All providers must report the PRF payments on the cost report’s statement of revenues for informational purposes. The revenue amount must be identified as COVID-19 PHE PRF. PRF payment amounts must be reported in aggregate on the following forms:
- Hospital, form CMS-2552-10, Worksheet G-3, line 24.50;
- Skilled Nursing Facility, form CMS-2540-10, Worksheet G-3, line 24.50;
- HHA, form CMS-1728-94, Worksheet F-1, line 31.50;
- Hospice, form CMS-1984-14, Worksheet F-2, column 3, line 16.50;
- ESRD, form CMS-265-11, Worksheet F-1, line 31.50;
- FQHC, form CMS-224-14, Worksheet F-1, line 28.50; and
- CMHC, form CMS-2088-17, Worksheet F, line 20.50
New: 8/26/2020