Analysis: The muddle of relief for Idaho’s rural hospitals

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How much did Idaho’s rural hospitals receive from the $10 billion rural health care relief funds? Short of asking each individual hospital, it is impossible right now to tell who got what.

That’s because the amounts that the U.S. Department of Health and Human Services said it would distribute does not match its database of actual disbursements made to date, which in turn does not match what was actually received based on the example of one health care provider who verified its relief funds with the Idaho Business Review.

Short of voluntary disclosure by every rural hospital of the relief each received, there is currently incomplete accountability on the part of HHS involving distributions.

HHS reported on May 1 that it would give $10 billion in relief to rural health care providers throughout the country. The agency reported that 92 rural recipients in Idaho would split the state’s allocated share, which was $122.9 million. All rural Community Access Hospitals would each receive a minimum of $1 million and anything over that amount would be based on each CAH’s operating expenses. HHS did say it would disclose all the relief payments that it managed under three different COVID-19 relief programs.

HHS reported all the health care providers that received funds through the Coronavirus Aid, Relief, and Economic Security Act, the Paycheck Protection Program, and the Health Care Enhancement Act through May 13, including the $10 billion allocation for rural providers. This online database of relief payments is posted on a U.S. Centers for Disease Control and Prevention website.

The table below shows all of Idaho’s CAHs and the amounts reported on the relief payment database at the CDC. Where a hospital name in the database was significantly different from what Idaho residents would use, that name was placed in parentheses.

This table represents the list of all Idaho CAHs eligible to receive a payment from the general distribution, high impact targeted allocation and/or the rural targeted allocation of the Provider Relief Fund, including all those who have “attested to receiving one or more payments and agreed to the Terms and Conditions” according to HHS.

Because no Idaho hospitals received any money from the high-impact targeted allocation, the awards shown here can only be from the general distribution or the rural distribution of relief moneys. Because every one of the hospitals listed here are CAHs, each should have received at least $1 million according to HHS’s own distribution guidelines.

The Idaho Business Review asked HHS why 13 of Idaho’s 27 CAHs did not receive the minimum amount according to the relief fund payments database.

Scott Kodish, an HHS spokesperson, explained that the data posted at https://data.cdc.gov/Administrative/HRSA-Provider-Relief-Fund-General-Allocation/kh8y-3es6 is comprised of providers that have received and attested to at least one payment under the General, High Impact, or Rural distributions of the Provider Relief Fund.

“If a provider received two payments and attested to both, both payments are included in the aggregate data,” he said. “Any Critical Access Hospitals or other rural providers that received Rural Distribution payments but have not yet attested will not be listed in the data set at this time. Entities that show payments less than the $1 million threshold for the Rural distribution may have attested to a payment under other distributions. When additional data is available, it will be updated at the link above.”

Buried on the HHS website are the rules on attestation. Each CAH must attest the receipt of all relief payments through an online HHS portal. Part of the attestation process includes the submission of CAH revenue data. Failure to “attest” to a payment means that the payment will not be reported on the database online at the CDC even though the money has already been distributed. The HHS said in its May 1 news release that: “Eligible providers will begin receiving funds in the coming days via direct deposit … regardless of their affiliation with organizations based in urban areas.” So the money has already been given out, but it won’t be accounted for unless the recipients does all the paperwork steps the HHS requires.

HHS can demand the return of that money if the health provider does not agree to the terms and conditions included as part of the attestation process. HHS has set a deadline of June 3 for providers to attest their relief payments.

Once the money was deposited by HHS in a hospital’s account, each CAH was given 30 days to attest to it; however, after 30 days, HHS will consider that the recipient has accepted the terms and conditions by default, which appears to be contradictory to HSS being able to demand the return of the money if no attestation is made.

The Idaho Business Review also inquired of both HHS and some hospitals as to why some CAHs received less than $1 million, and in three cases (St. Luke’s Jerome, Cassia Regional Hospital and Power County Hospital) no money at all.

St. Luke’s – Jerome spokesperson Michelle Bartlome responded that: “St. Luke’s Jerome is not a separate legal entity and their allocation amount is reflected under St. Luke’s Magic Valley. St. Luke’s McCall and St. Luke’s Jerome were appropriately allocated funds, which exceeded the minimum amount of $1 million as provided for by the CARES Act.”

The database of relief allocations did not indicate that St. Luke’s Jerome was part of St. Luke’s Magic Valley in terms of financial tracking. Therefore, it was not possible to ascertain that St. Luke’s Jerome did indeed receive its allocation without inquiring directly with St. Luke’s itself. Note that St. Luke’s Jerome is certified, accredited and operated as a CAH in its own right regardless of how its bookkeeping works internally in St. Luke’s Health System.

By HHS’s own rules, 1) relief payments are not publicly accounted for unless a CAH attests to them, 2) the database of attested payments is not final until after June, and 3) payments become automatically attested to after 30 days by default.

The Idaho Business Review will update this ongoing story and HHS’s interesting ways to report accountability in relief payments after the June 3 deadline.