The ASCA wants to ensure that our members have accurate and up-to-date information on the current COVID-19 pandemic. We are closely monitoring the situation so that we can provide the resources you need to support your family and your practice in this uncertain time. We encourage you all to take necessary precautions to keep yourselves, your families and loved ones, and your patients in good health.
Official ASCA Vaccine Statement
As the largest member representative organization of the chiropractic profession in Alabama, the Alabama State Chiropractic Association maintains that every individual should have the freedom of choice when considering healthcare decisions. Furthermore, the Alabama State Chiropractic Association advises that Doctors of Chiropractic must function within their scope of practice and that providing direct advice or recommendation regarding vaccinations does not fall within the scope of chiropractic practice in Alabama.
BCBS Telehealth Billing Guide - Effective from March 1, 2020 to June 1, 2020 Preferred Chiropractors have been added as eligible providers for E/M Codes
Financial Disaster Relief
Small Business Association (SBA) Loans
- Forgivable loans are under the SBA's Paycheck Protection Program (PPP). These are the short-term loans intended to help business owners make payroll for the next few months. They are available for a max amount of 2.5x your average monthly payroll costs. Forgiveness will be based on the money's usage towards eligible costs - payroll (of employees making less than 100k/year), rent, utilities, and mortgage interest. The SBA will not be handling the applications for these loans directly. You will need to coordinate with a local SBA approved lender to apply for these loans. At this time, it does not appear that many, if any, banks are set up to take applications. If you are interested in applying for a PPP loan, and have a banker or lender that you typically work with, please contact them immediately to see if they are capable of handling this loan, and find out what information you'll be required to submit once they begin accepting applications. For PPP loan FAQs CLICK HERE
- SBA considers a Full Time Employee to be an employee that works 30 hours per week instead of the 40 hours week used by the IRS. So, 2 employees that work 15 hours a week would equal 1 Full Time Employee
- Employee healthcare and other employment expenses are included with salaries as “Payroll Costs”.
- The application for PPP Loans has been updated so applicants will need to ensure that their forms are dated 04/2020.
- PPP Loan forgiveness applications are now available. The SBA has released the application for Paycheck Protection Program (PPP) Loan forgiveness. This document includes guidelines for what is eligible for forgiveness and instructions on how to apply for PPP Loan forgiveness. The application does not have to be submitted until the end of your 8 week spending period, but becoming familiar with it now will help guide your spending and make the process easier when the time comes. To apply fill out the application as instructed and submit it to the Lender of your PPP Loan. Download the application HERE
- Non-Forgivable loans are processed under the SBA's Economic Injury Disaster Loan (EIDL) program. These are low interest, longer term loans for higher dollar amounts that can be used for a broaded category of expenses. Unlike the PPP loans, you can apply for these directly through the SBA. The SBA website was updated last night and is online (for now!) with a streamlined application with much fewer of the required documents up front. To access the SBA's website CLICK HERE
- Based on the Senate committee's guidance, if you apply for and receive and EIDL loan before the PPP loans are available, you can refinance the EIDL loan into a PPP loan and still receive the forgiveness for the qualifying expenses. You cannot have both an active EIDL loan and PPP loan if they are used for the same purpose (ex. to cover payroll and rent).
- The CARES Act passed Friday also allows the SBA to provide immediate advances on EIDL loans up to $10,000 to eligible businesses. The SBA's new streamlined application has now been updated for this. This advance does not have to be paid back, even if you are denied for the EIDL loan; however, any amount you receive is subtracted from what is forgivable under a PPP loan. The SBA should send this money withing 3 days of receiving the application. To apply for the advance, go through the SBA website's new application. If you have already submitted your application on the previous system, or by paper upload, the SBA's site says to apply again through the streamlined application to apply for the advance. Applications for these advances are processed on a first come first serve basis from the appropriated funding. If you are a business owner with multiple businesses, the EIDL loans are processed by entity, so you will need to submit applications for each entity. To view more information CLICK HERE
- According to the SBDC, the $10,000 advance on Economic Injury Disaster Loans (EIDL) allowed by the CARES Act that was supposed to be sent to eligible businesses within 3 days of applying is now estimated to take 5 to 7 days to arrive. It is also rumored that the advance amount may be based on a formula that allows $1,000 per employee for up to 10 employees. However, this information is still unconfirmed
The Small Business Administration (SBA) has issued an Interim Final Rule regarding the Paycheck Protection Program (PPP). This rule has made the following changes to the program:
- The interest rate on loans made under the program has increased from 0.5% to 1%
- The repayment period for any part of the loan not forgiven has been decreased from 10 years to 2 years
- No more than 25% of the loan forgiveness amount may be attributed to non-payroll costs
- Loan payments can be deferred for 6 months; however, interest will accrue during the 6-month deferment period
- 1099 Contractors cannot be included in payroll calculations since they may apply for their own loan under the program
Read The Interim Final Rule In Its Entirety HERE
As a part of the CARES Act, CMS has announced an expansion of its Accelerated and Advance Payment Program for Medicare participating health care providers and suppliers, to ensure they have additional financial resources to combat the COVID-19 epidemic. CMS is expanding the program for all Medicare providers throughout the country during the current public health emergency.
To qualify for accelerated or advance payments, the provider must:
- Have billed Medicare claims within 180 days immediately prior to the date of signature on the provider
- Not be in bankruptcy
- Not be under active medical review
- Not have any outstanding delinquent Medicare overpayments
Qualified providers will be able to request up to 100% of the Medicare payment amount for a 3-month period. The repayment of these accelerated or advance payments begins 120 days after the date of issuance. Providers and suppliers will have 210 days from the date of accelerated or advance payment was made to repay the balance.
For More Information On This Program Or How To Apply CLICK HERE
Additional Financial Assistance
A variety of financial resources are being made available to help small businesses survive the economic effects of the COVID-19 pandemic. Below are some options that may be useful to you and your staff.
- A $1,200 refundable tax credit ($2,400 for married couples) has been implemented with an additional $500 per qualifying child. Taxpayers with an adjusted gross income (AGI) of over $99,000 ($198,000 for joint married filers) are not eligible to receive this credit. The IRS will be sending advanced payments of this credit within the next 3 weeks. Specific timelines and the process by which the money will be sent has not been made available yet.
- As detailed above, the SBA is offering forgivable Paycheck Protection Program (PPP) loans and non-forgivable Economic Injury Disaster Loans (EIDL). For more information on SBA loans refer to the section above or visit the SBA website HERE.
- A payroll tax credit has been created for businesses impacted by COVID-19 that continue to pay their employees. If you continue to pay your employees while your business is under a government order to close, you are entitled to a 50% credit against your payroll taxes, up to $10,000 per employee. This credit is refundable, and the IRS has stated that the payments will be prompt. For those who have not been placed under a government shutdown or continue to face struggles once shutdown orders are lifted, your payments to employees qualify for this tax credit if your gross receipts for the quarter are 50% or less than your gross receipts for the same quarter a year ago. The credit will be available until your quarterly gross receipts are more than 80% of the prior year quarter.
- Early withdrawals from retirement plans up to $100,000 for those who either get sick from COVID-19, who are laid off, or who were unable to work due to a lack of childcare, will not be subject to the early withdrawal penalty. You will also be allowed to divide the income over a 3-year period for tax reporting purposes.
- For the remainder of this year employers can provide tax free payments of an employee’s student loans, up to $5,250 until 1/1/2021. The payment will be deductible by your business, and the employee will not be required to report the income. If you are an employee of your own business with student loans, this applies to you as well.
- Payments for 50% of your federal payroll taxes, in other words the employer portions of FICA & Medicare, can be delayed. The first 50% of the amount deferred will be due no later than 12/31/2021, and the remainder will be due no later than 12/31/2022. Although this is available, we strongly urge clients to utilize this option ONLYif it is extremely necessary and as a last resort in conjunction with a solid business plan to restore cash flow to cover the delayed tax payments.
General Information on COVID-19
Symptoms may appear 2-14 days after exposure and include Fever, Tiredness, Dry Cough, Aches and Pains. People with mild cases should remain at home as they are still contagious. If you have these symptoms and have been in contact with a person diagnosed with COVID-19, call your healthcare provider and tell them you may have COVID-19 before you visit. Do Not Go To Any Clinic Or Urgent Care Facility. Severe cases may experience Difficulty Breathing or Shortness of Breath, Pain or Pressure in the Chest, Confusion or Inability to Arouse, Bluish Lips or Face. If you have a medical emergency requiring 911 notify the operator that you have or may have COVID-19.
If you are sick with COVID-19 or think you might have COVID-19, the CDC recommends taking the following steps:
- Stay Home Except To Get Medical Care: Mild cases are still contagious but most can be treated at home. Do not visit public areas and avoid using public transportation, ride-sharing, or taxis. Do not leave your home, except to get medical care. If possible, separate yourself from other people in your home and use a separate bathroom. Do not share personal household items like drinking glasses, eating utensils, or towels. If you have a medical appointment that cannot be postponed, call your doctor’s office, and tell them you have or may have COVID-19. Be sure to get care if you have trouble breathing, or have any other emergency warning signs, or if you think it is an emergency.
- Cover Your Coughs And Sneezes: Cover your mouth and nose when you cough or sneeze. Immediately wash your hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer. Wash your hands often, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food. If available, wear a facemask when you are around other people. You may need to improvise a facemask using a scarf or bandana.
- Clean All High-Touch Surfaces: Routinely clean high-touch surfaces including phones, remote controls, counters, doorknobs, bathroom fixtures, and keyboards. Clean and disinfect areas that may have blood, stool, or body fluids on them. When using household disinfectants be sure to follow the instructions on the label to ensure safe and effective use of the product. Many products recommend keeping the surface wet for several minutes to ensure germs are killed.
- Monitor Your Symptoms: Common symptoms include fever and cough. Trouble breathing is a more serious symptom that means you should get medical attention. Follow care instructions from your healthcare provider and local health department.
People with COVID-19 who have stayed home can stop home isolation if:
- The person has ha no fever (without the use of medicine) for at least 72 hours
- The person's other symptoms have improved
- At least 7 days have passed since the person's symptoms first appeared
For more information visit the CDC website HERE
Information for Healthcare Professionals
Older adults and persons who have certain underlying chronic medical conditions (including chronic lung disease, moderate to severe asthma, cardiac disease with complications, diabetes, or immunocompromising conditions) are at a higher risk of severe infection. Patients with underlying medical conditions should be advised to stay home as much as possible to reduce their risk of being exposed. If possible, work with patients to manage their underlying condition to the best of their ability, including ensuring that patients have sufficient medication and supplies. All patients should be encouraged to take the necessary steps to protect themselves and call their healthcare provider if they become sick with a fever, cough, or shortness of breath. Do what you can to take care of your mental health and encourage your patients to do the same.
For more information visit the CDC website HERE
In response to the PPE shortage caused by the COVID-19 epidemic the CDC and other health officials recommend using cloth face coverings to reduce potential spread of the virus. Cloth face coverings should fit snugly but comfortably, be secured with ties or ear loops, include multiple layers of fabric, allow for unrestricted breathing, and be machine washable without damage or changing shape. Below are tutorials for making coverings with or without sewing.
No Sew Demonstration CLICK HERE
US Surgeon General Dr. Jerome Adams demonstrates how to make a cloth face covering without sewing.
Materials needed: Scarf, Bandana or Old T-Shirt and 2 Rubber Bands
Sew and No Sew Instructions CLICK HERE
The CDC has provided guidelines on how to wear and care for cloth face coverings as well as multiple tutorials for making cloth coverings.
Materials needed (Sew): Cotton Fabric, Elastic or Rubber Bands, Needle and Thread, Scissors, Sewing Machine
Materials needed (No Sew): T-Shirt or Bandana, Rubber Bands or Hair Ties, Scissors
The CDC recommends that all employers consider how best to decrease the spread of COVID-19 and lower the impact in their workplace. To reduce transmission among employees, employers should encourage sick employees to stay home especially those that are experiencing fever, cough, or shortness of breath. Employees who are well but who have a sick family member at home should notify their supervisor. Identify where and how workers might be exposed to COVID-19 at work and routinely disinfect high-touch surfaces in your office. Keep in mind that some employees, or their family at home, may be at higher risk for serious illness. For these individuals consider minimizing face-to-face contact between these employees or assign work tasks that allow them to maintain a distance of six feet from other employees and patients. Employees who appear to have symptoms of COVID-19 upon arrival at work or who become sick during the day should immediately be separated from others and sent home. Employers should inform their staff if an employee is confirmed to have COVID-19 while maintaining confidentiality.
For more information visit the CDC website HERE
Chiropractic For A World In Crisis - Thursday May 7 at 1:00 p.m. CDT (Hosted by NCMIC)
We hear the word crisis in the news on a regular basis. Financial crisis, environmental crisis, political crisis and now the COVID-19 crisis. We have been in uncharted waters during recent months as the world slowed down and distanced. Chiropractors adapted through the early stages of the crisis. Now is the time for some to adapt again as practices reopen and take steps to ramp up again. The environment is unpredictable and challenging, yet opportunities exist for the chiropractic profession to be in a position amongst the healthcare crisis to become a better solution. Join Drs. Nicole Ingrando and Mario Fucinari for a special two hour webinar on practice resumption and creating opportunities in this crisis environment.