Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP)

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Health Resources and Services Administration (HRSA) released information on the $17 Billion Phase 4 and the $8.5 Billion Rural Distribution application. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

Supporting documentation and information needed to complete an application will include:

  • Applicant Tax Identification Number (TIN) and TINs for any subsidiaries

  • Internally-generated financial statements that substantiate operating revenues and expenses from patient care in 2019 Q1, Q3, and Q4; 2020 Q3 and Q4; and 2021 Q1 

  • Federal income tax return, audited financial statements, or internally-generated financial statements submitted in their entirety.

Application portal was open today.  CLICK HERE>>

Providers will apply for both programs in a single application Applications must undergo a number of validation checks before financial information is submitted. Providers are encouraged to begin their application as soon as possible to ensure they are able to meet the deadline. The application will close on October 26, 2021, at 11:59 p.m. ET.

Phase 4 General Distribution

PRF Phase 4 payments will be based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021. Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their changes in operating revenues and expenses at a higher rate compared to larger providers, and bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patient.

75% of the Phase 4 allocation will be calculated based on changes in operating revenues and expenses.

  •  Large providers will receive a minimum payment amount that is based on a percentage of their changes in operating revenues and expenses.

  • Medium and small providers will receive a base payment plus a supplement, with small providers receiving the highest supplement, as smaller providers tend to operate on thin margins and often serve vulnerable or isolated communities.

  • HHS will determine the exact amount of the base payments and supplements after analyzing data from all the applications received to ensure we stay within our budget and funds are distributed equitably.

  • No provider will receive a Phase 4 payment that exceeds 100% of their losses and expenses.

  • HHS will continue to use risk mitigation and cost containment measures in Phase 4 to protect program integrity and preserve taxpayer dollars.

25% of the Phase 4 allocation will be put towards bonus payments that are based on the amount and type of services provided to Medicaid, CHIP, and Medicare patients.

  • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.

Eligible providers:

  • Providers or suppliers who bill Medicare fee-for-service (Parts A and/or B) or Medicare Advantage, Medicaid (fee-for service or managed care) or CHIP as well as:

  • Dental service providers

  • State-licensed or certified assisted living facilities

  • Behavioral health providers

ARP Rural Distribution

Providers who serve Medicaid, CHIP, and Medicare patients who live in rural communities are eligible for the ARP Rural payments.

HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and CHIP services provided to rural patients from Jan. 1, 2019 through Sept. 30, 2020.

HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.

Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

ARP Rural payments will be determined based on the location of the patients, not the provider. Provider does not need to verify whether their patients live in an area that meets the definition of rural. Providers would have to select whether their organization (including any subsidiaries) would like to be considered for ARP Rural payments during the application process. HRSA will base payments on data already available to them on the amount and type of Medicare, Medicaid, and CHIP services provided to rural patients. HRSA will use the Federal Office of Rural Health Policy definition of rural.

For more information or assistance with your individual rate, contact your MSL representative who will be happy to assist your organization. Please contact us at 1-800- 683-5401.