Cases of COVID-19 continue to rise, contributing to financial pressures across our community, including to our healthcare provider organizations and individual practices. To help our PCMH providers, as well as independent practices in certain specialty areas, CareFirst is accelerating funding to numerous provider organizations in Maryland, Washington, D.C. and Northern Virginia.
CareFirst Accelerated Payment Program
In April 2020, CareFirst announced our Accelerated Payment program, which offered temporary advanced funding for certain PCMH practices, independent OBGYN, dental and behavioral health providers who needed additional assistance. At this time, CareFirst is no longer accepting applications for this program.
Through the CARES Act and FFCRA, relief for hospitals and providers are being implemented by federal agencies through direct payments, grants and other mechanisms. Funding and relief programs are outlined below.
A $1.4 trillion year-end spending package, “the Consolidated Appropriations Act (H.R. 133)” was signed into law on December 27, which provides $3 billion additional funding to the Provider Relief Fund. It also provides increased reporting and payment flexibilities for providers applying for or using these relief funds. More guidance will be released regarding these additional federal assistance for hospitals and providers.
Provided $106 billion in loans to providers and suppliers in March. Including:
- 22,000 Part A providers, totaling more than $98 billion in accelerated payments.
- More than 28,000 Part B suppliers—including doctors, non-physician practitioners and Durable Medical Equipment (DME) suppliers—received advance payments totaling more than $8.5 billion..
Funding Details and Timeline:
CMS announced new repayment terms for these Medicare loans: Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.
CMS also provided guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships.
To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans
Provides $200 million to promote telehealth for low-income consumers at their homes or mobile locations and ensure access to connected care services and devices in response to COVID-19.
Funding will be used for eligible health care providers to purchase telecommunications services, information services, and devices necessary to provide critical connected care services, whether for treatment of coronavirus or other health conditions during the coronavirus pandemic.
Each award cannot be more than $1 million.
Eligible providers in rural or urban areas: (1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; (2) community health centers (3) local health departments (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; or (8) other health care providers.
Applicants must obtain an eligibility determination from the Universal Service Administrative Company (USAC).
The application portal opened on Monday, April 13 at 12 pm ET.
The program is reviewing applicants on a rolling basis from now until the funding is expensed or the current pandemic has ended.
Steps parties can take in advance of filing an application:
- Obtain an FCC Registration Number (FRN) from the Commission Registration System (CORES), as well as a CORES username and password at that link. An FRN is a 10-digit number that is assigned to a business or individual registering with the FCC and is used to identify the registrant’s business dealings with the FCC.
- Obtain an eligibility determination from the Universal Service Administrative Company (USAC) by filing FCC Form 460.
- Register with the federal System for Award Management (SAM)
Paycheck Protection Program and Health Care Enhancement Act
H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act was signed into law by the President. Dubbed “Package 3.5”, the $484 billion interim relief package provides additional funding for small businesses, providers, and COVID-19 testing, including an additional $75 billion for the Provider Relief Fund for hospitals and healthcare providers to support COVID-19-related expenses and lost revenue.
On May 7, HHS, through the Health Resources and Services Administration (HRSA), awarded nearly $583 million, authorized from the Paycheck Protection Program and Health Care Enhancement Act, to 1,385 HRSA-funded health centers in all 50 states, the District of Columbia, and eight U.S. territories to expand COVID-19 testing.
- Nearly 88 percent of HRSA-funded health centers report testing patients, with more than 65 percent offering walk-up or drive-up testing. Health centers are currently providing more than 100,000 weekly COVID-19 tests in their local communities.
- These investments build upon the $1.42 billion HRSA has already awarded to health centers to address COVID-19.
- See here for a list of providers receiving funding from HRSA
On May 20, HRSA announced an additional $225 million for COVID-19 Testing to 4,500 rural health clinics. These investments will support COVID-19 testing efforts and expand access to testing in rural communities.
On June 11, HRSA awarded $8 million to 73 organizations to expand COVID-19 training and technical assistance for health centers.
- Primary Care Associations (PCAs) received nearly $6 million to conduct COVID-19 T/TA activities based on the needs of states and regions.
- National Training and Technical Assistance Partners (NTTAP) received $2.5 million to enhance their COVID-19 T/TA to health centers, including strengthening health center operations and capacity to ensure access to comprehensive primary care services.
On June 18, HRSA awarded $107.2 million to 310 recipients to grow and train the health workforce in rural and underserved communities, across 45 states and U.S. territories.
On July 9, HRSA awarded $21 million to 78 Health Center Program look-alikes to expand capacity for COVID-19 testing. HRSA also awarded $4.5 million to support the COVID-19 response of Health Center Controlled Networks (HCCNs) to strengthen health IT support necessary to effectively prevent, prepare for and respond to COVID-19.
Funding for Testing
HHS announced the delivery of more than $11 billion in new funding to support COVID-19 testing efforts. Specifically, the CDC will provide $10.25 billion to states, territories, and local jurisdictions through CDC’s existing Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) cooperative agreement, and the Indian Health Service (IHS) will provide $750 million to IHS, tribal, and urban Indian Health programs to expand testing capacity and testing-related activities (funding recipients).
NIH awarded $234 million to improve COVID-19 testing for underserved and vulnerable populations. A part of the Rapid Acceleration of Diagnostics (RADx) initiative, the RADx Underserved Populations (RADx-UP) program will support 32 institutions across the United States and will focus on populations disproportionately affected by the pandemic. The program aims to understand COVID-19 testing patterns better among underserved and vulnerable populations; strengthen the data on disparities in infection rates, disease progression and outcomes; and develop strategies to reduce these disparities in COVID-19 testing.
Maryland Health Services Cost Review Commission (HSCRC)
HSCRC is allowing hospitals to increase unit rates by approximately 5% as their volumes have declined substantially.
In line with the CARES Act provision, the agency is evaluating ways to implement the potential Medicare rate increase for inpatient COVID-19 cases, but no guidance has been released yet.
Provides hospital support funding through grants to eligible hospitals.
Grant amounts will be based on an allocation formula based on the number of beds or other methods.
Hospitals can use the grants to cover medical supplies and equipment, personnel costs, and costs of constructing and operating temporary sites.
While funding has been allocated, additional guidance on how to apply for these grants is still to come.
DC Contingency Cash Reserve Fund for COVID-19 Medical Surge
Mayor Bowser directed $35 million of the District’s Contingency Cash Reserve Fund to provide support to hospitals for the need for increased medical services.
Suspension of mandated Medicare sequestration cuts
2% increase in Medicare payment across the board.
Enhanced Medicare inpatient payment
20% enhanced Medicare inpatient payment for services provided to patients with a COVID-19 diagnosis.
Federal Nurse Education Grants
For FY2021-2025, $137 million for nurse education and practice grants and activities.
Federal Student Loan Program
To provide relief for student loan borrowers, federal student loan borrowers are automatically placed in administrative forbearance with 0% interest for the following types of loans:
- Defaulted and non-defaulted Direct Loans;
- Defaulted and non-defaulted FFEL Programs Loans
- Federal Perkins Loans
Students can contact their loan servicer to determine if their loans are eligible for 0% temporary interest rate.
President Biden signed an Executive Order to extend the pause on federal student loan interest and principal payment through the end of September.
Hospital Preparedness Program Grants
$250 million in funding for grants or cooperative agreements with grantees or sub-grantees of the Hospital Preparedness Program or that meet other criteria to be established by HHS.
Increase in federal payments to states
$4 billion increase in federal payments to states for uncompensated care funding through delayed cuts to the Disproportionate Share Hospital (DSH) payments.
Assistance to Community Health Centers
HHS/HRSA awarded $117 million in quality improvement awards to 1,318 health centers across all states, territories and D.C. HRSA-funded health centers will use these funds to strengthen quality improvement activities and expand quality primary care service delivery.
Funding for Ryan White HIV/AIDS Program
HHS/HRSA awarded $90 million for 581 Ryan White HIV/AIDS Program recipients in FY2020 across the country, including city/county health departments, health clinics, community-based organizations, state health departments, and AIDS Education and Training Centers.
HHS/HRSA Federal Office of Rural Health Policy (FORHP) awarded $165 million to 1,779 small rural hospitals and provides additional funding to 14 HRSA-funded telehealth resource centers to provide technical assistance on telehealth to help rural and underserved areas.
In response to the President's Executive Order on Improving Rural Health and Telehealth Access, HHS/HRSA awarded over $35 million to increase access to high-quality healthcare in rural communities. The awards reflect investments to more than 50 rural organizations across 33 states in key areas, including telehealth, health workforce training, health research, and technical assistance for vulnerable rural hospitals and HIV care and treatment.
Additional Assistance to Support Telehealth
HHS/HRSA Bureau of Health Workforce awarded $15 million to 159 organizations across five health workforce programs to increase telehealth capabilities in response to the COVID-19 pandemic. These investments will train students, physicians, nurses, physician assistants, allied health and other high-demand professionals to maximize telehealth for COVID-19 referrals for screening and testing, case management, outpatient care, and other essential care during the crisis.
HHS/HRSA Federal Office of Rural Health Policy awarded $5 million to two recipients through the Licensure Portability Grant Program to assist telehealth clinicians nationally on licensure and credentialing. Recipients will work with professional and state licensing boards and compacts to develop a streamlined process for telehealth clinicians to obtain multi-state licensure.
See here for a list of FY2020 COVID-19 Workforce Telehealth Awardees
HHS/HRSA awarded $8 million to fund the Telehealth Broadband Pilot (TBP) program. The TBP program assesses the broadband capacity available to rural healthcare providers and patient communities to improve their access to telehealth services.
- $6.5 million was awarded to the National Telehealth Technology Assessment Resource Center (TTAC), based out of the Alaska Native Tribal Health Consortium. The TTAC will implement the TBP in four state community locations, including Alaska, Michigan, Texas and West Virginia. TTAC will also work with the Rural Telehealth Initiative's federal partners to improve rural communities' access to broadband and telehealth services through existing funding opportunities and grant programs.
- HRSA's Federal Office of Rural Health Policy (FORHP) also awarded the Telehealth-Focused Rural Health Research Center through the University of Arkansas $1.5 million to evaluate the TBP program across all participating communities and to serve as a resource on telehealth for rural communities around the nation.
Funding for behavioral health
$425 million in funding for SAMSHA for Health Surveillance and Program Support; to remain available through FY 2021, to prevent, prepare for, and respond to coronavirus, domestically or internationally:
- $250 million: Certified Community Behavioral Health Clinic Expansion Grant program. Application closed on March 10.
- $100 million: SAMSHA Emergency Response Grants.
- $50 million: Suicide prevention programs.
- $15 million: To be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers.
SAMHSA is providing $40 million in emergency grants for suicide prevention. The grants will support states and communities during the COVID-19 pandemic in advancing efforts to prevent suicide and suicide attempts among adults 25 and older in order to reduce the overall suicide rate and number of suicides in the United States. The program also includes a special focus on victims of domestic violence.
Funding for vaccines
- Funding recipients are existing grantees through CDC’s Immunizations and Vaccines for Children cooperative agreement
Federal and state business assistance programs can provide low-interest loans, grants and tax relief if certain conditions are met. The Consolidated Appropriations Act, signed into law on December 27, 2020, extended deadline and applicability dates of several federal assistance programs, including the Paycheck Protection Program. These programs will be updated in the coming weeks as additional federal guidance is released. For Maryland county-specific grant programs, please see Maryland’s COVID-19 business support website.
Provides quick turnaround loans to overcome an immediate loss of revenue for businesses that have an established business relationship with a Small Business Administration (SBA) lender.
Loans with quick application times of up to $25,000. Provides cash flow for businesses waiting on a decision and disbursement of an Economic Injury Disaster Loan (EIDL).
Loan will be repaid with proceeds from the EIDL.
Must be a small business operating for profit.
Must have been an operating business as of March 13, 2020 and be adversely impacted by COVID-19.
Must also have an established banking relationship with an SBA Express Lender.
Must apply through March 13, 2021.
Contact your local Small Business Development Center or SBA Express Loan Lender for more information on how to apply.
Required documentation will include an IRS tax transcript, documentation providing an existing financial relationship between the business and the lender and a borrower information form.
Encourages employers who are not able to provide services due to COVID-19 to keep employees on their payroll by providing payroll tax credits per employee.
NOTE: The Consolidated Appropriations Act, signed into law on December 27, 2020, extends the tax credits through July 1, 2021, and increases the amount of the credit.
The tax credit covers 70% of the qualified wages each employee is paid. The maximum amount of wages taken into account is $10,000, so employers will receive a maximum of $14,000 per employee.
Any business that either:
- Fully or partially suspends operations in 2020 due to COVID-19, or
- Experiences a significant decline in gross receipts during the calendar quarter (i.e., 50% less compared to same quarter in 2019).
Government employees are not eligible for this credit.
Self-employed individuals are not eligible for this credit for their self-employment earnings.
Businesses may take both the Employee Tax Credit and participate in the Paycheck Protection Program
Applies to wages paid between March 12, 2020 and July 1, 2021.
- Report total qualified leave wages for each quarter on the federal employment tax return, typically form 941.
- Employers may retain federal employment taxes to provide qualified leave wages to their employees. If the taxes set aside are not sufficient, request a credit advance by completing Form 7200.
- If requesting an advance, fax a completed Form 7200 to the IRS at 855-248-0552.
The CARES Act allows employers to delay and defer estimated quarterly tax payments and employer payroll taxes.
NOTE: The Consolidated Appropriations Act, signed into law on December 27, 2020, extends the tax credits through March 2021.
Not applicable if the employer has had indebtedness forgiven under the Paycheck Protection Program.
However, if the employer has received a Paycheck Protection Program loan, but it has not yet been forgiven, the employer may defer taxes until the lender issues a decision to forgive the loan.
Applies to wages between March 27, 2020 through March 2021.
Deferred payroll taxes are due in two installments: 50% by December 31, 2021, and 50% by December 31, 2022.
Issued by the Small Business Administration (SBA), provides forgivable loans for small businesses to keep workers on the payroll during the COVID-19 pandemic.
The Consolidated Appropriations Act, signed into law on December 27, 2020, reopened the Paycheck Protection Program.
NOTE: Starting Wednesday, February 24, 2021, the SBA established a 14-day, exclusive PPP loan application period for businesses and nonprofits with fewer than 20 employees
100% of the loan can be forgiven if during the 8 to 24-week period following loan disbursement:
- Employee and compensation levels are maintained
- The loan proceeds are spent on payroll costs and other eligible expenses
- At least 60% are spent on payroll costs
Loan payments are deferred until the loan is forgiven. If a borrower does not apply for loan forgiveness, payments are deferred for 10 months after the end of the period of loan forgiveness (8 or 24 weeks)
Loans have an interest rate of 1% and maturity of five years
Loans can be used to fund payroll costs, including benefits, and may also be used to pay for mortgage interest, rent, utilities, worker protection costs related to COVID-19, uninsured property damage costs caused by looting or vandalism during 2020, and certain supplier costs and expenses for operations.
For First Time PPP Loans, the loans can be up to 2.5 times the average monthly payroll, subject to a $10 million cap
For Second Time PPP Loans, the loans can be up to 2.5 times average monthly payroll, subject to a $2 million cap. For borrowers in the Accommodation or Food Services Sector (see here) the max loan amount is 3.5 times up to $2 million.
First Time PPP Loans: Those that have not previously received a PPP loan, that are:
- Sole proprietor, independent contractor or self-employed
- Any small business concern that meets SBA’s size standards (either the industry size standard or the alternative size standard, see SBA’s size-based tool for more information)
- Any business, 501(c)(3) non-profit organization, 501(c)(19) veterans organization or tribal business concern (sec. 31(b)(2)(C) of the Small Business Act) with the greater of:
- 500 employees, or
- That meets the SBA industry size standard if > 500
- Any business with a NAICS code that begins with 72 (Accommodations and Food Services) that has more than one physical location and employs less than 500 per location.
Second Time PPP Loan:
- Previously received a First Draw PPP Loan and will or has used the full amount only for authorized uses
- Has no more than 300 employees; and
- Can demonstrate at least a 25% reduction in gross receipts between comparable quarters in 2019 and 2020.
Apply by March 31, 2021
- Complete the Paycheck Protection Program loan application (separate applications for first time and second time borrowers) and assemble payroll documentation
- Submit the application and required documentation to an approved SBA lender. See SBA’s Lender Match tool for a list of lenders in your area.
- To apply for forgiveness, contact your lender and complete the appropriate form.
Issued by the Small Business Administration (SBA), the Economic Injury Disaster Loan (EIDL) provides working capital loans and loan advances for payroll and operating expenses for businesses impacted by COVID-19.
NOTE: As of June 15, this program is available to both agricultural businesses and all other small businesses.
NOTE: While loans are still available, the loan advance of up to $10,000 is no longer available.
The EIDL provides low interest loans of up to $2 million with principal and interest deferment at the Administrator’s discretion.
Can be combined with a Paycheck Protection Loan as long as they don’t cover the same expenses.
EligibilityAny business with 500 or fewer employees is eligible to apply.
Agricultural businesses under 500 employees are also eligible. Includes those engaged in the production of food and fiber, ranching, and raising of livestock, aquaculture, and all other farming and agricultural related industries.
Business must have 500 or fewer employees to apply.
Subject to funding availability