The Provider Relief Fund: Frequently Asked Questions

Changes from February 7, 2022 to April 7, 2022

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The Provider Relief Fund:
~~February~~April 7, 2022 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) 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 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 to pay providers for providing ~~coronavirus~~COVID-19 testing, treatment, and vaccines to uninsured individuals and the use of the fund to 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 billion to Economic Security Act (CARES Act, P.L. 116-136), which provided $100 billion 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
billion, with $75 billion appropriated in the Paycheck Protection Program and Health Care billion, with $75 billion appropriated in the Paycheck Protection Program and Health Care
Enhancement Act (PPPHCEA, P.L. 116-139) and $3 billion appropriated in the Consolidated Enhancement Act (PPPHCEA, P.L. 116-139) and $3 billion 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 allocations. requirements for future fund 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 allocated, and the fund’s requirements for provider reporting. Data the fund, how funds have been allocated, 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
remaining;2 however, agency data are available for download and can be used to examine the remaining;2 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 received, among amounts that remain in the fund and the amount that a particular entity or state received, among
other things. other things.
Fund Overview Questions
What Is the Provider Relief Fund?
The CARES Act appropriated $100 billion to “to prevent, prepare for, and respond to The CARES Act appropriated $100 billion to “to prevent, prepare for, and respond to
coronavirus, domestically or internationally, for necessary expenses to reimburse, through grants coronavirus, domestically or internationally, 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.”3 These funds were appropriated to the Public revenues that are attributable to coronavirus.”3 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?”). .

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) in the three laws. To download these that these data include amounts appropriated to the Provider Relief Fund (PRF) in the three laws. To 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 One news report suggests that all PRF funds have been allocated; however, this information has not been confirmed. 2 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 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 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,” Administration Used Billions in Hospital COVID-19 Funds to Pay Drug Makers,” Stat, January 26, 2022, , January 26, 2022,
https://www.statnews.com/2022/01/26/the-biden-administration-used-billions-in-hospital-covid-19-funds-to-pay-https://www.statnews.com/2022/01/26/the-biden-administration-used-billions-in-hospital-covid-19-funds-to-pay-
drugmakers/. drugmakers/.
3 P.L. 116-136, 134 STAT. 563. 3 P.L. 116-136, 134 STAT. 563.
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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 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 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: 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.”5 In these provisions, “the Secretary” individuals with possible or actual cases of COVID-19.”5 In these provisions, “the Secretary”
refers to the HHS Secretary. Allocations from the fund have included both specific types of refers to the HHS Secretary. Allocations from the fund have included both specific types of
providers (e.g., nursing homes) and providers that bill specific programs (e.g., Medicare Fee-for-providers (e.g., nursing homes) and providers that bill specific programs (e.g., Medicare Fee-for-
Service).6 Service).6
How Much Was Appropriated to the Fund?
A total of $178 billion was appropriated to the fund across three laws, as follows: A total of $178 billion was appropriated to the fund across three laws, as follows:
 $100 billion in the CARES Act,  $100 billion in the CARES Act,
 $75 billion in the  $75 billion in the ~~Paycheck Protection Program and Health Care Enhancement~~
~~Act~~PPPHCEA , and , and
 $3 billion in the Consolidated Appropriations Act, 2021.  $3 billion in the Consolidated Appropriations Act, 2021.
These funds were appropriated through the Public Health and Social Services Emergency These funds were appropriated through the Public Health and Social Services Emergency
Fund as emergency-designated discretionary appropriations and remain available until Fund as emergency-designated discretionary appropriations and remain available until
they are expended. 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. HRSA is also administering two companion funds: (1) the fund administered by HRSA. HRSA is also administering two companion funds: (1) the
Uninsured Program,7 which includes an unspecified amount allocated from the CARES Uninsured Program,7 which includes an unspecified amount allocated 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.8
4 This contrasts with the Medicare Accelerated and Advance Payment Program, in which providers received Medicare 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 payments in advance of providing and billing for these services to Medicare beneficiaries. For more information, see
CRS Report R46698, CRS Report R46698, Medicare Accelerated and Advance Payments and COVID-19: Frequently Asked Questions. .
5 P.L. 116-136, 134 STAT. 563. 5 P.L. 116-136, 134 STAT. 563.
6 See information about targeted distributions and general distributions at HHS, “CARES Act Provider Relief Fund: 6 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.
7 Formally, this is termed the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, 7 Formally, this is termed the “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing,
Treatment, and Vaccine Administration for the Uninsured”; see HHS, Health Resources and Services Administration Treatment, and Vaccine Administration for the Uninsured”; see HHS, Health Resources and Services Administration
(HRSA), “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and (HRSA), “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and
Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim. Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim.
8 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance. Congressional Research Service Congressional Research Service

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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 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 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 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
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 allocated. In statute, the HHS Secretary had broad authority to determine how the PRF would be allocated.
HHS has chosen to allocate funds in two ways: (1) general, which are available to a broad group HHS has chosen to allocate 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. described in more detail below.
General Distributions
HHS has made four general distributions. Parts of the fourth general distribution were released in HHS has made four general distributions. Parts of the fourth general distribution were released in
December 2021 and January 2022.10 December 2021 and January 2022.10
Phase One
The first, Phase One, was a general allocation distributed to health care providers that billed The first, Phase One, was a general allocation distributed to health care providers that billed
Medicare Fee-for-Service.11 This distribution occurred because the federal government paid those Medicare Fee-for-Service.11 This distribution occurred because the federal government paid those
providers directly and therefore had the ability to provide funds quickly to those entities. Entities providers directly and therefore had the ability to provide funds quickly to those entities. Entities
did not need to apply for these funds. The CARES Act, enacted on March 27, 2020, established did not need to apply for these funds. The CARES Act, enacted on March 27, 2020, established

~~8 HHS, HRSA, “COVID-19 Coverage Assistance Fund,” https://www.hrsa.gov/covid19-coverage-assistance.~~
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 9 To download these data, go to https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6. 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 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-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 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 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-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. 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, 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, . 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-“Provider Relief Fund Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-relief/past-
payments/general-distribution, and U.S. Government Accountability Office, 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, , 21-105051, October 27, 2021, p. Appendix 8,
https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8.
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~~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 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 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 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 provider types that serve Medicare Fee-for-Service in 2018; as such, some safety-net and other provider types that serve
Medicaid and uninsured populations were either ineligible for this allocation or received lower Medicaid and uninsured populations were either ineligible for this allocation or received lower
amounts because of this methodology. amounts because of this methodology.
Phase Two
Phase 2Phase 2 targeted Medicaid, CHIP, and dental providers and included assisted living facilities.12 targeted Medicaid, CHIP, and dental providers and included assisted living facilities.12
The allocation as announced was to provide $18 billion to providers that were not included in The allocation as announced was to provide $18 billion to providers that were not included in
Phase 1 of the general distribution. These providers received an amount equal to 2% of the Phase 1 of the general distribution. 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 provider’s total patient care revenue. Phase 2 funds began in June and required that providers
applying for funding include in their applications certain financial information related to applying for funding include in their applications certain financial information related to
documenting revenue necessary to determine the amount that a facility would receive.13 Because documenting revenue necessary to determine the amount that a facility would receive.13 Because
HRSA did not receive sufficient eligible applicants, the full $18 billion was not allocated; instead, 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 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 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 allocation). were new or because they were behavioral health providers not included in a prior 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 also eligible to apply for additional funds, and could receive up to revenue in PRF assistance were also 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 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 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 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 funding in 2020.16 As of November 22, 2021, HRSA had allocated $21.36 billion through this
allocation to 65,367 providers.17 allocation to 65,367 providers.17
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
12 Medicare Fee-for-Service does not include dental benefits. As such, dentists generally do not bill the Medicare 12 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 and other types of services not covered by Medicare. These Some assisted living facilities provide personal care and other types of services not covered by Medicare. These
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).
13 See HHS, https://www.hhs.gov/sites/default/files/provider-distribution-instructions-phase-2.pdf. 13 See 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 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, Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-relief/past-payments/general-distribution,
and U.S. Government Accountability Office, 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/, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/
GAO-22-105051/index.html#appendix8. GAO-22-105051/index.html#appendix8.
15 HHS, “Provide Relief Fund Phase 3: Payment Calculation Methodology,” https://www.hrsa.gov/sites/default/files/ 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. 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/ 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. 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- 17 HHS, HRSA, “Provider Relief Fund Past Payments: Past General Distributions,” https://www.hrsa.gov/provider-
relief/past-payments/general-distribution. relief/past-payments/general-distribution.
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~~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~~
18 HHS, “Provide Relief Fund: Phase 3 Payment Reconsideration,” https://www.hrsa.gov/provider-relief/payment- Congressional Research Service 4 The Provider Relief Fund: Frequently Asked Questions methodology used to distribute payments and how it identified entities that may have been 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 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 methodology and submit an online form if the entity believed its payment amount was incorrect.19
Phase Four
Phase 4 Phase 4 ~~will provide~~provides $17 billion for providers $17 billion for providers’ lost revenue and COVID-19-related expenses lost revenue and COVID-19-related expenses
incurred between July 1, 2020, and March 3, 2021.20 incurred between July 1, 2020, and March 3, 2021.20 ~~HHS released an initial $9 billion of these~~
~~payments in December 202121 and released an additional $2 billion in January 2022.22~~As of March 2022, HHS has released $12 billion of the $17 billion allocated.21 These funds were released in phases: an initial $9 billion was released in December 2021,22 $2 billion was released in January 2022,23 $560 million was released in February 2022, and $413 million was released in March.24 HHS notes HHS notes
that it has processed more than 80% of the applications received for Phase 4. The remaining that it has processed more than 80% of the applications received for Phase 4. The remaining
applications require additional review.applications require additional review.2325 Given outstanding applications that may be eligible for Given outstanding applications that may be eligible for
payment, additional Phase 4 funds may be released in the future. Payments are being provided in payment, additional Phase 4 funds may be released in the future. Payments are being provided in
accordance with the requirements in the Consolidated Appropriations Act, which required that 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.2426
This distribution is providing less than the 85% required in the law. HHS is also using Phase 4 to 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 vulnerable communities reimburse smaller providers that have lower operating margins and serve vulnerable communities
at higher rates. It is also providing bonus payments to providers that serve Medicaid, CHIP, or at higher rates. It is also providing bonus payments to providers that serve 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. reconsideration.
19 HHS, “Provider Relief Fund Phase 3: Payment Calculation Methodology,” https://www.hrsa.gov/sites/default/files/ 19 HHS, “Provider Relief Fund Phase 3: Payment Calculation Methodology,” https://www.hrsa.gov/sites/default/files/
hrsa/provider-relief/phase-3-methodology-overview.pdf. hrsa/provider-relief/phase-3-methodology-overview.pdf.
20 HHS, “HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 20 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-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.
21 21 ~~CRS Insight IN11609, COVID-19 Vaccine: Financing for Its Administration.~~
21HHS, “HHS Distributing an Additional $413 Million in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic,” press release, March 22, 2022, https://www.hhs.gov/about/news/2022/03/22/hhs-distributing-additional-413-million-provider-relief-fund-payments-health-care-providers-impacted-by-covid-19-pandemic.html. 22 HHS, “HHS is Releasing $9 Billion Provider Relief Fund Payments to Support Health Care Providers Affected by 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-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. releasing-9-billion-in-prf-payments-to-support-providers-affected-by-covid-19.html.
2223 HHS, “HHS is Distributing $2 Billion More in Provider Relief Fund Payments to Health Care providers Impacted by 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-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. 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~~
~~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~~

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

24 HHS, “HHS Distributing $560 Million in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic,” press release, February 24, 2022, https://www.hhs.gov/about/news/2022/02/24/hhs-distributing-560-million-provider-relief-fund-payments-health-care-providers-affected-covid-19-pandemic.html; and HHS, “HHS Distributing an Additional $413 Million in Provider Relief Fund Payments to Health Care Providers Affected by the COVID-19 Pandemic,” press release, March 22, 2022, https://www.hhs.gov/about/news/2022/03/22/hhs-distributing-additional-413-million-provider-relief-fund-payments-health-care-providers-impacted-by-covid-19-pandemic.html. 25 HHS, “Provider Relief Fund: Current and Future Payments: Phase 4 and APR Rural Distributions,” https://www.hrsa.gov/provider-relief/future-payments. 26 P.L. 116-260, 134 STAT. 1920. Congressional Research Service 5 The Provider Relief Fund: Frequently Asked Questions Medicare populations with lower incomes and more complex medical needs.27 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). HHS is allocating 75% of the Phase 4 allocation (i.e., $12.75 billion) as base payments and is to 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 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 the Phase 4 allocation (i.e., $4.25 billion) is being allocated as bonus payments based on
provider’s Medicare, Medicaid, and CHIP participation.provider’s Medicare, Medicaid, and CHIP participation.2628 Applicants are required to verify their Applicants are required to verify their
Tax ID Numbers (TIN) and use specified methodology to calculate their initial loss ratios. HRSA 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 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.providing additional review to pharmacies and durable medical equipment suppliers.2729
Targeted Distributions
HHS also allocated PRF funds to certain types of providers in 2020 that had high needs due to HHS also allocated PRF funds to certain types of providers in 2020 that had high needs due to
COVID-19.COVID-19.2830 These included the following: 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 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 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 hospitals with one COVID-19 admission per day or a disproportionate intensity
of COVID admissions. 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 $5.0 billion in May homes at various points in 2020. It provided $5.0 billion in May 2020 to more than to more than
15,000 facilities. It provided an additional $2.25 billion in August for increased 15,000 facilities. It provided an additional $2.25 billion 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 also eligible to receive $2 billion in incentive payments in October and were also eligible to receive $2 billion in incentive payments in October and
December of 2020. December of 2020.
  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 $520 million in May 2020 to 319 IHS-funded health facilities. provided $520 million in May 2020 to 319 IHS-funded health facilities.
  Safety Net Hospitals. The fund provided $13.07 billion in June to 899 hospitals The fund provided $13.07 billion in June to 899 hospitals
that met certain criteria based on their patient mix, the amount of uncompensated that met certain criteria based on their patient mix, the amount of uncompensated
care they provided, or their profit margin. care they provided, or their profit margin.
  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~~
~~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 27 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. 28 HRSA, “HRSA Provider Relief Fund – Phase 4 and American Rescue Plan (ARP) Rural Distribution Revenue 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-Application Instructions, Payment Methodology” https://www.hrsa.gov/provider-relief/future-payments/phase-4-arp-
rural/payment-methodology. rural/payment-methodology.
2729 Ibid. Ibid.
2830 For information on targeted distributions, see HHS, “Provider Relief Fund: Provider Relief Fund Past Payments, Past 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 Targeted Distributions, https://www.hrsa.gov/provider-relief/past-payments/targeted-distribution and U.S. Government
Accountability Office, 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/, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/GAO-22-105051/
index.html#appendix8. index.html#appendix8.
~~29 For information on these designations, see CRS Infographic IG10023,~~ ~~Medicare Payment for Rural or~~
~~Geographically Isolated Hospitals~~.
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~~for HRSA’s Children’s Hospital GME program.30~~Congressional Research Service 6 The Provider Relief Fund: Frequently Asked Questions rural Medicare designations,31 and hospitals in small metropolitan areas. 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 for HRSA’s Children’s Hospital GME program.32 These hospitals generally have 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?
All providers who meet the criteria (e.g., bill Medicare) are eligible for a general distribution. To All providers who meet the criteria (e.g., bill 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 allocations to all types of health number of COVID-19 inpatients). HHS awarded funds in general allocations to all 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 allocations. both types of allocations.
What Information Is Known About Returned Funds?
Providers generally have to register and submit the required information to receive PRF 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-(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 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 PRF. They can return funds for a variety of reasons. These include ~~that funds~~funds that were not needed or were not needed or
that the amount was incorrect and the entity returns the original amount while expecting the 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; 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 however, HRSA estimated that $8.8 billion has been returned to the agency.agency.3133 Nearly three-quarters Nearly three-quarters
of the funds returned were from the Phase One general allocation that was based on the provider’s of the funds returned were from the Phase One general allocation that was based on the provider’s
Medicare fee-for-service payments.Medicare fee-for-service payments.3234
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.33 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~~
~~providers 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 31 For information on these designations, see CRS Infographic IG10023, Medicare Payment for Rural or Geographically Isolated Hospitals, 2021. 32 For information on this program, see CRS Report R45067, For information on this program, see CRS Report R45067, Children’s Hospitals Graduate Medical Education
(CHGME). .
3133 This information was drawn from U.S. Government Accountability Office, 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, , 21-105051, October 27, 2021, p. Appendix 8,
https://files.gao.gov/reports/GAO-22-105051/index.html#appendix8. 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~~
~~Family Foundation, Washington, DC, April 20, 2021, https://www.kff.org/policy-watch/funding-for-health-care-~~
~~providers-during-the-pandemic-an-update/.~~
~~34 MACPAC, COVID Relief Funding for Medicaid Providers, Washington, DC, January 2021,~~
~~Congressional Research Service~~

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

34 Ibid. Congressional Research Service 7 The Provider Relief Fund: Frequently Asked Questions and Medicaid.35 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 providers generally had lower revenue. The commission also found that some providers that were not Medicare providers did not receive payments from the PRF.36 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.3537
The fourth general distribution is providing additional funding to smaller providers and to The fourth general distribution is providing additional funding to smaller 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.~~36As~~38As noted above, providers that noted above, providers that
serve more vulnerable populations may have fewer privately insured patients, which may result in 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 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 than do payers such as Medicaid and CHIP. These providers may also serve more people who are
uninsured. uninsured.
How Are Allocations Determined?
HHS determined the amount that it would allocate to both targeted and general distributions. The HHS determined the amount that it would allocate 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 allocated in a specific manner. The Consolidated funding (PPPHCEA) did not require funds to be allocated 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
allocation that follows the Phase 3 general allocation. It also specified that for that allocation, allocation that follows the Phase 3 general allocation. It also specified that for that 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 available September 29, 2021.on September 10, 2021, with the applicant portal available September 29, 2021.3739 The Phase 4 The Phase 4
allocation was $17 billion; using the Government Accountability Office’s (GAO’s) estimates of 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 PRF funds allocated as of August 31, 2021, that amount represented 70.8% of funds remaining in
the PRF.the PRF.3840 HRSA told GAO that remaining funds were reserved for “future contingencies and HRSA told GAO that remaining funds were reserved for “future contingencies and
emerging needs.”emerging needs.”3941 In fall 2021, HRSA also announced that providers could have their Phase 3 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.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~~

42 In 35 Karyn Schwartz and Tricia 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/. 36 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. https://www.macpac.gov/wp-content/uploads/2021/02/COVID-Relief-Funding-for-Medicaid-Providers.pdf.
3537 Alexandra Ellerbeck, “The Health 202: Pandemic Relief Funds Boosted Surpluses for Some Large Hospitals,” June Alexandra Ellerbeck, “The 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-21, 2021, https://www.washingtonpost.com/politics/2021/06/21/health-202-pandemic-relief-funds-boosted-surpluses-
some-large-hospitals/. some-large-hospitals/.
3638 HHS, “HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding,” press release, September 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-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.
3739 Ibid. Ibid.
3840 U.S. Government Accountability Office, 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/, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/
GAO-22-105051/index.html#appendix8. GAO-22-105051/index.html#appendix8.
3941 Ibid, table note e. Ibid, table note e.
4042 HHS, “Provide Relief Fund: Phase 3 Payment Reconsideration,” https://www.hrsa.gov/provider-relief/payment- HHS, “Provide Relief Fund: Phase 3 Payment Reconsideration,” https://www.hrsa.gov/provider-relief/payment-
reconsideration. 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~~Congressional Research Service 8 The Provider Relief Fund: Frequently Asked Questions addition, HHS has also reportedly used $7 billion of PRF funds to acquire COVID-19 vaccines vaccines and therapeutics.43~~and therapeutics as an example of a~~
~~“contingency or an emerging need.”~~
~~Congressional Research Service~~

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~~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 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 billion appropriated in the Families First Coronavirus Fund has two components: (1) a total of $2 billion appropriated in the Families First Coronavirus
Response Act (P.L. 116-127)Response Act (P.L. 116-127)4244 and PPPHCEA for uninsured testing and (2) an allocation from the 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 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 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 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.the PRF to reimburse providers for COVID-19 treatment provided to uninsured patients.4345
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 will include administrative costs incurred by providers when vaccinating 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 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.with vaccinating underinsured individuals through the newly created Coverage Assistance Fund.4446
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.4547 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. GAO HHS has not specified amounts for the uninsured fund or for underinsured vaccine costs. GAO
estimated that HHS allocated $10 billion for this purpose.estimated that HHS allocated $10 billion for this purpose.4648
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 long as funds remain available. As ~~such, should provider payments exceed $10 billion, HHS may~~
~~choose to increase the amount allocated for uninsured treatment and vaccines and the Coverage~~
~~Assistance Fund.~~of March 22, 2022, the fund stopped accepting claims for testing and treatment for uninsured individuals because of lack of funding. As of April 5, 2022, the fund stopped accepting new vaccination claims because of funding constraints.49 As stated above, $2 billion was explicitly appropriated for uninsured testing, As stated above, $2 billion was explicitly appropriated for uninsured testing,
and this amount has been expended.and this amount has been expended.4750 On May 25, 2021, the Biden Administration announced On May 25, 2021, the Biden Administration announced
~~that it was allocating $4.8 billion from the American Rescue Plan Act (ARPA, P.L. 117-2) for~~
~~uninsured testing.48 These amounts are separate from the PRF; as such, PRF funds are not~~
~~currently being used for uninsured testing.~~
~~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-~~

42that it was allocating $4.8 43 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.” 44 CRS Report R46316, CRS Report R46316, Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127. .
4345 CRS Insight IN11526, CRS Insight IN11526, COVID-19 and the Uninsured: Federal Funding Options to Pay Providers for Testing and
Treatment. .
4446 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.
4547 CRS Insight IN11609, CRS Insight IN11609, COVID-19 Vaccine: Financing for Its Administration. .
4648 U.S. Government Accountability Office, 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/, 21-105051, October 27, 2021, p. Appendix 8, https://files.gao.gov/reports/
GAO-22-105051/index.html#appendix8. GAO-22-105051/index.html#appendix8.
4749 HHS, HRSA, “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim. 50 HHS, “HHS COVID-19 Funding: Treatment & Testing of the Uninsured,” https://taggs.hhs.gov/Coronavirus/ HHS, “HHS COVID-19 Funding: Treatment & Testing 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 Providers for
~~Testing and Treatment~~.
~~48 HHS, “HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 Testing for the Uninsured,” press~~
~~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.~~
~~Congressional Research Service~~

9

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

Congressional Research Service 9 The Provider Relief Fund: Frequently Asked Questions billion from the American Rescue Plan Act of 2021 (ARPA, P.L. 117-2) for uninsured testing.51 These amounts are separate from the PRF; as such, PRF funds are not currently being used for uninsured testing. 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. These data include the provider’s 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 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 geographic coordinates for the provider’s location. As such, this dataset includes more
information than information than ~~what~~ is available for the main PRF. 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 Section 9911 of ~~the American Rescue Plan Act~~ARPA appropriated $8.5 billion for rural providers that appropriated $8.5 billion for rural providers that
bill Medicare and Medicaid.bill Medicare and Medicaid.4952 This funding stream is to be administered in a number of ways that 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 are similar to the PRF (e.g., reporting requirements) but is separate from the $178 billion
appropriated for the PRF. 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 ~~will~~
~~follow~~follows the same timeline, with the applicant portal available September 29, 2021. the same timeline, with the applicant portal available September 29, 2021.5053 In accordance In accordance
with statute, the funds with statute, the funds ~~will be~~are available to rural providers that bill Medicare and Medicaid. The available to rural providers that bill Medicare and Medicaid. The
Biden Administration announced that this distribution will use the Federal Office of Rural Health Biden Administration announced that this distribution will use the Federal Office of Rural Health
Policy definition of “rural.”Policy definition of “rural.”5154 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.5255
On November 23, 2021, HRSA announced that it began distributing the rural payments to 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 providers. Under this distribution, HRSA provided a minimum payment of $500 to providers and
provided payments to more than 40,000 providers.provided payments to more than 40,000 providers.5356 Data on payments provided can be found at Data on payments provided can be found at
https://data.cdc.gov/Global-Health/American-Rescue-Plan-ARP-Rural-Payments/8v6a-z6zq.https://data.cdc.gov/Global-Health/American-Rescue-Plan-ARP-Rural-Payments/8v6a-z6zq.5457
Note that these data include the provider’s name, city, state, and nine-digit zip code. As such, this 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. 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 allocations as of August 31, 2021, and found that $0.980 billion was being~~
~~used to administer the fund and that $14.80 billion was allocated for “vaccine and therapeutic~~
~~development and procurement activities.”55 Additional news reports found that HHS used~~

49 Testing and Treatment. 51 HHS, “HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 Testing for the Uninsured,” press 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. 52 For information about this funding source, see the “Health Care Infrastructure and Provider Support” section of CRS For information about this funding source, see the “Health Care Infrastructure and Provider Support” section of CRS
Report R46834, Report R46834, American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health
Services, and Related Provisions. .
5053 Ibid. Ibid.
5154 HHS, HRSA, “Defining Rural Population,” https://www.hrsa.gov/rural-health/about-us/definition/index.html, and 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. HHS, HRSA, “Rural Health Grants Eligibility Analyzer,” https://data.hrsa.gov/tools/rural-health?tab=Address.
5255 Ibid. Ibid.
5356 HHS, “Biden-Harris Administration Begins Distribution American Rescue Plan Rural Funding to Support Providers 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-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. admin-begins-distributing-arp-prf-support-to-providers-impacted-by-pandemic.html.
5457 The methodology used to provide claims can be found at HHS, Payment Methodology, American Rescue Plan Rural 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. 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~~
~~“How Has Funding Been Allocated?”), the majority of funds have been allocated to providers~~
~~through either general or 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 providers for vaccine administration costs for uninsured individuals who do~~
~~not have vaccine coverage or who have cost sharing for vaccine administration costs (see~~ Congressional Research Service 10 link to page 12 link to page 12 link to page 12 link to page 6 link to page 6 The Provider Relief Fund: Frequently Asked Questions What Other Purposes Have the PRF Funds Been Used For? GAO examined PRF allocations as of August 31, 2021, and found that $0.980 billion was being used to administer the fund and that $14.80 billion was allocated for “vaccine and therapeutic development and procurement activities.”58 Additional news reports found that HHS used approximately $7 billion to acquire vaccines and therapeutics.59 In addition, $10 billion is being used to pay providers for treatment, vaccines, and vaccine administration costs for uninsured individuals who do not have vaccine coverage or who have cost sharing for vaccine administration costs. PRF funds were not used for uninsured testing. Instead, a total of $2 billion was appropriated in FFCRA and PPPHCEA for uninsured testing. Those funds have since been exhausted, and funds from ARPA were allocated by the Biden Administration for uninsured testing.60 However, no funding remains for uninsured testing as of March 22, 2022.61 (See “What
Is the Relationship Between the Provider Relief Fund, the Uninsured Fund, and the Coverage
Assistance Fund?”).
) As such, when summing the amount used for fund administration, vaccines and therapeutics, and uninsured care costs, approximately $33 billion of the $178 billion cannot be allocated to general provider payments. As discussed above (see “How Has Funding Been Allocated?”), the majority of funds have been allocated to providers through either general or targeted distributions. 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 allocations required that entities submit information for these providers. Subsequent allocations 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.
58 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. 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. 59 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/. 60 HHS, “HHS to Dedicate $4.8 Billion from the American Rescue Plan to COVID19 Testing for the Uninsured,” press 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. 61 HHS, HRSA, “COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured,” https://www.hrsa.gov/coviduninsuredclaim. Congressional Research Service 11 The Provider Relief Fund: Frequently Asked Questions 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
provider for the second general distribution).provider for the second general distribution).5762 Some terms and conditions apply across all of the Some terms and conditions apply across all of the
allocations. These include certification that allocations. 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 will be used only to prevent, prepare for, or respond to the  that payment will be used only to prevent, prepare for, or respond to the
coronavirus and will be used only for health care expenses or lost revenue coronavirus and will be used only for health care expenses or lost revenue
attributable to the virus; attributable to the virus;
 that payment will not be used to reimburse expenses or losses that have been  that payment will 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.~~
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~~The Provider Relief Fund: Frequently Asked Questions~~

 the entity will comply, in the required timeframe, with HHS reporting  the entity will 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 will maintain appropriate records and cost documentation; and  the entity will maintain appropriate records and cost documentation; and
 for all presumptive or actual cases of COVID-19, the entity will not seek to  for all presumptive or actual cases of COVID-19, the entity will 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.5863
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.5964
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 all received funds within a year of receiving them, the uses of their funds and to have expended all received funds within a year of receiving them,
and to report all their expenditures within three months after the end of the expenditure period. and to report all their expenditures within three months after the end of the expenditure period.
For example, funds awarded between April 10 and June 30, 2020, must For example, funds awarded between April 10 and June 30, 2020, must behave been expended by June 30, 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.6065 This CRS report discusses the requirements that were issued on June 11, 2021; 62 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. 63 ~~This CRS report discusses the requirements that were issued on June 11, 2021, which~~
~~supersede prior reporting requirements and apply to 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 For more information on “in-network” and “out-of-network” coverage, see CRS Report R46856, For more information on “in-network” and “out-of-network” coverage, see CRS Report R46856, Surprise Billing in
Private Health Insurance: Overview of Federal Consumer Protections and Payment for Out-of-Network Services. .
5964 HHS, “Acceptance of Terms and Conditions,” https://www.hhs.gov/sites/default/files/terms-and-conditions-provider- HHS, “Acceptance of Terms 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.
6065 See Tables 1 and 2 on page 2 in HHS, “Provider Relief Fund General and Targeted Distribution Post-Payment Notice See Tables 1 and 2 on page 2 in HHS, “Provider Relief Fund General and Targeted 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.~~
~~61 HHS, “Provider Relief Fund General and Targeted 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.~~
~~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)~~.
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~~The Provider Relief Fund: Frequently Asked Questions~~

Congressional Research Service 12 The Provider Relief Fund: Frequently Asked Questions these are the most recent, and they supersede prior reporting requirements and apply to all past and future PRF allocations.66 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);67  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 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. Specifically, lost revenue reimbursements may be  lost revenue reimbursement. Specifically, 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.6368
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 all payments that meet the $10,000 entity then registers with that TIN and must report on all 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.6469 of Reporting Requirements,” June 11, 2021, https://www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf. 66 HHS, “Provider Relief Fund General and Targeted 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. 67 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). 68 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/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf. 69 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 13 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 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
received funding.received funding.6570 For example, the earliest deadline For example, the earliest deadline iswas June 30, 2021, which June 30, 2021, which ~~applies~~applied to providers 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 use their funds by the June 30, 2021, deadline associated with that distribution ~~are~~ were required to 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.6671
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

~~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/~~
~~provider-post-payment-notice-of-reporting-requirements-june-2021.pdf.~~
~~64 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.~~
65committees. The law also specified that the OIG may conduct audits of interim payments prior to the final report. Additionally, 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 made from the fund, summarized by state. It also required that these reports be updated every 60 days until the funds are expended. Author Information Elayne J. Heisler Specialist in Health Services 70 For a time line, see HHS, HHS, “HHS Issues Revised Notice of Reporting Requirements and Reporting Timeline for 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/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. 11/hhs-issues-revised-reporting-requirements-timeline-for-provider-relief-fund-recipients.html.
6671 HHS, HRSA, “Provider Relief Fund General Information,” see “Terms and Conditions,” at https://www.hrsa.gov/ HHS, HRSA, “Provider Relief Fund General Information,” see “Terms and Conditions,” at https://www.hrsa.gov/
provider-relief/faq/general. provider-relief/faq/general.
Congressional Research Service Congressional Research Service

1314 The Provider Relief Fund: Frequently Asked Questions

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

~~committees. The law also specified that the OIG may conduct audits of interim payments prior to~~
~~the final report. Finally, 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~~
~~made from the fund, summarized by state. It also required that these reports be updated every 60~~
~~days until the funds are expended.~~

~~Author Information~~

~~Elayne J. Heisler~~

~~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
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