Hospital Assistance Frequently Asked Questions

(Revised December 30, 2020)

General


1. Question: What facilities are eligible for Hospital Staffing Assistance Funds awarded under this program?

Answer

Eligibility will be determined every 14 days for acute care hospitals according to data reported into the Healthcare Resource Tracking System (HRTS), with the last determination being December 22. Eligible hospitals are those that meet the following criteria according to either of the two most recent 7 day periods:

  • Adult staffed floor bed utilization averages 75% or more AND COVID-19 positive patients occupy 10% or more of staffed floor beds;
  • OR
  • Adult staffed floor bed utilization averages 85% or more AND COVID-19 positive patients occupy 6% or more of staffed floor beds;
  • OR
  • Adult ICU staffed bed utilization averages 70% or greater AND COVID-19 positive patients occupy 30% or greater of total adult staffed ICU beds.

2. Question: How will a hospital know if it is eligible for funding under this program?

Answer

Hospital eligibility will be determined every 14 days on every other Tuesday. TDH staff will examine each of the two weeks prior. If the hospital meets the eligibility requirements for either of those weeks, the hospital and their Regional Hospital Coordinator (RHC) will be notified immediately and allowable expenses will be reimbursed for four weeks (28 days) total, from two weeks prior to eligibility determination through two weeks after eligibility determination. The following table outlines the utilization periods that will be used to determine eligibility and the related eligible cost periods:

Date of TDH Data Pull/RHC Notification of hospital eligibility: ONE of these week periods must meet eligibility criteria: If ONE of the weeks is eligible, hospital can invoice for reimbursable expenses in this period: Period # Date Expenses Due for Submission:
September 1, 2020 August 18 – 24 OR
August 25 – 31
August 18 - September 14 1 Oct. 14
September 15, 2020 September 1 – 7 OR
September 8 – 14
September 1 – 28 2 Oct. 28
September 29, 2020 September 15 – 21 OR
September 22 – 28
September 15 – October 12 3 Nov. 12
October 13, 2020 September 29 – October 5 OR
October 6 – 12
September 29 – October 26 4 Nov. 25
October 27, 2020 October 13 – 19 OR
October 20 – 26
October 13 – November 9 5** Dec. 9
November 10, 2020 October 27 – November 2 OR
November 3 – 9
October 27 – November 23 6** Dec. 23
November 24, 2020 November 10 – 16 OR
November 17 – 23
November 10 – December 7 7** Jan. 7
December 8, 2020 November 24 – 30 OR
December 1 – 7
November 24 – December 21 8** Jan. 21
December 22, 2020 December 8 – 14 OR
December 15 – 21
December 8 – January 4 9** Feb. 4

The eligibility and utilization periods have been extended through June 30, 2021. Please see FAQ #23 for additional details.

*If the Hospital’s payroll periods do not align with the reimbursable expense periods, the Hospital may submit expenses for the payroll periods that cover this four-week period. For example, if the Hospital is eligible for the four-week period of November 10 – December 7 and their payroll periods are 11/8-11/21 and 11/22-12/6, both payrolls are eligible for reimbursement, up to the allocated amount of $259,200.

**Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400. For example, if a Hospital was eligible in period 4, they will receive $259,200 as well as an additional $129,600 for a total of $388,800. If the Hospital has not been eligible in previous periods and is eligible in period 5, they will receive the original $259,200 allocation, and an additional $259,200 for a total of $518,400 for the reimbursable expenses incurred between October 13 – November 9.

As a result of this update, additional allocation expenses may be submitted for period 4 and 5 between December 9 and December 23.


3. Question: Are recipients required to apply for funds?

Answer

No, applications are not required under this program. Eligibility will be determined automatically based on the seven-day average hospital staffed bed utilization calculated by the Tennessee Department of Health based on data reported by hospitals in the Healthcare Resource Tracking System.


4. Question: How much funding will each hospital receive?

Answer

A maximum of $259,200 of funding per month is available based on eligibility criteria described above. This figure is based on the assumption that a hospital meeting these criteria will have already taken or have plans to take action to expand capacity for COVID-19 positive patients by a minimum of 12 additional floor beds or 6 additional ICU beds (can be pro-rated for smaller facilities with less facility space). The hospital will need to upload a brief description/plan initially and may be asked for additional detail as a reporting requirement. The action to increase capacity to care for COVID-19 positive patients may have been taken before or after the funding period as long the increased capacity remains in place during the funding period and the hospital is able to document this bed availability increase.

Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400.


5. Question: Will there be any advances of funds or will all funds be disbursed on a reimbursement basis?

Answer

There will be no advance of funds. All funds will be issued on a reimbursement basis once supporting documentation is provided.


6. Question: What substantiating documentation for program expenses will be required?

Answer

Supporting documentation for all expenses will be required. Such support may include, but is not limited to, receipts, invoices, and proof of payment. Recipients should also include a detailed narrative with their reimbursement request outlining the specific expense(s) and why they were necessary due to COVID-19.


7. Question: What will a hospital need to complete the eligibility attestation form for this program?

Answer

Hospitals need to attest the following questions and statements with a yes/no answer once they have been registered in the CAMS system:

  • I certify that this funding is not supplanting other federal funds, including FEMA assistance, nor requesting duplicate reimbursement for services covered by other programs.
  • I am receiving federal Department of Health and Human Services (HHS) Funding.
    • (If yes to previous question) I certify that I expended all of my HHS funding earmarked for staffing before applying for TDH funding.
  • I certify that I am not actively recruiting staff from other TN hospitals.

Earmarked funding can include previously provided funds that have been budgeted for staffing or are required under the grant to be expended towards staffing costs. Hospitals are attesting to not having duplicate funding sources for the same expense.


8. Question: How will hospitals receive reimbursement for eligible staffing costs?

Answer

Once a hospital is notified of eligibility, it will need to promptly provide TDH staff (shannon.velasquez@tn.gov) with both primary and backup contact information. This information will be given to HORNE, our third-party grant manager. HORNE personnel will then assist in collecting an online attestation form and coordinate onboarding into their invoicing system. All payments will be made in accordance with the settings associated with the recipient’s Supplier ID that is identified in Tennessee’s Edison Accounting System.


9. Question: Is there additional information that will be needed prior to cost reimbursement?

Answer

Hospitals will need to provide supporting documentation for eligible costs incurred. Hospitals will need to upload a brief description of how staffed bed capacity is increased with the funds provided, including the number of additional beds provided. If pro-rated funding is requested for less than 12 floor or 6 ICU beds increases, a description of this brief proposal should be uploaded for approval.


10. Question: What is the deadline to spend the funds?

Answer

Eligible costs must be incurred within a four-week period, from 2 weeks prior to eligibility determination to two weeks after eligibility determination including the date of determination. Eligibility will be re-determined every 14 days. For example, for hospitals determined to be eligible September 1, eligible costs would include those incurred from August 18 thru September 14. New hospitals may meet the above criteria on the next determination date of September 15 and qualify for reimbursement from September 1-28. A hospital will only be eligible for a maximum of $259,200 every 4 weeks. The last day to incur eligible costs is December 30, 2020.

Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400.


11. Question: Is there a cap on the amount of reimbursement requests?

Answer

Yes, each hospital is eligible to receive a maximum amount of $259,200.00 per eligible four-week period.

Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400.


12. Question: What documentation is required for reimbursement of payroll expenses?

Answer

The Request for Reimbursement (RFF) documentation should include a detailed narrative explaining the use of the funds including the activities/duties performed and how those were in response to the COVID-19 public health emergency. Additionally, the normal capacity as compared to the increased capacity/need as a result of the expansion would be considered appropriate supporting documentation with the accompanying proof of payment for the funds requested for reimbursement.


13. Question: What should the hospital’s plan include?

Answer

The plan should be the hospital’s plan on how they intended to meet to goal of the program. The goal of this program is to provide hospital staff required to provide patient care for a minimum of 12 floor beds or 6 ICU beds in addition to the eligible hospital’s current staffed capacity. If a hospital is requesting less than the full amount of available funding and is implementing a smaller bed increase, that pro-rated proposal would need to be described in the plan submitted. There is not a draft a plan template.


14. Question: For proving our bed capacity increase due to COVID-19, can you provide some details on the time frame that is applicable for this increase? We had previously expanded our ICU beds for COVID capacity before the beginning of this program.

Answer

Eligible expenses are those incurred during the designated period of eligibility. Meaning if the ICU beds have been expanded only costs associated with the time period in which the hospital was deemed eligible will be reimbursed. The actual expansion may have occurred prior to eligibility and the additional costs incurred were due to sustainment of the expansion. The hospital will need to explain this in the submitted justification plan. Documentation detailing the necessity due to COVID, the normal capacity and increased capacity as a result of the expansion would be considered appropriate supporting documentation alongside the proof of payment for the funds requested for reimbursement.


15. Question: What will the allocation amount be if a Hospital is eligible for consecutive periods?

Answer

For newly eligible hospitals, the allocated amount is $259,200 over a four-week period. Additional eligibility allocations will increase by $129,600 every two weeks. For instance, if a hospital is eligible in one period, their allocation will be $259,200. If that hospital remains eligible for a second period, their allocated amount will increase by $129,600 to bring their total allocation to $388,800 for the six contiguous weeks. If a hospital is not eligible for a second period, the allocated amount will remain at $259,200 for the four-week eligibility period.

Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400. For example, if a Hospital was eligible in period 4, they will receive $259,200 as well as an additional $129,600 for a total of $388,800. If the Hospital has not been eligible in previous periods and is eligible in period 5, they will receive the original $259,200 allocation, and an additional $259,200 for a total of $518,400 for the reimbursable expenses incurred between October 13 – November 9.

As a result of this update, additional allocation expenses may be submitted for period 4 and 5 between December 9 and December 23.


16. Question: What will the allocation amount be if a Hospital is eligible for multiple, non-consecutive periods?

Answer

For newly eligible hospitals, the allocated amount is $259,200 over a four-week period. Additional eligibility allocations will increase by $129,600 every two weeks. For instance, if a hospital is eligible in one period, their allocation will be $259,200. If a hospital is not eligible for a second period, the allocated amount will remain at $259,200 for the four-week eligibility period. However, if the hospital becomes eligible in the third period, the eligibility allocation will increase by the $259,200 for the second eligible four-week period.

Due to additional staffing required related to the current COVID-19 surge, hospitals are eligible for additional funding reimbursement for costs incurred from October 13-December 30. The maximum allocation for each four-week period for periods 5-9 will increase to $518,400. For example, if a Hospital was eligible in period 4, they will receive $259,200 as well as an additional $129,600 for a total of $388,800. If the Hospital has not been eligible in previous periods and is eligible in period 5, they will receive the original $259,200 allocation, and an additional $259,200 for a total of $518,400 for the reimbursable expenses incurred between October 13 – November 9.


17. Question: Is there a limit to the number of RFFs submitted?

Answer

No. A recipient can submit as many RFFs as needed to adequately show each expense incurred. We recommend consolidating requests as possible to expedite the review and disbursement process.


18. Question: What if a hospital already received Department of Health and Human Services (HHS) funding and has not fully exhausted those funds?

Answer

A hospital can still submit RFFs for the COVID-19 Hospital Staffing Assistance if it has expended all HHS funding earmarked (previously budgeted/allocated) for staffing before applying for CRF funding.


19. Question: Can any of the funds be used for administrative expenses related to CRF reimbursements?

Answer

Hospitals may apply an indirect cost rate of 10% of the eligible expenses, to eligible direct staffing payroll expenses. For example, if a Hospital incurred $100,000 in eligible staffing expense. If hospital elects, they can apply an indirect cost rate of up to 10% for a maximum reimbursable amount of $110,000 in total.


20. Question: The Recipient Guidelines state that an RFF submitted after November 15, 2020 will not be reimbursed – has this changed?

Answer

Page 18 of the Recipient Guidelines is hereby amended to state that RFFs can be submitted in accordance with FAQ #2. Submission should be made in accordance with the corresponding eligibility period, with the last submission date being June 30, 2021. RFFs submitted after June 30, 2021 will not be eligible for reimbursement.


21. Question: How does a Hospital smaller than 50 staffed beds meet the eligibility requirements to increase staffed capacity?

Answer

The eligibility criteria that the Hospital must expand staffed capacity by a minimum of 12 additional floor beds or 6 additional ICU beds in addition to the Hospitals current staff capacity is waived for Hospitals with less than 50 staffed beds.


22. Question: Can other staff assisting with COVID inpatient care increase be included in eligible costs?

Answer

Yes, costs associated with additional staff hired due to COVID inpatient care increase (i.e. entrance screeners) are considered eligible expenses. The RFF narrative should include the necessity of the costs and their relation to the COVID inpatient care requirements.


23. Question: Will the program be extended past December 30, 2020?

Answer

Due to continued demand for hospital staffing assistance in response to the COVID-19 pandemic, The Tennessee Department of Health has extended the eligibility and utilization periods through June 30, 2021.

As with the initial program, hospital eligibility will be determined every 14 days on every other Tuesday. TDH staff will examine each of the two weeks prior. If the hospital meets the eligibility requirements for either of those weeks, the hospital and their Regional Hospital Coordinator (RHC) will be notified immediately and allowable expenses will be reimbursed for four weeks (28 days) total, from two weeks prior to eligibility determination through two weeks after eligibility determination. The eligible expenses will follow the original guidelines of a maximum of $259,200 for each four-week period for Periods 10-22.

The following table outlines the utilization periods that will be used to determine eligibility and the related eligible cost periods:

Date of TDH Data Pull/RHC Notification of hospital eligibility: ONE of these week periods must meet eligibility criteria: If ONE of the weeks is eligible, hospital can invoice for reimbursable expenses in this period:* Period # Date Expenses Due for Submission:
January 5, 2021 December 22 - 28 OR
December 29 - January 4
December 22 - January 18 10 February 18
January 19, 2021 January 5 - 11 OR
January 12 - January 18
January 5 - February 1 11 March 4
February 2, 2021 January 19 - January 25 OR
January 26 - February 1
January 19 - Februrary 15 12 March 18
Febuary 16, 2021 February 2 - February 8 OR
February 9 - February 15
February 2 - March 1 13 April 1
March 2, 2021 February 16 - February 22 OR
February 23 - March 1
February 16 - March 15 14 April 15
March 16, 2021 March 2 - March 8 OR
March 9 - March 15
March 2 - March 29 15 April 29
March 30, 2021 March 16 - March 22 OR
March 23 - March 29
March 16 - April 12 16 May 13
April 13, 2021 March 30 - April 5 OR
April 6 - April 12
March 30 - April 26 17 May 27
April 27, 2021 April 13 - April 19 OR
April 20 - April 26
April 13 - May 10 18 June 10
May 11, 2021 April 27 - May 3 OR
May 4 - May 10
April 27 - May 24 19 June 24
May 25, 2021 May 11 - May 17 OR
May 18 - May 24
May 11 - June 7 20 June 30
June 8, 2021 May 25 - May 31 OR
June 1 - June 7
May 25 - June 21 21 June 30
June 22, 2021 June 8 - June 14 OR
June 15 - June 21
June 8 - June 30 22 June 30

 

Eligible Expenses


1. Question: What expenses are eligible under the Hospital Assistance Program?

Answer

Only staffing costs are considered eligible expenses under this program. TDH will reimburse staffing costs associated with the hospital expansions. Eligible costs include:

  • Hazard pay for staff (i.e., additional pay for performing hazardous duty or work involving physical hardship related to COVID-19);
  • Overtime pay for critical staff;
  • Payments to a supplemental staffing agency;
  • Housing and travel costs for staff to the extent such is not already covered by the staffing contract; and
  • Pay differentials for staff willing to work shifts beyond their normal schedule.

Hospitals cannot use the funding in this contract to supplant other federal funding and must attest that any expense reimbursed under this contract is not reimbursed under any other program. This requirement is not meant to preclude the hospital from billing any form of insurance for care provided to any patient. If applicable, the hospital must first exhaust all funds from the federal Department of Health and Human Services CARES Act Provider Relief Fund earmarked for staffing before invoicing the State for further funding under this contract. The hospital must also attest that it will not use the funding in this contract to directly recruit staff from other Tennessee hospitals. Eligible hospitals must follow all applicable State and federal laws for hiring medical staff, and hospitals must meet all State and federal standards for providing healthcare.

Additionally, expenses related to staff hours dedicated to orientation/PPE training directly related to COVID-19 health services is eligible.


2. Question: Are bonuses and incentives for staff an eligible cost under this program?

Answer

No. These costs are not eligible due to federal funding restrictions.


3. Question: Can recipients use the funds to reimburse eligible expenses incurred prior to this program?

Answer

Grant funds may be used to cover eligible costs incurred from August 17, 2020 – December 30, 2020.


4. Question: Are staffing expenses related to care of all patients eligible or only those dedicated to COVID positive patients?

Answer

If the hospital has incurred additional costs for expanded staffing as a result of COVID, this expense would be eligible. If the staff would have been working regardless of COVID, this would not be an eligible expense. Likewise, if the staffing costs is covered by insurance reimbursement, this would not be an eligible expense.


5. Question: Are regular salaries considered eligible expenses if they are staffing expanded beds and expanded beds are used for COVID patients?

Answer

Only overtime pay, hazard pay, and contract staffing as a result of COVID expansion and related treatment of COVID patients is eligible under this program. Documentation will be required to be submitted demonstrating the hazard pay was directly tied to COVID-19 duties performed by the staff. Regular pay for staff assistance for non-COVID patients is not eligible as this would be covered by traditional payment mechanisms such as insurance reimbursement.


6. Question: If you qualify for one period, then not qualify the next, can you qualify for a following period?

Answer

Yes, eligibility qualifications are determined every two weeks according to the table above at FAQ #2. Eligibility for one period is not dependent on any prior periods.


7. Question: Is over-flow payroll an eligible expense?

Answer

The goal of this program is to provide hospital staff required to provide patient care for a minimum of 12 floor beds or 6 ICU beds in addition to the eligible hospital’s prior staffed capacity. We understand that COVID patient beds may require a hospital to expand capacity through the use overflow beds. Only overtime pay, hazard pay, and contract staffing as a result of COVID expansion and related treatment of COVID patients is eligible under this program. Regular pay for staff assistance non-COVID patients is not eligible as this would be covered by traditional payment mechanisms such as insurance reimbursement.


8. Question: Are clinical contract employee expenses eligible if they were not budgeted for prior to the COVID-19 Pandemic?

Answer

The goal of this program is to provide hospital staff required to provide patient care for a minimum of 12 floor beds or 6 ICU beds in addition to the eligible hospital’s prior staffed capacity. Only overtime pay, hazard pay, and contract staffing as a result of COVID expansion and related treatment of COVID patients is eligible under this program. Contract staffing to meet your staffing requirements for normal operations is not eligible, but contracted labor that is higher than budgeted due to COVID care (actual minus budgeted) would be eligible.


9. Question: Would an increase in base pay for PRN RNs and LPNs be an eligible expense?

Answer

Yes. If the hospital can demonstrate increased reliance and use of PRN staff as a result of COVID and that cost was anticipated in the planned response, that cost (actual minus budgeted or baseline pay) would be eligible. Hazard pay under a board approved hazard pay policy in response to COVID to get increased participation of staff is an eligible expense.


10. Question: Is RN staffing for drive through COVID testing eligible?

Answer

No, drive through COVID testing is not related to expanded hospital capacity and is therefore ineligible. The goal of this program is to provide hospital staff required to provide patient care for a minimum of 12 floor beds or 6 ICU beds in addition to the eligible hospital’s prior staffed capacity.


11. Question: Are the costs for replacement, or supplemental staff (contract employees) hired to fill positions of employees who are now dedicated to COVID-19 patients eligible?

Answer

Yes, so long as sufficient documentation is provided demonstrating a direct correlation between the replacement staff hired and the increased capacity due to COVID-19.


12. Question: Are the expenses related to infusing monoclonal antibody for COVID patients by hospital staff eligible?

Answer

Yes, additional staffing needs related to infusion centers for monoclonal antibodies given to COVID patients is an eligible expense.


13. Question: Are the expenses related to COVID-19 vaccine administration and training eligible?

Answer

Yes, additional staffing needs as a result of the COVID-19 vaccine distribution to train staff in administration of the vaccine as well as administration of the vaccine are eligible expenses. Please include detail regarding these expenses in the RFF.