021, that amount represented 70.8% of funds remaining in the PRF.38 HRSA told GAO that remaining funds were reserved for “future contingencies and emerging needs.”39 In fall 2021, HRSA also announced that providers could have their Phase 3 amount reconsidered; as such, some unallocated funds may be used for that purpose.40 In addition, HHS has also reportedly used $7 billion of PRF funds to acquire COVID-19 vaccines and therapeutics.41 https://www.macpac.gov/wp-content/uploads/2021/02/COVID-Relief-Funding-for-Medicaid-Providers.pdf. 35 Alexandra Ellerbeck, “The Health 202: Pandemic Relief Funds Boosted Surpluses for Some ~~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~~
~~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~~
~~Response Act (P.L. 116-127)25 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~~
~~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~~
~~the PRF to reimburse providers for COVID-19 treatment provided to uninsured patients.26~~
~~Subsequently, both the Trump Administration and the Biden Administration have clarified that~~
~~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~~

~~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 Large Hospitals,” June
21, 2021, https://www.washingtonpost.com/politics/2021/06/21/health-202-pandemic-relief-funds-boosted-surpluses-21, 2021, https://www.washingtonpost.com/politics/2021/06/21/health-202-pandemic-relief-funds-boosted-surpluses-
some-large-hospitals/. some-large-hospitals/.
2336 HHS, HHS, “ “HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,”HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 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-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. 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 37 Ibid. 38 U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 39 Ibid, table note e. 40 HHS, “Provide Relief Fund: Phase 3 Payment Reconsideration,” https://www.hrsa.gov/provider-relief/payment-reconsideration. 41 Rachel Cohrs, “The Biden Administration Used Billions in Hospital COVID-19 Funds to Pay Drug Makers,” Stat, January 26, 2022, https://www.statnews.com/2022/01/26/the-biden-administration-used-billions-in-hospital-covid-19-funds-to-pay-drugmakers/. HHS information confirming this report are not available at the time of this CRS report’s publication. It is also unclear whether HHS could cite the acquisition of vaccines and therapeutics as an example of a “contingency or an emerging need.” Congressional Research Service 8 The Provider Relief Fund: Frequently Asked Questions 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 uninsured individuals because no other funding was appropriated for this purpose. The Uninsured Fund has two components: (1) a total of $2 billion appropriated in the Families First Coronavirus Response Act (P.L. 116-127)42 and PPPHCEA for uninsured testing and (2) an allocation from the CARES allocation to the PRF for uninsured treatment and coverage assistance for vaccines. PRF funds were not specifically appropriated for either purpose. Instead, in April 2020, the Trump Administration announced that it would use an unspecified portion of the CARES allocation to the PRF to reimburse providers for COVID-19 treatment provided to uninsured patients.43 Subsequently, both the Trump Administration and the Biden Administration have clarified that this reimbursement will include administrative costs incurred by providers when vaccinating uninsured individuals. In addition, the Biden Administration is using the PRF for costs associated

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

with vaccinating underinsured individuals through the newly created Coverage Assistance Fund.with vaccinating underinsured individuals through the newly created Coverage Assistance Fund.2744
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.2845 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. HHS has not specified amounts for the uninsured fund or for underinsured vaccine costs. ~~The~~
~~Government Accountability Office (GAO)~~ GAO estimated that HHS estimated that HHS ~~al ocated $10 bil ion for this~~
~~purpose in March 2021.29 GAO’s estimate was prior to the announcement of the Coverage~~
~~Assistance Fund, so the estimate did not include funds reserved for this purpose.30~~
allocated $10 billion for this purpose.46 Reimbursements are provided on a rolling basis, with eligibleReimbursements are provided on a rolling basis, with eligible claims being paid to providers as claims being paid to providers as
long as funds remain available. As such, should provider payments exceed $10 long as funds remain available. As such, should provider payments exceed $10 ~~bil ion~~billion, HHS may , HHS may
choose to increase the amount choose to increase the amount ~~al ocated~~allocated for uninsured treatment and vaccines and the Coverage for uninsured treatment and vaccines and the Coverage
Assistance Fund. As stated above, $2 Assistance Fund. As stated above, $2 ~~bil ion~~ billion was explicitly appropriated for uninsured testing, was explicitly appropriated for uninsured testing,
and this amount has been expended.and this amount has been expended.3147 On May 25, 2021, the Biden Administration announced On May 25, 2021, the Biden Administration announced
that it was that it was ~~al ocating $4.8 bil ion~~allocating $4.8 billion from the American Rescue Plan Act (ARPA, P.L. 117-2) for from the American Rescue Plan Act (ARPA, P.L. 117-2) for
uninsured testing.uninsured testing.3248 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.
HHS is providing regularly updated information on amounts reimbursed from the Uninsured HHS is providing regularly updated information on amounts reimbursed from the Uninsured
Fund at https://taggs.hhs.gov/Coronavirus/Uninsured. Data are also availableFund at https://taggs.hhs.gov/Coronavirus/Uninsured. Data are also available about the providers about the providers
that receive reimbursements from this fund at https://data.cdc.gov/Administrative/Claims-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,”~~ 42 CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127. 43 CRS Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and Treatment. 44 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance. https://www.hrsa.gov/covid19-coverage-assistance.
2845 CRS CRS Insight IN11609, Insight IN11609, COVID-19 Vaccine: Financing for Its Administration. .
2946 U.S. U.S. Government Accountability Office, 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.~~
~~30 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,~~ ~~Continued Attention~~
~~Needed to Enhance Federal Preparedness, Response, Service Delivery, and Program Integrity~~ ~~, 21-551, July 2021, p.~~
~~87 and p. 93.~~
~~31 HHS, “HHS COVID-19 Funding: T reatment & T esting~~: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 47 HHS, “HHS COVID-19 Funding: Treatment & Testing of the Uninsured,” https://taggs.hhs.gov/Coronavirus/ of the Uninsured,” https://taggs.hhs.gov/Coronavirus/
Uninsured, andUninsured, and ~~CRS~~ CRS Insight IN11526, Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for
Testing and ~~Treatm ent~~.
~~32 HHS,~~ Treatment. 48 HHS, “HHS to Dedicate $4.8 Billion from the American Rescue“HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 Plan to COVID19 ~~T esting~~Testing for the Uninsured, for the Uninsured, ” press ” 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. 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

~~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~~

Congressional Research Service 9 The Provider Relief Fund: Frequently Asked Questions Reimbursement-to-Health-Care-Providers-and-/rksx-33p3. These data include the provider’s name, city, state, what the claim was paid for (i.e., testing, treatment, or vaccines) and the geographic coordinates for the provider’s location. As such, this dataset includes more information than what is available for the main PRF. 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 billion for rural providers that bill Medicare and Medicaid.49 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 billion appropriated for the PRF. An announcement about the release of these funds and the application procedures was included in 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 the September 10, 2021, announcement about the PRF Phase 4 distribution. This distribution ~~wil~~
will follow the same timeline, with the applicant portal availablefollow the same timeline, with the applicant portal available September 29, 2021.September 29, 2021.3450 In accordance In accordance
with statute, the funds with statute, the funds ~~wil~~ will be availablebe available to rural providers that to rural providers that ~~bil~~ bill Medicare and Medicaid. The Medicare and Medicaid. The
Biden Administration announced that this distribution Biden Administration announced that this distribution ~~wil~~ will use the Federal Office of Rural Health use the Federal Office of Rural Health
Policy definition of “rural.”Policy definition of “rural.”3551 Like the PRF and Uninsured Funds, the rural fund is administered Like the PRF and Uninsured Funds, the rural fund is administered
by HRSA.by HRSA.36
52 On November 23, 2021, HRSA announced that it began distributing the rural payments to providers. Under this distribution, HRSA provided a minimum payment of $500 to providers and provided payments to more than 40,000 providers.53 Data on payments provided can be found at https://data.cdc.gov/Global-Health/American-Rescue-Plan-ARP-Rural-Payments/8v6a-z6zq.54 Note that these data include the provider’s name, city, state, and nine-digit zip code. As such, this dataset includes more information than what is available for the main PRF. What Other Purposes Have the PRF Funds Been Used For?
GAO examined PRF GAO examined PRF ~~al ocations as of March 1~~allocations as of August 31, 2021, and found that $0.980 , 2021, and found that $0.980 ~~bil ion~~billion was being was being
used to administer the fund and that $used to administer the fund and that $~~9.970 bil ion was al ocated~~14.80 billion was allocated for “vaccine and therapeutic for “vaccine and therapeutic
development and procurement activities.”development and procurement activities.”~~37 As such, approximately $11 bil ion of the $178 bil ion~~
~~cannot be al ocated~~55 Additional news reports found that HHS used 49 For information about this funding source, see the “Health Care Infrastructure and Provider Support” section of CRS Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions. 50 Ibid. 51 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. 52 Ibid. 53 HHS, “Biden-Harris Administration Begins Distribution American Rescue Plan Rural Funding to Support Providers Impacted by the Pandemic,” press release, November 23, 2021, https://www.hhs.gov/about/news/2021/11/23/biden-admin-begins-distributing-arp-prf-support-to-providers-impacted-by-pandemic.html. 54 The methodology used to provide claims can be found at HHS, Payment Methodology, American Rescue Plan Rural Payment Overview,” https://www.hrsa.gov/provider-relief/future-payments/phase-4-arp-rural/payment-methodology. 55 U.S. Government Accountability Office, COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. For a discussion of the allocation of PRF funds for vaccines, see Rachel Cohrs, “The Trump Administration Quietly Spent Billion in Hospital Funds on Operation Warp Speed,” STAT, March 2, 2021. The amount allocated for vaccines was estimated by GAO to be $9.97 billion in their March report. See U.S. Congressional Research Service 10 link to page 6 link to page 12 link to page 12 link to page 12 The Provider Relief Fund: Frequently Asked Questions approximately $7 billion to acquire vaccines and therapeutics.56 As such, approximately $23 billion of the $178 billion cannot be allocated to provider payments. As discussed above (see to provider payments. As discussed above (see “How Has Funding Been
~~Al ocated~~Allocated?”), the majority of funds have been , the majority of funds have been ~~al ocated~~allocated to providers through either general or 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 information for these providers. Subsequent ~~al ocations~~allocations required that entities submit 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
distribution permitted entities that had previously received funds to receive up to 2% of their 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.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 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 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 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,~~ ~~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 the~~
~~allocation of PRF funds for vaccines, see Rachel Cohrs, “T he T rump Administration Quietly Spent Billion in Hosp ital~~
~~Funds on Operation Warp Speed,” STAT, March 2, 2021.~~
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~~The Provider Relief Fund: Frequently Asked Questions~~

~~provider for the second general distribution).38~~provider for the second general distribution).57 Some terms and conditions apply across Some terms and conditions apply across al all of the of the
~~al ocations~~allocations. These include certification that. 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  that payment ~~wil~~ will be used only to prevent, prepare for, or respond to the be used only to prevent, prepare for, or respond to the
coronavirus and coronavirus and ~~wil~~ will be used only for health care expenses or lost revenue be used only for health care expenses or lost revenue
attributable to the virus; attributable to the virus;
 that payment  that payment ~~wil~~ will not be used to reimburse expenses or losses that have been not be used to reimburse expenses or losses that have been
reimbursed by another source; reimbursed by another source;
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. 56 Rachel Cohrs, “The Biden Administration Used Billions in Hospital COVID-19 Funds to Pay Drug Makers,” Stat, January 26, 2022, https://www.statnews.com/2022/01/26/the-biden-administration-used-billions-in-hospital-covid-19-funds-to-pay-drugmakers/. 57 For links to the terms and conditions associated with each distribution, see HHS, “CARES Act Provider Relief Fund: For Providers,” https://www.hrsa.gov/provider-relief/past-payments/terms-conditions. Congressional Research Service 11 The Provider Relief Fund: Frequently Asked Questions  the entity will ~~ the entity wil~~ comply, in the required timeframe, with HHS reporting 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  the entity ~~wil~~ will maintain appropriate records and cost documentation; and maintain appropriate records and cost documentation; and
 for  for al all presumptive or actual cases of COVID-19, the entity presumptive or actual cases of COVID-19, the entity ~~wil~~ will not seek to 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.39
58 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.40
59 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 the uses of their funds and to have expended al all received funds within a year of receiving them, received funds within a year of receiving them,
and to report and to report al all their expenditures within three months after the end of the expenditure period. 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
of the awarding period, and the reporting period commences the day after and continues for three of the awarding period, and the reporting period commences the day after and continues for three
months.months.4160 This CRS report discusses the requirements that were issued on June 11, 2021, which This CRS report discusses the requirements that were issued on June 11, 2021, which
supersede prior reporting requirements and apply to supersede prior reporting requirements and apply to al all past and future PRF allocations.61 Entities are generally required to report using their normal basis of accounting. They are also required to report on  interest earned on PRF payments;  other assistance received (e.g., Paycheck Protection Program);62  use of Nursing Home Infection control payments, if applicable;  use of general or targeted distribution payments, which may be used only for expenses that have not or will not be reimbursed by another source;  net unreimbursed expenses attributable to coronavirus (requirements specify that this is to be calculated quarterly, net after PRF and other assistance payments are 58~~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 Providers.”~~
39 For more information on “in-network” and “out-of-network” coverage, see CRS For more information on “in-network” and “out-of-network” coverage, see CRS Report Report ~~R46116~~R46856, , Surprise Billing in
Private Health Insurance: Overview ~~and Federal Policy Considerations~~.
~~40 HHS, “Acceptance of T erms~~ of Federal Consumer Protections and Payment for Out-of-Network Services. 59 HHS, “Acceptance of Terms and Conditions,” https://www.hhs.gov/sites/default/files/terms-and-conditions-provider- 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.
~~41 See T ables~~60 See Tables 1 and 2 on page 2 in HHS, 1 and 2 on page 2 in HHS, “Provider Relief Fund“Provider Relief Fund General and General and ~~T argeted Distribut ion~~Targeted Distribution Post-Payment Notice Post-Payment Notice
of Reporting Requirements,” Juneof Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-
reporting-requirements-june-2021.pdf. reporting-requirements-june-2021.pdf.
42 61 HHS, HHS, “Provider Relief Fund“Provider Relief Fund General and General and ~~T argeted~~Targeted Distribution Post Distribution Post -Payment Notice of Reporting Requirements,” -Payment Notice of Reporting Requirements,”
June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-
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~~The Provider Relief Fund: Frequently Asked Questions~~

~~are general y required to report using their normal basis of accounting. They are also required to~~
~~report on~~
~~ interest earned on PRF payments;~~
~~ other assistance received (e.g., Paycheck Protection Program);43~~
~~ use of Nursing Home Infection control payments, if applicable;~~
~~ 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;~~
~~ net unreimbursed expenses attributable to coronavirus (requirements specify that~~
~~this is to be calculated quarterly, net after PRF and other assistance payments are~~
2021.pdf. 62 For more information on this program, see CRS Insight IN11324, CARES Act Assistance for Employers and Employees—The Paycheck Protection Program, Employee Retention Tax Credit, and Unemployment Insurance Benefits: Overview (Part 1), and CRS Insight IN11329, CARES Act Assistance for Employers and Employees—The Paycheck Protection Program, Employee Retention Tax Credit, and Unemployment Insurance Benefits: Assessment of Alternatives (Part 2). Congressional Research Service 12 The Provider Relief Fund: Frequently Asked Questions 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.  lost revenue reimbursement. ~~Specifical y~~Specifically, lost revenue reimbursements may be , 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.4463
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 entity then registers with that TIN and must report on al all payments that meet the $10,000 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.4564
Can Providers Refuse or Return Funds?
Providers must attest to certain terms and conditions after receiving funds. Providers may choose 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 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 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,~~ ~~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,~~ ~~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)~~.
~~44 For methodology to calculate lost revenue, see pages 10-11 of HHS, “Provider Relief Fund General and T argeted~~
~~Distribution Post~~ received funding.65 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 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.66 Agency Requirements What Are HHS Reporting Requirements for the Fund? 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 final payments are made. The report is to be submitted to the House and Senate appropriations 63 For methodology to calculate lost revenue, see pages 10-11 of HHS, “Provider Relief Fund General and Targeted Distribution Post-Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/-Payment Notice of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/
provider-postprovider-post -payment-notice-of-reporting-requirements-june-2021.pdf. -payment-notice-of-reporting-requirements-june-2021.pdf.
45 64 HHS HHS notes some entities may be subjectnotes some entities may be subject to additional auditingto additional auditing to ensure payment accuracy. See HHS,to ensure payment accuracy. See HHS, “Reporting “Reporting
Requirements and Auditing,”Requirements and Auditing,” https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/
index.html. index.html.
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~~The Provider Relief Fund: Frequently Asked Questions~~

~~received funding.46 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~~
~~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.47~~
~~Agency Requirements~~
~~What Are HHS Reporting Requirements for the Fund?~~
~~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~~
~~final payments are made. The report is to be submitted to the House and Senate appropriations~~
65 For a time line, see HHS, HHS, “HHS Issues Revised Notice of Reporting Requirements and Reporting Timeline 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. 66 HHS, HRSA, “Provider Relief Fund General Information,” see “Terms and Conditions,” at https://www.hrsa.gov/provider-relief/faq/general. Congressional Research Service 13 The Provider Relief Fund: Frequently Asked Questions 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. the final report. ~~Final y~~Finally, the law required a report not later than 60 days after enactment of the , 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

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
under the direction of Congress. Information in a CRS Report should under the direction of Congress. Information in a CRS Report should ~~n ot~~not be relied upon for purposes other be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
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copy or otherwise use copyrighted material. copy or otherwise use copyrighted material.

~~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~~
11 Congressional Research Service R46897 · VERSION 4 · UPDATED 14