Further Clarification on HHS Phase 4 Eligibility

Phase 4 General Distribution

Regarding our recent blog about the HHS Phase 4 Provider Relief Fund, there is one point of clarification we would like to make.

  • For the Base Payment most healthcare providers who can demonstrate a loss in the applicable period should qualify.
  • However, for the Bonus Payment a healthcare provider must have billed Medicaid, CHIP and Medicare. Below are additional, specific rules for eligibility.

To be eligible to apply, the applicant must fall into one of the following categories:

  1. Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, their state/territory Medicaid program (fee-for service or managed care) or Children’s Health Insurance Program (CHIP) for health care-related services during the period of January 1, 2019 to December 31, 2020; or
  2. Must be a dental service provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for oral health care-related services during the period of January 1, 2019 to December 31, 2020;
  3. Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, Medicare fee-for-service (Parts A and/or B) or Medicare Advantage (Part C) for health care-related services during the period of January 1, 2019 to December 31, 2020;
  4. Must be a state-licensed/certified assisted living facility on or before December 31, 2020;
  5. Must be a behavioral health provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for health care-related services during the period of January 1, 2019 to December 31, 2020;
  6. Must have received a prior Targeted Distribution payment.

To be eligible for the base payment:

  • Must be able to show an overall loss due to changes in revenue and expenses from July 1, 2020 to March 31, 2021

To be eligible for the bonus payment:

  • Must have provided services to Medicaid, CHIP, and Medicare beneficiaries from January 1, 2019 through September 30, 2020.

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