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The Provider Relief Fund Helped Select Nursing Homes Maintain Services During the COVID 19 Pandemic, but Some Found Guidance Difficult to Use

KEY TAKEAWAY

The Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) quickly distributed Provider Relief Fund (PRF) payments to nursing homes. Nursing homes reported that payments were integral to maintaining services during the COVID-19 pandemic, but that guidance from HRSA about the payments and reporting requirements was often difficult to use.

WHY WE DID THIS STUDY

Nursing homes and their residents have been among the hardest hit by the COVID-19 pandemic, partly because of longstanding challenges with staffing and infection control. To help nursing homes and other health care providers respond to the pandemic, Congress appropriated $178 billion and designated HHS to oversee PRF and related distributions to providers. HHS made approximately $9.4 billion in targeted PRF distributions to nursing homes and skilled nursing facilities (SNFs).

HOW WE DID THIS STUDY

We conducted this evaluation in conjunction with a series of Pandemic Response Accountability Committee (PRAC) studies examining COVID-19 funding in six select locations. We examined how 11 nursing homes in those locations used PRF payments during 2020 and 2021 to improve their responses to the COVID-19 pandemic. We also examined HRSA oversight of the funds. We based our findings on document reviews, an analysis of PRF payment data, and 33 interviews with leadership, staff, residents, and residents' family members from the selected nursing homes. We also conducted two group interviews with HRSA officials. We collected the documents and data in early 2022 to prepare for conducting interviews from May through December concurrently with the PRAC's site visits.

WHAT WE FOUND

After receiving congressional appropriations in March 2020, HHS quickly worked with HRSA and other stakeholders to develop PRF and began distributing general relief payments to health care providers the following month. HHS began the first targeted distribution payments to nursing homes in May. Although leaders for the nursing homes in our sample appreciated how quickly the payments were disbursed, they sometimes faced challenges with PRF distribution and attestation processes.

HRSA distributed nearly $15 million in PRF payments to the 11 nursing homes in our sample in 2020 and 2021, including more than $5 million from targeted distributions to nursing homes and SNFs. Nursing home leaders reported that HRSA's broad guidance on allowable uses was initially unclear and difficult to use. As a result, some were hesitant to use the funds for fear they would use the money incorrectly and be forced to pay it back later. Regardless of the challenges, the nursing homes had used and reported about $12 million of the $15 million when we began our site visits in May 2022. Nursing home leaders reported using the funds for expenses and lost revenue, and reported that PRF payments were integral to maintaining services during the pandemic.

HRSA required nursing homes to submit reports about PRF use. The nursing homes in this review generally complied with the reporting requirements, but some appeared to misreport data or had to resubmit information. Nursing home leaders reported that it was difficult to find time to review lengthy reporting guidance, and that completing the reports was a burden. Although HRSA reported plans to assess nursing home use of PRF, the agency had not yet begun conducting audits at the time we conducted our review.

WHAT WE RECOMMEND

We recommend that HRSA: (1) create a document to record lessons learned from managing PRF and submit the document to HHS leadership and (2) expedite audits of provider use of PRF payments. HRSA did not concur with the first recommendation and concurred with the second