- Billed Medicare fee-for-service during the period of Jan.1, 2019-Dec. 31, 2019; or
- Be a Medicare Part A provider that experienced a change in ownership and billed Medicare fee-for-service in 2019 or 2020 that prevented the otherwise eligible provider from receiving Phase 1 General Distribution payment; or
- Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan. 1, 2018 – Dec. 31, 2019; or
- Billed a health insurance company for oral healthcare-related services as a dental service provider; or
- Be a licensed dental service provider who does not accept insurance and has billed patients for oral healthcare-related services; or
- Be an approved assisted living facility.
Additionally, to be eligible to apply, the applicant must meet all of the following requirements:
- Filed a federal income tax return for fiscal years 2017, 2018, 2019; or be exempt from filing a return;
- Provided patient care after January 31, 2020 (Note: patient care includes health care, services, and support, as provided in a medical setting, at home, or in the community);
- Did not permanently cease providing patient care directly or indirectly; and
- For individuals, reported on Form 1040 (or other tax forms) gross receipts or sales from providing patient care.
Where can I apply?
Click here. The deadline is September 13, 2020.
What do I need to apply?
- Full Time Equivalent Count Worksheet Completed (FTEs as of 5/31/20) (The applicant’s FTE Worksheet, provided by HHS and available here.)
- Gross Revenue Worksheet Completed (If required by Field 15, the Gross Revenue Worksheet, provided by HHS and available here.)
Defined by HHS as: Enter the applicant’s most recent gross revenues number from its federal tax return of 2017, 2018, or 2019. If the applicant for tax purposes is a sole proprietor or disregarded entity owned by an individual: Enter Line 3 from IRS Form 1040, Schedule C excluding any income reported on W-2. partnership: Enter Line 1c minus Line 12 from IRS Form 1065.C corporation: Enter Line 1c minus Line 15 from IRS Form 1120. S corporation: Enter Line 1c minus Line 10 from IRS Form 1120-S. tax-exempt organization: Enter Line 9 from IRS Form 990 minus any joint venture income, if included in Part VIII lines 2a – 2f. trust or estate: Enter Line 3 from IRS Form 1040, Schedule C. entity not required to file any of the previously mentioned IRS forms: Enter a “net patient service revenue” number or equivalent from the applicant’s most recent audited financial statements (or management-prepared financial statements).
The gross will be based on your aggregate 17-19 returns.
- Other Docs/Info Needed:
- Most recently filed Tax Return (either 17, 18, or 19)
- Quarterly Federal Tax Return (IRS Form 941 for quarter 2020) or Federal Unemployment Tax Return (IRS Form 940)
- Estimate of Lost Revenues due to COVID (for March and April)
- Estimate of Increased expenses due to COVID (for March and April)
- Current Census totals by Payer Mix
- Total Amount you received from other Federal Programs (ie PPP, EIDL, etc)
Providers will receive approximately 2% of reported revenue from patient care.
Please reach out to your Mueller Prost specialist with any questions or in need of assistance.
Dental Provider? Click here for more details from the ADA.