COVID-19 Updates
End of the State of Emergency – Now what?
On March 21, 2022, the legislature overturned Governor Beshear’s veto on Senate Joint Resolution 150 to officially end the State of Emergency in Kentucky. What does this mean for chiropractors?
Continuing Education & Licensure
On March 30, 2022, the KBCE sent the email below to all licensees. What does this mean? The KBCE allowed for a 90-day grace period from the end of the State of Emergency for docs to become compliant with their continuing education credits and their physical license. There may be some docs who are potentially 3-years behind in their CEs and license. Make sure you bring your license current and become compliant before the 90-days run out to avoid any late fees! Check out the video on the right to learn more about what this means for your license.
Looking for CEs? Check out our available courses here!
Email from KBCE:
On March 21, 2022, the legislature ended the state of emergency relating to Covid-19. SJR150 (RS 2022). Under the state of emergency, licensees were granted additional time to complete certain administrative obligations. SB 150 (RS 2020); SB 25 (RS 2022). The Kentucky Department of Professional Licensing is notifying you that the time period started on March 21, 2022, for completion of your administrative obligations to renew your license, pay outstanding fees without a late fee, and complete continuing education requirements. If you are not sure if your renewal is current, please log into your eServices account (go to https://dpl.ky.gov/ and click “eServices”) for your board to find information about your renewal and expiration dates based on the time period set by SB 150 (RS 2020) or your board.
If you have further questions, please contact the Board Administrator at (502) 892-4250 or by email at kbce@ky.gov.
Thank You,
Department of Professional Licensing
Mask Mandate
At this time, we cannot find anything written related to masks being required in a healthcare facility at this time that is current in Kentucky. The CDC still recommends masks for everyone in healthcare settings, that has not changed. Further, the amount of PPE you’re wearing will determine how long/if you need to close after exposure. Additionally, the KBCE continues to encourage licensed chiropractors to practice social distancing, employ enhanced sanitization, employ appropriate Personal Protective Equipment, and screen patients for COVID-19 symptoms. At this time we are encouraging each doc to talk to their malpractice company on their liability and to create their own mask policy in their office.
Provider Relief Fund Reporting Portal for Reporting Period 2 Open Until March 31, 2022
If You Received PRF Payments Exceeding $10,000 Between July 1-December 31, 2020, You Must Report on the Use of These Funds by March 31st.
In January, the U.S. Department of Health and Human Services (HHS) opened the Provider Relief Fund (PRF) Reporting Portal for Reporting Period 2. All providers who received one or more General and/or Targeted PRF payments exceeding $10,000, in the aggregate, between July 1, 2020, and December 31, 2020, are required to report on their use of the funds in Reporting Period 2. The Reporting Portal will remain open through March 31, 2022, at 11:59 PM ET. This is a multi-step process so we recommend starting early.
For those that have previously reported, you can jump straight to the provider reporting portal here.
For those who have not previously reported, please read the steps below. You can find more details on each step on the Provider Relief Fund Reporting Requirements and Auditing website here.
Step 1: Register in the Provider Relief Fund Reporting Portal
A reporting TIN submitting reports in multiple reporting periods will only need to register once. However, those new to the reporting process will need to complete this step.
Registration takes approximately 20 minutes and must be completed in a single session.
Step 2: Read the Reporting Requirements Notice
The Post-Payment Notice of Reporting Requirements updated on June 11, 2021, provides details on how to report on the use of funds. This supersedes all previous Notices of Reporting Requirements. Read the Reporting Requirements Notice (PDF – 232 KB) and reference the Reporting and Auditing FAQ.
Step 3: Complete and Submit Your Report
Complete and submit your report via the PRF Reporting Portal. For further information, refer to the Reporting Portal User Guide – Reporting.
Need Help With Reporting?
We have detailed answers to common questions related to reporting requirements and auditing. Read the Reporting and Auditing FAQ.
For all other questions related to reporting, call the Provider Support Line at 866-569-3522; for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday. Hours are subject to change.
What is the Process to Return Unused Funds?
There is a two-part process to return funds. Part 1 is to complete an online form via the Return Unused PRF Funds Portal . Next, you will be redirected to Part 2 to transfer the funds via Pay.gov. Refer to the instructions for returning unused funds and the new Returning Funds Fact Sheet (PDF – 178 KB) for more information.
Partial Return of Funds
Once the report has been filed, the provider must return any unused funds from the corresponding Payment Received Period to the government within 30 calendar days after the end of the applicable Reporting Time Period, as explained in the Terms and Conditions and the Post-Payment Notice of Reporting Requirements (PDF – 232 KB) (June 11, 2021).
Note: People using assistive technology may not be able to fully access information in these files. For assistance, please email PRBInformation@hrsa.gov or call 301-945-9371.
Upcoming reporting periods:
- Reporting Period 3 opens on July 1, 2022
- Reporting Period 4 opens on January 1, 2023
All information can be found here
1.27.2022 KBCE Memo for Chiropractors
The Kentucky Board of Chiropractic Examiners had their regularly scheduled meeting on January 21, 2022. During that meeting, they discussed important issues pertaining to the chiropractic practice. On January 27, 2022, the KBCE released the following memo. Below is a recap of the memo as a result of their board meeting.
- The state of emergency has been extended through April 14, 2022 by way of passing of Senate Bill 25. In the memo, the board encourages licensed chiropractors to continue practicing social distancing, employ enhanced sanitization, employ appropriate Personal Protective Equipment and screen patients for COVID-19 symptoms.
- The KBCE will accept 12 hours of online education for both the March 2022 renewal cycle and the March 2023 renewal cycle. A doctor can attend in-person, should they choose, however the licensing board has extended the deadline to allow for all CEs online for both years listed directly above.
- Peer Reviews may also obtain all 6 CE hours online for the March 2022 and March 2023 renewal cycle as well.
- The KBCE encourages all chiropractors to renew their license early, before the March 1, 2022 deadline.
- Providers have 90-days from the date the state of emergency ends to become compliant with their CEs and to get their license active. Currently that date is July 13, 2022 – if the state of emergency is not extended past April 14, 2022.
- There is also a bill (SJR 150) that may shorten the state of emergency to ending in March 2022 instead of April – this may impact the time required to get your CEs. We again recommend start tackling those CEs and renewing your license if you are behind. You can read that bill here: SJR 150
Use of PPE in your office
In the same memo released from the KBCE on January 27, 2022 – the board addressed the use of personal protective equipment in your office. It is up to the individual provider to implement policies in their office and further, talk with their malpractice insurance to mitigate any risk. We encourage all doctors to review the latest CDC guidance on determining how long/if you need to close after a COVID-19 exposure in their office. You can find the latest return to work after a healthcare provider has been exposed to COVID-19 CDC recommendations here.
A few other reminders from the KAC regarding continuing education.
- You do not have to turn in your CE certificate to the licensing board unless you were audited. If you were audited, you would have found out through the email you received from the licensing board in December 2021. The email will look similar to the following:
- You can only complete 8 hours of CE on any one day – whether online or in-person.
- All CE courses must be from the approved list on the KBCE’s website. For the most up-to-date list of approved CE courses, visit kbce.ky.gov, under Continuing Education.
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.
Portal Registration User Guide
Portal Worksheets (downloadable Excel workbook)
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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):
- Eligible providers serve patients living in Federal Office of Rural Health Policy-defined rural areas.
- Payments based on the “amount and type of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) services provided to rural patients.”
- Minimum payments distributed to providers “who serve any patients living in Federal Office of Rural Health Policy-defined rural areas.”
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 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
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 Funds | Reporting Time Period | |
| Period 1 | From April 10, 2020 to June 30, 2020 | June 30, 2021 | July 1 to September 30, 2021 |
| Period 2 | From July 1, 2020 to December 31, 2020 | December 31, 2021 | January 1 to March 31, 2022 |
| Period 3 | From January 1, 2021 to June 30, 2021 | June 30, 2022 | July 1 to September 30, 2022 |
| Period 4 | From July 1, 2021 to December 31, 2021 | December 31, 2022 | January 1 to March 31, 2023 |
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
- Make a list of all PRF payments you received and the dates (many of these funds were distributed by UHC and labeled with HHS).
- 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
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 – 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?
- 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.
- 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.