UPDATED: COVID-19 Funding Sources Impacting Rural Providers

The Technical Assistance and Services Center (TASC), in coordination with the Federal Office of Rural Health Policy (FORHP), are pleased to provide an update of the COVID-19 Funding Sources Impacting Rural Providers guide. This funding resource is intended to support rural health care providers, along with their state and local partners, navigate the availability of federal funds to support the novel coronavirus (COVID-19) pandemic response and recovery efforts. This guide is updated regularly to capture changes in funding sources.

Seven tables, or matrices, are provided for quick reference at the beginning of this resource. The tables can be used to check eligibility of participation in funding sources by provider types: rural prospective payment system (PPS) and critical access hospitals (CAH), rural health clinics (RHC), federally qualified health centers (FQHC), long-term care (LTC) or skilled nursing facilities (SNF), tribal facilities, and emergency medical services (EMS). The tables also provide an at-a-glance view for each provider type sharing the different types of funds that may be accessed from various funding sources dependent on their participation eligibility. Each funding source is described in its own section of this resource with an executive summary followed by further detail on the use of funds, reporting requirements, hyperlinks to the legislation and detailed information. The majority of the updates are in sections on the RHC COVID-19 Testing and Mitigation Program and the HRSA Health Center Grants.

Please feel free to share this updated resource broadly.

The guide can be found in COVID-19 Collection located on The National Rural Health Resource Center’s website. This collection consists of trusted and reliable resources, such as the COVID-19 Funding Sources Impacting Rural Providers Guide, along with standing links to additional organizations’ COVID-19 resources, FAQs, webinars, tools, and trainings. The Center aims to help direct the most up-to-date and relevant tools and resources to rural hospitals, clinics, and their communities. This Collection will be updated regularly to help assist with the abundance of circulating information relating to COVID-19.

Webinar: Identifying Allowable Expenses for COVID-19 Programs

Date: September 23, 2021

Time: 1:00 PM CDT

Registration Link

Join us as the National Rural Health Resource Center and National Organization of State Offices of Rural Health continue to provide clarification on the allowable uses of a variety of Rural Health Clinic (RHC) funding programs, including the RHC COVID-19 Testing Program (RHCCT) and the RHC COVID-19 Testing and Mitigation Program (RHCCTM). Speakers will also help RHCs to clarify “what is a reimbursed versus unreimbursed expense?”

As an important reminder, RHCs have until December 31, 2021 to allocate expenses from the RHCCT Program. NARHC recognizes the concerns of many RHCs in using and reporting on these various programs and the importance of not “double-dipping” from different, yet similar, funding buckets. National Rural Health Resource Center and National Organization of State Offices of Rural Health hope you utilize all available resources including this webinar to increase your confidence surrounding these programs!

Moderator: Sarah Hohman

  • Nathan Baugh, Director of Government Affairs, NARHC
  • Shannon Chambers, Contractor, National Organization of State Offices of Rural Health (NOSORH)

This webinar is being provided free of charge. However, you must register in advance.

When the webinar begins you will be connected to audio using your computer’s speakers.

To watch the recording of this and other webinars visit our TA Webinars page under the Resources tab on narhc.org.

HHS Announces the Availability of $25.5 Billion in COVID-19 Provider Funding

HRSA is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes:

  • $17 billion for Provider Relief Fund (PRF) Phase 4 payments for a broad range of providers who can document revenue loss and expenses associated with the pandemic. For these Phase 4 payments, smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—will receive reimbursements for lost revenues and COVID-19 expenses at a higher rate compared to larger providers. Phase 4 will also include bonus payments based on the amount of services providers furnish to Medicaid/Children’s Health Insurance Program (CHIP) and Medicare patients, who tend to be lower income and have greater and more complex medical needs.
  • $8.5 billion from the American Rescue Plan (ARP) for providers who serve rural Medicaid, CHIP, or Medicare patients. ARP Rural payments to providers will be based on the amount of Medicaid/CHIP and Medicare services provided to patients living in rural areas as defined by the Federal Office of Rural Health Policy.

Providers will apply for both programs with a single application. The application portal opens on Wednesday, September 29.

More information is available on HRSA’s website regarding eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments.

The announcement also includes an important update about PRF reporting for payments received in the first half of 2020. Given challenges from recent natural disasters and the Delta variant, HHS announced a 60-day grace period to help providers come into compliance with their PRF reporting requirements if they fail to meet the upcoming deadline (Thursday, September 30) to report payments received from April 10, 2020, to June 30, 2020. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during the grace period.

See the HHS press release for more information.

Clarification of COVID-19 Relief Funding Programs

NARHC would like to provide some additional clarification on the differences between a variety of COVID-19 relief funding programs that RHCs received, to ensure that you are confident in your allowable uses and reporting requirements for each program. Please review the matrix below and see all of our continuously updated resources on https://www.narhc.org/narhc/COVID-191.asp.


 Program Name 

 Allowable Expenses


 Project Period


Testing Program

 Testing and testing-related 

   per RHC

 Jan. 27, 2020 – 
Dec. 31, 2021

 through January 2022  

 Provider Relief Fund

Unreimbursed expense
 and lost revenue
 attributable to COVID-19

  Varying amounts in 
  multiple phases 


Dependent on
 when funds were

 Provider Relief Fund Portal
 by Sep. 30, 2021
if received in Period 1
(4/10-6/30 2020)


RHC COVID-19 Testing 
and Mitigation Program

 Testing, mitigation,
 and related expenses

   per RHC

 Jan. 1, 2021 –
 Dec. 31, 2022 

 through January 2023


RHC Vaccine Confidence
(not all RHCs received)


Education, outreach,
 promotion, etc. to increase
 vaccine confidence

   Approx. $49,500
    per RHC

  July 1, 2021 –
 June 30, 2022

 To be announced later
  in the project period 


If you have any additional questions regarding these programs, please contact Sarah.Hohman@narhc.org.

Webinar: What is the RHC COVID-19 Vaccine Distribution Program?

Date: August 31, 2021

Time: 2:00 PM CT

Registration Link

Join the Georgia Health Policy Center, Georgia State University, for a virtual learning session on the Health Resources and Services Administration’s (HRSA) Rural Health Clinic COVID-19 Vaccine Distribution Program.
In this one-hour webinar, we will share:
• What the Rural Health Clinic COVID-19 Vaccine Distribution Program is;
• Why you should be a part of it;
• How to enroll; and
• The TA resources available.

The Rural Health Clinic Vaccine Distribution Program (RHCVD) distributes COVID-19 vaccines directly to Rural Health Clinics (RHCs) to increase the availability of COVID-19 vaccines in rural communities.

Webinar: Back to School and COVID-19: For Rural Educators and Administrators

Date: August 31, 2021

Time: 7:00 PM ET

Registration Link

The webinar will provide an overview of the Centers for Disease Control and Prevention’s (CDC) K-12 school guidance, adolescent vaccination recommendations, school-based vaccination strategies, and approaches to support socio-emotional well-being among school-age children and adolescents. Participants will have an opportunity to ask questions of the presenters and panelists.

CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations

August 24, 2021

Part of Biden-Harris Administration Vaccine Outreach, CMS Boosts Vaccine Access in Smaller Group Homes, Assisted Living Facilities, and Other Group Living Situations

As part of the Biden-Harris Administration’s ongoing commitment to increasing access to vaccinations and improving health equity, CMS is expanding opportunities for people to receive COVID-19 vaccinations in their home. To ensure Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach can receive the vaccination, health care providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.

This announcement aims to further boost the administration of COVID-19 vaccination – including second and third doses – in smaller group homes, assisted living facilities, and other group living situations by allowing vaccine providers to receive the increased payment up to 5 times when fewer than 10 Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination.

“We are doing everything we can to remove barriers to vaccinations, including ensuring appropriate payment levels for vaccine providers to connect with more people in their communities who are unable to receive the vaccine in a traditional setting,” said CMS Administrator Chiquita Brooks-LaSure. “We’ve seen the difference that vaccinations have in communities, and we are calling on providers to join us as we continue to increase vaccination rates across the country. Today’s actions ensure that everyone has the ability to be vaccinated against COVID-19, including older adults with mobility or transportation challenges and other at-risk individuals.”

While many Medicare beneficiaries are able to receive a COVID-19 vaccine at a retail pharmacy or from a health care provider, some people have great difficulty leaving their homes or cannot easily access vaccination in these settings. These individuals are often at-risk patients who could require complex care if they contracted COVID-19 and needed to be hospitalized. To better serve this group, Medicare previously increased the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose, in certain circumstances.

Delivering COVID-19 vaccination to access-challenged and hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration. Along with the CDC guidance, this announcement helps vaccine providers meet these challenges and successfully administer vaccinations.

The additional payment amount also accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary’s home. The payment rate for administering each dose of a COVID-19 vaccine, as well as the additional in-home payment amount, is geographically adjusted based on where the service is furnished.

How to Find a COVID-19 Vaccine:

As states and the federal government continue to break down barriers – like where vaccines can be administered – resources for connecting communities to vaccination options remain key. Unvaccinated individuals and those looking to assist friends and family can:

  1. Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby
  2. Text GETVAX (438829) for English or VACUNA (822862) for Spanish for near-instant access to details on three vaccine sites in the local area
  3. Call the National COVID-19 Vaccination Assistance Hotline at 1-800-232-0233 (TTY: 1-888-720-7489) for assistance in English and Spanish

Coverage of COVID-19 Vaccines:

The federal government is providing the COVID-19 vaccine free of charge or with no cost-sharing for Medicare beneficiaries. As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any amount for administering the vaccine.

Because no patient can be billed for COVID-19 vaccinations, CMS and its partners have provided a variety of information online for providers vaccinating all Americans regardless of their insurance status:

  • Original Medicare and Medicare Advantage: Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible.
  • Medicaid and the Children’s Health Insurance Program (CHIP): State Medicaid and CHIP agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the COVID-19 Public Health Emergency (PHE) and (generally) for over a year after it ends. For the very limited number of Medicaid beneficiaries who are not eligible for this coverage (and do not receive it through other coverage they might have), providers may submit claims for reimbursement for administering the COVID-19 vaccine to underinsured individuals through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration (HRSA), as discussed below. Under the American Rescue Plan Act of 2021 (ARP), signed by President Biden on March 11, 2021, the federal matching percentage for state Medicaid and CHIP expenditures on COVID-19 vaccine administration is currently 100% (as of April 1, 2021), and will remain 100% for more than a year after the COVID-19 PHE ends. The ARP also expands coverage of COVID-19 vaccine administration under Medicaid and CHIP to additional eligibility groups. CMS recently updated the Medicaid vaccine toolkit to reflect the enactment of the ARP.
  • Private Plans: The vaccine is free for people enrolled in most private health plans. The COVID-19 vaccines and the administration are covered without cost sharing for most enrollees, and such coverage must be provided both in-network and out-of-network during the PHE. Current regulations provide that out-of-network rates must be reasonable as compared to prevailing market rates, and the rules reference using the Medicare payment rates as a potential guideline for insurance companies. In light of CMS’s action, CMS expects health insurance issuers and group health plans to continue to ensure their rates are reasonable when compared to prevailing market rates. Under the conditions of participation in the CDC COVID-19 Vaccination Program, providers cannot charge plan enrollees any administration fee or cost sharing, regardless of whether the COVID-19 vaccine is administered in-network or out-of-network.

For individuals who are underinsured, vaccine providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-19 Coverage Assistance Fund administered by HRSA after the claim to the individual’s health plan for payment has been denied or only partially paid.

For individuals who are uninsured, vaccine providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by HRSA. See information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program.

More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available on the Medicare COVID-19 Vaccine Shot Payment webpage.

More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available on the CDC COVID-19 Vaccination Program Provider Requirements and Support webpage.

Webinar: Missouri’s Public Health Response to COVID-19: Key Findings and Recommendations

Date: September 14, 2021

Time: 1:00 – 2:30 PM CT


As of August 2021, COVID-19 has tragically taken the lives of more than 10,000 Missourians and upended the social and economic fabric of all its residents. The pandemic continues to challenge public health in the state, highlighting the importance of a strong public health system at all levels of government.

In the summer of 2020, the Missouri Foundation for Health contracted the George Washington University to assess Missouri’s public health preparedness and response capacities to the pandemic and future public health crises.

The state now has a singular opportunity to build and modernize stronger public health agencies at the state and local levels. But how do we move forward?

 In this webinar we will discuss:

  • The preliminary assessment of state and local foundational public health capabilities;
  • Implications of the state’s governance and funding structure for public health;
  • Recommendations for strengthening the public health infrastructure in Missouri.

Webinar: Grants Management 101 for RHC Vaccine Confidence Grant Program

Date: August 25, 2021

Time: 1:00 PM CT


Starting up a new grant-funded program can be difficult for even a seasoned program manager. Join the National Organization of State Offices Rural Health (the Federal Office of Rural Health Policy designated technical assistance provider) to learn how to ensure your work on Vaccine Confidence grant efforts can be managed in order to meet all requirements and have a meaningful impact in your community. This webinar will be presented with a practical look at how you can be successful in a hectic environment.

At the conclusion of the webinar, participants will understand how to:

  • Implement 5 simple strategies for successful grants management
  • Utilize required websites and basic tools to manage, track and report on all aspects of the grant program
  • Tap the expertise of technical assistance who will help your organization be successful