One problem is that many rural hospitals didn't see any covid-19 patients, so they're not sure how funds meant to help with covid-19 expenses can be spent and should be reported, and some rural hospital CEOs say the Department of Health and Human Services guidelines are unclear, Carey reports.
Rural hospitals got CARES Act funds n several ways; $10 billion was appropriated to help rural hospitals treat covid-19 patients and cover revenue shortfalls from canceling normal business such as elective surgery. Some rural hospitals also received funds allocated for providers with a higher historical share of revenue from Medicare compared to total net patient revenue from all sources.
Rural hospitals rely more on Medicaid and Medicare, but often get less funding because the formula Congress used to allocate the money ended up disproportionately helping providers that have many privately insured patients, the Kaiser Health Foundation reports. Rural hospitals are generally more vulnerable to Medicaid and Medicare reimbursement policy changes since they rely so much on it.
"For hospitals who received Paycheck Protection Program loans from the Small Business Administration, there are even more questions," Carey reports. "The biggest of these is whether hospitals that use the PPP program to pay for salaries will have to return some reimbursements from the Centers for Medicare and Medicaid Services."