In an attempt to address in some meaningful way the serious impact of last month’s cyberattack against Optum’s Change Healthcare—which went on to create ripples in the stability of the nation’s overall healthcare system—the Centers for Medicare and Medicaid Services (CMS) issued this past Saturday an announcement that it was providing immediate help.

The agency has been in constant communication with Change Healthcare and its parent company, UnitedHealth Group, since the company revealed the details of the attack and its attendant disruptions in downline processes, including interruptions in the payment of medical claims by multiple insurance plans and programs.

Offering a Lifeline

As a means of providing some measure of temporary relief, CMS began on March 9 to release funds to hospitals and other providers as a stop-gap measure to offset the current hold on payments due to the effects of the cyberattack on various healthcare operations. According to a fact sheet released by CMS:

On March 9, 2024, CMS made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions as a result of the Incident. The CHOPD accelerated and advance payments may be granted in amounts representative of up to thirty days (30) of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider between August 1, 2023 and October 31, 2023, divided by three. These payments will be repaid through automatic recoupment from Medicare claims for a period of 90 days. A demand will be issued for any remaining balance on day 91 following the issuance of the accelerated or advance payment.

Yes, There Is a Catch

In order for hospitals to take advantage of these payments, they will have to meet an extensive set of requirements, to include the following:

• CHOPD accelerated and advance payments must be requested for individual providers, i.e., unique National Provider Identifier (NPI) and Medicare ID (PTAN) combinations. Providers receiving Periodic Interim Payments are not eligible for accelerated payments.
• In the CHOPD accelerated and advance payment request, the provider must make the following certifications:
• The provider is not able to submit claims to receive claims payments from Medicare.
• The provider has experienced a disruption in claims payment or submission due to a business relationship the provider, or the provider’s third-party payers, has with Change Healthcare or another entity that uses Change Healthcare or requires the provider to use Change Healthcare.
• The provider has been unable to obtain sufficient funding from other available sources to cover the disruption in claims payment, processing, or submission attributable to the Incident.
• The provider does not intend to cease business operations and presently is not insolvent.
• The provider, if currently in bankruptcy, will alert CMS about this status and include case information.
• Based on its best information, knowledge, and belief, the provider is not aware that the provider or a parent, subsidiary, or related entity of the provider is under an active healthcare-related program integrity investigation in which the provider or a parent, subsidiary, or related entity of the provider: (1) is under investigation for potential False Claims Act violations related to a federal healthcare program; (2) is a defendant in state or federal civil or criminal action (including a qui tam False Claims Act action either filed by the Department of Justice (DOJ) or in which DOJ has intervened); or (3) has been notified by a state or federal agency (including a state or federal prosecutor, the HHS Office of Inspector General, or the Centers for Medicare & Medicaid Services (including its contractors, such as the Unified Program Integrity Contractors)), that it is a subject of a civil or criminal investigation or Medicare program integrity administrative action (e.g., revocation of enrollment or payment suspension); or (4) has been notified that it is the subject of a program integrity investigation by a licensed health insurance issuer’s special investigative unit (or similar entity).
• The provider is enrolled in the Medicare program and has not been revoked, deactivated, precluded, or excluded by CMS or the HHS Office of the Inspector General.
• The provider does not have any delinquent Medicare debts.
• The provider is not on a Medicare payment hold or payment suspension.
• The provider will use the funds for the operations of the specific provider for which they were requested.

The hospital provider would then need to acknowledge an extended list of terms, including that the funds represent an advance on claims payments. For a full list of these terms, please check out the full CMS fact sheet: Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to Part B Suppliers | CMS.

CMS says that it continues to monitor the situation, including the level of disruption being caused by the February incident. The agency advises hospitals to “work with all their payers for the latest updates on how to receive timely payments, and any additional short term funding programs offered through other payers.” In addition, CMS advises providers to work with their liability insurers to determine whether coverage for this disruption is available.

The American Hospital Association (AHA) was quick to praise the CMS action. On its website, the AHA released the following statement:

We appreciate that CMS continues to work with stakeholders to find solutions to the Change Healthcare disruption and ameliorate its impact on hospitals, health systems, physicians and other providers. We welcome today’s announcement and will continue to work with policymakers as the impacts from the cyberattack persist.

It is good to see so many organizations—both private and public—cooperating together to create common solutions to this industry-wide crisis. Sometimes, something good can emerge from intended harm. We salute all who are working to provide a way through the current difficulties. We stand as your partners in solutions process.