H E A L T H C A R E S T A B I L I Z A T I O N

Health Care Provider Stabilization Grant Program

Presenter: Nicole DiStasio, Senior Policy Advisor (DVHA)

Webinar Topic: Designated Agency & Specialized Service Agency

July 24, 2020

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Meeting Logistics

• This meeting is being recorded.

• All attendees must remain muted.

• You may submit your questions in the chat box, or you can holdquestions until after the webinar presentation portion has ended.

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Overview

1. Revenue Section

2. What is Eligible?

3. Expenditures Guidance

4. Documentation Requirements

5. Uploading Documentation

6. Financial Assistance To Date

7. Basic Starting Calculation the Award Amount

8. Award Amount

9. Questions & Next Steps

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All-Payer Revenue

The Health Care Stabilization Grant Program includes “all payer” revenue changes as eligible for coverage. To determine an applicant’s coverage-eligible revenue changes, AHS requires information on three areas:

1. All Payer Revenue2. Gross Staff Wages3. Total Operating Costs

“All payer” revenue considers both traditional claims-based revenue (often referred to as “Fee For Service”), non-traditional types of claims based revenue (such as, bundled rates, episodic payments, tier-based payments, case rates using “shadow claims,” etc.), and non-claims-based revenues (such as, OneCare Vermont ACO Payments, Success Beyond Six contracts, and other types of AHS Departmental grants).

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Revenue: Collecting the Baseline Data

• Applicants will be asked if they have been providing services since on/before January 1, 2019 to determine if they have one full year of baseline data available.

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Claims-Based Revenue: Billed & Paid Amounts

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The Revenue grid is collecting your baseline data. The baseline being collected for most providers will be for Calendar Year 2019, including all categories of service with a date of service between January 1, 2019 and December 31, 2019.

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Claims-Based Revenue: Billed & Paid Amounts

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You must enter both the Billed and the Paid Amounts. The application will calculate an estimate (what % of your billed amount is, on average, paid) and apply that same percentage to the March 1 – June 15, 2020 data.

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Claims-Based Revenue: Payers & Services

• Applicants must include all the same revenue types in the baseline data as you will include in the March 1 – June 15 application period.

• Applicants should include all categories of service for which they are applying (E&M, Dental, Surgery, etc.)

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Claims-Based Revenue: Payers & Services

• Applicants should include all out of pocket revenues collected from clients as “Self Pays.” Be sure to enter the Billed and Paid amount (even if it is the same).

• Applicants should overwrite the “Other” rows with any additional lines of claims-based revenue. Do not leave it as “Other” and complete the data, we need to be able to determine if it is an eligible revenue type.

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Non-Claims-Based Revenue: Paid Amounts

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• You may include all non-claims-based revenue in which you were the direct care provider.

• Applicants should overwrite the “Other” rows with any additional lines of claims-based revenue. Do not leave it as “Other” and complete the data, we need to be able to determine if it is an eligible revenue type.

• If you did not see any revenue losses in an area, you do not need to include it here if you also do not include it in the 2020 data.

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Revenue Changes: Total Operating Costs & Gross Staff Wages

• You must include your Total Operating Costs (including gross Staff Wages) in the first question.

• The Gross Staff Wages is asked separately to determine what % of your Total Operating Costs are made up of staff wages.

• The application has completed the baseline data capture at this point.

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Capturing the COVID19-related Revenue Changes

The next two questions ask about the March 1st – June 15th time period.

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All Payer Revenue Changes

Applicants are asked to provide the aggregated data here but must include all the same categories and payers that they included in the baseline data.

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All Payer Revenue Changes

You only need to use the billed amount for the claims-based revenue.

The formula will assume that you received approximately the same % of billed claims as you received in your baseline data.

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What is likely to be Eligible?

An expense that is likely to be eligible must meet all three of the requirements below:

✓Must be a COVID-19-related expense

✓Must be an actual expense incurred during the application period • March 1, 2020 through June 15, 2020

✓Must be either a new cost OR the marginal increase of a normal cost• A new cost, which means a COVID-19-specific cost your entity did not have

prior to COVID-19, or

• The marginal increase of a normal, anticipated cost (see next slide)

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COVID-19 Marginal Cost Consent

A Marginal Cost refers to the incremental costs that are incurred when producing additional units of a good or service. In the case of COVID-19, it specifically means the additional costs (above normal operating costs) that you had because of COVID-19.

Before including expenses, applicants must consent to the following statement:

• I hereby certify that I have read and understand the definition of a marginal cost, and I am only including COVID-19 related expenditures for new and/or marginal cost increases.

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First Example: COVID-19-related Cleaning Expenses

• Pre-COVID-19, the cost to disinfect the applicant’s facility is $1,000 per cleaning, and the applicant disinfected facilities once per month. During the COVID-19 pandemic, the cost to disinfect the applicant’s facility rose to $2,000 per cleaning and the cadence increased to 5 times per month.

• This grant award will cover the marginal costs increases, which are those costs above and beyond the “normal” costs for that same service or supply.

• In this example, the eligible costs for one month would be $9,000.

• This eligible cost is determined by taking $10,000 (the new monthly cost for cleaning) and subtracting $1,000 (the normal monthly cost cleaning).

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Second Example: COVID-19-related IT & Telehealth Expenses

• Pre-COVID-19, provider entity had 30 licenses to provide telehealth to patients/clients for a total monthly cost of $300. During the COVID-19 pandemic, provider increased to 50 licenses to provide telehealth to patients/clients for a total monthly cost of $500.

• This grant award will cover the marginal costs increases, which are those costs above and beyond the “normal” costs for that same service or supply.

• In this example, the eligible costs for one month would be $200.

• This eligible cost is determined by taking $500 (the new monthly cost for telehealth licenses) and subtracting $300 (the average monthly cost for telehealth licenses).

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Expenditures & Documentation

• Expenditures Guidance Document: https://dvha.vermont.gov/sites/dvha/files/documents/News/Expenditures%20Guide.pdf

• Documentation Requirements: https://dvha.vermont.gov/sites/dvha/files/documents/News/Application%20Readiness%20and%20Documentation%20Uploads%20Guide.pdf

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Uploading Documents

• Expenses must be uploaded in the appropriate category:• Federally-reimbursable

• Vermont-expanded reimbursable

• Other Eligible COVID-19-related

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General Documentation Requirements

• Must be formatted as a PDF.

• Applicants must include all the documentation required and in must be provided in accordance with the guidance.

• 100% of applications will be reviewed at the close of the application period.

• AHS reserves the right to request additional information if the uploads do not sufficiently validate the requests. Failure to include the required documentation may result in the reduction of your grant award amount.

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Documentation Required

Organizations should prepare the following information before beginning the application:

1. Vermont Employer Identification Number (7-digit number used for Vermont Department of Labor filings). Providing this number is not required but helps populate some of the application required fields.

2. Federal Employer Identification Number (FEIN).3. Contact information for the individual responsible for the application.4. All Payer Revenue 5. Gross Staff Wages 6. Total Operating Expenses7. COVID-19-related Eligible Expenses8. Federal and State Tax Returns for 20199. All Billing Provider NPIs/Medicaid Billing Provider IDs you are applying for

OR your approved certification letter.

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Financial Assistance To Date

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• DO NOT include any loans or advanced payments in this section. • We are only looking for information on financial assistance your entity will

not need to pay back or that is not held as advances against future payments.

• DO include:• Payroll Protection Program grants/loans

• Vermont Agency of Human Service’s COVID-19-related relief (April Retainer, Sustained Monthly, DA/SSA, PNMI, Nursing Homes, etc.)

• Other Federal Disbursements (CDC, FEMA, HHS, SAMHSA HRSA, etc.)

• Other local and community grants (such as, the Vermont Community Fund)

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Maximum Award Amounts

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REIMBURSABLE AREAS FOR-PROFIT ENTITIESNON-PROFIT & PRIVATE NON-PROFIT ENTITIES

COVID-19-specific All Payer Revenue Losses

Up to 100% from AHS Up to 100% from AHS

Federally reimbursable COVID-19-specific Expenses

Up to 100% from AHSUp to 25% from AHS

Up to 75% from FEMA

COVID-19-specific Vermont-Expanded Reimbursable Coverage

Up to 100% from AHS Up to 100% from AHS

Other COVID-19-specific Eligible Expenses

Up to 100% from AHSUp to 25% from AHS

Up to 75% from FEMA

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Webinar Series

• Monday, July 20th from 6-7PM, General Overview of the Program• Tuesday, July 21st from 6-7PM, Completing the Revenue Expenses (focus on

providers that bill insurance for revenue)• Wednesday, July 22nd from 6-7PM, Completing the Revenue Expenses (focus on

providers that mainly take out of pocket, grants, and other non-insurance revenue)

• Thursday, July 23rd from 6-7PM, Claiming COVID-19-related Expenses• Friday, July 24th, Time TBD and by invitation only, Designated Agency and

Specialized Service Agency Applicants

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Resources Available to Assist

• The DVHA Covid-19 Website where you can find regular updates, as well as guidance on the Health Care Provider Stabilization Grant Program:

• Program Overview• Frequently Asked Questions (this is an early release, more to come)• Application Readiness and Document Uploads Guidance• Expenditures Guidance• Peer Support & Program Pre-Approval Certification• Coming Soon! Revenue Changes Guide• Coming Soon! Financial Assistance to Date Guide• Coming Soon! Payment Disbursement & Auditing Guide

• Submit a question using the Online Questions Submission Form

• Sign Up for the Listserv to stay up to date on important changes and announcements

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