SPARK Funding Update
KHA Contacts: Tara Mays and Shannan Flach
The State Office of Recovery has released some information about next steps for qualifying hospitals that may have interest in applying for the recently allocated SPARK frontline retention funds. The Office of Recovery has requested to receive a Letter of Intent from each eligible hospital by 5 p.m. on Friday, Sept. 24. KHA staff has reached out to qualifying hospitals. The Office of Recovery will be hosting a Webinar at 11 a.m. on Wednesday, Sept. 29 in which additional details will be shared about the application process, funding timeline and reporting requirements. Register online.
KHA Summary of Funding for Hospitals During COVID-19 Crisis
CARES Act Overview
KHA Contacts: Audrey Dunkel and Shannan Flach
The Coronavirus Aid, Relief, and Economic Security Act, Public Law 116-136, signed into law on March 27, included $100 billion in Public Health and Social Service Emergency Fund appropriations to be distributed by grants or other payment mechanisms to healthcare providers for expenses or lost revenues attributable to COVID-19 not reimbursable to by other sources. Providers will be reimbursed through grants and other payment mechanisms.
Coronavirus Relief Fund
KHA Contact: Audrey Dunkel
The CARES Act provides $150 billion in assistance for governments in states, territories and tribal areas through the Coronavirus Relief Fund. Eligibility is dependent on the location, level of government, and use of potential funds. The funds can be used to pay for three types of programs:
- Programs that are necessary expenditures incurred due to the public health emergency with respect to COVID-19;
- Programs that were not accounted for in the budget most recently approved as of the date of enactment (March 27, 2020) of this section for the State or government; and
- Programs that were incurred during the period beginning on March 1, 2020, and ending on Dec. 3, 2020.
Federal Reserve Emergency Lending Program
KHA Contact: Audrey Dunkel
The CARES Act authorizes $454 billion in emergency loans for businesses, states and municipalities, subject to certain conditions. The bill encourages Treasury to establish a lending program for organizations with between 500 and 10,000 employees. The program would be available to both for-profit and non-profit hospitals. Governmental hospitals would have access to the funds through the state or municipality.
Public Health and Social Services Emergency Fund
KHA Contacts: Audrey Dunkel and Shannan Flach.
The CARES Act includes $100 billion in Public Health and Social Service Emergency Fund appropriations to be distributed by grants or other payment mechanisms to healthcare providers for expenses or lost revenues attributable to COVID-19 and not reimbursable by other sources. Providers will be reimbursed through grants and other payment mechanisms. The Paycheck Protection Program and Health Care Enhancement Act became law on April 24 providing more funding to health care providers by adding $75 billion to the CARES Act Provider Relief Funding (see more information below).
GENERAL DISTRIBUTIONS
American Rescue Act (ARP) Rural Payment –11/23/21
HRSA began releasing ARP Rural payments to providers and suppliers who have served rural Medicaid, Children's Health Insurance Program, and Medicare beneficiaries from Jan. 1, 2019 through Sept. 30, 2020. Every eligible provider that served at least one rural Medicare, Medicaid, or CHIP beneficiary will receive funding. The average payment announced in November 2021 was approximately $170,700, with payments ranging from $500 to approximately $43 million. Providers in all 50 states, Washington, DC, and six territories will receive ARP Rural payments. In Kansas, 692 providers will receive funding for a total of $135,094,348.
CARES Act Provider Relief Fund General Distribution Phase 1 – ($50 Billion) – Initial $30 Billion
In order to expedite emergency funds to hospitals and health systems from the CARES Act, HHS disbursed $30 billion to all facilities and providers that received Medicare fee-for-service payments in 2019. Health care providers received a disbursement on either April 10 or April 17 based on their share of the total 2019 Medicare fee-for-service payments. Letter to Members on CARES Act Funding – April 10, 2020.
An additional $20 Billion
An additional tranche of $20 billion was disbursed to a portion of providers on April 24 based on revenue data from their 2018 Medicare cost reports. The payment made to each provider took into account what they had previously received in the initial $30 billion tranche of funding so that their total allocation under Phase 1 is proportional to their share of 2018 total net patient revenue. HHS stated that on April 24, a portion of providers would automatically be sent a payment based on the revenue data from their Medicare cost reports. Providers without adequate code report data must submit this information to a portal. Payments will be distributed weekly on a rolling basis as information is validated.
CARES Act Provider Relief Fund General Distribution Phase 2 – ($18 Billion)
HHS made available $18 billion in Phase 2 General Distribution. Eligible providers include participants in state Medicaid/CHIP programs, Medicaid managed care plans, dentists and certain Medicare providers including those who missed Phase 1 General Distribution payment equal to 2 percent of their patient care revenue or who had a change in ownership in 2019 or 2020. Assisted living facilities are also eligible to apply.
CARES Act Provider Relief Fund General Distribution Phase 3 – ($24.5 Billion)
HHS made available $20 billion in new funding available for Phase 3 General Distribution allocation. Providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be eligible to apply, and an expanded group of behavioral health providers will also be eligible for relief payments. On Dec. 16, HHS announced an additional $4.5 billion would be added to the Phase 3 distribution to satisfy close to 90 percent of each applicant's reported lost revenues and net change in expenses caused by the COVID-19 pandemic.
Targeted Distributions
COVID-19 High-Impact Targeted Distribution – ($22 Billion)
April 21, HHS announced it would be distributing $10 billion to hospitals in areas particularly impacted by the COVID-19
outbreak. The Department of Health and Human Services announced on July 17, it would distribute an additional $10 billion from the PHSSEF to hospitals that had been highly impacted by COVID-19.
Rural Targeted Distribution – ($11 Billion)
HHS allocated $10 billion to rural hospitals and rural health clinics as early as the week of April 27 on the basis of operating expenses, using a methodology that distributes payment proportionately to each facility and clinic.
On July 10, HHS announced an additional $1 billion would be going out to specialty rural hospitals, urban hospitals with certain Medicare designations, and hospitals in small metropolitan areas. The additional funding is an expansion of the criteria for the initial $10 billion rural payments and will go to 500 hospitals.
Rural Health Clinic Funding – ($225 Million)
On 5-20-20, HHS distributed $225 million nationally to RHCs at a rate of nearly $50,000 per site to support COVID-19 testing efforts and expand access to testing in rural communities. There were 174 Kansas RHCs in Kansas that received a total of around $8.6 million.
Skilled Nursing Facilities Targeted Distribution – ($7.4 Billion)
HHS distributed a series of funding to nursing homes across the nation. The first distribution was $4.9 billion to Skilled Nursing Facilities and a second distribution of nearly $2.5 billion to skilled nursing facilities and nursing homes nationwide was distributed to help combat the devastating effects of this pandemic. Additionally, a separate $2 billion incentive payment structure was established to provide more funding to nursing homes and skilled nursing facilities based on certain performance measures.
Tribal Hospitals, Clinics and Urban Health Centers Targeted Distribution – ($500 Million)
HHS distributed $500 million to Tribal hospitals, clinics and urban health centers distributed on the basis of operating expenses. This funding complements other funding provided to expand Indian Health Service's capacity for telehealth and testing.
Safety Net Hospitals Targeted – ($14.4 Billion)
On June 12, HHS announced $10 billion in funding would be made to eligible hospitals serving a disproportionate share number of Medicaid patients and who provided large amounts of uncompensated care.
An additional distribution of $3 billion was announced by HHS on July 10 to allow hospitals that did not qualify for the June distribution to receive funding. HHS expanded the criterion for the payment qualification for the profitability threshold that was established in the earlier distribution.
HHS also distributed $1.4 billion to nearly 80 free-standing children's hospitals facing financial hardships caused by the pandemic.
Allocation for Uninsured Patients
A portion of the funds will be distributed to health care providers who have provided treatment for uninsured COVID-19 patients on or after Feb. 4, 2020. Providers can request claims reimbursement and will be reimbursed at Medicare rates, subject to available funding. To request reimbursements and learn how the program works, visit the COVID-19 Uninsured Program Portal.
Rural Health Clinic COVID-19 Testing and Mitigation Program
In June 2021, the HRSA awarded $424million to rural health clinics for COVID-19 testing. $100,00 each to more than 4,200 rural health clinics to maintain and increase COVID-19 testing, expand access to testing for rural residents, and broaden efforts to mitigate COVID-19's spread in ways tailored to their local communities.
CARES Act Small Business Administration (SBA) 7(a) Loans/Payroll Protection Program
KHA Contact: Steve Poage
Eligible hospitals are encouraged to work with their local bank to access these funds available through the Small Business
Administration.
The Small Business Administration and the Department of the Treasury have issued final guidance on the Payment Protection Program that was part of the CARES Act. Additional information and resources, including the application form, are online Kansas SBA Statewide Lender
Paycheck Protection Program and Health Care Enhancement Act
KHA Contact: Steve Poage and Shannan Flach
On April 24, the PPPHCEA was signed into law, which adds another $484 billion in a COVID-19 "3.5" relief package. This package includes an additional $75 billion in funding to hospitals and other health care providers to reimburse eligible health care providers for healthcare-related expenses or lost revenues not otherwise reimbursed that are directly attributable to COVID-19. The package also includes an additional $349 billion for the Paycheck Protection Program, as well as providing funding to support efforts to research, develop, validate, manufacture, purchase and expand capacity for COVID-19 tests.
ASPR Grant (Assistant Secretary for Preparedness and Response)
KHA Contact: Ron Marshall
HHS announced it would provide $100 million in aid to hospitals and health care systems in preparing for a surge in COVID-19 patients. Of that funding, $50 million was allotted to State Hospitals Associations for distribution through competitive grant applications. KHA received $784,542 in funds, which were distributed on May 1. Recently, KHA was awarded an additional $1.95 million to be distributed in the future.
Medicare Accelerated/Advance Payment Program
KHA Contact: Shannan Flach
As authorized through the CARES Act, the Centers for Medicare & Medicaid Services expanded the Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers, during the duration of the public health emergency. Part A inpatient acute care hospitals, children's and cancer hospitals can request up to 100 percent of their Medicare payment amounts for a six-month period, and CAHs can request up to 125 percent of their Medicare payment amounts for a six-month period. Repayment of the Accelerated Payments was originally scheduled to begin 120 days after issuance of the payment with repayment in full after 12 months. The program was suspended on April 26, 2020. The Continuing Appropriations Act 2021 and Other Extension Act extended the repayment terms to begin one year after the payment was issued and as well as changing the recoupment terms and the interest rate for unrecovered payments.
Payroll and Taxes
KHA Contact: Steve Poage
Private Loan Financing: Kansas Bankers Association (KBA)
KHA Contact: Steve Poage
COVID-19 SHIP Funds (Small Hospital Improvement Program)
KHA Contact: Jennifer Findley
The Health Resources and Services Administration's Federal Office of Rural Health Policy received funding through the CARES Act. HRSA will use CARES funding to assist hospitals that are eligible through the Small Rural Hospital Improvement Program. One-time funding will provide support to hospitals to prevent, prepare for, and respond to the COVID-19 public health emergency. The Kansas COVID-19 SHIP is managed by the State Office of Rural Health within the Bureau of Community Health Systems at the Kansas Department of Health and Environment. KDHE has contracted with KHERF to administer this program.
State of Kansas COVID-19 Grant
KHA Contact: Shannan Flach
On April 16, Governor Laura Kelly announced a special emergency grant funding program for Kansas hospitals. This emergency funding was requested by KHA on behalf of the community hospitals and is being distributed to help offset the financial strains caused by the COVID-19 pandemic. Hospitals are not required to complete an application, and there are no specific requirements tied to the utilization of the funds. The grant funds are being distributed in the following manner: Critical Access Hospitals will receive $100,000; Rural PPS hospitals will receive $150,000, and Semi-Urban (as noted by KDHE's Map of Peer County Groups below) and Urban PPS hospitals will receive $250,000. Payments will be distributed electronically on April 24.
KHA Sponsor COVID-19 Resources
Other Funding Options/Resources
The USDA announced it is temporarily deferring payments for borrowers participating in both the USDA Community Facilities Direct Loan Program and Guarantee Loan Program.