The “Coronavirus Aid, Relief, and Economic Security Act” (CARES Act) will directly impact doctors who billed Medicare in 2019. The federal government has allocated $30 billion in “relief funds” that will include individual providers, including doctors of chiropractic. This is NOT a loan. Instead, it is an automatic grant.
Beginning Friday, April 10, funds were automatically deposited into your bank account via Optum Bank (CMS partner in this project) with “HHSPAYMENT” as the payment description. If you are typically paid by Medicare via check, then your funds will arrive in the next 2 weeks.
HHS has placed “terms and conditions” on the funds that must be accepted within 30 days of receipt through the HHS portal. You can find the HHS portal by visiting the provider relief fund page. Included in those conditions:
- “Providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider;”
- “The Recipient certifies that it will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.” This would include funds for PPP loans or EIDL loans;
- “shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.” Thus, lost revenues are a component of these funds that would NOT be included in the PPP or EIDL funds.
- Recipient must also keep documentation regarding the use of the funds.
HHS gives further clarification of intent on the main relief page:
- “This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and canceled elective services.
- If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.
- Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.” [emphasis added]
Log onto the HHS portal to agree to the terms and conditions. If you are uncomfortable and do not believe you meet the terms and conditions, you will need to send the funds back to HHS. More information is available on the HHS provider relief site.
The guidance for the reopening of chiropractic offices is currently being finalized. There are multiple suggestions for chiropractic, and those are being evaluated now. We do not know what the guidance will look like at this time, but once we have a clearer picture, we will release that information to you. Currently, the KAC has recommended the use of non-N95 masks and gloves as available. This would mirror other guidance in the healthcare field currently.
As healthcare providers, it is our understanding that we will be issued guidance from the state, and you do not have to submit your own plan for reopening.
There is no defined time table at this time, but there is light at the end of the tunnel.
Last night Governor Beshear announced that Monday there will be the starting of some limited healthcare services. There will be some more clarification, but at this point, it appears to be very limited to some facility-based services.
“We are very close to coming to a consensus and an agreement in being able to put out guidelines for the gradual reopening of many of our hospital and health care services,” Gov. Beshear said. “We will be moving from this phase to others. Health care is a good and important place to start some of our reopening.”
Read the full press release here.
As you can see from the governor’s statement, they are working across many segments of healthcare to allow the reopening in the coming weeks.
Internet claim filing is listed at the top.
When to file:
FridayIf you Missed your day
The Governor has stated that you will not be penalized for waiting until it’s your day.
If you are treated as a W2 employee in your practice you can file for Unemployment. The Governor is working on the ability for independent contractors and Self Employed to be able to file for Unemployment as well. Watch the state for information on that.
President Trump signed this bill into law on March 18th, 2020. This bill expands your employees FMLA rights and paid sick leave starting April 1st, 2020. Small employers that previously did not have to comply with FMLA are now required to meet new standards. This is a complex issue and we have been able to work with ChiroHealthUSA to bring you a webinar with the most current information on how this may impact your practice.
The Small Business Association Economic Injury Disaster Loans (EIDL) and Loan Advance are available to businesses that have been impacted by COVID-19 (including Doctors of Chiropractic). This program includes an emergency advance of up to $10,000 to small businesses affected by COVID-19. To access the advance, you must first apply for an EIDL and then request the advance. Our research shows the advance does not need to be repaid, but you will verify that through this process. The funds may be used to keep employees on payroll, to pay for sick leave, meet increased production costs due to supply chain disruptions, or pay business obligations, including debts, rent, and mortgage payments. You may also qualify for funds above the emergency advance to help your practice.
There is a lot of confusion about the types of loans available, and some think they must maintain their employees to be eligible. While this may be true for some loans, this advance and loan do not require you to keep your employees. This loan is to structured to give immediate assistance to businesses that have seen an economic impact due to COVID-19. You must qualify as one of the business types below and be able to certify the second list of criteria to be eligible.
- Choose your business type:
•Applicant is a business with not more than 500 employees.
•Applicant is an individual who operates under a sole proprietorship, with or without employees, or as an independent contractor.
•Applicant is a cooperative with not more than 500 employees.
•Applicant is an Employee Stock Ownership Plan (ESOP), as defined in 15 U.S.C. 632, with not more than 500 employees.
•Applicant is a tribal small business concern, as described in 15 U.S.C. 657a(b)(2)(C), with not more than 500 employees.
•Applicant is a business, including an agricultural cooperative, aquaculture enterprise, nursery, or producer cooperative, that is small under SBA Size Standards
•Applicant is a business with more than 500 employees that is small under SBA Size Standards
•Applicant is a private non-profit organization that is a non-governmental agency or entity that currently has an effective ruling letter from the IRS granting tax exemption under sections 501(c),(d), or (e) of the Internal Revenue Code of 1954, or satisfactory evidence from the State that the non-revenue producing organization or entity is a non-profit one organized or doing business under State law, or a faith-based organization.
- Review and Check All of the Following, Applicant must review and check all the following:
•Applicant is not engaged in any illegal activity (as defined by Federal guidelines).
•No principal of the Applicant with a 50 percent or greater ownership interest is more than sixty (60) days delinquent on child support obligations.
•Applicant is not an agricultural enterprise (e.g., farm), other than an aquaculture enterprise, agricultural cooperative, or nursery.
•Applicant does not present live performances of a prurient sexual nature or derive directly or indirectly more than de minimis gross revenue through the sale of products or services, or the presentation of any depictions or displays, of a prurient sexual nature.
•Applicant does not derive more than one-third of gross annual revenue from legal gambling activities.
•Applicant is not in the business of lobbying.
•Applicant cannot be a state, local, or municipal government entity and cannot be a member of Congress.
Contact your accountant to see if a SBA EIDL is right for you. Or you can visit https://covid19relief.sba.gov/#/ for more information to start the application process.
There was an important section in the “Coronavirus Aid, Relief, and Economic Security Act” (CARES Act) passed by Congress last Friday (3/27/2020) that provides for SBA loans that ultimately can be forgivable. Most people refer to this section as the “Paycheck Protection Program.” At this point, the Small Business Administration (SBA) has until April 11 to establish the regulations or rules for this act, which will be necessary to answer some additional questions and to begin the loan application process. SBA is now indicating that applications will start being accepted on April 3rd.
These loans will have different requirements than those found in most SBA rules. Some requirements are more restrictive, and some are significantly loosened. The information below is based on our understanding of the law now and may be adjusted based on new information and the release of regulations by SBA. You will have to apply for this loan at a SBA approved bank. Contact your local bank to find out if they are an approved lender.
How the CARES loan different than typical SBA loans and the basic CARES loan requirements:
- Do NOT have to prove that you cannot receive credit from other sources. This is a typical SBA requirement, but it appears this has been removed for these loans.
- NO personal guarantee will be required.
- 100% guaranteed by the federal government.
- No federal government guarantee fees or prepayment fees.
- The borrower MUST make good faith certifications that they have been impacted by COVID-19 AND will use the funds to maintain payroll and other debt obligations. This language includes, i) “that the uncertainty of current economic conditions makes necessary the loan request to support the ongoing operations of the eligible recipient; (ii) acknowledging that funds will be used to retain workers and maintain payroll or make mortgage payments, lease payment, and utility payments”; and no other SBA loans applications are pending.
- Must have fewer than 500 employees.
- Funds must be used to cover payroll costs, benefits and leave, mortgage interest, rent, and utilities.
- Interest is capped at 4%.
- The borrower can defer payments (including the low interest) between 6-12 months.
- The amount of the loan can be up to the average monthly payroll from 2019 times 2.5 (i.e. 2019 total payroll expenses are $240,000, then 240,000/12 = 20,000 x 2.5 = $50,000 maximum). However, the loan amount is reduced by any amounts paid to individuals greater than $100,000.
- $1 million loan amount maximum.
- Section 1106 of the Act, titled “Loan Forgiveness,” provides that the Government will forgive up to the original principal amount of a loan under the Act that a recipient can document was used to pay: (1) payroll costs; (2) mortgage interest; (3) rent and (4) utilities—in each case for up to eight weeks following the issuance of the loan. Additional details:
- Like the loan amount, the forgiveness will be proportionately reduced for salaries greater than $100,000.
- Each of these documented expenditures for utilities, lease payments, mortgage interest must have been in place prior to 2/15/2020 (i.e. no mortgage interest can be included if the mortgage began on 2/25/2020).
- The forgiveness is reduced proportionately based on that 8-week period vs. last year.
- Employees must remain employed through the end of June.
- Employee pay cuts greater than 25% will reduce the forgiveness proportionately.
- If you have already laid-off employees, you can re-hire them once the loan is disbursed and count them toward the calculation.
- The loan forgiveness is not taxable income.
- SBA has indicated they would have a process in place by the end of this week.
- They have indicated that they anticipate the loans MAY be able to be disbursed the same day. However, local banks may have a longer review process.
- It appears that you can apply NOW for an Economic Injury Disaster Loan Assistance (EIDLA) and then later apply for the Payroll Protection Program loan. You could choose which one to use OR re-finance the EIDLA loan into the PPP loan.
What can you do now while waiting for the process to be finalized (i.e., for applications to be made available)?
Contact your accountant to see if the PPP is something that would benefit your practice. Start gathering documentation for the application while waiting for the process to finalize. This would include payroll information for 2019. This includes ALL payroll expenses, such as health benefits, retirement benefits, etc. Include everything, and you can negotiate with the bank as to what, if any, they will exclude. In addition to payroll information, gather documents showing mortgage interest, rent, and utilities in place prior to 2/15/2020.
Link to SBA site for Payroll Protection – they have now indicated applications can begin on April 3, 2020.