Governor of Puerto Rico Urges Centers for Medicare & Medicaid Services to Include Hospitals’ Medicare Advantage Revenues as Part of CARES Act Relief

(April 15th, 2020 – Washington, D.C.) Governor Vázquez Garced sent a letter to Administrator Seema Verma, Administrator, Centers for Medicare & Medicaid Services (CMS) urging the agency to include Medicare Advantage (MA) revenues in the definition of “Medicare revenues” for the distribution of Public Health and Social Services Emergency Funds appropriated under the recently enacted CARES Act (PL 116-136). 

The MA program in Puerto Rico currently serves more than 585,000 seniors on the island with the highest participation rate in the nation at 75 percent. As Puerto Rico continues to combat the COVID-19 pandemic, hospitals are at the front and center of the island’s healthcare system and essential to providing an effective response during this emergency. Furthermore, last week, the Governor’s COVID-19 Medical Task Force anticipated the peak of COVID-19 cases on the island would be from April 15th– through May 8th, 2020. Thus, it is a priority to provide immediate resources to Puerto Rico’s healthcare system and hospitals. If Puerto Rico doesn’t receive the necessary funding, the island’s healthcare could collapse from the anticipated strain on the system. 

Hospitals in Puerto Rico are facing much lower than anticipated funds being available from the CARES Act because MA revenues were not included in the definition of “Medicare revenues”. While the CARES Act provided resources for the pandemic, it failed to consider the impact of MA enrollment on hospital operating revenues.  In the letter, the Governor requested that within CMS’s discretionary authority, CMS advances advance funds equivalent to the historical Medicare Advantage (MA) reimbursements for services rendered to Medicare-eligible beneficiaries to remedy this inequity as soon as possible. Currently, for Puerto Rico, the CMS formula only applies to approximately 20 percent of hospital reimbursements under the Medicaid Program. 

“We urge Administrator Verma, to use CMS’s discretionary authority to provide our hospitals with the necessary resources to continue effectively combating this emergency,” said Jennifer M. Storipan, Esq. “It is essential that CMS includes the MA revenues in the definition of Medicare Revenues as our hospitals are in dire need of these funds. This would address in the short-term, several challenges of our healthcare system,” said Jennifer M. Storipan, Esq. “I believe our most vulnerable population must have access to quality healthcare, as the COVID-19 continue to disproportionally affect our elderly.” 


Leave a Reply