Toyon’s COVID-19 Resources

Visit Toyon’s COVID-19 Resources for updates on hospital funding estimates, recommendations on documenting cost and revenue losses associated with this public health emergency. Toyon recently updated an interactive model estimating hospital payments from the $50 billion General Fund here.






CMS New Waivers and Flexibilities

On April 30, CMS released extensive regulatory waivers and flexibilities. CMS also published detailed regulatory insight on these waivers and flexibilities by provider type (including acute care hospitals and teaching hospitals) here. CMS also posted an interim final rule related to COVID-19 revised policies here.

HHS has released updated guidance related to HHS General Fund FAQs as well as Terms and Conditions for CARES Funding. Listed below under “Initial Key Language from COVID-19 Regulatory Updates” is Toyon’s composition of initial key language from these important updates for hospitals. Toyon will continue to provide updates and insight on these changes in the coming weeks.

$50 Billion General Fund Allocations

  • The Provider Relief Fund Application Portal has been deployed in order to collect information from providers in receipt of General Distribution payments prior to April 24, 2020 at 5 p.m. EST.
  • HHS will be processing applications in batches every Wednesday at 12:00 noon EST. For providers submitting tax and financial loss information, HHS intends to distribute additional funds within 10 business days of the submission.
  • HHS would like the General Distribution to “replace a percentage of a provider’s annual gross receipts, sales, or program service revenue.
  • The initial $30 billion tranche was expedited to providers by April 17. Medicare revenue from federal fiscal year 2019 was used as the basis for these initial payments.
  • The second $20 billion tranche is being provided to providers as of April 24. This allocation uses net patient revenue from 2018 so the “whole $50 billion general distribution is allocated proportional to providers’ share of net patient revenue.

COVID-19 Uninsured Program Portal

The COVID-19 Uninsured Program Portal, which allows for reimbursement for uninsured patients receiving COVID-19 is open. FAQs related to this Program are available here.

Please contact Robert Howey at or 888.514.9312 with any questions.


Toyon Associates, Inc. 

Initial Key Language from COVID-19 Regulatory Updates for Providers

Listed below is Toyon’s composition of initial key language from these important updates for hospitals. Toyon will continue to provide updates and insight on these changes in the coming weeks.

I.  CMS New Waivers and Flexibilities

Teaching Hospitals

  • CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals to meet COVID-related needs, or penalize hospitals without teaching programs that accept these residents
  • Teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education
  • To help teaching hospitals quickly expand their workforce, medical residents will have more flexibility to provide services under the direction of the teaching physician. In addition to being able to directly supervise a resident with their physical presence during key portions of a procedure, teaching physicians can now also provide supervision virtually using audio/video communication technology.

Expansion Sites, Home Health and Telehealth

  • Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider-based department of the hospital.
  • CMS is allowing payment for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patients’ homes.
  • CMS is allowing healthcare systems and hospitals to provide services in locations beyond their existing walls to help address the urgent need to expand care capacity and to develop sites dedicated to COVID-19 treatment.  For example, a healthcare system can use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients. 
  • As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.
  • CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
  • Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home. 
  • CMS will now pay for more than 80 additional services when furnished via telehealth. These include emergency department visits, initial nursing facility and discharge visits, and home visits, which must be provided by a clinician that is allowed to provide telehealth.

Other Notable Waivers and Flexibilities

  • Hospital Outpatient Departments: CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS.  Importantly, hospitals may also relocate outpatient departments to more than one off-campus location, or partially relocate off-campus while still furnishing care at the original site.  These flexibilities allow payment for outpatient hospital services — such as wound care, drug administration, and behavioral health services — that are delivered in temporary expansion locations, including parking lot tents, converted hotels, or patients’ homes (when they’re temporarily designated as part of a hospital).
  • CMS Audits: The agency will continue to engage in oversight activities but will suspend requesting additional information from providers, healthcare facilities, Medicare Advantage and Part D prescription drug plans, and States.
  • Accountable Care Organizations (ACO): CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.
  • Ambulatory Surgery Centers (ASCs): ASCs can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan.
  • Hospital Benefits: CMS is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child-care services while the physicians and other staff are at the hospital providing patient care.
  • Rehab Hospitals: CMS is excepting certain requirements to enable freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care.
  • Respiratory Care: Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously, Medicare covered them under certain circumstances.

II. HHS General Fund FAQs

Revenue Loss

  • Before you initiate your application via the Provider Relief Fund Application Portal, please collect the following data…3. An estimate the organization’s lost revenue for March 2020 and April 2020. 
    • Lost revenue can be estimated by comparing year-over-year revenue, or by comparing budgeted revenue to actual revenue. 
    • For April 2020, an estimate of the total monthly loss based on data from the first few weeks in April or by extrapolation from March data is acceptable
  • How to Estimate – You may use a reasonable method of estimating the revenue during March and April compared to the same period had COVID-19 not appeared. For example, if you have a budget prepared without taking into account the impact of COVID-19, the estimated lost revenue could be the difference between your budgeted revenue and actual revenue. It would also be reasonable to compare the revenues to the same period last year.
  • We realize that a final revenue number may not be available until a certain time after the end of April. As the program seeks to provide liquidity support to the healthcare system in a timely manner we are using estimated revenues.
  • We are collecting the “gross receipt or sales” or “program service revenue” data to have an understanding of a provider’s usual operations. We are collecting the revenue loss information to have an understanding of COVID impact. We are collecting tax forms in order to verify the self-reported information. And we are collecting information about organizational structure and subsidiary TINs so that we do not overpay or underpay providers who file tax returns covering multiple legal entities (e.g. consolidated tax returns)…This information may also be used in allocating other Provider Relief Fund distributions.

Cash Flow/Payment Confirmation

  • We will be processing applications in batches every Wednesday at 12:00 noon EST. Funds will NOT be disbursed on a first-come-first-served basis, which is to say, an applicant will be given equal consideration regardless of when they apply.
  • For providers submitting tax and financial loss information, HHS intends to distribute additional funds within 10 business days of the submission.
  • If a provider meets certain terms and conditions, the payments received do not need to be repaid at a later date.
  • Retention and use of funds are subject to certain terms and conditions. If these terms and conditions are met, payments do not need to be repaid at a later date.
  • You will receive an email when your application is completed.
  • You will receive no notification from HHS as to the status of your application once submitted.
  • We do not anticipate that you will receive any inquiries from HHS. If additional information is requested, HHS will use the email used to access the Provider Portal.
  • There is no appeals or dispute process.

III.   Terms and Conditions

  • The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and that the Payment shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.
    • FFCRA T&C language…if the Recipient subsequently receives reimbursement for any items or services for which the Recipient requested Payment from the FFCRA Relief Fund, the Recipient will return to HHS that portion of the Payment which duplicates payment or reimbursement from another source. The Recipient will not include costs for which Payment was received in cost reports or otherwise seek uncompensated care reimbursement through federal or state programs for items or services for which Payment was received.
  • The Recipient certifies that it will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.
  • Not later than 10 days after the end of each calendar quarter, any Recipient that is anentity receiving more than $150,000 total in funds…shall submit…a report. This report shall contain: the total amount of funds received from HHS under the foregoing enumerated Acts; the amount of funds received that were expended or obligated for each project or activity; a detailed list of all projects or activities for which the funds were expended or obligated, including: the name and description of the project or activity, and the estimated number of jobs created or retained by the project or activity, where applicable; and detailed information on any level of subcontracts or subgrants awarded by the Recipient or its subcontractors or subgrantees.
  • The Recipient shall maintain appropriate records and cost documentation including, as applicable, documentation described in 45 CFR § 75.302 – Financial management and 45 CFR § 75.361 through 75.365 – Record Retention and Access, and other information required by future program instructions to substantiate the reimbursement of costs under this award. The Recipient shall promptly submit copies of such records and cost documentation upon the request of the Secretary, and Recipient agrees to fully cooperate in all audits the Secretary, Inspector General, or Pandemic Response Accountability Committee conducts to ensure compliance with these Terms and Conditions.
  • The Secretary has concluded that the COVID-19 public health emergency has caused many healthcare providers to have capacity constraints. As a result, patients that would ordinarily be able to choose to receive all care from in-network healthcare providers may no longer be able to receive such care in-network. Accordingly, for all care for a presumptive or actual case of COVID-19, Recipient certifies that it will not seek to collect from the patient out-of-pocket expenses in an amount greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network Recipient.
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