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Human Resources, Government Programs, Financial Assistance, Safety

 

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Government Programs/Financial Assistance

The Department of Health & Human Services (HHS) has released new guidance on the reporting requirements for physicians and practices that received Provider Relief Fund payments. Here are the websites that detail that information.

Cares Act Provider Relief Funds

HHS Provider Relief Auditing

HHS Provider Relief Reporting

HHS Provider Relief Reporting Elements

Q: Our practice is participating in the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) in 2020 – given the health crisis, is there any relief available for us?

A: Yes, if you have been significantly impacted by COVID-19, you can submit an Extreme & Uncontrollable Circumstances Application to reweight any or all of the MIPS performance categories. Keep in mind that if you fill out this application requesting relief, you must also be prepared to provide justification of how your practice has been significantly impacted. 

Q: Our practice serves mostly Medicaid eligible patients and we’ve not received any Federal funds, is there anything available for our practice?

A: Yes, as of June 8, 2020, HHS announced enhanced provider portal, relief fund payments for Safety Net Hospitals, Medicaid and CHIP providers.  Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers, serving Medicaid/CHIP beneficiaries, possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities and other home and community-based services providers.
Application information can be located here.   

Q:  Will there be a second round of payments from the Provider Relief Fund?

A:  Providers who received payments through the Provider Relief Fund may be eligible for a second round of funding from the Provider Relief Fund.  They must apply for these funds on the following link:  https://covid19.linkhealth.com/docusign/#/step/1.  President Donald J. Trump signed the bipartisan CARES Act that provides $100 billion in relief funding to hospitals and health care providers. Providers who have already received payments from the CARES Act Provider Relief Fund may be eligible to receive additional funds.  Providers who have already received payments from the CARES Act Provider Relief Fund must attest to each payment associated with their billing Taxpayer Identification Number(s). In addition, providers who have already received payments will need to upload their most recent IRS tax filings as well as estimates of lost revenues for March and April 2020.

Q:  Will a borrower’s PPP loan forgiveness amount (pursuant to section 1106 of the CARES Act and SBA’s implementing rules and guidance) be reduced if the borrower laid off an employee, offered to rehire the same employee, but the employee declined the offer?

A:  No. As an exercise of the Administrator’s and the Secretary’s authority under Section 1106(d)(6) of the CARES Act to prescribe regulations granting de minimis exemptions from the Act’s limits on loan forgiveness, SBA and Treasury intend to issue an interim final rule excluding laid-off employees whom the borrower offered to rehire (for the same salary/wages and same number of hours) from the CARES Act’s loan forgiveness reduction calculation. The interim final rule will specify that, to qualify for this exception, the borrower must have made a good faith, written offer of rehire, and the employee’s rejection of that offer must be documented by the borrower. Employees and employers should be aware that employees who reject offers of re-employment may forfeit eligibility for continued unemployment compensation.   For more information on the Paycheck Protection Program, see the Treasury Department's FAQs.

Q: Should we take any action on the “HHSPAYMENT” or “HHS Stimulus”money the practice received in its bank account?

A:  Yes. On April 10, HHS began issuing provider relief funding via direct deposit and checks to hospitals and other healthcare providers to support expenses or lost revenue as authorized by the CARES Act. These are payments, not loans subject to repayment. They are available to all providers and facilities that received Medicare fee for service reimbursement in 2019. HHS partnered with UnitedHealth Group and Optum Bank to distribute the funds according to information on file with United, Optum, or Medicare. Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. You may also choose to reject the funds. If you received these funds, you should review the eligibility and requirements available at https://www.hhs.gov/provider-relief/index.html. The portal for attestation/rejection is open via the same link.

Q:   Is there a number I can call if I have not received my provider relief HHS Stimulus Payment?

A:  HHS partnered with UnitedHealth Group (UHG) to deliver the initial distribution to providers. Physicians who believe they should have received funds but did not can contact UHG’s Provider Relations at (866) 569-3522.
UHG representatives can answer questions about eligibility, whether payment has been issued and where it was sent. UHG is continuing to issue disbursements and expects to complete the direct deposit payments by the first week of May.

Q:  I understand there are loans available for small businesses, including medical practices.  What are the options and how do I apply?

A:    This helpful fact sheet does a great job of explaining the different programs that are available.  There are four options available through the Small Business Administration (SBA):

  • Paycheck Protection Program
  • Economic Injury Disaster Loan (EIDC) Emergency Advance
  • SBA Bridge Loans
  • SBA Debt Relief
Q:  I need more information about the CARES Act passed by Congress on March 27, 2020.
  • This document from MGMA provides the key provisions affecting medical groups in the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act.
  • This document from the AMA provides high level guidance for practice owners and administrators as their practice are confronting new and unique operational and business challenges as they manage patients during the COVID-19 pandemic.
  • The U.S. Small Business Administration has provided this site with comprehensive information for small business owners.  There is a line to the Coronavirus (COVID-19) application for an Economic Injury Disaster Loan.  This link will assist physicians in determining their entities eligibility for such a loan.
  • The SBA provides low-interest disaster loans to help businesses and homeowners recover from declared disasters. This site provides information on the process and a link to the application.  
 

 

Human Resources/Safety

Q: Are there any strategies for dealing with individuals that are potentially upset or violent towards our staff because we’ve asked them to wear masks or because we only allow the patient to come into our office?

A: The CDC offers strategies to limit violence towards workers that may occur when the practice put in place policies and practices to help minimize the spread of COVID-19 among employees and customers. These policies may include requiring masks to be worn by employees and customers, asking customers to follow social distancing rules, and setting limits on the number of customers allowed in a business facility at one time.  

OSHA video provides guidance on the proper implementation of a respiratory protection program and its relationship to the current COVID-19 pandemic.
Includes addressing asymptomatic and pre-symptomatic transmission in a healthcare facility:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?deliveryName=USCDC_425-DM26319
Q:  I'm an 'essential' business under the Executive Order to shelter-in-place.  Is there a letter that I can give my employees to carry with them as they drive to and from work?

A:  With several states requiring a shelter-in-place order, employees are concerned about being stopped by police when they travel to and from work.  This draft sample letter can be used by employers for their employees that are working for an 'essential' business.

Essential Worker Sample Letter (letter will download automatically when you click the link)

Q:  With the possibility of infection so high among healthcare workers, what is my responsibility to my employees?

A:  There are no new requirements for employers. The Occupational Safety and Health Act (OSHA) has always required employers, including medical practices, to assure safe and healthful working conditions. OSHA’s Guidance on Preparing Workplaces for COVID-19 can be found here.

Q:  What are my responsibilities to pay employees who are self-quarantined or out sick?

A:  The Families First Coronavirus Response Act: Employer Paid Leave Requirements went into effect April 1, 2020. This Act requires employers with less than 500 employees to provide their employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. 

Q:  Where can I get the required DOL FFCRA poster?

A:  Each covered employer must post a notice of the Families First Coronavirus Response Act (FFCRA) requirements in a conspicuous place on its premises. An employer may satisfy this requirement by emailing or direct mailing this notice to employees, or posting this notice on an employee information internal or external website.  Additional questions regarding the poster may be found at: https://www.dol.gov/agencies/whd/pandemic/ffcra-poster-questions

Q:  Do you have any strategies you recommend we use with our employees during this time?

A:  We recommend you follow the CDC guidance in this regard.  

Q:  One of our providers may have been exposed to the Coronavirus.  What should we do?

A:  Again, CDC is providing excellent guidance which we recomment you follow.  They continue to update this page as new information is learned.

Q:  What do I need to consider if I have employees working from home?

A:   From a HIPAA standpoint, employees should treat patient information with the same privacy and security as they would in the office.  The current relaxation of Security guidelines only relates to Telehealth.  Practices must include employees working remotely to their Security Risk Analysis in order to remain compliant. Additionally:

  • Employees should have Confidentiality Agreements already in place, whether they are working in the office or at home.
  • Specific policies and procedures should be in place for employees that work from home.
  • Limit employee access to only the information necessary to do their job.
  • Encrypt home wireless routers and change default passwords on their wireless routers to something more challenging.
  • Utilize a Virtual Private Network (VPN) if staff must log into a server.
  • Require work to be completed in an area of the home wher eonly the employee can access and see patient information.
  • Instruct employees not to make copies, print, or save patient information on private devices.
  • If hard copies of patient information must be printed or kept, it should remain in a secure location with only employee access or destroyed in a proper way such as confetti shredding.
  • Avoid emailing patient information unless using encrypted email.
  • Protect login information in a secure location and do not leave it out for anyone to see.

 

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