AAO-HNS COVID-19 Resources: Federal and State Financial Relief

[January 14] Reminder: MIPS Extreme and Uncontrollable Circumstances Exception Application Deadline February 1

For the 2020 Merit-based Incentive Payment System (MIPS) performance period, CMS is using the Extreme and Uncontrollable Circumstances policy to allow clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories due to the COVID-19 pandemic. Recognizing the varying effects of the pandemic on eligible practitioners, CMS has extended the deadline to submit a COVID-19 related 2020 extreme and uncontrollable circumstances application to February 1, 2021. Learn More.

[January 11] U.S. Small Business Administration (SBA) Paycheck Protection Loan Resumes  On January 11 the U.S. Small Business Administration (SBA), along with the U.S. Treasury Department, reopened the Paycheck Protection Program (PPP). The SBA began accepting “first draw” loans from small businesses that had not yet received a PPP loan. Effective January 13, businesses that already applied for a PPP loan can pursue “second draw” PPP loans. To promote access for smaller lenders and their customers, SBA will initially only accept “first draw” and “second draw” loan applications from participating community financial institutions. Applicants are generally eligible for a “second draw” PPP loan if the borrower 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. Learn more about loan details and how to apply as well as access additional resources provided by the SBA.

[October 29] Deadline Approaching to Apply for Phase 3 Provider Relief Fund Payments
Physicians have until Friday, November 6 to apply to the additional $20 billion in new funding for those on the frontlines of battling the coronavirus pandemic. Providers who have already received payments can now apply for additional funding based on financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020, are also now eligible to apply.

The U.S. Department of Health and Human Services has released an updated fact sheet and webinar recording to assist providers in applying for these additional funds.

On October 8, the Centers for Medicare & Medicaid Services announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program. Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. Read More.

[October 1] HHS Announces New CARES Act Provider Relief Funding Available October 5

Today the U.S. Department of Health and Human Services (HHS) announced $20 billion in new funding for physicians on the frontlines of battling the coronavirus pandemic. Providers who have already received payments can now apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Additionally, previously ineligible providers, such as those who began practicing in 2020, are also now eligible to apply. While physicians will have from October 5, 2020, through November 6, 2020, to apply for Phase 3 General Distribution funding, HHS in encouraging physicians to apply at the earliest possible date. Learn More. 

[September 19] HHS Provider Relief Reporting Requirements

The U.S. Department of Health and Human Services (HHS) released additional information about data reporting requirements for Provider Relief Fund recipients who received aggregated payments of more than $10,000. The notice includes the data elements and information that recipients will need to report to comply with the Terms and Conditions of receiving and using the funds. Please note the additional detail and changes to the expense and lost revenue categories. The reporting requirements do not apply to the Nursing Home Infection Control distribution, Rural Health Clinic Testing distribution, or the HRSA Uninsured Program. Learn More. 

[September 4] HHS Again Extends Provider Relief Fund Deadline; Physicians Now Have Until September 13 to Apply

The U.S. Department of Health and Human Services (HHS) is extending the deadline for physicians to apply for the Provider Relief Fund for both Medicare and Medicaid providers. This deadline applies to the targeted distribution for Medicaid providers as well as Medicare providers who missed the previous deadline to apply for additional funding from the second $20 billion tranche of the $50 billion general distribution. Physicians now have until September 13, 2020, to apply. Learn More.

[August 10] HHS Provider Relief Fund Now Accepting Additional Applicants

On July 31, the Department of Health and Human Services (HHS) announced that certain Medicare providers would be given another opportunity to receive additional Provider Relief Fund payments. Providers who are newly eligible for funding include those who received funding in the first round but missed the June 3 deadline to submit revenue information; practices who underwent a change in ownership during 2019 or 2020; providers that did not have Medicare Fee-For-Service revenue in 2019; and practitioners who had received, but returned funding, and are now interested in re-applying. These eligible providers may now submit their application by August 28 for possible funds. Read More.

[July 6] Paycheck Protection Program Has Reopened

The Paycheck Protection Program resumed accepting applications July 6, 2020, at 9:00 AM EDT in response to President signing the program’s extension legislation. The new deadline to apply for a Paycheck Protection Program loan is August 8, 2020. Learn More. 

[July 1] Congress Approves PPP Deadline Extension through August 8

The U.S. House of Representatives followed the Senate in passing a five-week extension of the Paycheck Protection Program (PPP). The bill has been sent to President Trump, who is expected to sign the legislation into law. Approximately $130 billion of funding remains available for new PPP loans. Once the bill in enacted, qualified small businesses, including physician practices, will have until August 8 to apply for relief. Learn more here https://home.treasury.gov/policy-issues/cares/assistance-for-small-businesses

[June 22] PPP Guidance on Applying Early for Loan Forgiveness

On June 22, the Treasury and the U.S. Small Business Administration (SBA) released an interim final rule addressing the process for applying early for loan forgiveness. Additionally, the final rule clarifies that it is the borrower’s responsibility to provide an accurate calculation of the loan forgiveness amount.

[June 19] Provider Relief Funding Available for Medicaid and CHIP Providers

As reported in last week’s OTO News, on June 9 the U.S. Department of Health and Human Services (HHS) announced new COVID-19 relief payments from the CARES Act Provider Relief Fund to support physicians and hospitals participating in state Medicaid programs and the Children’s Health Insurance Program (CHIP). HHS opened a new application portal to distribute the $15 billion in payments to eligible providers, those who received Medicaid and CHIP payments in 2017, 2018, 2019, or 2020 who have not received any payments from the Provider Relief Fund General Distribution. Eligible physicians have until July 20, 2020 to submit their application and report required information, such as annual patient revenue data. The payment amount will be based on this data submission. HHS will be hosting two webcasts at 2 pm (ET) on Tuesday, June 23, and Thursday, June 25, for physicians interested in learning more about the application process. Registration for these webcasts is required.

[June 15] Main Street Lending Program Begins Operation

On June 15, the Federal Reserve Bank announced the launch of its Main Street Lending Program. The Federal Reserve recently made changes to the program to allow more small and medium-sized businesses to be able to receive support, such as lowering the minimum loan size for certain loans to $250,000 from $500,000 and extending the repayment period for all loans by delaying principal payments for two years rather than one. Potential borrowers should contact their existing lenders to confirm whether they will participate and discuss the application process. Learn More.

[June 11] SBA, Treasury Issue Guidance on PPP Flexibility and New Application Form

On June 11, the U.S. Small Business Administration and U.S. Department of the Treasury issued initial regulations to implement the Paycheck Protection Program Flexibility Act, which became law last week. The new regulations address the extension of loan maturity from two to five years for certain loans, the reduction of expenses required to be spent on payroll from 75% to 60%, and clarification that borrowers who fail to achieve the 60% threshold remain eligible for partial forgiveness. June 30 remains the last date on which a PPP loan application can be approved. Learn more.

[June 9] HHS Releases New Provider Relief Fund Payments for Medicaid/CHIP Providers

On June 9, 2020, the U.S. Department of Health and Human Services (HHS) announced $15 billion in new COVID-19 related relief payments to physicians and hospitals that participate in state Medicaid programs and the Children’s Health Insurance Program (CHIP). Eligible providers are those experiencing lost revenue or increased expenses due to COVID-19, who have not yet received payments from the Provider Relief Fund General Distribution. Providers who are eligible can apply through the enhanced HHS relief act portal and must agree to the program Terms and Conditions. Learn More. 

[June 9] Academy Applauds Introduction of Physician Liability Protection Legislation

Since the beginning of the COVID-19 outbreak, the AAO-HNS and our partners in the Health Coalition on Liability and Access have been working to develop legislation to address physician liability during the pandemic. As a result of these lobbying efforts, U.S. Representatives Phil Roe, MD (R-TN), and Lou Correa (D-CA) introduced H.R. 7059, the Coronavirus Provider Protection Act, on May 28. This bill takes important steps to protect frontline healthcare providers acting in good faith from unwarranted liability lawsuits. Learn More. 

[June 3] Congress Passes Legislation to Update Small Business Paycheck Protection Program

On June 3, the U.S. Senate passed H.R. 7010, the “Paycheck Protection Program Flexibility Act of 2020,” by unanimous consent, following passage by the U.S. House of Representatives last week. This legislation makes important changes to the PPP to grant small businesses additional time and flexibility for the use of funds under the program. H.R. 7010 will now be sent to the President’s desk to be signed into law. Learn More.

Deadline is Today [June 3] to Accept or Reject Funds from on Cares Act Provider Relief Fund

This Payment Portal will guide providers through the attestation process to accept or reject the funds. If providers are not ready to attest to a payment, but want to be considered for a complete General Distribution payment, providers may reject the payment, initiate the return of the payment, and submit the requested revenue documents necessary to facilitate HHS calculation of one’s total final payment through the General Distribution Portal by June 3. Rejection of an initial payment will not preclude a provider from receiving their total general distribution amount that is approximately 2% of revenues. Learn More. 

[May 21] HHS Updates CARES Act Provider Relief Fund FAQs The U.S. Department of Health and Human Services (HHS) issued updated guidance for Medicare providers receiving payments from the CARES Act Provider Relief Fund. The updated frequently asked questions (FAQs) document addresses common questions on attestation and rejecting payments (beginning on page two) with the notation “added 5/20/2020.” The FAQs also provide guidance on revenue reporting through the portal, entering taxpayer identification numbers into the General Distribution Portal, estimating lost revenue, and the definition of a rural facility.

[May 19] Medicare Reimbursement for COVID-19 Diagnostic Tests On May 19, the Centers for Medicare & Medicaid Services (CMS) updated its guidance on payment for COVID-19 diagnostic tests to include details for additional CPT codes created by the American Medical Association as well as specific reimbursement rates from Medicare Administrative Contractors (MACs). For COVID-19 tests that do not use high throughput technology, MACs developed payment amounts for claims that will be used until CMS establishes national payment rates. There is no cost-sharing for Medicare patients. Read More

[May 15] SBA Releases Application for PPP Loan Forgiveness On May 15, the Small Business Administration (SBA) released an application and instructions for Paycheck Protection Program (PPP) loan forgiveness. The borrower is expected to complete the application and submit it to their lender, who will ultimately be responsible for assessing forgiveness. The process can be completed electronically. The SBA plans to issue regulations and guidance to further assist borrowers as they complete their applications and to provide lenders with direction on their responsibilities.

[May 7] HHS Extends Provider Relief Fund Payment Deadline to 45 Days for Attestation, Acceptance of Terms and Conditions The U.S Department of Health and Human Services (HHS) has extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. Instead of 30 days, providers will now have 45 days from the date of payment receipt to attest and accept the Terms and Conditions or return the funds. Under the new deadline extension, providers who have not returned payments within 45 days of receipt of funds will be deemed to accept the program’s Terms and Conditions. Additional information on the deadline’s extension is available HERE.

[May6] SBA Extends Deadline to Return PPP Loans to May 14 The U.S. Small Business Administration (SBA) has extended the safe-harbor period for returning Paycheck Protection Program (PPP) funds by one week to May 14. The previous deadline for returning funds (May 7) was initially provided for entities that received PPP funds [removed comma] but then determined that they were unable to certify in good faith that their PPP loan was necessary. For additional guidance from the SBA, please see question 45 (bottom of page 15) on the FAQ document.

[April 30] Federal Reserve Announces New Details on Main Street Lending Program The Federal Reserve released updated information and an FAQ regarding its Main Street Lending Program. This loan program was created through the CARES Act to help small and medium-sized businesses, like physician practices, via the provision of credit to companies that were in sound financial condition prior to the COVID-19 pandemic. The new Main Street loans can range from $500,000 to $25 million but are full-recourse loans and are not forgivable. The program has not yet been operationalized. The Academy will provide additional details on the program as they become available.

[April 30] NOW OPEN: HRSA COVID-19 Uninsured Program Portal Clinicians who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, are now eligible for reimbursement through the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program. Funding is subject to availability. The portal to register to participate in the program is now open. Once registered, providers can begin to submit claims electronically on May 6. To receive funding, providers must attest that no other payer will reimburse them for COVID-19 testing or treatment, accept the defined program reimbursement as payment in full, and abstain from balance billing. The agency has prepared a FAQ document outlining eligibility for the program, reimbursement rates, and terms and conditions for participation.

[April 27] An updated CMS fact sheet outlining the programmatic changes is available HERE

[April 26] CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program PRESS RELEASE

On April 26, CMS announced that, effective immediately, it is suspending its Advance Payment Program for Part B suppliers and reevaluating the amounts that will be paid under its Accelerated Payment Program. CMS had expanded these temporary loan programs to provide frontline providers with immediate financial support needed to combat the beginning stages of the COVID-19 pandemic. CMS reports that, since March 28, 2020, approximately $40 billion in advance payments has been sent to physicians, nonphysician providers, and other suppliers. As noted in the Academy’s recent email updates, additional grant funding will continue to be available to Medicare providers and suppliers primarily via the U.S. Health and Human Services Provider Relief Fund.

[April 25] PORTAL IS OPEN: HHS Releases Additional $20 Billion in CARES Act Provider Relief Funding

On April 22, the U.S. Department of Health and Human Services (HHS) announced that it is adding an additional $20 billion to the CARES Act Provider Relief Fund. All facilities and providers with a Medicare Provider Number are eligible for these funds. As of Friday, April 24th, HHS has already distributed $30 billion of the $100 billion fund to providers, in proportion to their Medicare Fee for Service payments in 2019. These distributions were sent directly to providers by automatic deposit or by paper check. Providers were not required to engage in any activity or application in order to get these funds, though providers are required to sign an attestation if they wish to keep the funds.

As part of the distribution of the remaining $70 billion in funds, HHS is asking providers who have already received payments from the initial distribution of $30 billion to supply information from IRS tax filings and to supply estimates of lost revenues in March and April of 2020, if they wish to be eligible to receive additional funds. HHS will be distributing an additional $20 billion to these providers.

This morning, HHS opened the portal for providers to attest to their net 2018 revenue for purposes of determining the new allocation of funds. All providers who accept these funds must accept terms and conditions, such as abstaining from balance billing for care delivered to patients with presumptive or actual cases of COVID-19. Additional terms and conditions include submitting documentation to ensure funds received were used for healthcare expenses or to cover lost revenue from the COVID-19 Public Health Emergency.


[April 24] SBA to Resume Accepting PPP Applications on Monday, April 27

The Small Business Administration will resume accepting Paycheck Protection Program (PPP) loan applications on Monday, April 27 at 10:30 am (ET) from approved lenders on behalf of any eligible borrower. The program authorized under the CARES Act was quickly depleted of funds after only two weeks of operation. Following enactment of the Paycheck Protection Program and Health Care Enhancement Act, an additional $321 billion in funding for PPP loans was appropriated. Of the $321 billion in funding, $60 billion is set aside for small, midsize, and community lenders (including minority lenders).

As noted in previous communications, for those who are seeking but have not received PPP funds, we urge you to apply immediately with your community lender. Read the SBA press release. 

[April 24] Fourth Coronavirus Relief Package Signed into Law

Today, April 24, the President signed into law, the “‘Paycheck Protection Program and Health Care Enhancement Act.” The Act provides $484 billion in new funding to support the federal government’s response to the COVID-19 pandemic. Highlights of this fourth COVID-19 relief package, which directly impact practicing otolaryngologist-head and neck surgeons, include an additional:

  • $321 billion in funding for the Paycheck Protection Program, with a special focus on community banks and credit unions
  • $75 billion in funding for hospitals and Medicare providers to support COVID-19 related expenses and lost revenue
  • $60 billion in funding for Economic Injury Disaster Loans
  • $25 billion for state-led COVID-19 testing plans, research and development, with funding support for federal agencies such as the CDC and the NIH

We expect certain portions of this additional funding to become immediately available. The AAO-HNS will continue to provide updates as they develop.


[April 16] Update on Paycheck Protection Program and Financial Relief Resources: Special Message from James C. Denneny III, MD, AAO-HNS Executive Vice President and CEO

One of the cornerstone pieces of legislation designed to help small business owners was the CARES Act, which contained the Paycheck Protection Program (PPP) that allocated $349 billion to offset small business owner’s costs of maintaining employees. The initial funding for the PPP has been expended and the Small Business Administration (SBA) has stopped accepting applications. My colleagues in the banking industry are recommending that you apply for a PPP loan through your community bank. They indicate that the applications will be processed by the banks and then submitted to the SBA when additional funding is provided by Congress. Your Academy continues to lobby for further economic support of our distressed practices and expects that there will be additional support available in the future.

[April 16] Did You Get a PPP Loan? Tips for Managing the Funds

In the SBA PPP report, as of April 13, 1,035,086 loans had been distributed in the amount of $247,543,393. Of total funds distributed 11.27 percent were directed to “Health Care and Social Assistance.” If you received a PPP loan since the program opened on April 3, there are some valuable tips to consider in tracking the management of those funds, or any COVID-19 relief monies you receive, such as setting up a separate bank account dedicated specifically to the accounting of those funds. There are numerous sources of guidance to make future forensic accounting more fluid. While we don’t recommend or endorse any one source, this information provided by Inc., offers a few quick steps to ensure success in managing these funds.

HHS Announces $30 Billion of CARES Act Relief Funding to Providers

On April 10, the Department of Health and Human Services (HHS), announced it will begin delivery of an initial $30 billion in relief funding to healthcare providers. The funding is part of the $100 billion passed in the coronavirus aid, relief, and economic security, or CARES, Act. Rapid distribution of the funds will go to hospitals and providers across the United States who received Medicare fee-for-service (FFS) reimbursements in 2019. This initial $30 billion is being directed to hospitals and physician practices in direct proportion to their share of Medicare fee-for-service spending. The total amount of Medicare FFS spending in 2019 was $484 billion. Hypothetically, if a Medicare provider with a Taxpayer ID Number (TIN) accounted for 1% of total Medicare FFS spending in 2019, the TIN would receive 1% of the $30 billion. These are payments, not loans, to healthcare providers, and will not need to be repaid. Providers do not have to apply.  In order to receive these funds, providers must agree to accept Medicare rates for patients who are uninsured and not to seek to collect a “surprise” balance bill from a COVID-19 patient. HHS is partnering with UnitedHealth Group (UHG) to deliver the initial $30 billion of relief as soon as possible. Providers will be paid through Automated Clearing House information already on file with CMS or UHG. Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for calculating one’s applicable payment and signing the attestation will be open the week of April 13, 2020, and will be linked HERE. Be sure to read the Terms and Conditions linked on this site prior to signing up. Additional details regarding the CARES relief funding can be found HERE.

House of Medicine Letter on CARES Act Emergency Funding 

Today, April 7, 2020, the AAO-HNS joined scores of groups across the House of Medicine in sending a letter to U.S. Secretary of Health and Human Services (HHS) Alex Azar regarding immediate financial relief for physician practices. The coalition urged HHS to provide one month of revenue to each physician (MD or DO) enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses resulting from the COVID-19 crisis. This funding was included in the CARES Act, which authorized $100 billion in direct financial support for healthcare providers.


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