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COVID-19 Pandemic


The COVID-19 (coronavirus) pandemic threatens to overwhelm healthcare resources nationwide, but particularly in major metropolitan areas. The California Department of Public Health is providing information outlining the threat in our state updated as new information is available, and the stat remains under a stay home order instituted in an attempt to "flatten the curve" (slow the rate) of the spread of infection.

The US Centers for Disease Control (CDC) is advising -- and the American Academy of Ophthalmology and other national ophthalmology groups concur -- that the following steps are vital:

"Health care facilities and clinicians should prioritize urgent and emergency visits and procedures now and for the coming several weeks. The following actions can preserve staff, personal protective equipment and patient care supplies; ensure staff and patient safety; and expand available hospital capacity during the COVID-19 pandemic:

  • Delay all elective ambulatory provider visits.
  • Reschedule elective and non-urgent admissions.
  • Delay inpatient and outpatient elective surgical and procedural cases.
  • Postpone routine dental and eyecare visits."

Practices are reminded of urgent shortages of Personal Protective Equipment (PPE), and are encouraged to inventory their supplies of PPE such as surgical/N-95 masks, eye shields, etc., and consider DONATING any amounts beyond reasonable anticipated urgent/emergent use to hospitals and emergency departments where shortages exist.

Patients that practices continue to see for urgencies should be spaced so as to have minimal contact with other patients and appropriately screened. During times a practice is closed please:

  • Update all voicemail messages and websites with current and clear information regarding contingencies to handle emergencies
  • Post appropriate signage with similar information outside the practice entrance (or in the reception area of multi-office buildings).

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) became law on March 27, 2020. Programs designed to aid small businesses, such as physician practices, are being rolled out as quickly as possible.

Note that many of these programs have statutorily limited funding that may be exhausted as potential recipients are spread over the entire nation. Therefore, applying sooner than later for appropriate options will help ensure any amounts you may both need and qualify for remain available.

Note further that integrating the provisions of some of the programs can be complex, and appropriate accounting and legal advice is almost certainly necessary to avoid cancelling out potential benefits when participating in multiple options.


NOTE
: CAEPS cannot give you formal legal or financial advice. While it is believed the information provided is accurate and from reliable sources, members are advised to consult qualified tax, accounting, and legal professionals before concluding any of the following options are potentially beneficial for your individual circumstances.

Resources

RETURN TO PRACTICE

Governor Gavin Newsom recently indicated that circumstances surrounding the COVID-19 state of emergency have improved sufficiently to permit resumption of non-cosmetic elective surgeries (i.e., those not considered "urgent or emergent").

The California Department of Public Health (CDPH) has followed with guidance supporting that decisionThe included recommendations appear to permit performing ophthalmic surgery -- prioritized by medical need -- to the degree this is not countermanded by county health authorities based on the demands of COVID-19 care on the local health system and assuming:

  • Availability of qualified staff to safely perform procedures and provide needed follow up care. 
  • An adequate stock of Personal Protective Equipment (PPE) when considering the potential for COVID-19 surges.
  • Availability of testing with prompt results when knowing the COVID-19 status of staff or patients is important for clinical care and infection control.
  • Establishment of systems and infection control precautions to minimize exposure and spread while caring for both COVID positive and non-COVID patients.

Of particular note is the statement "Providers and facilities are encouraged to gradually resume full scope of services when possible and safe to do so, based on these guidelines." The guidance also includes specific recommendations regarding PPE, Facility and Office Site Standards, Care Prioritization and Scheduling, and Work Force Availability.

CAEPS Legislative Advocate Joseph Lang -- who is advising the Newsom administration on many COVID-19-related issues -- and other members of our lobbying team worked with CDPH officials to provide input on the guidance and seek its release as soon as possible.

CAEPS also is working with the American Academy of Ophthalmology (AAO) and other sources to assist practices in "rebooting" as quickly as possible, being mindful that missteps can lead to an unintended resurgence of infections.

The American College of Surgeons (ACS), the Centers for Medicare and Medicaid Services (CMS), and the California Medical Association have issued broad guidance on this subject. In addition, the ACS, the American Society of Anesthesiology, and others have issued a Joint Statement. In addition, the Medical Group Management Association has produced a fairly comprehensive COVID-19 Medical Practice Reopening Checklist.

CAEPS has been monitoring these and other sources of information, and proposes the following initial guidance regarding reopening an office or facility. While CAEPS believes the following to be reliable, it cannot give you legal advice, so please consult with legal counsel or regulators as applicable:

Basic Considerations

  • First and foremost, it is important to understand that patients will likely have a high level of anxietyregarding placing themselves in circumstances where they fear they might become infected, such as a healthcare facility. This concept should underpin any aspects of a "reopening" plan.
  • Regardless of recommendations, use common sense.
  • Ensure any use of Personal Protective Equipment (PPE) used for care activities under local community conditions will not adversely impact those handling COVID-19 related emergency care.
  • As most care patterns in ophthalmology offices are geared toward avoiding the treatment of those with known COVID-19 disease (also see section below on regulations regarding aerosol transmitted diseases) with the goal of preventing spread, strong consideration should be given to evaluating true ophthalmic emergencies with known or suspected COVID-19 infections in a setting such as an emergency room better equipped to handle the concurrent condition.

General Facility Issues

  • Review standards for signage or safety standards that may have been implemented in your jurisdiction (for example, San Francisco has required new postings and protocols on social distancing standards).
  • Reinforce social distancing rules with voluntary signage.
  • Prepare Electronic Health Record systems to accommodate screening data for COVID-19 clearance and any coding changes that may impact care patterns.
  • Consider outsourcing billing and coding, or permitting telecommuting for existing billing staff.
  • Ensure Heating, Ventilation, and Air Conditioning (HVAC) filters are pathogen-attractive, fresh and exchanged regularly. Increase air exchange rate if possible.
  • Consider counter-top plexiglass barriers to facilitate required interactions with front office staff.
  • Investigate and offer if possible online (e.g., PayPal, Zelle, etc.) or other electronic options for collecting co-pays
  • Plan for potential delays in supply chains; deliveries should occur through alternate entrances, if possible, while patients are present.


Patient Communication

  • Communications must be patient-centric and explicitly convey the patient's well-being is the practice's highest priority.
  • Develop sample "scripts" for those making contacts to ensure a consistent and empathetic message.
  • Outline and emphasize updated facility safety policiesas part of the conversation, including the use of Personal Protective Equipment (PPE).

Scheduling

  • As recommended by the CDPH guidance, review pending surgeries and prioritize by relative urgency (including by objective means where needed), then by patient availability. 
  • Pre-Screen for symptoms based on Centers for Disease Control (CDC)-based protocols (note, this document is for a dialysis facility, but the basics points are generally applicable) during a scheduling call, and ask patient to call if status changes.
  • Day-before confirmation (ask them to check their temperature at home if they have the means) is vital to avoid no-shows due to skittishness or potential infection.
  • Adjust appointment/procedure scheduling times are spaced to minimize the potential for patient interaction.
  • Consider extended hours to handle backlogs; if you received a Paycheck Protection Program loan, paying overtime may assist you in reaching loan forgiveness benchmarks.
  • In situations where the patient will undergo ophthalmic testing to be used conjunction with a subsequent telehealth visit, ensure the requesting provider has entered an appropriate order in advance.

Facility Flow

  • Do a "walk through" of your office to identify the most efficient way for patients to arrive, be seen, and check out while maintaining social distancing standards.
  • In a multi-office/practice building, coordinate with other tenants to ensure patient access meeting distancing standards.
  • If multi-story building also has non-medical tenants, if reasonable, consider a dedicated elevator for use by patients of medical practices, and work with building staff to appropriately limit stops
  • Attempt to establish "one-way" traffic as much as possible.
  • Where there is no option to avoid two-way traffic, establish a protocol such that only one person/set of people is/are in that space at a given time
  • Remove or consolidate unneeded furniture/fixtures so as to maximize open space for traffic distancing, or block access to some seating to achieve the same.
  • Install floor/wall markings demonstrating 6 foot social distancing spacing as visual cues.
  • Consider temporarily relocating existing workstations(e.g., check out could be at the door of an unused examination lane along your ideal traffic path) to improve options.
  • Consider having patients leave through an atypical exit (e.g., side door) if available, to avoid cross traffic.
  • Schedule supply delivery during non-patient hours or using access points that avoid primary traffic where possible; sterilize package surfaces prior to opening.

Greeting/Day of Visit Screening

  • Adapt processes to minimize risks.
  • Have patients call the office on arrival to allow re-administration of screening questions by phone and to ensure you are ready to receive them under adequate distancing standards.
  • Establish a greeting area either outside the facility entrance (weather and space permitting) or at the entrance to your lobby/waiting room on one side, far enough away from the actual entrance/exit to limit cross traffic.
  • Distribute PPE to patients on arrival should they not have a suitable face mask, require use of hand sanitizer, and distribute tissues
  • Perform temperature readings, and document findings.
  • Those who ultimately fail any aspect of screeningshould be deferred.
  • Exclude non-patients from facility unless absolutely necessary (translator, vital caregiver, guardian for a minor, etc.)

Examination/Facility Rooms

  • Consider general CDC recommendations for infection control.
  • Remove all non-essential items -- educational tools, brochures, decorations, plants, etc. -- to limit what needs sterilization between patients.
  • Install breath shields (see Resources: Clinical) on slit lamps and other testing equipment where close contact between patients and staff may occur.
  • The AAO recommends tonometer tips should be cleaned with dilute bleach followed by adequate rinsing (directed more at adenovirus, however COVID-19 is also eradicated), or be disposable.
  • Multi-dose eye drops should be stored in an enclosed space to avoid contamination.
  • Place incoming patients (seat only if absolutely necessary to limit potentially contaminated furniture/fixtures) so they can witness sterilization procedures (in hallway or in exam room if large enough).
  • Perform sterilization procedures per Centers for Disease Control Standards (See Item 10) using appropriate agents and following manufacturer guidance where available (e.g., for exam chairs and ophthalmic equipment).
  • Providers should wash hands, apply gloves, etc. in the presence of patient, not before entering the room.

Staff Considerations

  • All personnel should be screened upon arrival at work and at approximately 4 hour intervals, with appropriate log maintenance. Those failing screenings should cease patient care and seek medical assistance as appropriate.
  • Update training on appropriate use of PPE and infection control procedures and standards
  • Perform PPE "Fit Tests" for appropriate equipment (e.g., N-95 respirators), and follow appropriate reuse standards if absolutely necessary.
  • Familiarize staff with guidance from trusted sources like the AAO and others.
  • Be aware of the additional potential for "burnout" during this stressful time.

California Standards for Aerosol Transmitted Diseases

  • California Code of Regulations Title 8, Section 5199outlines strict standards to limit the spread of aerosol transmitted diseases (ATDs) in health care facilities. Subsection (a)(2)(B), however, exempts "Outpatient medical specialty practices whose policy is not to diagnose or treat ATDs," if its "Injury and Illness Prevention Program includes written screening procedures to identify potential ATD cases, and then refer those patients for further evaluation to an appropriate medical provider."
  • As COVID-19 qualifies as a "novel or unknown pathogen" transmitted by aerosol means under the regulation, and an ophthalmology practice qualifies as a "medical specialty practice," the exemption appears maintainedby a screening process you establish to exclude patients with active disease from an office setting. Therefore, screening policies for COVID-19 and the training provided for employees on these policies would reasonably be added to your Injury and Illness Prevention Program, which is required for employers under Title 8, Section 3203.


Clinical

Returning To Practice

finances

Cash Flow

Practices are rightly expressing concern about their ability to meet their financial obligations during this time of upheaval. While CAEPS cannot give you legal or accounting advice as your circumstances may be unique, the following information may be helpful in making decisions about what payments to prioritize and is provided for informational purposes

  • CARES Act Provider Relief Funds.The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) included $100 billion in funds to provide direct relief for hospitals and other healthcare providers. According to the US Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) is beginning to distribute $30 billion of those funds. To be eligible to retain these funds, providers must agree not to "balance bill" patients, i.e., "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."


    Other requirements apply as outlined in these 
    Terms and Conditions and in communications to be sent by CMS to each eligible provider. Members are urged to review these carefully as they decide whether they can meet all attestation requirements. The portal for making such attestations (due 30 days after receiving the funds) is open and linked to this webpage. Other reporting requirements apply to those who receive $150 thousand or more in funds.

    Payments will be based on total Medicare Part B Fee-For-Service (FFS) Reimbursements for 2019 (i.e., excluding Medicare Advantage amounts). The amount can be estimated by multiplying total reimbursements by 6.2% (0.062), given there were $484 billion in total Part B FFS payments in 2019 and $30 billion in available funds. These will be made by Taxpayer Identification Number (meaning groups may receive payment for multiple providers) by direct deposit to those with such information on file (look for a payment from Optum Bank with "HHS-STIMULUS" of HHSPAYMENT" as the payment description). Others will receive a check sent to their normal payment address. These are being considered "payments, not loans, to health care providers and will not need to be repaid," [emphasis added], per the HHS announcementNote that these payments are independent of those for the Medicare Accelerated and Advanced Payment Program (see below) and CARES Act related programs (such as the Paycheck Protection Program) which are loans.

    The remaining $70 billion in funds will be distributed in the near future, with a focus on "providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans," per HHS.

  • Property Tax Delays/Penalty Waivers. The normal April 10th delinquency deadline to pay the usual second installment of July 2019-June 2020 Fiscal Year Property Taxes without penalties (the formal due date is February 1st) is looming, and some counties are offering delays or the potential to avoid fees and penalties.

    CAEPS recognizes that many may have already paid these taxes or pay them as part of a mortgage payment arrangment. For those of you who have not or cannot make a timely free-standing payment, consider consulting your county website. This would includeverifyingany information below using the appropriate links, as changes may occur after publication of this advisory:
  • Accelerated and Advanced Payments Program for Medicare. Permits providers to receive up front 100 percent of their historical Medicare payment amounts for a three-month period. In addition, claims submitted in the interim will continue to be paid at normal rates. This is essentially an interest-free loan that will be recouped by Noridian from claims processed on or after 120 daysfrom the date of any accelerated payment. Any unpaid remainder would be due within 90 days once recoupment begins.


    Applications (
    Updated Form) can be submitted to Noridian Healthcare Solutions, the Medical Administrative Contractor for the Jurisdiction that includes California, which is anticipated to issue the payments within seven days of the request. New: Noridian is offering webinars that address this issue. CMS has also made available a press release and a fact sheet describing the program, which, among other things, indicates that to qualify for the payments, the provider or supplier must:

    • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider's/ supplier's request form,
    • Not be in bankruptcy,
    • Not be under active medical review or program integrity investigation, and
    • Not have any outstanding delinquent Medicare overpayments.
  • Federal and State tax payments and returns for both 2019 (final) and 2020 (estimated) should be deferrable until July 15th.
  • IRS Coronavirus Tax Relief 
  • Mortgages related to Fannie Mae or Freddie Mac may allow forbearance for up to 12 months.
  • Absent further federal or state intervention, contact individual lenders, lessors, credit card companies, etc., to make individual arrangements.
  • Explore City/County Based assistance programs (e.g., these for San Francisco and Los Angeles).
  • Pre-existing or new (issued by September 27, 2020) non-disaster related SBA Loans (e.g., 7(a), 504, and microloans) will have all loan payments, interest, and fees covered by the SBA for six months.
  • Special federal tax treatment is available when accessing up to $100,000 in retirement account assets related to a COVID-19 diagnosis or business interruption. Among other benefits, the 10-percent early withdrawal penalty is waived for withdrawals after January 1, 2020, and any incurred tax can be spread over three years. The funds can also be recontributed for 3-years. Plan administrators should have details.
  • refundable tax credit against qualifying Social Security taxes can be available to those whose operations were fully or partially suspended due to a COVID-19 government-mandated shut-down order, or who suffer a greater that 50% decline in revenue compared to the corresponding calendar quarter of the prior year. Note this is NOT available to an entity that obtains a PPP loan, and it is reduced by any payroll credit related to the Families First Coronavirus Response Act mandate to provide paid sick leave and paid family and medical leave. Consult your accountant or payroll service.
  • In general, businesses may defer payment of most employer federal payroll taxes and half of self-employed tax liability imposed between the March 27 and December 31, 2020. Deferred amounts will be payable in two equal installments due by December 31, 2021 and December 31, 2022 respectively.Note that this deferral option is eliminated if you receive debt forgiveness under the Paycheck Protection Program and unrelated to the payroll tax credit related to mandated Paid Sick Leave under the Families First Coronavirus Act.  Closely coordinate with your accountant or any commercial payroll service you might use to take advantage of this option.
  • Pandemic Unemployment Assistance program has been established through December 31, 2020 to provide payment to those not traditionally eligible for unemployment benefits (self-employed, independent contractors, and others) who are unable to work as a result of the coronavirus public health emergency. As of this writing, no formal guidance regarding this has been provided about these new provisions on the website of the Employment Development Department, which manages Unemployment Insurance, so it isunclear if there will be an attempt to restrict this benefit. If you -- in consultation with your accountant, as appropriate -- believe you are eligible, it would be reasonable to apply. Unemployment Insurance payments are taxable income at the federal (but not California) level. Should you receive such benefits and desire federal tax withholding, you can submit Internal Revenue Form W-4V to the EDD.

  • Other Tax Changes
    • Loss limitations applicable to pass-through businesses and sole proprietors have been modified so excess business losses may limit taxes and permit preservation of cash flow.
    • Prior Alternative Minimum Tax (AMT) credits can be recovered in an accelerated fashion permitting entities to claim a refund now and obtain additional cash flow during the COVID-19 emergency.
    • Business interest expense allowances have been increased from 30 percent to 50 percent of taxable income (with appropriate adjustments) for 2019 and 2020, permitting increased liquidity through a reduced cost of capital.
    • Qualified improvement property rule changes allow some facilities improvements to be written off immediately rather than be amortized over the life of a building (typically 39 years), with the potential to amend prior returns.
    • Net Operating Losses (NOL) arising in a tax year beginning in 2018, 2019, or 2020 can now be carried back five years. The provision also temporarily removes the taxable income limitation to allow an NOL to fully offset income.

Insurance

Some commercial business packages include business interruption insurance (note this link is meant to provide a general description of this type of insurance and may not reflect the specific terms of any coverage you may have). Such insurance may offer coverage for "interruption for civil or military authority." If part of your coverage, consult your insurance professional to assess any possible recovery.

Business Loans/Emergency Funding

Useful Business Loan Links

  • US Chamber of Commerce Coronavirus Emergency Loan Small Business Guide and Checklist (Focuses on Payroll Protection Program)
  • US Small Business Administration Disaster Assistance Loans (some "non-disaster," but compare terms to other credit you may have available).
  • PAYCHECK PROTECTION LOAN APPLICATION WEBSITES
    • 1st Century Bank ACTIVE (Requires a business relationship)
    • Bank of America - ACTIVE (Requires a Small Business lending and Small Business checking relationship as of February 15, 2020; or a Small Business checking account open no later than February 15, 2020 and not having have a business credit or borrowing relationship with another bank)
    • Banc of CaliforniaACTIVE (Contact "Relationship Manager" or PPP by Phone/Online Request)
    • Bank of Marin - Pending (Has applied to be an approved SBA Lender, so may be several days)
    • Bank of San Francisco APPEARS ON HOLD (No longer invites inquiries to an email address; no indication of need for prior affiliation)
    • Bank of the West - ACTIVE (Requires a pre-existing business checking account prior to February 15)
    • Banner BankACTIVE (Submit downloadable form by email; requires banking relationship)
    • California Bank and TrustACTIVE (For current customers; Appears to Allow New Customers as outlined on "Application Checklist")
    • CapitalOne ACTIVE (Login to your business account and select the “Contact me” button when you receive  the Paycheck Protection Program message to receive e-mail updates; unclear if this gives you any priority; requires a business banking relationship)
    • Chase - ACTIVE (If you previously submitted basic information, log-in on the PPP webpage to complete application; Requires prior banking relationship an log-in; brief form will generate call back/contact from Banker)
    • Citibank - ACTIVE (Updated LinkOnly Citibank Small Business Customers).
    • Citizens Business Bank ACTIVE  (Customers with a banking or lending relationship at Citizens Business Bank are eligible to apply; contact your Business Financial Center or the SBA Group at 866.465.4SBA.)
    • City National BankACTIVE (Contact Relationship Manager, so implies prior relationship)
    • East West BankACTIVE (Limited to existing clients with a business checking account for the specific business entity; contact bank directly)
    • Epoch LendingACTIVE (Out-of State mortgage lender but accepting applications from the entire country; no prior relationship required.)
    • NEW Kabbage ACTIVE (No Prior Relationship Required)
    • Live Oak Bank - ON HOLD FOR ADDITIONAL APPLICATIONS  (Online bank operating nationwide; continues accepting contact information for interested applicants)
    • Pacific Western BankACTIVE (Contact your "Relationship Manager" to begin the application.)
    • NEW PayPal - ACTIVE (No Prior Relationship Required)
    • Silicon Valley BankACTIVE (Appears limited to current clients)
    • Sunwest Bank - ACTIVE (Allows New Customers)
    • TD BankACTIVE (requires a pre-existing business account relationship)
    • Wells Fargo Bank - ACTIVE
    • Torrey Pines Bank - ACTIVE (Appears to require banking relationship)
    • Union Bank  - ACTIVE [Link NOT ACTIVE, BUT PROCESS IS TO COMPLETE SBA FORM AND TAKE TO A BRANCH (per phone discussion with an agent)].
    • US Bank ACTIVE: Complete an Inquiry Form (if you haven't already) to be contacted for the full application.

Programs

  • March 31, 2020 12:00 AM | Craig H Kliger (Administrator)

    Loan Application Period OPEN for MOST Institutions

    The Paycheck Protection Program (PPP) is a government-guaranteed loan program related to the economic impact of the COVID-19 pandemic that will launch Friday, April 3, 2020. All loans will have the same terms. A US Small Business Administration (SBA) webpage for this program is being updated regularly.

    Many typical SBA loan requirements (e.g., fees, a "credit elsewhere test," and collateral or other guarantee requirements) have either been relaxed or waived for this program. Demand is expected to be high, so it would be wise to submit any desired request as soon as possible.

    The US Department of Treasury has made available a helpful Fact Sheet and the basic PPP application (fillable .pdf form). Note that as of this writing, the SBA website has only a "Sample" Version of the form, which should not be completed for submission (has "SAMPLE" watermark).

    The US Chamber of Commerce has also provided an Emergency Loan Small Business Guide and Checklist (geared for the PPP).

    According to the SBA PPP webpage, "You can apply through any existing SBA 7(a) lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating." The 100 "Most Active SBA 7(a) Lenders" (for 2019, per the SBA) are listed here and the SBA provides a Lender Match Tool. Lenders may have their own additional forms to complete. Furthermore, theywill essentially become the de facto "arbiters" regarding interpreting the meaning of various terms underpinning the program.

    As indicated in the Fact Sheet, one of the "certifications" will be that you be required to make is that "You have not and will not receive another loan under this program." Therefore, submitting applications with multiple lenders does not seem advisable (but abandoning one and applying with another might be possible).

    In general, loans will be available to all small businesses (500 or fewer employees) and these can be in amounts up to 2.5 times qualifying amounts, which, according to the Fact Sheet include:

    • Salary, wages, commissions, or tips (capped at $100,000 on an annualized basis for each employee);
    • Employee benefits including costs for vacation, parental, family, medical, or sick leave; allowance for separation or dismissal; payments required for the provisions of group health care benefits including insurance premiums; and payment of any retirement benefit;
    • State and local taxes assessed on compensation; and
    • For a sole proprietor or independent contractor: wages, commissions, income, or net earnings from self-employment, capped at $100,000 on an annualized basis for each employee.

    Key to this for many practices is the apparent ability to include up to $100,000 for practice owners or independent contractors that receive "wages, commissions, income, or net earnings from self-employment." [UPDATE: US Department of Treasury guidance issued April 2, 2020 indicates that "independent contractors have the ability to apply for a PPP loan on their own so they do not count for purposes of a borrower’s PPP loan calculation" (see page 11, emphasis added). What is not clear if this is meant to say they don't count toward the number of employees, the payroll costs, or both. Furthermore, this seems to contradict other statement in the guidance. Therefore, it would be very important to consult your accountant or lender for clarity.]

    PPP loans appear particularly attractive in that principal amounts used for permissible purposes during the eight-week period after the inception of the loan can be 100% forgivable (and if so, no interest would be owed) if certain employee retention and salary maintenance requirements are met before June 30th. Expenses include:

    • Payroll support (employee compensation; vacation, family, or medical leave; severance; insurance payments; retirement benefits; state & local taxes on employee compensation) [Note: Consult your lender on its expectations regarding funds potentially paid to owners and independent contractors]
    • Mortgage/rent, utility payments and interest for obligations incurred before February 15, 2020
    • Interest on specified debt obligations incurred before February 15, 2020.

    The simplest way to ensure 100% forgiveness of the loan principal is to have the same number of full-time equivalent employees (including rehires) who receive 75% or greater wages on June 30th as prior to February 15th. Should that not be possible, the loan forgiveness is reduced on a proportional basis related to attrition of full-time equivalent employees and by certain salary reductions that have occurred over a defined period of time. Note that forgiveness under this program will NOT be considered taxable income.

    NEW The repayment terms of amounts not forgiven will be 2 years at 1.0% interestIn addition, at least 75% of forgiven loan proceeds must be used for Payroll-related expenses.

    Note that if you have already applied for/received an SBA Economic Injury Disaster Loan (you will be asked to declare such assistance) related to the COVID-19 pandemic, you may be able to "refinance" the portions that would be used for the same purposes into a PPP. Discuss that possibility with your lender as appropriate.

    An accountant that writes for Forbes Magazine recommends (among other things) establishing a standalone bank account for distribution of loan funds to streamline an audit trail.


  • March 31, 2020 12:00 AM | Craig H Kliger (Administrator)

    The CARES Act has expanded the availability of low-interest SBA Economic Injury Disaster Loans (EIDLs). While EIDLs do not offer the "forgiveness" described above for the PPP, they do offer the possibility of up to a $10,00Economic Injury Disaster Loan Advance, which must be made available within 3 days of successful application. Such grants do not need to be repaid even if the entity receiving the grant does not ultimately qualify for the loan.

    Furthermore, the CARES Act has a provision that would allow refinancing an EIDL -- or possibly a portion of it since you can obtain both an EIDL and a PPP loan to the degree their purposes do not overlap -- into a PPP loan once the latter is available. Therefore, an EIDL may be attractive while waitingfor the PPP to become functional. Note, however, that any advance under the EIDL program would numerically offset any forgiveness under the PPP program.

    Payment and interest deferment may be possible.

    The SBA offers an online application for this loan type specifically directed toward COVID-19 related economic injury.

  • March 31, 2020 12:00 AM | Craig H Kliger (Administrator)

    These are up to $25,000 loans to provide emergency funding while waiting for a formal approval of an EIDL that might be needed beyond the $10,000 advance grant that may be obtained. They require a pre-existing relationship with an SBA-approved lender, which allows streamlined paperwork.

    Amounts disbursed will usually offset amounts ultimately received from an approved EIDL.

telehealth

Medicare will temporarily pay for telehealth services. Commercial payers may follow suit on a case-by-case basis, so monitor provider services pages of various payor websites.

Employment

Federal Information

    H.R. 6201, the Families First Coronavirus Response Act (FFCRA), was signed into law on March 18th. The Department of Labor (DOL) has issued summary overviews of what the law will require of employers (and employees) for emergency paid sick leave and the Family Medical Leave Act (FMLA). Note that there are provisions for employers of less than 50 people to seek exemption if compliance would "jeopardize the viability of the business as a going concern." Note also that many provisions are NOT applicable if your workplace is closed or if workers are furloughed (See FFRA: Questions and Answers).

    California Information

    • Sick and vacation leave options from the California Department of Industrial Relations
    • Information on disability and unemployment insurance from the California Employment and Development.
    • Comprehensive summary of programs for which employees impacted by Coronavirus may qualify (either themselves or family members) from the California Department of Labor.

     


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