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Future Payments

Phase 4 and ARP Rural Distributions

On November 23, 2021, HRSA began distributing ARP Rural payments. Applicants receiving payments will receive both an email notification as well as a paper letters with additional detail on their aggregate payment, including individual payment amount(s) for any eligible subsidiary billing TINs included in their application. The vast majority – approximately 96 percent – of ARP Rural applications have now been processed. Providers who have not yet received any communication regarding their payment determination will be notified as soon as HRSA completes the review and processing of the remaining applications. For more information on how payments are calculated, please consult the payment methodology webpage.

Within 90 days of receiving a payment, recipients must sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions of payment by re-entering the Provider Relief Fund Application and Attestation Portal. HRSA Exit Disclaimer Should a recipient choose to reject the funds, they must also complete the attestation to indicate this and return the funds within 15 calendar days.

To ensure transparency, HHS is publishing a public dataset with the names, locations (by city, state, and ZIP code), and payment amount of all ARP Rural payment recipients at the applicable subsidiary or billing TIN level, as well as a state-by-state breakdown of ARP Rural payments to date.

HRSA expects to begin releasing PRF Phase 4 payments in December 2021. Similar to the ARP Rural payments, HRSA plans to send individual communications to providers when final payment determinations are made. Providers with questions about the Phase 4 and ARP Rural application process should contact the Provider Support Line at 866-569-3522 (for TTY dial 711).

Resources

Attestation

ARP Rural Payment Recipients

Application Resources

* Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email the Provider Relief Bureau at PRBInformation@hrsa.gov.

General Program Information

Terms and Conditions

Technical Assistance Webinars

What Is the Provider Relief Fund?

Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

What Is ARP Rural?

ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers; funding will be available to providers who serve patients in these communities. Eligible applicants can apply for the ARP Rural funds through the same Application and Attestation Portal that is available to apply for the Phase 4 General Distribution. Providers will apply for both programs in a single application.

In order to be considered for an ARP Rural payment, applicants must include any billing Tax Identification (TIN) owned by the applicant. ARP Rural payments will be determined based on the amount and type of Medicare, Medicaid, and CHIP services provided by billing TINs to rural beneficiaries. Applicants do not need to verify whether their beneficiaries live in an area that meets the definition of rural. HRSA will base payments on data already available to it using the Federal Office of Rural Health Policy definition of rural.

What Does "Provider" Mean?

Any provider or supplier of health care, services, and support in a medical setting, at home, or in the community, including, but not limited to:

  • Academic Medical Centers
  • Children’s Hospitals
  • Acute care hospitals
  • Ambulatory surgical centers
  • Assisted Living Facilities
  • Behavioral health providers (e.g., substance use disorder, counseling, psychiatric services)
  • Dental services
  • Diagnostic services (e.g., independent imaging, radiology, labs)
  • Durable Medical Equipment (DME) suppliers
  • Eye and vision services
  • Federally Qualified Health Centers
  • Home and community-based support (e.g., housing services, care navigators, case management)
  • Home health agencies
  • Inpatient behavioral facilities (e.g., inpatient rehabilitation facilities, long-term acute care hospitals, other residential facilities)
  • Multi-specialty practices
  • Nursing homes and skilled nursing facilities
  • Other ancillary services (e.g., chiropractors, speech and language pathologists, physical therapy, occupational therapy)
  • Other inpatient facilities
  • Other outpatient clinics (e.g., urgent care, dialysis center)
  • Other services (e.g., foster care, developmental disability services)
  • Other single-specialty practices
  • Pediatrics practices
  • Pharmacies
  • Primary care practices
  • Rural Health Clinics

What Documentation Do I Need?

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

  • A comprehensive list of all billing TINs under the filing TIN that provide patient care and are owned by the filing TIN that is applying.
  • 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:
    If the applicant for tax purposes is a… The applicant must provide…
    Sole proprietor or disregarded entity owned by an individual IRS Form 1040 including Schedule C.
    Trust or estate IRS Form 1041 including Schedule C.
    Partnership IRS Form 1065.
    C corporation IRS Form 1120.
    S corporation IRS Form 1120-S.
    Tax-exempt organization IRS Form 990.
    Not required to file federal income taxes (e.g., government entities) Internally-generated financial statements (or management-prepared financial statements) and a statement explaining why the entity is not required to file a federal tax form.

Who Is Eligible To Apply?

Phase 4 General Distribution: To be eligible to apply, the applicant must meet all of the following requirements:

  1. 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.
  2. Must have either (i) filed a federal income tax return for fiscal years 2018, 2019, or 2020, or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return (e.g. a state-owned hospital or health care clinic); and
  3. Must have provided patient care after January 31, 2020; and
  4. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  5. If the applicant is an individual that was providing patient care, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.

ARP Rural Distribution: In accordance with the statutory requirements, to be eligible to apply for ARP Rural Payments, the applicant or at least one subsidiary TINs must be:

  1. A rural health clinic as defined in section 1861(aa)(2) of the Social Security Act; or
  2. A provider treated as located in a rural area pursuant to section 1886(d)(8)(E), such as critical access hospitals; or
  3. A provider or supplier that:
    1. Has directly billed for health care-related services between January 1, 2019 and September 30, 2020:
      1. Medicare fee-for-service (Parts A and/or B);
      2. Medicare Advantage (Part C)
      3. Their state/territory Medicaid program (fee-for service or managed care); or
      4. Their state/territory Children’s Health Insurance Program (CHIP); and
    2. Operates in or serves patients living in the HHS Federal Office of Rural Health Policy’s (FORHP) definition of a rural area:
      1. All non-Metro counties;
      2. All Census Tracts within a Metropolitan county that have a Rural-Urban Commuting Area (RUCA) code of 4-10. The RUCA codes allow the identification of rural Census Tracts in Metropolitan counties;
      3. 132 large area census tracts with RUCA codes 2 or 3. These tracts are at least 400 square miles in area with a population density of no more than 35 people per square mile; and
      4. 295 outlying Metropolitan counties with no Urbanized Area population.

Payments from both programs can be used for lost revenues or eligible expenses incurred dating back to from Jan. 1, 2020 which are not obligated to be reimbursed from another funding source.

How Will Payments Be Calculated?

Read the Phase 4 and ARP Rural - Payment Calculation Methodologies to understand how payments will be calculated and how HHS will continue to use risk mitigation and cost containment measures to protect program integrity and preserve taxpayer dollars.

Phase 4 General Distribution: Consistent with the requirements included in the December appropriations bill, 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 beneficiaries.

Approximately 75% of the Phase 4 allocation will be used for Base Payments, which are a percentage of a provider’s change in quarterly operating revenues and expenses.

  • Provider size categories (Small, Medium, and Large) will be based on annual net patient care revenues, and will be established after the close of the Phase 4 application.
  • Large providers will receive a Base Payment amount that is a percentage of the change in their quarterly operating revenues and expenses.
  • Base Payments for medium and small providers will include the same percentage of the change in their quarterly operating revenues and expenses plus a scaled supplement, with small providers receiving the greatest amount.
  • No provider will receive a Base Payment that exceeds 100% of their change in quarterly operating revenues and expenses.

Approximately 25% of the Phase 4 allocation will be put towards bonus payments.

  • Bonus payments will be based on the amount and type of services provided to Medicaid, CHIP, and Medicare beneficiaries from January 1, 2019 through September 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.

ARP Rural Distribution: HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and CHIP services provided to rural beneficiaries from January 1, 2019 through September 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.
  • Eligible billing TINs that have at least one Medicaid, CHIP, or Medicare claim for a rural beneficiary will receive a minimum payment of $500.
Date Last Reviewed:  November 2021