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Phase 4 and ARP Rural Distributions

PRF Phase 4 payments

ARP Rural payments

Archived information: Phase 4 and ARP Rural Distributions

On November 23, 2021, HRSA began distributing ARP Rural payments and on December 16, 2021, HRSA began distributing Phase 4 General Distribution payments. For more information on how payments were calculated, refer to the Phase 4 and ARP Rural methodology. All payments for PRF were accompanied by email notifications. For ARP Rural, applicants receiving payments received both an email notification and a paper letter with additional detail on their aggregate payment, including individual payment amount(s) attributable to any eligible subsidiary billing TINs included in their application.

Applicants that HRSA determined would not receive a payment received email notifications that include the primary reason for their payment determination. Providers who have not yet received any communication regarding their Phase 4 and/or ARP Rural payment determination will be notified as soon as HRSA completes the review and processing of their application.

Within 90 days of receiving a payment, recipients must sign an attestation confirming receipt of the funds and agreeing to the Terms and Conditions of payment by re-entering the Provider Relief Fund Application and Attestation Portal. Should a recipient choose to reject the funds, they must still complete the attestation to indicate this and then return the funds within 15 calendar days.

For more information on how Phase 4 and ARP Rural payments are calculated, please consult the payment methodology webpage. Providers with questions about the Phase 4 and ARP Rural application process or who need payment support should contact the Provider Support Line at 866-569-3522 (for TTY dial 711).

What is the Provider Relief Fund?

Qualified providers of health care, services, and support were eligible to receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions did not need to be repaid to the US government, assuming providers complied with the Terms and Conditions.

What is ARP Rural?

The American Rescue Plan (ARP) Rural distribution was intended to address the disproportionate impact of COVID-19 on rural communities and rural health care providers. HRSA made payments to providers based on the amount and type of services they provided to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) patients who live in rural areas, as defined by the Federal Office of Rural Health Policy.

Who was eligible to apply?

Phase 4 General Distribution: To be eligible to apply, the applicant must have met all of the following requirements:

  1. Must fall into one of the following categories:
    1. Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, their state/territory Medicaid program (fee-for service or managed care) or Children’s Health Insurance Program (CHIP) for health care-related services during the period of January 1, 2019 to December 31, 2020; or
    2. Must be a dental service provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for oral health care-related services during the period of January 1, 2019 to December 31, 2020;
    3. Must have either directly billed, or owns (on the application date) an included subsidiary that has directly billed, Medicare fee-for-service (Parts A and/or B) or Medicare Advantage (Part C) for health care-related services during the period of January 1, 2019 to December 31, 2020;
    4. Must be a state-licensed/certified assisted living facility on or before December 31, 2020;
    5. Must be a behavioral health provider who has either directly billed, or owns (on the application date) an included subsidiary that has directly billed, health insurance companies or patients for health care-related services during the period of January 1, 2019 to December 31, 2020;
    6. Must have received a prior Targeted Distribution payment.
  2. Must have either (i) filed a federal income tax return for fiscal years 2018, 2019, or 2020, 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 (for example, a state-owned hospital or health care clinic); and
  3. Must have provided patient care after January 31, 2020; and
  4. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
  5. If the applicant is an individual that was providing patient care, 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.

ARP Rural Distribution: In accordance with the statutory requirements, to be eligible to apply for ARP Rural Payments, the applicant or at least one subsidiary TINs must have been:

  1. A rural health clinic as defined in section 1861(aa)(2) of the Social Security Act; or
  2. A provider treated as located in a rural area pursuant to section 1886(d)(8)(E), such as critical access hospitals; or
  3. A provider or supplier that:
    1. Has directly billed for health care-related services between January 1, 2019 and September 30, 2020:
      1. Medicare fee-for-service (Parts A and/or B);
      2. Medicare Advantage (Part C);
      3. Their state/territory Medicaid program (fee-for service or managed care); or
      4. Their state/territory Children’s Health Insurance Program (CHIP); and
    2. Operates in or serves patients living in the HHS Federal Office of Rural Health Policy’s (FORHP) definition of a rural area:
      1. All non-Metro counties;
      2. All Census Tracts within a Metropolitan county that have a Rural-Urban Commuting Area (RUCA) code of 4-10. The RUCA codes allow the identification of rural Census Tracts in Metropolitan counties;
      3. 132 large area census tracts with RUCA codes 2 or 3. These tracts are at least 400 square miles in area with a population density of no more than 35 people per square mile; and
      4. 295 outlying Metropolitan counties with no Urbanized Area population.

Payments from both programs could be used for lost revenues or eligible expenses incurred dating back to from Jan. 1, 2020 which are not obligated to be reimbursed from another funding source.

How were payments calculated?

Read the Phase 4 and ARP Rural - Payment Calculation Methodologies to understand how payments were calculated and how HHS will continue to use risk mitigation and cost containment measures to protect program integrity and preserve taxpayer dollars.

Resources: application, attestation, terms and conditions

The deadline to initiate an application was October 26, 2021 at 11:59 p.m. ET, while the deadline to submit a completed application was November 3, 2021 at 11:59 p.m. ET

*Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email the Provider Relief Bureau at PRBInformation@hrsa.gov.

General program information

Technical assistance webinars

What documentation was required?

Supporting documentation and information needed to complete an application will include:

  • A comprehensive list of all billing TINs under the filing TIN that provide patient care and are owned by the filing TIN that is applying
  • Internally generated financial statements that substantiate operating revenues and expenses from patient care in 2019 Q1, Q3, and Q4; 2020 Q3 and Q4; and 2021 Q1
  • Federal income tax return, audited financial statements, or internally generated financial statements submitted in their entirety:
    If the applicant for tax purposes is a… The applicant must provide…
    Sole proprietor or disregarded entity owned by an individual IRS Form 1040 including Schedule C.
    Trust or estate IRS Form 1041 including Schedule C.
    Partnership IRS Form 1065.
    C corporation IRS Form 1120.
    S corporation IRS Form 1120-S.
    Tax-exempt organization IRS Form 990.
    Not required to file federal income taxes (e.g., government entities) Internally-generated financial statements (or management-prepared financial statements) and a statement explaining why the entity is not required to file a federal tax form.
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