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Category: Congress

COVID-19 Estimates of CARES Act Hospital Relief Payments

Toyon is pleased to provide this interactive model estimating hospital relief payments from the Public Health and Social Services Emergency Fund (PHSSEF). These hospital relief payment estimates are for discussion purposes only. This model includes estimated amounts from the $50bn general allocation, $12bn High Impact (with estimated hospital admissions and DSH portion isolated) and rural hospital funding.   HHS is dispersing actual funds using tax documentation and is collecting information from Sole Proprietor/Disregarded Entities (LLC). HHS published a user guide here.  
Please find below the estimates by CCN number, hospital type, state, county, and city (county and city are only provided with available data, some providers are not listed by county and/or city).  Provided amounts are for hospital estimates only and include acute care, critical access, skilled nursing, psychiatric, rehabilitation, LTCH, cancer, children’s hospitals as well as outpatient dialysis providers and rural health clinics.  Non-hospital providers (i.e., physicians), home health, community health medical centers and federal qualified health centers are not included in this analysis.
Please contact Robert Howey at 925.685.9312, ext. 3147 / with any questions. 
There are 7 distinct pages of analytics that can be navigated via the arrows at the bottom center of the visuals. For best viewing, we recommend expanding analysis to full screen by selecting the expansion arrows in the lower right-hand corner.


Data Sources:
 – Medicare FY 2019/2020 IPPS DRG Impact File (Updated for Correction Notice) 
 – FFY 2019 Final Rule Standard Operating (Labor and Non-Labor) and Capital Rates 
 – FFY 2019 Final Rule Post-Reclassified Wage Index Factor 
 – Medicare discharges from Medicare cases for the provider from the FY 2018 MedPAR, March 2019 update 
 – Medicare case mix index from the transfer adjusted Case Mix Index under Grouper V37 and FY 2020 Post-Acute Transfer Policy 
 – All add-ons and adjustments from this file (DSH, IME, etc) are included and be turned “on and off” on tab 2 “File Notes” 

2. Estimated Outpatient Payments for Acute Care Hospitals
– Worksheet E Series settlement data for Sub-providers and all other hospital types: critical access, skilled nursing, psychiatric, rehabilitation, cancer, children’s hospitals, dialysis and rural health clinics  
 – Net Patient Service Revenue from worksheet G-3, line 3, column 1
 – Total Patient Days from worksheet S-3, Part I, column 8.
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COVID-19 Summary of Additional Hospital Funding Sources

Updated from original April 20, 2020 news post.

Below is a summary of additional hospital funding sources available to the healthcare community as result of the COVID-19 pandemic.

Direct and Indirect Funding That Impacts Hospitals




Authority / Source


CARES Act (H.R. 748) Provider Relief Fund Reimbursement to healthcare providers for expenses or lost revenue due to COVID-19 (Division B, Title VIII – DHHS,Public Health and Social Services Emergency Fund of $100B)


Initial Disbursement – Proportional Distribution to All Providers based on 2018 Net Patient Revenue

Payments distributed via UHC beginning 4/10/2020, more info here.


$20B Second Disbursement – Proportional Distribution to AllProviders based on 2018 Net Patient Revenue Payments distributed beginning 4/24/2020
$10B Allocated to Hospitals Heavily Impacted by COVID-19
DHHS is determining how to distribute these targeted funds
$10B Allocated to Rural Providers
$400M Allocated to Indian Health Services
$20B To Be Determined(likely to be based on reimbursement for uninsured)
Reimbursement to providers for COVID-19 testing for uninsured patients
Families First Coronavirus Response Act (H.R. 6201) Division F – Health ProvisionsSec. 6004 Coverage of COVID-19 Testing DHHS is not yet accepting applications; timeframe unknown
Funding for grantees ofHospital Preparedness Program $250M Assistant Secretary for Preparedness and Response HPP coalitions will distribute funds;timeframe unknown
Grants to hospital associations forpreparedness response $50M Assistant Secretary for Preparedness and Response State hospital associations expected to distributefunds to hospitals in April

2% Sequestration Adjustment temporary relief

CARES Act (H.R. 748)Title III – Supporting America’s Health Care System Sec. 3709 Adjustment of Sequestration Effective for all Medicare claims with dates of service between May 1 to Dec 31, 2020(See Toyon’s calculation estimator)
20% increase in reimbursement for Medicare COVID-19 hospital inpatients
CARES Act (H.R. 748)Title III – Supporting America’s Health Care System Sec. 3710 Medicare Add-on for COVID-19 Patients Effective for all claims coded with COVID-19 ICD-10 diagnosis code (U07.1) throughoutPublic Health Emergency (PHE) period
6.2% FMAP increase for Federal matching of Medicaid program funding via CPEs and IGTs
Families First Coronavirus Response Act (H.R. 6201) Division F – Health ProvisionsSec. 6008 Temporary Increase of Medicaid FMAP Effective 1/1/2020 through end of quarter in which PHE ends

Telehealth Funding Program

CARES Act (H.R. 748)Title V, Sec. 15002(c) Federal Communications Commission Guidance on eligible providers and application process can be found here.

Source: California Association of Public Hospitals and Health Systems, U.S. Dept of Health & Human Services

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