PYA Covid-19 Information Hub
Published February 10, 2021

Provider Relief Fund: $40 Billion Still Has Not Been Distributed

Since March 2020, Congress has appropriated $178 billion to the Provider Relief Fund to assist hospitals, physicians, and other providers with lost revenue and healthcare-related expenses attributable to the coronavirus.    

Legislation

Date

Amount

Coronavirus Aid, Relief, and Economic Security (CARES) Act

March 2020

$100 billion

Paycheck Protection Program and Health Care Enhancement Act

April 2020

$  75 billion

Consolidated Appropriations Act, 2021

December 2020

$    3 billion

TOTAL

 

$178 billion

The agency within the Department of Health and Human Services (HHS) responsible for administering the Provider Relief Fund, the Health Resources and Services Administration (HRSA), has not published a detailed accounting of payments made to providers. Instead, HRSA announced a series of general and targeted distributions throughout 2020. Added together, these announced distributions total $150.4 billion. 

Distribution

Total Amount

Date Announced

Phase I General Distribution

$50 billion

April

Phase II General Distribution

$18 billion

June

Phase III General Distribution

$24.5 billion 

October

High Impact Area Targeted Distributions

$22 billion

May and July

Rural Provider Targeted Distributions

$11.3 billion

May and July

Skilled Nursing Facility Targeted Distribution

$  4.9 billion

May

Nursing Home Infection Control Distribution

$  2.5 billion

August

Nursing Home Quality Incentive Payments

$  2 billion

September

Indian Health Services Targeted Distribution

$  0.5 billion

May

Safety Net Hospitals Targeted Distributions

$13.3 billion

June and July

Children’s Hospitals Targeted Distribution

$  1.4 billion

August

TOTAL

$150.4 Billion

 

In addition to these distributions, HRSA is using Provider Relief Fund monies to pay claims made by providers for COVID-19 testing and treatment furnished to uninsured individuals in excess of the $2 billion Congress appropriated for this purpose in the Families First Coronavirus Response Act as well as the Paycheck Protection Program and Health Care Enhancement Act. As of February 3, HRSA has reimbursed providers approximately $3.4 billion for these services, meaning it has used about $1.4 billion from the Provider Relief Fund for this purpose. Even assuming HRSA reserves another $6 billion for future payments, there would still be more than $20 billion in Provider Relief Funds remaining — more than 10% of the total amount appropriated by Congress.

Other Expenditures

Total Amount

Actual Uninsured Testing and Treatment Reimbursement (through February 3)

$1.4 billion

Reserve for Uninsured Testing and Treatment Reimbursement (PYA estimate)

$6 billion

TOTAL – Provider Relief Funds Distributed To Date

$157.8 billion

 

 

TOTAL – Provider Relief Funds Remaining for Distribution

$20.2 billion

But wait, there’s more to the story. HHS maintains a public data file listing every provider that has received and accepted at least one Provider Relief fund payment and the total amount received by that provider. (If, for example, a provider received a Phase I General Distribution and a Safety Net Hospital Targeted Distribution, the file lists only the total amount received by that provider.) As of February 3, 2021, 405,414 providers have attested to having received a total of $104.5 billion in Provider Relief  Funds, or $53.3 billion less than the total amount HRSA has distributed. 

Part of this $53.3 billion gap can be attributed to the rules for the inclusion of individual payments in the public data file. First, the $104.5 billion does not include the $1.4 billion in reimbursement to date or our estimated $6 billion reserve for testing and treatment for uninsured individuals as recipients of these funds are not listed in the above-referenced public data file. That brings the gap down to $45.9 billion.

Second, HRSA has made two rounds of payments totaling $854 million from the $2 billion in nursing home quality incentive payments; two more rounds of payments remain to be made. Some of these payments were made less than 90 days ago, meaning some of the recipients are still within the 90-day period to formally accept those payments (and thus be included in the public data file). For purposes of this analysis, we make the conservative assumption that none of the nursing home quality incentive payments – $2 billion – are included in the $104.5 billion. So that brings the gap down to $43.9 billion.

Third, HRSA still is making payments to those providers that applied for Phase III General Distribution funds. The most recent report from the agency states $10.9 billion in payments have been made, with $13.6 billion yet to be distributed to providers. Again, because these payments did not begin until mid-December, Phase III recipients still are within the 90-day period to formally accept these payments. And again, for purposes of this analysis, we assume that none of the Phase III General Distribution Funds – $24.5 billion – are included in the $104.5 billion. And that brings the gap down to $19.4 billion 

The remaining $19.4 billion gap appears to represent the amount providers have returned to the federal government. As you’ll recall, a provider receiving a general or targeted Provider Relief Fund distribution had the option of returning the full amount if the provider did not believe it would have lost revenue or healthcare-related expenses related to coronavirus, or if they did not want to be held to the associated terms and conditions. HRSA has not made public any information regarding these providers, other than the information cited above from which we calculated this amount. 

Added to the $20.2 billion HRSA has not distributed, this means there is almost $40 billion – about one-fifth of the total amount Congress appropriated – in Provider Relief Funds that have not made their way into providers’ hands. Unlike providers in those areas impacted by the spring surge in COVID-19 cases, providers now responding to the fall and winter surge have not received additional targeted distributions. 

In the Consolidated Appropriations Act, Congress directed HRSA to expend at least 85 percent of any remaining Provider Relief Fund appropriations “to make payments to eligible health care providers based on applications that consider financial losses and changes in operating expenses occurring in the third or fourth quarter of calendar year 2020, or the first quarter of calendar year 2021, that are attributable to coronavirus.” In addition to preparing to report on their 2020 Provider Relief Fund expenditures, providers should be looking for the opportunity to secure additional funds to cover later-surge lost revenue and expenses.

Executive Contacts

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