COVID-19 Updates

Provider Relief Fund Reporting Deadline September 30, 2021

Provider Relief Fund Reporting Deadline September 30, 2021

The Provider Relief Fund (PRF) Reporting Portal has now been open for two months. Healthcare providers who received PRF Funds between April 10, 2020 to June 30, 2020 had a deadline to spend funds received during that time period prior to June 30, 2021 and must report on the uses of those funds in the HRSA Reporting Portal by September 30, 2021. The portal does ask for a significant amount of information including, net patient service revenue, by payor, by quarter, along with personnel, patient and facility metrics from Q1 of 2019 through Q2 of 2021. As such, please ensure you plan an adequate amount of time to gather the required information and complete the reporting.

Below are links to resources that may be helpful to healthcare providers as you navigate this new reporting requirement.


HHS ANNOUNCES NEW PROVIDER RELIEF FUND PAYMENTS (PHASE 4)

HHS ANNOUNCES NEW PROVIDER RELIEF FUND PAYMENTS (PHASE 4)

$25.5 billion additional dollars will be allocated to healthcare providers who can document revenue loss and expenses associated with the pandemic. These funds will be made available through the American Rescue Plan and Phase 4 of the Provider Relief Fund, and the application process will be combined for both distributions. HHS specifically includes chiropractors in the list of eligible providers.

ARP funds will be distributed to providers who serve Medicaid, Children’s Health Insurance Program (CHIP), or Medicare members living in rural areas as defined by the HHS Federal Office of Rural Health Policy

PRF funds will be distributed to smaller providers for revenue and expenditures lost between July 1, 2020, and March 31, 2021. The PRF Phase 4 includes bonus payments to providers who service Medicaid, CHIP, and/or Medicare members who are lower-income and have complex medical needs.

Webinar

HRSA is hosting a webinar on Thursday, October 21, 2021, 3-4pm ET, to provide technical guidance on the application process. To register, go to www.hrsa.gov/provider-relief/future-payments and scroll down to “Technical Assistance Webinars.” While there, you can also view eligibility requirements and other application resources. If you have questions, contact the HRSA Provider Support Line at 1-866-569-3522.

The announcement by HHS indicated that the applications will be open beginning September 29, 2021, and HHS did not indicate when the application process would end. However, according to more detailed information from HHS, most of the distributions will not occur until all applications are reviewed and compared.

The application period is now open and will close on Tuesday, October 26, 2021.

There is a single application process for both programs. The application portal opens on September 29, 2021.

STEPS TO PREPARE FOR THE APPLICATION:

  • Gather your practice financial information for July 1, 2020, through March 31, 2021:
    • Tax documents.
    • Financial statements.

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Use this link to determine if any of your patients live in Federal Office of Rural Health Policy-defined rural areas.

Providers interested in applying for the funds can learn more on the Provider Relief Fund Future Payments website. The website includes a listing of eligible provider types, the information needed to apply, and how payments are calculated.

ELIGIBILITY

ARP funds will be distributed to providers who serve Medicaid, Children’s Health Insurance Program (CHIP), or Medicare members living in rural areas as defined by the HHS Federal Office of Rural Health Policy

PRF funds will be distributed to smaller providers for revenue and expenditures lost between July 1, 2020, and March 31, 2021. The PRF Phase 4 includes bonus payments to providers who service Medicaid, CHIP, and/or Medicare members who are lower-income and have complex medical needs.

APPLYING FOR APR or PRF FUNDS

There is a single application process for both programs. The application portal opens on September 29, 2021.

Providers interested in applying for the funds can learn more on the Provider Relief Fund Future Payments website. The website includes a listing of eligible provider types, the information needed to apply, and how payments are calculated.

PROVIDER RELIEF FUND PHASE 4 INFORMATION ($17 BILLION):

  • $12.75 billion:
    • Based on lost revenues and pandemic related expenses between July 1, 2020 and March 31, 2021.
    • Large providers (typically hospital systems) will receive minimum payments based on percentage of lost revenues and COVID-19 related expenses.
    • Medium providers will receive a base payment plus a supplement.
    • Small providers will receive a base payment plus a larger supplement.
    • Payments will not be greater than revenue losses and pandemic expenses.
  • $4.25 billion:
    • Also based on lost revenues and pandemic related expenses between July 1, 2020, and March 31, 2021.
    • Bonus payments issued based on the “amount and type of services provided to Medicaid, CHIP, and Medicare patients.”
    • Minimum payments distributed to providers “who serve any patients living in Federal Office of Rural Health Policy-defined rural areas.”

AMERICAN RESCUE PLAN RURAL DISTRIBUTION ($8.5 BILLION):

OTHER ANNOUNCEMENTS:

  • HHS released detailed information on how Phase 3 calculations were performed. Providers who submitted a Phase 3 application and believe they received an incorrect payment according to the released information can request a redetermination.
  • Although the KAC still strongly recommends that providers complete by September 30, 2021, their reporting for the first Provider Relief Fund Reporting time period, HHS is allowing a final 60-day grace period for this reporting. If you would like more information about the reporting requirements, you can read this article.

Questions about the funds or the application process should be directed to the Health Resources and Services Administration (HRSA) Provider Support Line at (866) 569-3522 or for TTY dial 711. The line is open Monday through Friday from 9 a.m. to 11 p.m. Eastern Time/8 a.m. to 10 p.m. Central Time. 

As more information is released about this plan, the Kentucky Association of Chiropractors will keep our members up to date.

President Biden Announces New Nationwide COVID-19 Action Plan

President Biden Announces New Nationwide COVID-19 Action Plan

President Biden held a press conference yesterday outlining new COVID-19 vaccination mandates nationwide.  This article provides our members with information concerning the announcement and subsequent regulatory body press releases and coming actions.

The announcement addressed three primary areas: all Executive Branch federal workers (most of the federal government workforce), companies with 100 or more employees, and facilities accepting payments from Medicare and Medicaid. The mandates for federal workers and 100+ employee companies do not appear to directly impact the vast majority of chiropractic physicians and their practices.

However, it is still unclear whether the COVID-19 vaccine mandates for Medicare and Medicaid facilities will impact chiropractors because we are still awaiting further information about how “Medicare and Medicaid facilities” could be defined under federal rules.

At this time, the Centers for Medicare and Medicaid Services (CMS) has not released many specific details surrounding the Medicare announcement. The Kentucky Association of Chiropractors has reviewed the announcement and can provide our members with the following  information as of today, based on the limited information available in the CMS press release:

  • These new COVID-19 vaccine mandates are NOT in place yet. Each federal agency will have to issue Emergency Rules that will outline details. CMS has indicated that they are “developing an Interim Final Rule with Comment Period that will be issued in October.” This means that we will not know the full intent of the mandate until at least October 2021 (possibly longer with a comment period), and, particularly, whether the mandate will in any way apply to chiropractic practices.
  • The CMS press release indicates the new mandate will apply to “hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others.” There was no further information about the term “among others.”
  • The CMS press release states that the vaccine mandate will apply to Medicare and Medicaid-certified “facilities,” but it does not give a full definition of “facilities.” The release only includes an online list of “facilities” here, and that list does not directly name providers rendering services in their offices.
  • For potential context, Medicare traditionally separates facilities and non-facilities by naming hospitals as an example of a facility, and by referring to health care offices as examples of a non-facility.  See “How to Use the MPFS Look-Up Tool” page 12.
  • However, some CMS definitions of “facilities serving Medicare and Medicaid beneficiaries” in the context of other regulations are broader and more non-specific.
  • Until CMS releases more information, the Kentucky Association of Chiropractors can only provide an analysis of the information currently available.

As a reminder, once CMS finalizes these rules, both state and federal rules must be considered, and the more restrictive rule or Executive Order would apply.

The Kentucky Association of Chiropractors will continue to closely monitor these new federal mandates.  As more information is released, we will continue to provide information to our members.

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.