Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments, A-02-23-01012
What This Document Is
This OIG audit report from U.S. Department of Health and Human Services Office of Inspector General examines Provider Relief Fund through the source document titled "Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments". Congress appropriated $178 billion to HHS to provide funds to eligible providers for health care-related expenses or lost revenues attributable to COVID-19 under the Provider Relief Fund (PRF) program. HHS was responsible for initial PRF program oversight and policy decisions, and HRSA administered the PRF program.
Factual Summary
The source reports these central findings: Of the 30 selected ALFs we reviewed, 7 ALFs claimed a total of $283,000 in unallowable PRF expenditures, and 2 ALFs inaccurately reported $11 million in lost revenues. These nine ALFs received a total of $25.6 million in PRF payments. The remaining ALFs used PRF funds for allowable expenditures and lost revenues.
Recommendation or agency-response note: We made two recommendations to HRSA, including that it require the selected ALFs to return any unallowable expenditures and lost revenue amounts to the Federal Government or ensure that the ALFs properly account for these expenditures and lost revenues. HRSA concurred with our recommendations.
Key Facts
- Document title: Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments.
- Report number: A-02-23-01012.
- Document date shown in source front matter: December 2025.
- Issuer/court: U.S. Department of Health and Human Services Office of Inspector General.
- Document type: OIG audit report.
- Program(s): Provider Relief Fund.
- Review purpose: Congress appropriated $178 billion to HHS to provide funds to eligible providers for health care-related expenses or lost revenues attributable to COVID-19 under the Provider Relief Fund (PRF) program. HHS was responsible for initial PRF program oversight and policy decisions, and HRSA administered the PRF program.
- Primary source finding: Of the 30 selected ALFs we reviewed, 7 ALFs claimed a total of $283,000 in unallowable PRF expenditures, and 2 ALFs inaccurately reported $11 million in lost revenues. These nine ALFs received a total of $25.6 million in PRF payments. The remaining ALFs used PRF funds for allowable expenditures and lost revenues.
- Recommendation/status note: We made two recommendations to HRSA, including that it require the selected ALFs to return any unallowable expenditures and lost revenue amounts to the Federal Government or ensure that the ALFs properly account for these expenditures and lost revenues. HRSA concurred with our recommendations.
Source Caveats
- Use the PDF for exact quotations, pagination, tables, figures, appendices, and agency-response language.
- Where the source uses samples, surveys, snapshots, or selected files, do not generalize beyond the scope stated in the report.
- Document type
- Audit
- Date
- 2020-03-13
Cite this document
“Nine of Thirty Selected Assisted Living Facilities Did Not Comply With Terms and Conditions and Federal Requirements for Expending Provider Relief Fund Payments, A-02-23-01012.”
Original at oig.hhs.gov, dated 2020-03-13. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2020-03-13-nine-of-thirty-selected-assisted-living-facilities-did-not-comply-with-terms-an/
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December 2025 | A-02-23-01012
Nine of Thirty Selected Assisted
Living Facilities Did Not Comply
With Terms and Conditions and
Federal Requirements for
Expending Provider Relief Fund
Payments
OIG.HHS.GOV
December 2025 | A-02-23-01012
Nine of Thirty Selected Assisted Living Facilities Did Not Comply With
Terms and Conditions and Federal Requirements for Expending Provider
Relief Fund Payments
Why OIG Did This Audit
• Congress appropriated $178 billion to HHS to provide funds to eligible providers for health care-related
expenses or lost revenues attributable to COVID-19 under the Provider Relief Fund (PRF) program. HHS
was responsible for initial PRF program oversight and policy decisions, and HRSA administered the PRF
program.
• Providers receiving PRF payments were to ensure that the payments were: (1) used to prevent, prepare
for, or respond to COVID-19; (2) used for health care-related expenses or lost revenues attributable to
COVID-19; (3) not used to cover expenses or losses reimbursed by other funding sources; and (4) not
used to pay salaries in excess of a certain threshold or to pay for certain prohibited activities.
• This audit is part of a series reviewing PRF payments to various provider types. Specifically, this audit
assessed whether 30 selected assisted living facilities (ALFs) expended taxpayer funds in accordance
with Federal and program requirements.
What OIG Found
• Of the 30 selected ALFs we reviewed, 7 ALFs claimed a total of $283,000 in unallowable PRF
expenditures, and 2 ALFs inaccurately reported $11 million in lost revenues. These nine ALFs received
a total of $25.6 million in PRF payments. The remaining ALFs used PRF funds for allowable
expenditures and lost revenues.
• These deficiencies occurred because although ALFs attested to the PRF terms and conditions and HRSA
provided continuously updated guidance to PRF recipients, the ALFs made clerical errors in their
reporting of expenditures and did not always correctly interpret HRSA guidance, maintain
documentation to support reported expenditures, or have procedures to verify the accuracy of lost
revenue calculations.
What OIG Recommends
We made two recommendations to HRSA, including that it require the selected ALFs to return any unallowable
expenditures and lost revenue amounts to the Federal Government or ensure that the ALFs properly account
for these expenditures and lost revenues. HRSA concurred with our recommendations.
OIG.HHS.GOV
TABLE OF CONTENTS
INTRODUCTION ............................................................................................................................. 1
Why We Did This Audit...................................................................................................... 1
Objective ........................................................................................................................... 1
Background ....................................................................................................................... 2
The Provider Relief Fund ....................................................................................... 2
HHS’s and HRSA’s Oversight of the Provider Relief Fund Program ........................ 3
Requirements for Assisted Living Facilities That Received Provider Relief
Fund Payments ................................................................................................... 4
How We Conducted This Audit.......................................................................................... 6
FINDINGS ...................................................................................................................................... 7
Some Assisted Living Facilities Used Provider Relief Fund Payments for Unallowable
Expenditures and Inaccurately Calculated Lost Revenues .............................................. 8
Costs Not Adequately Supported .......................................................................... 8
Salary Costs Exceeded the Federal Executive Level II Salary Limit ......................... 8
Costs Charged but Not Incurred ............................................................................ 8
Duplicate Expenses ................................................................................................ 9
Expenditures Not Attributable to COVID-19 .......................................................... 9
Inaccurate Lost Revenue Calculations .................................................................. 9
Causes of Unallowable Expenditures and Inaccurately Calculated Lost
Revenues ...................................................................................................................... 10
RECOMMENDATIONS.................................................................................................................. 11
OTHER MATTERS ......................................................................................................................... 11
HEALTH RESOURCES AND SERVICES ADMINISTRATION COMMENTS AND OFFICE OF
INSPECTOR GENERAL RESPONSE .............................................................................................. 12
APPENDICES
A: Audit Scope and Methodology .................................................................................... 13
B: Related Office of Inspector General Reports ............................................................... 16
C: Provider Relief Fund General and Targeted Distribution Payments ............................ 17
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012)
D: Options for Calculating Lost Revenues ........................................................................ 19
E: Selected Assisted Living Facilities’ Reported Use of Provider Relief Fund Payments for
Reporting Periods 2 and 3 .......................................................................................... 20
F: Summary of Sampled Assisted Living Facilities’ Unallowable Expenditures and
Inaccurately Calculated Lost Revenue Amounts ........................................................ 21
G: Other Matters – Potential Savings Calculations .......................................................... 22
H: Health Resources and Services Administration Comments......................................... 24
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012)
INTRODUCTION
WHY WE DID THIS AUDIT
On March 13, 2020, the President declared the COVID-19 outbreak a national emergency. In
response, Congress passed three bills, which the President signed into law. These Federal laws
appropriated to the Department of Health and Human Services (HHS) a combined $178 billion
in funds, part of which HHS used to establish the Provider Relief Fund (PRF). 1 The PRF provided
payments to eligible assisted living facilities (ALFs) and other health care providers (collectively
referred to as “providers”) for: (1) health care-related expenses or lost revenues (e.g., due to
canceled elective services) attributable to COVID-19, (2) COVID-19 testing and treatment for
uninsured individuals, and (3) the administration of COVID-19 vaccines. HHS distributed PRF
funds, in part, as direct payments to providers in a series of PRF General and Targeted
Distributions. 2 As of October 2024, the Health Resources and Services Administration (HRSA)
had distributed $145.9 billion of the PRF to providers. 3
This audit assessed selected ALFs’ compliance with terms and conditions and Federal
requirements for expending PRF payments. It is one of several Office of Inspector General
(OIG) audits of various aspects of PRF payments, including: (1) HHS’s and HRSA’s controls
related to the requirements for submitting revenue information and attesting to the
acceptance or rejection of PRF payments, (2) HHS’s and HRSA’s controls over PRF payment
calculations and provider eligibility determinations, and (3) claims for COVID-19 testing and
treatment services for uninsured individuals. See Appendix B for a list of related OIG reports.
OBJECTIVE
Our objective was to determine whether selected ALFs that received PRF payments complied
with terms and conditions and Federal requirements for expending PRF funds.
1
Specifically, the Coronavirus Aid, Relief, and Economic Security Act, P.L. No. 116-136, signed into law on Mar.
27, 2020, appropriated $100 billion; the Paycheck Protection Program and Health Care Enhancement Act, P.L. No.
116-139, signed into law on Apr. 24, 2020, appropriated $75 billion; and the Consolidated Appropriations Act, 2021,
P.L. No. 116-260, signed into law on Dec. 27, 2020, appropriated $3 billion.
2
Under the General Distributions, PRF payments were distributed in four phases (Phases 1, 2, 3, and 4). For
example, under the Phase 1 General Distribution, PRF payments were distributed to eligible Medicare providers
that billed Medicare fee-for-service (Medicare Parts A or B) in calendar year (CY) 2019. Under the Targeted
Distributions, PRF payments were made to eligible providers or specific provider types to address added COVID-19
challenges, such as high-need populations, including nursing facilities and providers serving individuals in rural
areas and safety net hospitals.
3
This dollar figure is based on latest PRF distribution data provided by HRSA. As of June 2023, with the passage of
the Fiscal Responsibility Act of 2023, P.L. No. 118-5, Congress rescinded unobligated PRF funds, except for limited
funding Congress directed be used for program oversight and administration. In response, HRSA stopped making
PRF payments to providers.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 1
BACKGROUND
The Provider Relief Fund
As a result of the COVID-19 public health emergency, many States placed restrictions on
admissions to long-term care facilities and required infection control measures to minimize the
risk of transmission and ensure the safety of vulnerable individuals. 4 ALFs throughout the
Nation reported that extensive resources were dedicated to the cost of personal protective
equipment, routine testing, and staff support. 5 Additionally, ALFs requested financial
assistance, including loans and grants to help cover the increased costs associated with
implementing COVID-19 safety measures.
In response to the public health emergency, the PRF was established to provide funds to
eligible providers for health care-related expenses or lost revenues attributable to COVID-19. 6
HHS received a combined $178 billion in funding, of which $145.9 billion was distributed via PRF
payments to providers. 7 PRF funds were distributed as direct payments to providers in a series
of General and Targeted Distributions.
The Exhibit on the next page details the PRF distributions to health care providers. For further
details on how PRF payments were distributed, see Appendix C.
4
On Jan. 31, 2020, the Secretary of Health and Human Services declared the COVID-19 outbreak a public health
emergency. Then, on Mar. 13, 2020, the President declared the COVID-19 outbreak a national emergency. Both
the COVID-19 public health and national emergencies ended on May 11, 2023.
5
American Health Care Organization, “COVID-19 Exacerbates Financial Challenges Of Long Term Care Facilities.”
Accessed on July 17, 2025.
6
Providers had up to the end of the quarter in which the public health emergency ended (June 30, 2023) to use
PRF payments for any lost revenues attributable to COVID-19.
7
Congress also appropriated $8.5 billion of COVID-19-related relief for rural providers enrolled in Medicare or
Medicaid programs (American Rescue Plan Act of 2021, P.L. No. 117-2). This funding was administered by HRSA
and had similar limitations and requirements as the PRF but was not part of the PRF.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 2
Exhibit: Provider Relief Fund Distributions to Health Care Providers
Notes: Amounts for the Targeted Distributions do not add to $57.5 billion due to rounding. CHIP stands for the
Children’s Health Insurance Program.
HHS’s and HRSA’s Oversight of the Provider Relief Fund Program
The HHS Office of the Secretary was responsible for initial PRF program oversight and policy
decisions. The HHS Office of the Secretary’s direct responsibility for the PRF allowed HHS to
meet its mission to expedite the establishment of the PRF and the distribution of funds as
quickly as possible for providers’ health care-related expenses or lost revenues attributable to
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 3
COVID-19. Within HHS, HRSA was responsible for providing day-to-day oversight and managed
all aspects of the PRF program. 8
HRSA provided various resources to providers on the proper use and reporting of PRF
payments, including issuing a collection of evolving Frequently Asked Questions (FAQs), and
other guidance on allowable expenses and lost revenue calculations. 9 HRSA also conducted
technical assistance webinars on the reporting process. In addition, HRSA engaged external
audit firms to conduct risk-based audits for a sample of providers to ensure that providers used
PRF payments in accordance with PRF terms and conditions.
Requirements for Assisted Living Facilities That Received Provider Relief Fund Payments
Providers, including ALFs, may have been eligible to receive PRF payments from multiple
distributions. 10, 11 ALFs that received PRF payments had to comply with certain provisions of
the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS
Awards (45 CFR part 75). Specifically, the ALFs had to comply with 45 CFR § 75.302 (Financial
management and standards for financial management systems) and 45 CFR §§ 75.361 through
75.365 (Record retention and access).
As a condition of receiving PRF payments, providers agreed to the PRF terms and conditions,
including meeting eligibility criteria; filing expenditure reports; and ensuring that payments
were: (1) used to prevent, prepare for, or respond to COVID-19; (2) used for health care-related
8
HHS and HRSA, PRF General & Targeted Distribution Cycle Memo, dated Sept. 30, 2020, and Sept. 30, 2021.
9
HRSA, Provider Relief Programs: Provider Relief Fund and ARP Rural Payments Frequently Asked Questions (PRF
FAQs). Accessed on July 17, 2025. HRSA, Provider Relief Fund Distributions and American Rescue Plan Rural
Distribution Post-Payment Notice of Reporting Requirements (PRF Reporting Requirements). Accessed on July 17,
2025.
10
PRF payments were distributed to providers based on providers’ taxpayer identification numbers (TINs). ALFs
and other providers were required to report on their PRF payments if they received $10,000 or more during a
specified timeframe (i.e., payment period). For providers to meet this requirement, HRSA established reporting
periods, which specified when providers had to report on the use of PRF payments and were based on the payment
period(s). For example, reporting periods 1 and 2 covered PRF payments received during CY 2020. We use the
term “ALF” to refer to an ALF reporting entity. An ALF reporting entity may have registered its TIN through the PRF
Reporting Portal to report to HRSA on the use of PRF payments received by that TIN and TINs associated with the
entity’s subsidiary entities (e.g., individual ALFs). An ALF may be a stand-alone ALF, an ALF group, or a parent
organization.
11
For details on General and Targeted Distribution payments, see Appendix C. In addition to PRF payments, ALFs
may have received COVID-19-related assistance from other sources such as the Federal Emergency Management
Agency, the Department of the Treasury, and the Small Business Administration, as well as from grants and
donations from other local and State governments or private sources.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 4
expenses or lost revenues (i.e., patient care revenues) attributable to COVID-19; 12 (3) not used
to reimburse expenses or losses already reimbursed from other funding sources; and (4) not
used to pay salaries in excess of a certain threshold or to pay for certain prohibited activities
(e.g., lobbying). 13
Provider Relief Fund Expenditures and Lost Revenues
For reporting purposes, HRSA established periods during which providers were required to use
and report on PRF payments. 14 Providers, including ALFs, were required to report on their use
of PRF payments in broad categories (i.e., lost revenues, health care-related expenses, or
general and administrative expenses). For expenses, ALFs were required to report their use of
PRF payments for health care-related expenses (e.g., expenses for purchasing equipment such
as sanitizing supplies for infection control) and general and administrative expenses (e.g.,
salaries, utilities, rent), including expenses incurred prior to receipt of PRF payments (i.e., pre-
award costs dated back to January 1, 2020). 15 ALFs were required to follow their basis of
accounting (cash or accrual basis) to determine expenses and only use PRF payments for
eligible expenses or lost revenues during what is known as the period of availability. 16
For lost revenues, ALFs could apply their PRF payments toward lost revenue amounts during a
period of availability calculated using one of the following three options:
1. the difference between actual patient care revenues from 2019 and actual patient care
revenues during the period of availability,
2. the difference between budgeted patient care revenues (approved by ALF officials prior
to March 27, 2020) and actual patient care revenues, or
12
Patient care means health care, services, and supports as provided in a medical setting, at home, via telehealth,
or in the community. Items not considered patient care revenue include nonpatient care dining services, grants,
bad debt, any gains or losses on investments, and contractual adjustments.
Recipients were not allowed to use PRF payments to pay any salary at a rate in excess of Executive Level II, which
13
was set at $197,300 for 2020 and $199,300 for 2021.
14
HRSA required all providers that received PRF payments exceeding $10,000 in the aggregate during any given
payment-received periods (i.e., time periods in which a health care provider received one or more PRF payments)
to report on their use of the payments during the applicable reporting period.
15
HRSA, PRF Reporting Requirements.
16
The period of availability ends 1 year after the end of the quarter or semiannual period in which the payment
was received. The first payment receipt period was Apr. 10, 2020, through June 30, 2020. Subsequent payment
receipt periods were 6 months.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 5
3. any reasonable method of estimating revenues. 17
HRSA guidance for the treatment of unallowable or ineligible expenditures of PRF funds stated
that providers were allowed to replace unallowable or ineligible expenditures allocated to PRF
payments in a closed reporting period with unreimbursed lost revenues in subsequent
reporting periods. Providers were not required to return PRF payments used for unallowable
purposes (e.g., lobbying) to the Federal Government if they had sufficient unreimbursed lost
revenues to offset unallowable amounts. See Appendix D for a detailed description of how
providers could choose to calculate lost revenues.
HOW WE CONDUCTED THIS AUDIT
Our audit covered $156.1 million in PRF payments to a nonstatistical sample of 30 ALF taxpayer
identification numbers (TINs) during calendar years (CYs) 2020 and 2021. 18 (We refer to these
sample units throughout the report as “ALFs.”) 19 The selected ALFs reported that they used
$14.1 million of their PRF payments to offset lost revenues, $74.8 million for general and
administrative expenses, and the remaining $67.2 million for health care-related expenses. 20
Appendix E contains details on how the selected ALFs used PRF payments issued in CYs 2020
and 2021.
We selected ALFs based on an analysis that considered the amount of PRF payments received,
geographic location (i.e., areas most impacted by COVID-19, urban and rural areas), and
organizational structure (e.g., ALF groups and stand-alone ALFs). 21 We reviewed the ALFs’ PRF
payments used to offset lost patient care revenues or cover general and administrative and
health care-related expenses. Specifically, for each of the selected ALFs that reported
expenditures, we reviewed a nonstatistical sample of expenses that we selected based on
17
For payments received in periods 5, 6, or 7, the period of availability to use PRF payments for lost revenues
attributable to COVID-19 ended June 30, 2023, the end of the quarter in which the COVID-19 public health
emergency ended (HRSA, PRF Reporting Requirements).
18
PRF payments for reporting period 2 were distributed from July 1, 2020, to Dec. 31, 2020. PRF payments for
reporting period 3 were distributed from Jan. 1, 2021, to June 30, 2021.
19
The sampling frame consisted of 3,690 ALFs that received and kept 1 or more PRF payments totaling
approximately $640.7 million. PRF payment recipients had 90 days to return a payment to HHS, otherwise the
recipient was deemed to have accepted the terms and conditions. Our sample included ALFs that received PRF
payments issued in CYs 2020 and 2021 and for which ALFs attested to the payment terms and conditions or were
deemed to have accepted the terms and conditions.
20
ALFs reported these amounts on expenditure reports submitted to HRSA for reporting periods 2 and 3.
21
Our sample unit was an ALF that reported the use of PRF General Distribution payments. Each sampled ALF
could be a stand-alone ALF or was part of a parent-subsidiary system that included a parent company and one or
more subsidiary ALF. The 30 selected ALFs each received PRF payments from $460.9 thousand to $72.8 million
during CYs 2020 and 2021 and were located in 15 States. All thirty ALFs were part of parent-subsidiary systems.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 6
materiality and expense descriptions (e.g., salaries, supplies, equipment). For the selected ALFs
that reported lost revenues, we reviewed the ALFs’ lost revenue calculations. 22
We conducted this performance audit in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions
based on our audit objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
Appendix A describes our audit scope and methodology.
FINDINGS
Of the 30 selected ALFs, 21 used the funds for allowable general and administrative and health
care-related expenses and to offset lost revenues attributable to COVID-19. However, the
remaining nine ALFs did not comply with Federal requirements. Specifically, seven ALFs used
PRF payments for unallowable expenditures, and two ALFs inaccurately calculated lost
revenues. These deficiencies occurred because although ALFs attested to the PRF terms and
conditions and HRSA provided continuously updated guidance to PRF recipients, the ALFs made
clerical errors in their expenditure reporting and did not always correctly interpret HRSA
guidance, maintain documentation to support reported expenditures, or have procedures to
verify the accuracy of lost revenue calculations.
As a result of these deficiencies, 9 of the 30 selected ALFs used PRF payments for unallowable
expenditures totaling approximately $283,000 and inaccurately calculated lost revenues
totaling approximately $11 million. 23 These funds could have been used to offset allowable lost
revenues or to support other activities related to the COVID-19 public health emergency,
including preventing, preparing for, and responding to COVID-19.
Appendix F contains a summary of our audit results for the sampled ALFs.
22
Of the 30 ALFs, 5 ALFs reported both expenses and lost revenues, 5 ALFs reported only lost revenues, and 20
ALFs reported only expenses.
23
Unallowable expenditures totaled $282,676, and inaccurately calculated or unsupported lost revenues totaled
$11,009,668.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 7
SOME ASSISTED LIVING FACILITIES USED PROVIDER RELIEF FUND PAYMENTS FOR
UNALLOWABLE EXPENDITURES AND INACCURATELY CALCULATED LOST REVENUES
Costs Not Adequately Supported
PRF recipients must comply with certain Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for HHS Awards (45 CFR part 75). The financial management system of
each PRF recipient must provide accurate, current, and complete disclosure of the financial
results of each Federal award or program. The PRF recipient’s records must identify the source
and application of funds for federally funded activities and be supported by source
documentation (45 CFR §§ 75.302(b)(2) and (3)).
Three ALFs did not maintain adequate documentation to support the use of PRF payments to
cover COVID-19-related expenditures totaling approximately $57,000. Specifically, one ALF
used PRF payments totaling $52,856 to cover food expenses based on estimated amounts
and did not maintain supporting documentation for the actual food costs. The ALF stated
that it believed maintaining documentation for the estimated food cost was adequate.
Another ALF used PRF payments to cover a subsidiary’s expenses totaling $3,780 for which
the ALF could not provide supporting documentation for the expenses. The ALF indicated
that the documentation for the expenses was not available because the subsidiary had been
sold. Lastly, one ALF did not maintain documentation to support the purchase of blood
oxygen readers totaling $300. The ALF indicated that it could not locate the credit card
receipt for the purchase.
Salary Costs Exceeded the Federal Executive Level II Salary Limit
The PRF terms and conditions specified that PRF recipients could not use PRF payments to
pay the salary of an individual at a rate in excess of the Executive Level II salary level. 24 The
Federal Executive Level II salary level was $197,300 in CY 2020.
One ALF used PRF payments to pay the salaries for two executives making $300,000 each,
exceeding the Executive Level II salary level for CY 2020 by a total of $205,400.
Costs Charged but Not Incurred
PRF recipients must comply with certain Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for HHS Awards (45 CFR part 75). The financial management system of
each PRF recipient must provide accurate, current, and complete disclosure of the financial
results of each Federal award or program. The PRF recipient’s records must identify the source
and application of funds for federally funded activities and be supported by source
documentation (45 CFR §§ 75.302(b)(2) and (3)).
24
PRF General and Targeted Distribution payments terms and conditions.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 8
One ALF used PRF payments for $11,290 in costs that were not incurred. Specifically, the
ALF recorded $57,616 of expenses in its financial management system based on amounts
detailed in purchase orders; however, the actual invoices and payment amounts totaled
$46,326.
Duplicate Expenses
PRF recipients must comply with certain Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for HHS Awards (45 CFR part 75). The financial management system of
each PRF recipient must provide accurate, current, and complete disclosure of the financial
results of each Federal award or program. The PRF recipient’s records must identify the source
and application of funds for federally funded activities and be supported by source
documentation (45 CFR §§ 75.302(b)(2) and (3)). Additionally, PRF payments may not be
applied to the same expenses and lost revenues that were reported on in prior reporting
periods. 25
One ALF used PRF payments to cover two expenses for the same invoice, resulting in duplicate
expenses totaling $7,620.
Expenditures Not Attributable to COVID-19
PRF recipients must comply with the PRF terms and conditions. Specifically, the recipient
certifies that the payment will only be used to prevent, prepare for, and respond to COVID-19,
and that the payment shall reimburse the recipient only for health care-related expenses or lost
revenues that are attributable to COVID-19.
One ALF used PRF payments to cover expenses that were not attributable to COVID-19.
Specifically, the ALF used PRF payments to cover the purchase of alcoholic beverages, totaling
$1,430. The ALF stated that it missed the expense when it reviewed whether COVID-19-related
expenses were appropriately coded.
Inaccurate Lost Revenue Calculations
PRF payment amounts not fully expended on health care-related expenses attributable to
COVID-19 may be applied to lost revenues. Lost revenues can be calculated by one of three
options, including determining the difference between actual 2019 patient service revenues
and actual patient care revenues during the period of availability. 26, 27 In addition, HRSA’s
guidance for lost revenue calculations provided recipients flexibility in the reconciliation of lost
25
HRSA, PRF FAQs.
26
HRSA, PRF Reporting Requirements.
27
HRSA, “How to Calculate Lost Revenues for PRF and ARP Rural Reporting.” Accessed on July 17, 2025.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 9
revenues among parent entities and subsidiaries. However, HRSA’s FAQs stated that expenses
and lost revenues may not be duplicated, and payments may not be applied to the same
expenses and lost revenues that were reported in prior reporting periods.
Two ALFs inaccurately calculated and reported lost revenues totaling $11 million. Specifically,
the ALFs overstated lost revenues by including $9.3 million and $1.7 million, respectively,
related to facilities that they no longer owned. This occurred because the ALFs included 2020
budgeted net patient service revenues for these facilities in the baseline to calculate their lost
revenues.
CAUSES OF UNALLOWABLE EXPENDITURES AND INACCURATELY CALCULATED LOST REVENUES
These deficiencies occurred because although ALFs attested to the PRF terms and conditions
and HRSA provided continuously updated guidance to PRF recipients, the ALFs made clerical
errors in their reporting of expenditures and did not always correctly interpret HRSA guidance,
maintain documentation to support reported expenditures, or have procedures to verify the
accuracy of lost revenue calculations.
Further, in the context of extraordinary challenges from the COVID-19 public health emergency,
HRSA’s operational objective at the beginning of the public health emergency was to rapidly
disburse PRF payments to support providers facing severe economic hardship. In addition,
some ALFs indicated that they had dedicated extensive resources to the cost of personal
protective equipment, routine testing, and staff support. 28 These and other unprecedented
challenges of the pandemic may have contributed to clerical errors when reporting PRF
expenditures or caused staff to misinterpret HRSA’s guidance.
In addition to the recommendations below, key stakeholders and decisionmakers should use
the information included in this report when determining lessons learned from administering
PRF distributions during the COVID-19 public health emergency and look for additional ways to
safeguard Federal funds when rapidly disbursing assistance payments to providers in response
to future public health emergencies.
28
American Health Care Organization, “COVID-19 Exacerbates Financial Challenges Of Long Term Care Facilities.”
Accessed on July 17, 2025.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 10
RECOMMENDATIONS
We recommend that the Health Resources and Services Administration:
• require the seven ALFs that we determined as having used PRF payments for
unallowable expenditures totaling $283,000 to return the unallowable amounts to the
Federal Government or ensure that the ALFs properly replace the unallowable
expenditures with allowable unreimbursed lost revenues or eligible expenses, if any,
and
• require the two ALFs that we determined as having inaccurately calculated and reported
lost revenues totaling $11 million to identify and return to the Federal Government any
PRF payments used to offset inaccurately calculated lost revenues or replace them with
allowable unreimbursed lost revenues or eligible expenses, if any.
OTHER MATTERS
PRF payment amounts not fully expended on health care-related expenses attributable to
COVID-19 may be applied to patient care lost revenues. As noted previously, recipients could
choose to apply PRF payments toward lost revenues using one of the following three options:
1. the difference between actual patient care revenues from 2019 and actual patient care
revenues during the period of availability,
2. the difference between budgeted patient care revenues (approved by ALF officials prior
to March 27, 2020) and actual patient care revenues, or
3. any reasonable method of estimating revenues.
HRSA’s guidance allowed recipients to calculate lost revenues as a stand-alone quarterly
calculation and consider only those quarters with lost revenues to determine total loss amounts
for each reporting period. 29 Option 3 provided reporting entities additional flexibility in the
reconciliation of lost revenues among parent and subsidiary entities, including the application
of lost revenues as the reporting entity saw fit.
Ten of the thirty selected ALFs reported lost revenues totaling $135.8 million. For these ALFs,
we recalculated the reported lost revenues to determine what these amounts would have been
on an annual basis under option 1 (i.e., comparing 2019 actual patient care revenues to 2020
29
HRSA, PRF FAQs.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 11
through 2022 actual patient care revenues). 30 Based on our analysis, we determined that the
methodologies prescribed by HRSA resulted in ALFs reporting higher lost revenue amounts and
did not always result in an efficient use of PRF payments.
If HRSA had required reporting entities to use option 1 and annualize their revenues, 9 of the 10
selected ALFs would not have been able to report a total of $82.3 million in lost revenues and
would not be able to apply PRF payments to offset this amount. For any PRF payments applied
against these excess lost revenue amounts, the PRF payments could have been used for other
purposes that supported ALFs’ activities (e.g., purchasing cleaning supplies and personal
protective equipment) related to the COVID-19 public health emergency. In addition, instead of
refunding the PRF payment amounts used for unallowable expenditures, HRSA allowed ALFs to
offset unallowable amounts against amounts calculated for lost revenues. 31 For further details,
see Appendix G.
HEALTH RESOURCES AND SERVICES ADMINISTRATION COMMENTS AND
OFFICE OF INSPECTOR GENERAL RESPONSE
In written comments on our draft report, HRSA concurred with our recommendations and
indicated that it will review the relevant records and seek repayment, as appropriate.
Regarding our Other Matters section, HRSA noted that it was legally required to allow providers
to use “any reasonable” method to determine revenue losses, and OIG’s analysis and
conclusion were at odds with flexibilities afforded to providers.
We acknowledge that certain flexibilities were available to providers for lost revenue
calculations. However, we maintain that calculating revenue losses by comparing year-over-
year actual patient service revenues would have resulted in a more efficient use of PRF
payments.
HRSA also provided technical comments, which we addressed as appropriate. HRSA’s
comments, excluding the technical comments, are included as Appendix H.
30
The PRF expenditure report for the payment period ending Dec. 31, 2020, was due on Mar. 31, 2022. The
expenditure report for the payment period ending June 30, 2021, was due on Sept. 30, 2022. Therefore, actual
patient care revenues for CYs 2020 and 2021 would have been available prior to the PRF report due dates.
31
In its FAQs, HRSA indicated that the reporting entities could replace unallowable expenses with unreimbursed
lost revenues.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 12
APPENDIX A: AUDIT SCOPE AND METHODOLOGY
SCOPE
We identified 3,690 ALFs that received and kept 1 or more PRF payments totaling
approximately $640.7 million during CYs 2020 and 2021. We selected for audit a nonstatistical
sample of 30 ALFs that received PRF payments from General Distributions totaling $156.1
million during CYs 2020 and 2021. 32 We selected ALFs based on a risk analysis that included
geographic location (i.e., COVID-19 high-impact areas, urban and rural areas), total PRF
payment amounts, and organizational structure (ALF groups and stand-alone ALFs). We
reviewed the selected ALFs’ use of PRF payments received from General Distributions.
We limited our review of HRSA’s and the selected ALFs’ internal controls to those applicable to
our audit objective. We did not assess HRSA’s or the ALFs’ overall internal control structure.
Specifically, we reviewed HRSA’s policies and procedures for reviewing expenditure information
submitted by providers and its guidance to providers on the use and reporting of PRF
payments. We also reviewed selected ALFs’ policies and procedures for monitoring, tracking,
and expending PRF payments.
We established reasonable assurance of the authenticity and accuracy of the PRF payment data
by reconciling it with PRF expenditure reports submitted by the ALFs through HRSA’s PRF
Reporting Portal.
We conducted our audit from April 2023 through August 2025.
METHODOLOGY
To accomplish our objective, we:
• reviewed applicable Federal laws, regulations, and guidance, including the PRF terms
and conditions and HRSA’s FAQs related to providers’ use of PRF payments;
• met with HRSA officials to gain an understanding of the PRF’s payment terms and
conditions, reporting requirements, and HRSA’s monitoring and oversight activities;
• reviewed HRSA’s policies and procedures related to its oversight of recipients’ reporting
on the use of PRF funds and compliance with the terms and conditions for PRF
payments;
32
The sampling frame consisted of 3,690 ALFs that received and kept 1 or more PRF payments totaling
approximately $640.7 million. PRF payment recipients had 90 days to return a payment to HHS, otherwise the
recipient was deemed to have accepted the terms and conditions. Our sample included ALFs that received PRF
payments during the audit period for which the ALFs attested to the payment terms and conditions or were
deemed to have accepted the terms and conditions.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 13
• obtained from HRSA a list of ALFs that received a payment through General
Distributions and the associated payment data; 33
• created a list of ALFs in areas that received PRF payments greater than $10,000 from
General Distributions;
• selected a nonstatistical sample of 30 ALFs that received PRF payments based on the
amount of PRF payments received, geographic locations (areas most impacted by
COVID-19, urban and rural areas), and organizational structure (ALF groups and stand-
alone ALFs); 34 35
• for each ALF selected for audit, interviewed ALF officials; reviewed its expenditure
reports submitted to HRSA and a nonstatistical sample of expenses based on materiality
and expense descriptions; and analyzed supporting accounting, personnel, and other
records to determine whether:
o payments were used only to prevent, prepare for, and respond to COVID-19;
o payments were used for health care-related or general and administrative
expenses or were applied to offset eligible lost revenues attributable to COVID-
19, and whether the amount for any lost revenues applied toward PRF payments
was accurately calculated; 36
o payments were not used to pay for expenses or losses reimbursed or eligible for
reimbursement from other funding sources (e.g., reimbursements from the
Federal Emergency Management Agency, Medicare/Medicaid or commercial
health insurance, the Paycheck Protection Program, and assistance from State or
local government agencies); and
o payments were not used to pay salaries at a rate in excess of certain thresholds
or for other prohibited activities.
• discussed the results of our audit with HRSA officials.
33
We obtained from HRSA a list of TINs associated with ALFs that received PRF payments from the General
distributions. We then extracted PRF payments for these TINs from the PRF payments attestation file provided by
OIG’s Division of Data Analytics.
34
The sampling frame consisted of 3,690 ALFs that received and kept 1 or more PRF payments totaling
approximately $640.7 million.
35
See footnote 21 for details regarding our sample unit.
36
We recalculated lost revenue amounts using the same option that the entity used for determining lost revenues.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 14
We conducted this performance audit in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions
based on our audit objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 15
APPENDIX B: RELATED OFFICE OF INSPECTOR GENERAL REPORTS
Report Title Report Number Date Issued
Four of Thirty Selected Dental Providers Did Not
Comply With Terms and Conditions and Federal
A-02-23-01013 11/25/2025
Requirements for Expending Provider Relief Fund
Payments
Seventeen of Twenty-Five Selected Hospitals Did Not
Comply or May Not Have Complied With the Provider A-02-22-01018 9/19/2025
Relief Fund Balance Billing Requirement
Eleven of Thirty Selected Hospitals Did Not Comply
With Terms and Conditions and Federal Requirements A-02-22-01003 6/11/2025
for Expending Provider Relief Fund Payments
Ten of Thirty Selected Nursing Facilities Did Not
Comply or May Not Have Complied With Terms and
A-05-22-00012 6/9/2025
Conditions and Federal Requirements for Expending
Provider Relief Fund Payments
Selected Home Health Agencies Complied With Terms
and Conditions and Federal Requirements for Provider A-01-22-00503 11/26/2024
Relief Fund Payments
Seven of Thirty Hospices Reviewed Did Not Comply or
May Not Have Complied With Terms and Conditions
A-02-22-01014 11/8/2024
and Federal Requirements for Provider Relief Fund
Payments
HRSA Made Some Potential Overpayments to
Providers Under the Phase 2 General Distribution of A-09-22-06001 3/4/2024
the Provider Relief Fund Program
The Provider Relief Fund Helped Select Nursing Homes
Maintain Services During the COVID 19 Pandemic, but OEI-06-22-00040 12/12/2023
Some Found Guidance Difficult To Use
HHS’s Oversight of Automatic Provider Relief Fund
Payments Was Generally Effective but Improvements A-02-20-01025 10/30/2023
Could Be Made
HRSA Made COVID-19 Uninsured Program Payments
to Providers on Behalf of Individuals Who Had Health
A-02-21-01013 7/13/2023
Insurance Coverage and for Services Unrelated to
COVID-19
Targeted Provider Relief Funds Allocated to Hospitals
Had Some Differences With Respect to the Ethnicity OEI-05-20-00580 7/12/2023
and Race of Populations Served
HHS’s and HRSA’s Controls Related to Selected
Provider Relief Fund Program Requirements Could Be A-09-21-06001 9/26/2022
Improved
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 16
APPENDIX C: PROVIDER RELIEF FUND GENERAL AND TARGETED DISTRIBUTION PAYMENTS
As of October 2024, HRSA distributed $145.9 billion of the $178 billion appropriated to HHS
under the PRF program. Of the $145.9 billion, $88.4 billion was distributed in General
Distributions and $57.5 billion was distributed in several Targeted Distributions. A portion of
the remaining $32.1 billion was distributed or allocated for HRSA’s program for uninsured
individuals, the COVID-19 Coverage Assistance Fund, and Phase 4 General Distribution
payments. 37
General Distributions
HRSA made General Distributions in four phases to health care providers, including Medicare
providers; providers participating in Medicaid, Children’s Health Insurance Program (CHIP), or
Medicaid managed care plans; dentists; ALFs; and behavioral health providers.
• Phase 1 General Distribution: HRSA distributed $48.5 billion to providers in two rounds
under the Phase 1 General Distribution for eligible providers that billed Medicare fee-
for-service. These funds were allocated proportional to providers’ shares of annual
patient service revenues.
• Phase 2 General Distribution: HRSA distributed $5 billion in the Phase 2 General
Distribution to Medicaid, CHIP, and dental providers, as well as ALFs and certain
Medicare providers who did not receive a Phase 1 General Distribution payment equal
to 2 percent of their total patient care revenue or had a change in ownership in 2019 or
2020. Providers were required to apply for funding and included in their applications
certain financial information related to documenting revenue necessary to determine
the amount that a facility would receive.
• Phase 3 General Distribution: HRSA distributed $19.3 billion in the Phase 3 General
Distribution to providers that had not received funding in prior distributions (i.e.,
because they were new or because they were behavioral health providers not included
in a prior allocation). Providers that had previously received PRF payments but had not
received the full 2 percent of their annual patient revenue in PRF assistance were also
eligible to apply for additional funds. Providers were required to apply for these funds.
• Phase 4 General Distribution: HRSA distributed approximately $15.6 billion in the Phase
4 General Distribution to providers based on changes in revenues and expenses as well
as the amount and type of services provided to Medicare, Medicaid, and/or CHIP
patients. Providers were required to apply for these funds.
37
As of June 2023, with the passage of the Fiscal Responsibility Act of 2023, P.L. No. 118-5, Congress rescinded
some unobligated PRF payments. In response, HRSA stopped making PRF payments to providers.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 17
Targeted Distributions
HRSA also distributed PRF funds to certain types of providers that had high needs due to
COVID-19. These included the following:
• COVID-19 High-Impact Area Providers: HRSA distributed nearly $22 billion in COVID-19
high-impact area payments to hospitals that had large numbers of COVID-19 inpatient
admissions. 38
• Safety Net Hospitals and Children’s Hospitals: HRSA distributed $13.3 billion to safety
net and acute care hospitals and $1.1 billion to children’s hospitals.
• Rural Providers: HRSA distributed $11.2 billion in rural payments to rural hospitals,
including rural acute care general hospitals and critical access hospitals; rural health
clinics; and Federally Qualified Health Centers located in rural areas, including specialty
rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals
in small metropolitan areas.
• Tribal Hospitals, Clinics, and Urban Health Centers/Indian Health Service Providers: HRSA
distributed $540 million in relief funds to Tribal hospitals, clinics, and urban health
centers. These payments were based on operating expenses.
• Skilled Nursing Facilities and Nursing Homes: HRSA distributed $4.9 billion in skilled
nursing facility distribution payments. Additionally, to help combat the devastating
effects of COVID-19, HRSA distributed $4.5 billion to skilled nursing facilities and nursing
homes nationwide, which included payments for infection control and quality incentive
payments to nursing homes that created and maintained safe environments for their
residents.
38
Hospitals that treated 100 or more COVID-19 patients between Jan. 1 and Apr. 10, 2020, were eligible for the first
round of high-impact distributions. Hospitals that treated more than 160 COVID-19 patients between Jan. 1 and
June 10, 2020, were eligible for the second round of high-impact distributions.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 18
APPENDIX D: OPTIONS FOR CALCULATING LOST REVENUES
Providers, including ALFs, could use one of the following three options to calculate their lost
revenues.
Lost Revenues
Option 1 Option 2 Option 3
Options
The difference
between actual
patient care
revenues from The difference between Any reasonable
2019 and actual budgeted and actual method of estimating
Definition of Option
patient care patient care revenues revenues
revenues during
the period of
availability
PRF Reporting 2020 Budgeted Alternate Reasonable
2019 Actual Revenue
Portal Option Revenue Methodology
Base Period for
2019 2020 or 2021 Not prescribed
Calculation
Actuals vs. Actuals
Calculation Method (e.g., Q1 2020 vs. Budget vs. Actuals Not prescribed
Q1 2019)
Frequency of
Quarterly Quarterly Quarterly
Calculation
Each quarter during the
Duration of Lost Each quarter during the Each quarter during the period of availability in
Revenues Period period of availability period of availability which lost revenues were
determined
Service Lines To All patient care services
All patient care
Include in All patient care services (as appropriate for
services
Revenues methodology)
Budget Approval
Not applicable Before March 27, 2020 Not prescribed
Date
Source: HRSA, Provider Relief Fund Lost Revenues Guide - Reporting Period 2. Accessed on July 17, 2025.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 19
APPENDIX E: SELECTED ASSISTED LIVING FACILITIES’ REPORTED USE OF PROVIDER RELIEF
FUND PAYMENTS FOR REPORTING PERIODS 2 AND 3
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 20
APPENDIX F: SUMMARY OF SAMPLED ASSISTED LIVING FACILITIES’ UNALLOWABLE
EXPENDITURES AND INACCURATELY CALCULATED LOST REVENUE AMOUNTS
Unallowable
Expenditures
and
Inaccurately
Sample Total PRF Payments Calculated Reason for Unallowable Expenditures and
ALF ALFs Reported in Lost Revenue Inaccurately Calculated Lost Revenue
Number Periods 2 and 3 Amount Amount
1 $1,259,420 $0
2 $5,308,593 $0
3 $1,018,993 $0
4 $965,981 $11,290 Costs charged but not incurred
5 $2,727,160 $0
6 $2,438,601 $0
7 $997,297 $0
8 $1,759,446 $1,681,229 Inaccurately calculated lost revenues
9 $1,741,379 $0
10 $943,598 $9,328,439 Inaccurately calculated lost revenues
11 $72,803,206 $0
12 $3,968,188 $0
13 $1,540,108 $205,400 Salary costs exceeded Federal Salary Limit
14 $16,823,440 $3,780 Costs not adequately supported
15 $817,391 $52,856 Costs not adequately supported
16 $5,533,075 $0
17 $1,084,258 $0
18 $527,930 $0
19 $9,546,834 $0
20 $2,380,922 $0
21 $1,837,390 $0
22 $797,074 $0
23 $760,013 $0
24 $766,412 $0
25 $460,861 $7,620 Duplicate expense
26 $635,837 $0
27 $1,147,429 $300 Costs not adequately supported
28 $1,132,183 $1,430 Expense Not Attributable to COVID-19
29 $10,549,687 $0
30 $3,872,083 $0
Total $156,144,788* $11,292,344
* Amounts do not add up to the total due to rounding.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 21
APPENDIX G: OTHER MATTERS – POTENTIAL SAVINGS CALCULATIONS
(A) (B) (C) (D) (E) (F) (G) (H)
Total
Option Total Lost Recalculated Potential
Total PRF
ALFs Revenues Lost Savings if
Total PRF Payment ALFs
Used To Remained Revenues if ALFs Used
OIG Payments ALFs Applied To
Calculate Total Lost Revenues ALFs Calculated After ALFs Used Option 1 and
Sample Reported in Offset Lost
Lost and Reported Reporting Option 1 and Annualized
Number Periods 2 and Revenues in
Revenues Periods 2 and Annualized Loss
3 Periods 2 and
(1, 2, 3, or 3 Loss Calculation
3
N/A) (D) - (E) = (F) Calculation
(D) - (G) = (H)
1 1 $1,259,420 $4,586,477 $377,003 $4,209,474 $675,103 $3,911,374
2 1 $5,308,593 $21,974,809 $3,790,620 $18,184,189 $21,511,790 $463,019
3 1 $1,018,993 $4,384,146 $82,276 $4,301,870 $3,816,468 $567,678
4 1 $965,981 $8,444,059 $637,629 $7,806,430 $8,444,059 $0*
5 3 $2,727,160 $2,958,785 $1,389,554 $1,569,231 $1,362,387 $1,596,398
6 3 $2,438,601 $13,270,777 $2,438,601 $10,832,176 $0 $13,270,777
7 3 $997,297 $4,709,747 $997,297 $3,712,450 $669,926 $4,039,821
8 3 $1,759,446 $23,254,856 $1,759,446 $21,495,410 $1,395,666 $21,859,190
9 3 $1,741,379 $24,848,582 $1,741,379 $23,107,203 $0 $24,848,582
10 3 $943,598 $27,355,865 $943,598 $26,412,267 $15,630,703 $11,725,162
11 N/A $72,803,206 Did not use PRF to offset lost revenues $0 $0 $0 $0
12 N/A $3,968,188 Did not use PRF to offset lost revenues $0 $0 $0 $0
13 N/A $1,540,108 Did not use PRF to offset lost revenues $0 $0 $0 $0
14 N/A $16,823,440 Did not use PRF to offset lost revenues $0 $0 $0 $0
15 N/A $817,391 Did not use PRF to offset lost revenues $0 $0 $0 $0
16 N/A $5,533,075 Did not use PRF to offset lost revenues $0 $0 $0 $0
17 N/A $1,084,258 Did not use PRF to offset lost revenues $0 $0 $0 $0
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 22
(A) (B) (C) (D) (E) (F) (G) (H)
Total
Option Total Lost Recalculated Potential
Total PRF
ALFs Revenues Lost Savings if
Total PRF Payment ALFs
Used To Remained Revenues if ALFs Used
OIG Payments ALFs Applied To
Calculate Total Lost Revenues ALFs Calculated After ALFs Used Option 1 and
Sample Reported in Offset Lost
Lost and Reported Reporting Option 1 and Annualized
Number Periods 2 and Revenues in
Revenues Periods 2 and Annualized Loss
3 Periods 2 and
(1, 2, 3, or 3 Loss Calculation
3
N/A) (D) - (E) = (F) Calculation
(D) - (G) = (H)
18 N/A $527,930 Did not use PRF to offset lost revenues $0 $0 $0 $0
19 N/A $9,546,834 Did not use PRF to offset lost revenues $0 $0 $0 $0
20 N/A $2,380,922 Did not use PRF to offset lost revenues $0 $0 $0 $0
21 N/A $1,837,390 Did not use PRF to offset lost revenues $0 $0 $0 $0
22 N/A $797,074 Did not use PRF to offset lost revenues $0 $0 $0 $0
23 N/A $760,013 Did not use PRF to offset lost revenues $0 $0 $0 $0
24 N/A $766,412 Did not use PRF to offset lost revenues $0 $0 $0 $0
25 N/A $460,861 Did not use PRF to offset lost revenues $0 $0 $0 $0
26 N/A $635,837 Did not use PRF to offset lost revenues $0 $0 $0 $0
27 N/A $1,147,429 Did not use PRF to offset lost revenues $0 $0 $0 $0
28 N/A $1,132,183 Did not use PRF to offset lost revenues $0 $0 $0 $0
29 N/A $10,549,687 Did not use PRF to offset lost revenues $0 $0 $0 $0
30 N/A $3,872,083 Did not use PRF to offset lost revenues $0 $0 $0 $0
Total - $156,144,788† $135,788,103 $14,157,404† $121,630,699† $53,506,102 $82,282,001
* The ALF used option 1 and suffered revenue losses in all eight quarters.
† Amounts do not add up to the total due to rounding.
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 23
APPENDIX H: HEALTH RESOURCES AND SERVICES ADMINISTRATION COMMENTS
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 24
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 25
Assisted Living Facilities’ Compliance With Provider Relief Fund Requirements (A-02-23-01012) 26
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