Hospices Try to Untangle Provider Relief Funds Rules

Hospice providers who are seeking federal aid through the Provider Relief Fund established by the CARES Act need clarity on the law’s definition of “lost revenue” due to apparently  conflicting language in guidance provided by the U.S. Department of Health & Human Services (HHS). The more pressing question is whether “lost revenue” includes financial losses from reduced philanthropic donations and other fundraising. 

The National Hospice & Palliative Care Organization has written to HHS Secretary Alex Azar, asking the agency to make the distinction clear as to what constitutes “lost revenue.” 

“Hospices rely on fundraising support to provide hospice and palliative care services and bereavement services to children and others in need throughout the community. The operation of hospice thrift stores is also a source of revenue that a number of hospice providers rely on to enable patient care,” said NHPCO President and CEO Edo Banach.

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The CARES Act, enacted on March 27, earmarked $175 billion to health care providers across the continuum through the Provider Relief Fund.

HHS issued guidance on the fund on June 19, 2020 that defined “lost revenue” as any revenue that a health care provider lost due to coronavirus. Many hospices, including many smaller companies and nonprofits, have lost a considerable amount of dollars due to diminished fundraising in addition to losses from reduced referrals and rising expenses. 

Philanthropic and fundraising dollars often finance programs such as palliative care services, complementary therapies, hospice houses as well as programs for the homeless, among other initiatives. 

The financial and operational impact of the pandemic has been monumental for hospices. Providers have been in dire need of additional supplies, with acquiring personal protective equipment (PPE) as a top priority. The tremendous global demand for those products has driven up prices. Hospices have also had difficulty accessing patients, investing in new telehealth capabilities and covering paid leave for staff who have been exposed to the virus.

Later HHS guidance released in September, indicated that reportable lost revenue under the Provider Relief Fund Rules is limited to “revenue/net charges from patient care.” NHPCO in its letter to Azar argues that this is inconsistent with the language in the CARES Act.

“The CARES Act and HHS’s [Provider Relief Fund] Terms and Conditions broadly authorize PRF payments to be used for lost revenues attributable to the coronavirus, and do not impose such additional constraints as requiring that the lost revenues be lost patient care revenues,” NHPCO said in the letter. “Indeed, there was no indication that HHS was imposing this additional constraint until the September reporting guidance was released.”

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