The ADA had advocated for HHS to extend the deadline and was pleased to learn the department agreed. The Provider Relief Fund was established by the Coronavirus Aid, Relief and Economic Security Act — known as the CARES Act — and allows dental providers to apply for payments made for health care-related expenses or lost revenue attributable to the pandemic.
This is “great news,” ADA President Chad P. Gehani said in an Aug. 1 Issues Alert email. “I urge all dentists to act quickly if you haven’t already.”
“By giving providers until Aug. 28 to apply, HHS is hopeful it has struck the right balance in terms of providing as much flexibility as possible, recognizing the constraints on smaller practices already operating on thin margins with limited administrative staff,” the department said in July 31 news release.
HHS also said beginning Aug. 10 and continuing through Aug. 28:
• Dentists who previously received small automatic payments from the General (Medicare) Distribution due to Medicare billings, will be allowed to apply and receive additional funding from the Provider Relief Fund.
• Dentists who experienced a recent change in ownership may submit their revenue information along with documentation proving a change in ownership for consideration for Provider Relief Fund payment.
The following dental providers are eligible to apply now:
• Dentists who have directly billed their state Medicaid/Children’s Health Insurance Programs or Medicaid managed care plans for health care-related services between Jan. 1, 2018, to Dec. 31, 2019.
• Providers who own an included subsidiary that has either directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for health care-related services between Jan. 1, 2018, to Dec. 31, 2019.
• Providers who have either directly billed health insurance companies for oral health care-related services, or who own an included subsidiary that has directly billed health insurance companies for oral healthcare-related services.
• Licensed providers who do not accept insurance and have either directly billed patients for oral health care-related services, or who own (on the application date) an included subsidiary that does not accept insurance and has directly billed patients for oral health care-related services.
Eligible providers must also meet all of the following requirements:
• Have filed a federal income tax return for fiscal years 2017, 2018 or 2019 or 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).
• Have provided patient dental care after Jan. 31.
• Not have permanently ceased providing patient dental care directly or indirectly through included subsidiaries. However, dental offices that shut down during the pandemic are eligible.
• If the applicant is an individual, has gross receipts or sales from providing patient dental care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a statutory employee.
HHS has said it is basing relief payments on 2% of gross revenues for patient care to all eligible providers. The first step in the application process is for dentists to have their Taxpayer Identification Numbers validated. HHS has also said they will be providing a more simplified application form, but until that happens, are urging dentists to initiate the process of validating their Taxpayer Identification Numbers before the Aug. 28 deadline. Dentists who have their Taxpayer Identification Number validated after Aug. 28 will still be permitted to complete the full application.
For more information about the Provider Relief Fund, the ADA has created an FAQ on popular Provider Relief Fund questions the Association has received from dentists. The questions include those on balance or surprise billing, which HHS has clarified to say that dental providers who are not caring for patients with presumptive or actual cases of COVID-19 “are not subject to balance billing prohibitions.” Since most dentists are not caring for patients with active COVID infections, they will not be covered by this bar.
The phone number for the HHS Provider Support Line is 866-569-3522 and the hours of operation are 7 a.m. to 10 p.m. CT, Monday – Friday.
There are also a number of HHS resources online, including the PRF Payment Portal User Guide, HHS instructions for filling out the application, HHS Webinar Recordings and two FAQs: General Information about the PRF FAQ and the Medicaid, CHIP and Dental Providers Distribution FAQ.
For more information about the ADA's advocacy efforts during the COVID-19 pandemic, visit ADA.org/COVID19Advocacy.