• Providers who did not submit all patient revenue covered by their tax identification number before the portal closed on July 3. This situation typically affects companies that have both Medicare and non-Medicare providers under the same tax identification number (e.g., Assisted Living Waiver, some ID/DD providers) and that did not include the non-Medicare providers' revenue on the Medicare cost report.
  
• Providers who with a change of ownership (CHOW) after the period used to calculate the payment. In this case, typically HHS paid the previous operator, who then had to return the payment. The new operator received nothing.
  

In both scenarios, HHS states that they will provide an opportunity for these providers the week of August 10. For the "second chance" providers, HHS wrote, "[t]hey will have until August 28, 2020, to complete an application to be considered for the balance of their additional funding up to 2 percent of their annual patient revenues." For the providers with CHOWs, HHS wrote, "providers who experienced change in ownership challenges may submit their revenue information, along with documentation proving a change in ownership, by August 28 for consideration for Provider Relief Fund payment."

In the concluding paragraph of the announcement, HHS alluded to future payments from the fund "to new providers in 2020 along with those that have yet to receive any funding for a variety of reasons," which could include private pay assisted living.

Self-Insured SNFs No Longer Required to Pay for Testing. In a meeting yesterday afternoon between state officials and the associations representing SNFs about the impending second round of staff testing, the state agreed to pay for testing for self-insured providers, but they will continue billing other third-party payers (commercial insurance, coverage under a spouse or parent, Medicaid, etc.). Please note that in exchange for covering employees of self-insured providers, the state asked all providers to supply complete and accurate insurance information on the laboratory requisitions. Marisa Weisel of the Department of Medicaid explained that 80% of the forms for the baseline testing were filled out improperly. The state will expect the lab to bill the self-insurance plan and for the plan to send the bill to the state. That process is not fully fleshed out, but obviously it depends on the lab having information on who to bill.

CMS Releases Final Medicare Payment Rules. Not directly related to COVID-19, but certainly important for providers, yesterday afternoon the Centers for Medicare and Medicaid Services (CMS) issued the final SNF and hospice payment rules for Federal Fiscal Year 2021. The SNF rule applies a 2.2% market basket adjustment but makes no other changes to the Patient-Driven Payment Model (maintaining for now the positive revenue impact). The hospice market basket is 2.4%, but also is the only payment change, as CMS simply updated the payment cap by the market-basket percentage. In both rules, CMS capped negative wage index adjustments at 5%. The rules reflect CMS’s understanding that payment system changes/reductions are inappropriate when providers are grappling with the pandemic.