Phase 1 Payments
Two weeks after enactment of the CARES Act, on April 10, 2020, HHS initially projected and announced $30 billion in the Phase 1 General Distribution funding to eligible providers who billed Medicare fee-for-service in order to provide financial relief during the coronavirus (COVID-19) pandemic. An additional $20 billion was later announced. These funds were allocated proportional to providers' share of annual patient revenue.
Total Allocated Amount (as of 11/12/2021): $42.82 billion
Payments to (as of 11/22/21): 306,328 providers
Initial $30 Billion
Payment Allocation per Provider = (2019 Medicare Fee-For-Service Payments / $453 Billion**) x $30 Billion
**This is the total sum of Medicare Fee-For-Service Payments in 2019. These payments were distributed immediately to providers.
Additional $20 Billion
Payment Allocation per Provider = ((Most Recent Tax Year Annual Gross Receipts x $50 Billion) / $2.5 Trillion) – Initial General Distribution Payment to Provider
(Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution.
Providers that received an initial Phase 1 payment had the opportunity to apply for additional funds if they had not yet received 2 percent of their gross receipts or sales or program service revenue. Payments were calculated as the lesser of the sum of losses in March and April 2020 or 2 percent of their gross receipts or sales or program service revenue.
All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 were eligible for this initial distribution.
- All relief payments were made to the billing organization according to its Taxpayer Identification Number (TIN).
- Payments to practices that are part of larger medical groups were sent to the group's central billing office.
Those who ceased operation as a result of the COVID-19 pandemic were still eligible to receive funds so long as they provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care did not have to be specific to treating COVID-19. HHS broadly viewed every patient as a possible case of COVID-19.
HHS partnered with UnitedHealth Group (UHG) to provide rapid payment to providers.
- Providers were paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
- The automatic payments came to providers via Optum Bank with "HHSPAYMENT" as the payment description.
- Providers who normally receive a paper check for reimbursement from CMS, received a paper check in the mail for this payment as well.
- Providers had to sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 90 days of receiving the payment.
- Not returning the payment within 90 days of receipt was viewed as acceptance of the Terms and Conditions. Uncashed checks were voided after 90 days and recipients were viewed as rejecting the Terms and Conditions.
Phase 2 Payments
HHS initially projected and announced $18 billion in the Phase 2 General Distribution funding. This allocation was later revised as HHS received less than $18 billion in applications eligible for funding. Eligible providers included participants in state Medicaid programs, including Medicaid managed care plans, Children’s Health Insurance Program (CHIP), and certain Medicare providers, including those who did not receive a Phase 1 General Distribution payment equal to 2% of their total patient care revenue or had a change in ownership in 2019 or 2020. Assisted living facilities and some dentists were newly eligible to apply under Phase 2.
Total Allocated Amount (as of 11/12/2021): $5.09 billion
Payments to (as of 11/22/21): 103,449 providers
To be eligible to apply, the applicants met all of the following requirements:
- Must have either (i) directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services during the period of January 1, 2018, to December 31, 2019; or
- Must be a dental service provider who has either (i) directly billed health insurance companies for oral health care-related services, or (ii) owns (on the application date) an included subsidiary that has directly billed health insurance companies for oral health care-related services; or
- Must be a licensed dental service provider who does not accept insurance and has either (i) directly billed patients for oral health care-related services, or (ii) who owns (on the application date) an included subsidiary that does not accept insurance and has directly billed patients for oral health care-related services;
- Must have billed Medicare fee-for-service during the period of January 1, 2019 and December 31, 2019; or
- Must be a Medicare Part A provider that experienced a change in ownership and billed Medicare fee-for-service in 2019 and 2020 that prevented the otherwise eligible provider from receiving a Phase 1 - General Distribution payment; or
- Must be a state-licensed/certified assisted living facility.
- Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or health care clinic); and
- Must have provided patient care after January 31, 2020; and
- Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
- If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee.
Providers who have received a payment under Phase 1 General Distribution were initially prohibited from submitting an application under Phase 2 General Distribution. However, HHS expanded eligibility midway through the application cycle to allow those providers who received a previous Phase 1 General Distribution payment to apply and, if they had not yet received a payment that is approximately 2% of annual revenue from patient care, receive additional funds.
*The application period for Phase 2 General Distribution closed on September 13, 2020.
Phase 3 Payments
HHS initially made $24.5 billion in new funding available from existing PRF funds for a Phase 3 General Distribution allocation. Providers previously eligible from earlier phases or who had already received Provider Relief Fund payments were invited to apply for additional payments that would take into account their financial losses and changes in operating expenses caused by the coronavirus, but the payments they had received earlier were deducted from any Phase 3 payment. Previously ineligible providers, such as those who began operations in the first quarter of 2020, were invited to apply, and an expanded group of behavioral health providers were eligible for relief payments.
Total Allocated Amount (as of 11/12/2021): $21.36 billion
Payments to (as of 11/22/21): 65,367 providers
Phase 3 General Distribution Relief Fund Terms and Conditions (PDF - 66 KB) (PDF - 67 KB)
Requesting a Phase 3 Payment Reconsideration: Providers who believed their PRF Phase 3 payment was not calculated correctly according to this methodology (PDF - 175 KB) (PDF – 175 KB) had an opportunity to request reconsideration. The application period for reconsideration has now closed. Visit our Payment Reconsideration page for more information.
All providers eligible for a previous PRF distribution, plus new 2020 providers and behavioral health providers could apply. Some providers were eligible regardless of whether they were eligible for, applied for, received, accepted, or rejected payment from prior PRF distributions. This included providers who do not bill Medicare, Medicaid, or CHIP.
To be eligible to apply, the applicant must have met at least one of the following criteria:
- Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan. 1, 2018-Mar. 31, 2020; or
- Billed a health insurance company for oral healthcare-related services as a dental service provider as of Mar. 31, 2020; or
- Be a licensed dental service provider as of Mar. 31, 2020 who does not accept insurance and has billed patients for oral healthcare-related services; or
- Billed Medicare fee-for-service during the period of Jan. 1, 2019-Mar. 31, 2020; or
- Be a Medicare Part A provider that experienced a CMS approved change in ownership prior to Aug. 10, 2020; or
- Be a state-licensed / certified assisted living facility as of Mar. 31, 2020
- Be a behavioral health provider as of Mar. 31, 2020 who has billed a health insurance company or who does not accept insurance and has billed patients for healthcare-related services as of Mar. 31, 2020
Additionally, to be eligible to apply, the applicant must have met all of the following requirements:
- Filed a federal income tax return for fiscal years 2017, 2018, 2019 if in operation before Jan. 1, 2020; or be exempt from filing a return; and
- Provided patient care after Jan. 31, 2020 (Note: patient care includes health care, services, and support, as provided in a medical setting, at home, or in the community); and
- Did not permanently cease providing patient care directly or indirectly; and
- For individuals providing care before Jan. 1, 2020, have gross receipts or sales from patient care reported on Form 1040 (or other tax form)
Note: Receipt of funds from SBA and FEMA for coronavirus recovery or of Medicaid HCBS retainer payments did not preclude a healthcare provider from being eligible.