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Program Update

With the passage of the Fiscal Responsibility Act of 2023 and related rescission of program funds, no further payments will be made to providers under the Provider Relief Fund or the American Rescue Plan Rural Distribution, including no reconsideration payments. Likewise, no additional claims payments will be made under the Uninsured Program or Coverage Assistance Fund. Per the Terms and Conditions of each Program, all reporting and auditing requirements will continue without disruption.

Repayment and Debt Collection

As part of its ongoing program integrity efforts, HRSA must uphold its responsibility of properly stewarding taxpayer dollars and ensure that providers used Provider Relief Fund (PRF), American Rescue Plan (ARP) Rural, Uninsured Program (UIP), and Coverage Assistance Fund (CAF) payments appropriately. To date, providers have submitted the required information regarding their use of funds for 99% of funding distributed through these programs.

What actions does HRSA take before debt collection?

HRSA goes to great lengths to routinely inform providers about PRF, ARP Rural, UIP, and CAF requirements and supports providers in complying with them. The Terms and Conditions and Reporting Requirements are clearly documented on the PRF website. In addition, HRSA has regularly communicated PRF, ARP Rural, UIP, and CAF compliance requirements and deadlines to providers via technical assistance webinars, stakeholder associations, and direct communications.

Providers at risk of being referred to debt collection for not returning funds include:

  • Providers who rejected the Terms and Conditions in the PRF Application and Attestation Portal and did not subsequently return PRF funds
  • Providers who failed to submit a required report during a specific reporting period or submit a report as part of the subsequent Request to Report Late Due to Extenuating Circumstances process
  • Providers deemed required to repay funds as a result of audit and assessment findings
  • Providers deemed ineligible, noncompliant, or otherwise owing funds as a result of post-payment oversight, indictment, or other information not revealed through audit

Final actions before debt collection

HRSA takes multiple steps to communicate with recipients of PRF, ARP Rural, UIP, and CAF payments prior to debt referral. HRSA will send providers an initial and final request for repayment prior to referring to debt collection.

Providers will be allowed to take one of the below actions:

  • Return payment to HRSA as noted in the Final Repayment Notice. Details and instructions on how to return funds are on the Returning Funds webpage.
  • Request a Decision Review to appeal HRSA's request for repayment. Through the Decision Review process, HRSA gives providers an opportunity to dispute HRSA's decision to recover funds. After a provider submits the required documentation, HRSA will review the documentation and make a final decision to either uphold the initial finding that the provider must return funds allow the provider another opportunity to come into compliance, or determine the requested repayment was in error. NOTE: Providers are only allowed one opportunity for Decision Review.

Providers who do not take one of these actions may be referred to the Department of Health and Human Services (HHS) Program Support Center (PSC) Debt Collection Center for the initiation of debt collection activities.

Note: Debts are due and owing, whether providers contend they received a Final Repayment Notice or not.

How can providers come into compliance after they are in debt collection?

A provider cannot come into compliance to halt debt collection once HRSA refers a debt to the HHS PSC. Providers referred for collection no longer have the opportunity to report, as applicable, or take other actions to resolve debts. HRSA has no authority to waive a debt.

What is the role of the HHS Program Support Center (PSC), the Treasury Centralized Receivables Service (CRS), and Treasury Cross-Servicing (Cross-Servicing)?

The PSC is a part of HHS. PSC’s Debt Collection Center provides centralized debt collection services for HHS agencies and offices.

PSC refers debts to the Department of the Treasury’s CRS. A written demand for payment will be issued by CRS requiring the debt to be repaid within 30 days. If the debt is not repaid within 90 days, it will be transferred to Treasury’s Cross-Servicing program. Cross-Servicing may enforce collection of the debt by one or more of the following actions: offsetting federal payments owed to you; referral to a private collection agency; and/or referral to the Department of Justice for litigation and enforced collection. Additionally, collection fees will be assessed and added to the amount you owe.

HRSA and PSC will not communicate with providers about their debts after they have been referred to Treasury for collection. Please see the following points of contact for Treasury CRS and Cross-Servicing:

CRS: 888-618-3103

Cross-Servicing: 888-826-3127

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