CARES Act Information

As part of the CARES Act, the U.S. Department of Health and Human Services (HHS) is contracting with UnitedHealth Group to facilitate the delivery of HHS’ initial $30 billion distribution to providers as quickly as possible in support of the national response to COVID-19. For information, visit hhs.gov/providerrelief. For questions regarding the distribution of funds, please call the toll-free CARES Provider Relief line at 866-569-3522.

On March 27, 2020, President Donald Trump signed into law a $2 trillion bipartisan package called the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act is designed to inject stimulus into the economy and provide relief to individuals and businesses impacted by COVID-19.

Learn more about the provisions for small businesses or read the CARES Act. 

Here’s how UnitedHealthcare will apply the CARES Act increase in the DRG weighting factor to care provider payments.

Medicare Advantage

For dates of service from Jan. 27, 2020 through the end of the national public health emergency period, Section 3710 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act increases the weighting factor applicable to the diagnosis-related group (DRG) by 20 percent under the Centers for Medicare & Medicaid Services (CMS) inpatient prospective payment system (IPPS) in the case of a discharge of an individual diagnosed with COVID-19. Due to a delay in CMS releasing necessary information related to the increase in this weighting factor, and to accelerate payment to care providers, UnitedHealthcare will process inpatient claims according to currently available information. Once CMS officially releases the updated weighting factor information, UnitedHealthcare will automatically reprocess the impacted claims. No action is required by care providers to initiate the reprocessing.

• Contracted Care Providers: UnitedHealthcare will pay care providers according to the terms of their participation agreement. For care providers who treat Medicare Advantage members and whose contracted reimbursement is based upon CMS IPPS reimbursement methodology, we will apply the increase, as appropriate, for discharges of individuals diagnosed with COVID-19 during the national public health emergency period. Care providers are required to comply with CMS coding and billing requirements. 
• Out-of-Network Care Providers: UnitedHealthcare will apply the Medicare COVID-19 add-on payment for inpatient stays to payments to out-of-network care providers who treat Medicare Advantage members. For out-of-network providers who treat Medicare Advantage members, we will comply with CMS requirements and apply the increase, as appropriate, for discharges of individuals diagnosed with COVID-19 during the national public health emergency period. Care providers are required to comply with CMS coding and billing requirements. For a care provider who treats commercial or Medicaid members, we will pay for covered services in accordance with the member’s health plan benefits and applicable laws and regulations.

Medicaid and Individual and Group Market (Commercial) Health Plans

UnitedHealthcare pays contracted facilities according to the terms of their participation agreement. Facilities in our Medicaid and Individual and Group Market Health Plan (commercial) networks may be contracted based on several payment methodologies, including the MS-DRG payment method. As applied to providers in the Medicaid and Individual and Group Market Health Plan (commercial) networks, this payment method does not follow the CMS IPPS payment method. The payment appendices do not include add-on payments in the calculation of the contract rate. Providers in our Medicaid and Individual and Group Market Health Plan (commercial) networks are not entitled to the CARES Act 20% add-on payment under the terms of their participation agreement.

As previously noted, Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act creates a temporary waiver of the Medicare Sequester for a period currently scheduled to end Dec. 31, 2020. Upon expiration of the waiver, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver for contracted care providers, out-of-network care providers and capitated groups.

Contracted Care Providers

We intend to implement the waiver according to the terms of care provider participation agreements. On Jan. 1, 2021, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver. 

• If you have a Medicare Advantage plan fee-for-service contract with us based on Medicare methodology or rates that have been adjusted for sequestration, including Medicare fee schedules, we intend to implement the waiver of the 2 percent Medicare Sequester for physician, facilities, ancillary provider and other health care professional payments for dates of service or dates of discharge from May 1, 2020 through the end of the waiver period. 
• If you have a capitated Medicare Advantage plan contract with us based on a percentage of CMS revenue that has been adjusted for sequestration, we intend to implement the waiver of the 2 percent Medicare Sequester for capitated payments for dates on or after May 1, 2020 through the end of the waiver period.
• If you have a contract with a Medicare Advantage incentive program that includes calculations based on a percentage of premium or CMS revenue as well as affected medical expenses, the waiver of the 2 percent Medicare Sequester will be passed through to these calculations accordingly for dates on or after May 1, 2020 through the end of the waiver period.

Out-of-Network Care Providers

For out-of-network providers who treat UnitedHealthcare Medicare Advantage members, we intend to implement the waiver for physician, facility, ancillary provider and other health care professional payments for claims with dates of service or dates of discharge from May 1, 2020 through the end of the waiver period. Once the waiver period ends, we will resume reimbursement in the manner that was in effect prior to the implementation of the waiver. 

Capitated Groups

Capitated groups who are delegated for claims payment should review their direct contracts with downstream care providers to determine how their payment methodologies and rates relate to Medicare methodology and rates, and to determine whether to implement the waiver. If you have questions, please contact your network representative.