Member Alert June 19: Provider Relief Fund Update

Last week, HHS launched an application portal to distribute $15 billion in CARES Act Provider Relief Fund payments to eligible Medicaid and CHIP physicians and organizations. The payment will be at least 2 percent of reported gross revenue from patient care, and the final amount will be determined based on submitted data, including the number of Medicaid patients served. Eligible physicians and organizations have until July 20, 2020, to submit their application and report other necessary information, such as annual patient revenue data.

HHS is hosting two webcasts at 2 pm EST on Tuesday, June 23 and Thursday, June 25 for physicians and other health care professionals who are interested in learning more about the application process. Registration is required.

The new Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund starting Wednesday, June 10, 2020. At this time, this portal will serve as the point of entry for providers who have received Medicaid and CHIP payments in 2017, 2018, 2019 or 2020 and who have not already received any payments from the $50 billion Provider Relief Fund General Distribution.

The first Provider Relief Fund Payment Portal was used for providers who received a General Distribution payment prior to Friday, April 24th. These providers were required to submit financial information in order to receive approximately 2% of gross revenues derived from patient care.

HHS has developed the new Enhanced Provider Relief Fund Payment Portal for providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care, and behavioral health providers.)

Medicaid Timeline Update

In Dec. 2019, less than a month after the newly awarded Medicaid Managed Care Organization (MCO) contracts were announced, Governor Andy Beshear cancelled and re-bid the Medicaid managed care contracts.

In late May, Governor Beshear and Cabinet for Health and Family Services Secretary Eric Friedlander announced the state had awarded the Medicaid MCO contracts to the same five companies that were previously awarded contracts: Aetna, Humana, Molina Healthcare, UnitedHealthcare, and WellCare.

Aetna will also serve children in Kentucky SKY (Supporting Kentucky Youth), the Medicaid risk-based managed care delivery program for the state foster care program and the Department for Juvenile Justice.

Anthem and Passport Health Plan (which was purchased by Evolent Health last year) have confirmed that they are in the process of filing protests for the second time to challenge Kentucky’s decision to award Medicaid managed care contracts statewide to five other insurers.

The Secretary of the Finance and Administration Cabinet has the authority to determine protests for procurements conducted under Kentucky Revised Statutes (“KRS”) Chapter 45A.  KRS 45A.285.  KRS 45A applies “to every expenditure of public funds by this Commonwealth under any contract or like business agreement.”

While Anthem and Passport continue to use the protest process as the legal remedy for contract dispute, they will continue to operate as MCOs.

Other factors could impact the January 20201 start date:

  • Reversal of the contract awards in connection with one or more successful protests by Anthem and Passport
  • Delay in the start date for the contracts
  • Other actions taken by the Beshear administration

Meanwhile it is business as usual for all the current MCOs.