COVID-19 Updates

Provider Relief Fund Reporting Required

Provider Relief Fund Reporting Required

Many chiropractors in Kentucky received funds from the federal government under the Provider Relief Fund (PRF) program. As a reminder, this program had three primary phases, and the first phase happened without any action on the provider’s part (i.e. the money appeared in the provider’s account).

In addition to the attestations and applications required along the way of the three-payment program, there is also a reporting requirement for some providers. The reporting opened July 1, 2021 and providers should complete the report based on the “Payment Received Period” by the “Reporting Time Period” deadline.

In short, only providers who received greater than $10,000 in any reporting period must report for that period. See the chart below to see the Payment Received Period. If you received $10,000 or more for any of those periods, you would be required to report for that period.

Summary of Reporting Requirements

 Payment Received Period (Payments Exceeding $10,000 in Aggregate Received)Deadline to Use FundsReporting Time Period
Period 1From April 10, 2020 to June 30, 2020June 30, 2021July 1 to September 30, 2021
Period 2From July 1, 2020 to December 31, 2020December 31, 2021January 1 to March 31, 2022
Period 3From January 1, 2021 to June 30, 2021June 30, 2022July 1 to September 30, 2022
Period 4From July 1, 2021 to December 31, 2021December 31, 2022January 1 to March 31, 2023
Source: https://www.hhs.gov/about/news/2021/06/11/hhs-issues-revised-reporting-requirements-timeline-for-provider-relief-fund-recipients.html

HOW SHOULD FUNDS BE USED?

According to HHS, the PRF funds should “be used to prevent, prepare for, and respond to coronavirus. Provider Relief Fund payments may also be used for lost revenues attributable to the coronavirus.” Additionally, they should not have been “reimbursed from other sources and other sources were not obligated to reimburse them.” This means that if you attributed funds for a PPP loan or another grant program reimbursed for expenses, then they would NOT be eligible to be included for PRF reporting.

HHS went further to provide examples: “Expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, personnel, and other healthcare-related costs/expenses for the period of availability.”

Interestingly, HHS also deems as eligible expenses the taxes that you paid on the PRF amounts.

Also, HHS allows for funds to offset a loss in revenue. This means if your revenues are lower in a given reporting period in 2020 vs. the same period in 2019, the funds can be used for offsetting that reduction. In addition, any unused portion of lost revenue for an earlier period can be carried forward to a future reporting period.

WHAT ABOUT DOCUMENTATION?

HHS states, “Reporting Entities are not required to submit that documentation when reporting. Providers are required to maintain supporting documentation which demonstrates that costs were obligated/incurred during the period of availability. The burden of proof is on the Reporting Entity to ensure that adequate documentation is maintained.”

NEXT BEST STEPS

  1. Make a list of all PRF payments you received and the dates (many of these funds were distributed by UHC and labeled with HHS).
  2. If the total amount of PRF received during any period is greater than $10,000, then:
    • Determine lost revenues during the reporting period,
    • Determine eligible expenses,
    • Complete the Report during the Reporting Time Period listed in the chart above.
    • Make a permanent file to maintain all reporting determinations, as HHS requires.

As of the morning of July 1, 2021, the Health and Human Services (HHS) Provider Relief Fund (PRF) Reporting Portal is open.


Sources:

HHS Issues Revised Notice of Reporting Requirements and Reporting Timeline for Recipients of Provider Relief Fund Payments: https://www.hhs.gov/about/news/2021/06/11/hhs-issues-revised-reporting-requirements-timeline-for-provider-relief-fund-recipients.html

Reporting Requirements and Auditing https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/index.html

OSHA – Emergency Temporary Standard regarding COVID-19

OSHA – Emergency Temporary Standard regarding COVID-19

On January 21, 2021, President Biden issued an Executive Order which declared that ensuring the health and safety of workers is a national priority and a moral imperative. The order directed the Occupational Safety and Health Administration (OSHA) to take action to reduce the risk that workers may contract COVID-19 in the workplace.

The agency has determined that existing standards and regulations, and the OSH Act’s General Duty Clause, are inadequate to address the COVID-19 hazard for these workers. Additionally, it has become clear that a Federal standard is needed to ensure sufficient protection for healthcare workers in all states. OSHA has issued an emergency temporary standard (ETS) to address this hazard.

There are several sections in the COVID-19 ETS in Subpart U. Section 1910.502 – Healthcare: Except as otherwise provided in the standard, applies to all settings where any employee provides healthcare services or healthcare support services.

In short – If you meet the following 3 criteria, you do NOT need to implement the Emergency Temporary Standard in your office. If you do not meet the following 3 criteria, you must implement the Emergency Temporary Standard – which includes screening your patients.

  • If you are a non-hospital ambulating care setting,
  • All non-employees are screened prior to entry AND
  • People with suspected or confirmed COVID-19 are not permitted to enter

If you do not meet all three guidelines above, you must implement the emergency temporary standards in your office, as outlined by Subpart U – which includes screening all people entering your office.

If you have to implement the Emergency Temporary Standards in your office, it includes:

  • Developing a COVID-19 plan
  • Patient screening and management
  • Standard and transmission-based precautions
  • PPE
  • Aerosol-generating procedures on a. Person with suspected or confirmed COVID-19 cases
  • Physical distancing
  • Physical barriers
  • Cleaning and disinfection
  • Ventilation
  • Health screen and medical management
  • And more.

To summarize – if you do not meet the above 3 criteria, you must implement the Emergency Temporary Standard, which includes a screening protocol. So if you implement a screening protocol and do not allow people with suspected or confirmed COVID-19 in your office, you are exempt from the remainder of the Emergency Temporary Standards.


To view the OSHA Fact Sheet on the Emergency Temporary Standards, click here.

To view “Is your workplace covered by the COVID-19 Healthcare ETS?”, click here

To view all information regarding the OSHA Emergency Temporary Standards, click here

June 11, 2021 – Updates to Mask Guidelines

June 11, 2021 – Updates to Mask Guidelines

June 11, 2021 – Earlier today , Governor Beshear gave his last regularly scheduled press conference related to COVID-19. Gov. Beshear signed a new Executive Order (EO) which lifts the mask mandate for the state of Kentucky with a few exceptions, including public transit, long-term care facilities and health care facilities.

In line item 4.ii, the executive order states: “any person in a healthcare setting shall wear a face covering.” At this time, any person in a chiropractic office is still required to wear a face mask.

Further, in section 2, the order states that the “Healthy at Work” requirements and the “Healthy at Work” website are rescinded. Best practices and recommendations remain on the KYCOVID19.ky.gov website here under the health care guidance. Offices are encouraged to follow best practices and recommendations listed here.

We will continue to monitor any changes to the guidelines and update you accordingly. We appreciate your dedication and membership to the KAC as we continue to serve you and your office.

HHS Round 3 Funds Available

Late last week, Phase 3 of the Provider Relief Fund was approved to distribute an additional $20 Billion to providers impacted by COVID-19. Once again, Doctors of Chiropractic are included in this program and eligible for further relief funds. In fact, HHS indicates that, “Providers may be eligible regardless of whether they were eligible for, applied for, received, accepted, or rejected payment from prior PRF distributions.”

Beginning Monday, October 5, providers can apply for these funds by visiting the provider portal. The deadline for application is November 6.

Who is eligible?

  • Providers who previously received rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
  • Behavioral Health providers, including those that previously received funding and new providers.
  • Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.

What are the criteria for payment?

  1. All provider submissions will be reviewed to confirm they have received a Provider Relief Fund payment equal to approximately 2 percent of patient care revenue from prior general distributions. Applicants that have not yet received Relief Fund payments of 2 percent of patient revenue will receive a payment that, when combined with prior payments (if any), equals 2 percent of patient care revenue.
  2. With the remaining balance of the $20 billion budget, HRSA will then calculate an equitable add-on payment that considers the following:
  • A provider’s change in operating revenues from patient care
  • A provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus
  • Payments already received through prior Provider Relief Fund distributions.

What do you need to provide on the application?

You will have to provide your operating revenue and expenses for the 1st and 2nd quarter of 2020. If you have not submitted your tax information from 2019, that may be required as well.

  • “Operating revenues from patient care” means revenues that represent amounts received for the delivery of health care services directly to patients. This amount should exclude non-patient care revenue such as insurance, retail, or real estate revenues (exception for nursing and assisted living facilities’ real estate revenue where resident fees are allowable); pharmacy revenues 2 (exception when derived through the 340B program); grants or tuition; contractual adjustments from all third party payors; charity care adjustments; bad debt; any gains and/or losses on investments, and any prior Provider Relief Funds received.
  • “Operating expenses from patient care” means the operating expenses incurred as part of the delivery of care, including salaries, benefits, medical supplies, contracted and/or employed physicians, and interest and depreciations on building and equipment used in the provision of patient care. Operating expenses should exclude any non-operating expense such as costs incurred on any rental property (exception for nursing and assisted living facilities’ real estate costs where resident costs are allowable), contributions made, and gains and/or losses on investments.

What are my next steps?

Based on HHS’ statement that providers may be eligible for the new phase of funding regardless of their previous eligibility or rejection, the KAC would strongly encourage doctors to submit an application for this round of funding.

To find out more information about the Provider Relief Fund, click here.  If you believe you meet the requirements for the third round of Provider Relief Funding, simply visit the Provider Relief Fund Application and Attestation Portal, sign in (or create a new account), and complete the application. You can start that application here.

Paycheck Protection Plan Flexibility Act

On 06/03/2020, the US Senate passed the Paycheck Protection Plan Flexibility Act and is sending it to the President for his signature. We expect the President will sign this bill that will assist chiropractic physicians who have obtained or will be obtaining a PPP loan. The legislation makes the following changes:

Extends the 8-week forgiveness period to 24 weeks. This will allow employers more time to offset the loan amount with payroll expenses. In other words, employers can now use payroll expenses for the entire 24-week period and increase their forgiveness amount.

Reduce the payroll expense requirement from 75% to 60%. However, if employers do not use at least 60% for payroll expenses, then none of the loan will be forgiven. This is unlikely with the changes mentioned above.

Employers can now use the entire 24-week period to restore their workforce to the pre-COVID-19 era (February 20th, 2020) levels.

It allows for additional forgiveness exceptions. It specifically codifies the “good faith offer to return to work” exception. Then it adds other exceptions for those businesses that cannot find qualified candidates or those that can never return to pre-COVID-19 levels as a result of the pandemic operating restrictions.

It extends the term of the loan from 2 years to 5 years. For those loans already in place, the term can be extended if both the borrower and lender agree.

It also allows for PPP recipients to delay payment of payroll taxes that were previously restricted in the CARES Act.

Second Round of HHS Funds Now Being Deposited

A few weeks ago, we informed you of a new round of Provider Relief Funds that were becoming available. If you received the initial HHS funding in April, you qualify to apply for the second round of funds. You will have to apply and include information from your 2018 tax return. Today we are hearing from doctors that have gotten their second round of money. If you have not applied yet, there is still time.

HHS has begun the next round of payments under the Provider Relief Fund. This round is $20 billion and is based on your net revenue in 2018 against the entire estimated healthcare net revenue amounts from 2018 (some estimating $2.5 trillion total). Additionally, most providers are required to submit information via a portal to receive their portion of the $20 billion.

To receive your funds, you must submit your application through the portal. You can find the link for the general distribution application portal on the Provider Relief Fund page or by direct link here.

According to the General Distribution portal FAQ, HHS is collecting four pieces of information for use in allocating these remaining General Distribution funds:

  1. a provider’s “Gross Receipts or Sales” or “Program Service Revenue” as submitted on its federal income tax return;
  2. the provider’s estimated revenue losses in March 2020 and April 2020 due to COVID;
  3. a copy of the provider’s most recently filed federal income tax return; and
  4. a listing of the TINs any of the provider’s subsidiary organizations that have received relief funds but that DO NOT file separate tax returns.

Like the first $30 billion, these funds can be used to cover additional COVID-19 expenses OR lost revenues. Thus, if you had lower revenue in March and April that are greater than the funds received from HHS from the initial disbursement and this disbursement combined, that will satisfy the usage portion of the requirement.

General Distribution Portal

General Distribution Portal FAQFull Provider Relief Page

Updated Massage Therapy Guidance Released

Today the official guidance for massage therapy to reopen was released on the Healthy as Work Website. The full document can be reviewed here.

The official guidance released today has changed from the guidance that was released earlier from the massage therapy board. Below are the highlights of the requirements to reopen massage therapy. Please ensure you read and fully understand the full guidance if you utilize massage in your practice.


Massage therapy businesses should eliminate the use of any waiting areas, provide services by appointment only, and communicate when the client may enter the premises by phone or text. Massage therapy businesses must ensure clients do not congregate before or after their appointment.

Given the close personal interaction inherent in massage, massage therapy businesses should consider screening potential clients over the phone to ensure they are not currently experiencing any symptoms of COVID-19. Massage therapy businesses also may take temperatures of clients upon entry. Massage therapy businesses may refuse service to someone who is exhibiting COVID-19 symptoms

Massage therapy businesses should ensure that their facilities, including workstations, common areas, breakrooms and restrooms and are properly cleaned and ventilated.

Massage therapy businesses must ensure that massage tables are sanitized and that linens and hydrocollator pack covers are replaced after each client.

Massage therapy businesses should ensure that lotion/lubricant bottles are disinfected before and after each client or should consider using disposable lotion/lubricant packets.

Massage therapy businesses must ensure their employees wear face masks for any interactions between clients and co-workers or while in common travel areas of the business (e.g., aisles, hallways, stock rooms, breakrooms, bathrooms, entries and exits). Employees are not required to wear face masks while alone in personal offices, more than six (6) feet away from anyone else, or if doing so would pose a serious threat to their health or safety.

Massage therapy businesses should consider lining tables, table warmers, bolsters, face, cradles, and pillows with non-permeable barriers, such as vinyl mattress pad covers.

Massage therapy businesses should apply a washable face-cradle cover to the face cradle, and consider topping it with a pillowcase, leaving a pocket underneath that could catch client aerosols when they are prone.

Massage therapy businesses should ensure clients and other visitors (e.g., suppliers and vendors) wear face masks while on the premises unless doing so would present a serious risk to their health or safety or they will remain more than six (6) feet away from anyone else at all times. Massage therapy businesses should make masks available for clients; however, clients may bring and utilize their own face mask if they wish. Massage therapy businesses should consider asking clients to keep the mask on at all times other than while in the prone position on the table. If clients, suppliers or vendors refuse to wear masks, the massage therapy business may, at their discretion, refuse those individuals entrance.

Massage therapy businesses should establish a policy as to whether to serve clients who do not adhere to the business’s policy to comply with CDC guidelines.

Massage therapy businesses must require employees to wear gloves anytime they are touching a client’s face and the gloves must be immediately removed or replaced after they are no longer touching the client’s face. Massage therapy businesses may require employees to wear gloves in other instances, but gloves are not required provided the massage therapist refrains from touching their own face while massaging the client and thoroughly washes their hands for at least twenty (20) seconds per CDC guidelines before and after touching each client.

New PPP Guidance – Forgiveness On Loans Under 2 Million

Some doctors have had concerns about the requirement to satisfy the certification indicating that the “[c]urrent economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.” As a result, some doctors have been concerned about future audits and even consider returning the funds. However, the Treasury Department released new information regarding audits, good-faith certifications, and safe harbors on 5/13/2020 that should give our PPP recipients relief.

SBA has now clarified, in FAQ #46, that anyone receiving PPP “loans” less than $2 million would have less access to adequate liquidity in the current economic environment. Thus, they are considering all PPP loans of less than $2 million automatically meet the required certification of necessity. Additionally, they cited that this will also allow them to focus their limited resources to larger loans.

This should give all of our doctors who received PPP loans (assuming they are less than $2 million) comfort that there will be no necessity audits for PPP loans and do not have to be concerned with the return of funds.

https://home.treasury.gov/system/files/136/Paycheck-Protection-Program-Frequently-Asked-Questions.pdf

46. Question: How will SBA review borrowers’ required good-faith certification concerning the necessity of their loan request?

Answer: When submitting a PPP application, all borrowers must certify in good faith that “[c]urrent economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.” SBA, in consultation with the Department of the Treasury, has determined that the following safe harbor will apply to SBA’s review of PPP loans with respect to this issue: Any borrower that, together with its affiliates,20 received PPP loans with an original principal amount of less than $2 million will be deemed to have made the required certification concerning the necessity of the loan request in good faith. SBA has determined that this safe harbor is appropriate because borrowers with loans below this threshold are generally less likely to have had access to adequate sources of liquidity in the current economic environment than borrowers that obtained larger loans. This safe harbor will also promote economic certainty as PPP borrowers with more limited resources endeavor to retain and rehire employees. In addition, given the large volume of PPP loans, this approach will enable SBA to conserve its finite audit resources and focus its reviews on larger loans, where the compliance effort may yield higher returns. Importantly, borrowers with loans greater than $2 million that do not satisfy this safe harbor may still have an adequate basis for making the required good-faith certification, based on their individual circumstances in light of the language of the certification and SBA guidance. SBA has previously stated that all PPP loans in excess of $2 million, and other PPP loans as appropriate, will be subject to review by SBA for compliance with program requirements set forth in the PPP Interim Final Rules and in the Borrower Application Form. If SBA determines in the course of its review that a borrower lacked an adequate basis for the required certification concerning the necessity of the loan request, SBA will seek repayment of the outstanding PPP loan balance and will inform the lender that the borrower is not eligible for loan forgiveness. If the borrower repays the loan after receiving notification from SBA, SBA will not pursue administrative enforcement or referrals to other agencies based on its determination with respect to the certification concerning necessity of the loan request. SBA’s determination concerning the certification regarding the necessity of the loan request will not affect SBA’s loan guarantee.

KBCE Changes CE Requirements

Today during the KBCE meeting, there were several items discussed. We will be creating a meeting recap that will be posted on the KAC website next week. One item of note that we would like to inform you of is a change to the Continuing Education (CE) requirements for the 2021 renewal.

KBCE voted today to issue emergency regulations that will allow all 12 hours of CE to be obtained online for the 2021 license renewal period. This is a departure from their current policy of allowing no online CE hours. Courses will have to be approved through KBCE, but you will start to see online CE hours approved for Kentucky. The KAC is taking steps to provide online continuing education hours that will be approved and allowed for renewal. These will include our Annual Convention and the 2021 LB Payne Insurance Seminar.

We are waiting to see the official language for this new regulation. Based on the discussions at the meetings, we anticipate these changes going into effect next week. We will continue to monitor the situation and update you as this evolves.

Licensed Massage Therapist To Reopen

Based on guidance that has been posted on the Kentucky Board of Licensure for Massage Therapy (KMT) website, licensed massage therapists (LMT) may reopen on May 25th. They do have a six-page document with guidance for how this reopening will occur. This guidance is very detailed, and if you offer massage therapy services in your office, you need to understand the guidance fully.

We do not have any further information at this time pertaining to this guidance. Any questions should be directed to the Kentucky Board of Massage Therapy or the Kentucky Massage Therapy Association.

Read the entire reopening guidance located on KMT.