Tag: Families First Coronavirus Response Act (FFCRA)

IRS Guidance on Taxation of HHS Provider Relief Funds

On July 7, 2020, the Internal Revenue Service published a series of Frequently Asked Questions that address the taxation of payments to health care providers under the HHS Provider Relief Fund.

As part of the Coronavirus Aid, Relief and Economic Security Act (CARES Act), Congress appropriated $100 billion to reimburse eligible health care providers for health care-related expenses and/or lost revenue attributable to the COVID-19 pandemic.  The Paycheck Protection Program and Health Care Enhancement Act appropriated an additional $75 billion to the Provider Relief Fund.

The first FAQ addressed the issue of taxation for for-profit health care providers.  Specifically, the IRS was asked whether a for-profit health care provider is required to include HHS Provider Relief Fund payments in its calculation of “gross income” under Section 61 of the Internal Revenue Code (Code), or whether such payments were excluded from gross income as “qualified disaster relief payments” under Section 139 of the Code.

The IRS indicated that payment from the Provider Relief Fund do not qualify as qualified disaster relief payments under Section 139 of the Code.  As a result, these payments are includible in the gross income of the entity.  The IRS further indicated that this holds true even for businesses organized as sole proprietorships.

The second FAQ addressed the issue of taxation for tax-exempt organizations.  The IRS indicated that health care providers that are exempt from federal income taxation under Section 501(a) would normally not be subject to tax on payments from the Provider Relief Fund.  Notwithstanding this general rule, the IRS indicated that the payment may be subject to tax under Section 511 of the Code to the extent the payment is used to reimburse the provider for expenses or lost revenue attributable to an unrelated trade or business as defined in Section 513 of the Code.

The IRS FAQ can be viewed in its entirety by clicking here.  Members are advised to discuss the issue of potential taxation of any relief funding they received with their tax professionals.

For-profit providers have to pay taxes on COVID-19 relief grants

From Modern Healthcare on July 13, 2020

The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.

The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.

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COVID Testing for EMS

This document provides a brief overview of COVID-19 testing to inform decision-making for first responders including emergency medical service (EMS), Fire & Rescue, Law Enforcement and 911 telecommunicators.

Overview of testing for SARS-CoV-2 (the virus that causes the disease COVID-19): The Food and Drug Administration (FDA) is the U.S. government entity responsible for regulating medical devices, including tests and devices like those being used to detect SARS-CoV-2. Because of the public health emergency caused by a novel coronavirus, the FDA has issued multiple Emergency Use Authorizations (EUA) for various types of medical devices, including tests. Final validation of these tests still needs to be completed through all of the normal FDA clearance processes and receive approval by the FDA under the traditional marketing pathways approval processes. A list of tests that have been issued EUAs is available at EUA Information: FDA.gov.

Types of Testing:

  • Molecular: The molecular diagnostic tests look for evidence of an active infection by detecting either the genetic material of the pathogen or a unique marker of it. This type of test detects signs of the virus’s genetic material. One type of molecular testing is called a reverse transcriptase – polymerase chain reaction (RT-PCR). This method requires only a small sample size of the pathogen (ex. from blood or saliva) and amplifies segments of the virus’ genetic code and replicates it in order to show its presence and allow it to be more easily detected. A positive result indicates the presence of actual infectious viral material in the body. However, these results cannot alone determine if the pathogen remains viable (e.g., infective) or is dead and no longer infective. The presence of such material does not necessarily indicate if the patient is infectious (although for provider safety, patients with a positive test should be presumed infectious) but simply that such material is there. Test samples are usually obtained from humans using a special nasal swab designed for this purpose.
  • Antigen: The antigen diagnostic tests quickly detect fragments of pathogen proteins found on or within the virus from human testing samples often from a swab of the nasopharyngeal cavity. However, antigen tests may not detect all active infections. Antigen tests are very specific for the virus but are often not as sensitive as molecular RT-PCR tests because of the certainty of positive samples used to develop the actual test. Positive results from antigen tests are highly accurate but there is also a higher chance of false negatives. As a result, negative results do not rule out infection. Until well-validated antigen testing is available, negative results from this approach may warrant confirmatory testing using a molecular test (i.e. an antigen test may need to be confirmed with a RT-PCR test prior to making treatment decisions to help prevent the possible spread of the virus due to a false negative).
  • Serological: The serology tests look for the presence of antibodies, which are specific proteins made in response to an infection as part of the body’s attempt to fight that infection. It does not specifically indicate current (active) disease. It is important to remember that the development of antibodies takes some time, usually weeks, to develop after exposure to the infection. There are also different types of antibodies that are developed and can be tested for individually (i.e. IgG, IgM). Depending upon when someone was infected and the timing of the test, antibodies may not have developed in sufficient quantities to be detected by the test. We currently don’t know if detection of antibodies, and at what level, indicates immunity, and/or protection from future exposure. Similarly, there is another concern that any detected antibodies may instead reflect other strains of more commonly occurring coronaviruses, such as variations of the common cold.

Testing Limitations: No test is 100% accurate 100% of the time.

a. Specificity: Specificity is a measure of a test’s ability to correctly generate a negative result for people who don’t have the condition that’s being tested for (also known as the “true negative” rate). A high-specificity test will correctly rule out almost everyone who doesn’t have the disease when the test is negative and won’t generate a high percentage of false-positive results. (Example: a test with 90% specificity will correctly return a negative result for 90% of people who don’t have the disease but will return a positive result — a false-positive — for 10% of the people who don’t have the disease and should have tested negative.)

b. Sensitivity: Sensitivity is a measure of how often a test correctly generates a positive result for people who have the condition that’s being tested for (also known as the “true positive” rate). A test that’s highly sensitive will identify almost everyone who has the disease and not generate many false-negative results. (Example: a test with 90% sensitivity will correctly return a positive result for 90% of people who have the disease but will return a negative result — a false-negative — for 10% of the people who have the disease.)

c. There are currently a variety of tests which have not been reviewed by FDA but may be purchased to test for COVID-19. The concern with false negatives relates to the higher potential for future transmissions whereas the concern for a false positive relates to unnecessary diagnostic or medical procedures for the patent and wasted PPE use for the provider. A false negative result could lead to additional exposure to contacts of the patient, including first responders and EMS personnel.

Testing Evaluation Tips:

a. Testing for first responders and EMS clinicians should be coordinated with the EMS Medical Director and other local/state public health agencies.

b. Check the FDA site (COVID-19 Testing EUA Recipients) to determine whether the test you are considering purchasing has received an EUA by the FDA.

c. Work with the EMS Medical Director to identify the test error rate to determine whether the results can be relied upon and if actions should be made based upon the data obtained.

d. Purchase tests only through verified suppliers to ensure authenticity. There have been reports of counterfeit tests being sold to unsuspecting clients.

e. Follow the test instructions exactly to avoid increasing the error rate and to achieve full test performance. Use Clinical Laboratory Improvement Amendments (CLIA)-certified labs for test processing, if required, based on the specific test.

Research References:

CDC Serology Testing: https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
Emergency Use Authorizations: https://www.fda.gov/medical-devices/emergency-use-authorizations-medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices
FAQs on Diagnostic Testing for SARS-CoV-2: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2
FDA Contact Information on Testing:
• Toll-free line 24 hours a day: 1-888-INFO-FDA option *;
• Email to report shortages: deviceshortages@fda.hhs.gov;
Email applicable diagnostic tests: COVID19DX@FDA.HHS.GOV
FDA Statement Regarding COVID-19 Antigen Testing: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-antigen-test-help-rapid-detection-virus-causes
Serology Test FAQs: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2#serology
CDC recommendations for the Testing of COVID 19: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html
Infectious Disease Society of America (IDSA) primer on serological testing : https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf*

Critical Care Decontamination System (CCDS) for N95 Respirators

Prehospital Use of the Critical Care Decontamination System (CCDS) for
N95 Respirators

Download as PDF

PURPOSE:
Use of personal protective equipment (PPE) during the COVID-19 pandemic response is at unprecedented levels. In order to slow usage rates and maintain supply chain stability, the U.S. Food and Drug Administration (FDA) has authorized an Emergency Use Authorization (EUA) for the emergency use of an N95 respirator decontamination system. This is one of several EUAs for decontamination technologies granted by the FDA. This document is intended to provide basic information on the Critical Care Decontamination System (CCDS) for pre-hospital use.

MANUFACTURER SYSTEM REQUIREMENTS

  • Method: vapor phase hydrogen-peroxide (VPHP)
  • For use in decontaminating N95 or N95-equivalent respirators
  • Respirators can undergo up to 20 decontamination cycles with the CCDS.
  • Due to incompatibility, the CCDS is not authorized for use with respirators containing cellulose-based materials.
  • All compatible N95 respirators provided to CCDS must be free of any visual soiling or contamination (e.g., blood, bodily fluids, makeup).
  • If N95 respirators are soiled or damaged, they will be disposed of and not returned after decontamination.
  • Healthcare personnel should follow the instructions provided by the CCDS program in Instructions for Healthcare Personnel
  • There is not a cost for use of the system
  • First responders will have access to the system(s) in their region
  • Healthcare facilities and first responder agencies need to request a Site Location Code from the CCDS program.
  • The Site Location Code must be placed by the healthcare facility or first responder agency on each of their N-95 respirators.
  • This is not a one-for-one exchange program –if the N95 cannot be disinfected, it will not be replaced. Decontaminated N95s will be returned to the healthcare facility with the designated facility code and chain-of-custody forms.

LOCATIONS
The CCDS location for your area can be found by contacting your state or local EMS agency/public health agency / Emergency Operations Center (EOC).

NOTE: If there is not one in your area, a request can be submitted through your local EOC to
utilize others.

Further information can be found on the CCDS Site

EMS Update: Sustaining Mental Health during COVID-19

NORA Public Safety Sector Council Meeting – EMS Sustainability Update

Sustaining Mental Health during COVID-19
Thursday April 30th, 2020 – 11:00am-11:30am EDT

The NORA Public Safety Sector Council, is hosting an EMS Sustainability Update at 11:00 EDT on Thursday April 30, 2020 via Zoom. The topic is Sustaining Mental Health during COVID-19. The attachment includes the agenda for the meeting as well as available resources and tools outlined on page 2.

Register Here

Registration is required using the link above. This is part of an ongoing series of updates to be hosted every other week. The registration link will register you for all occurrences and you can attend those you are interested in.

 

Healthcare Resilience Task Force: Three New Documents Released

The Prehospital [911 and Emergency Medical Services (EMS)] Team of the Healthcare Resilience Task Force has released three more informational documents. The first contains guidance for emergency communications stakeholders on available funding in the CARES Act. The second is a summary document on the status of the Emergency Medical Services (EMS) education pipeline during a series of recent conference calls with EMS stakeholder organizations. The third is a corrected version of the COVID-19 Crisis Standards of Care.

These documents will also be posted on EMS.gov and/or 911.gov (as appropriate).  Two portals for COVID Resources were created which we will continue to update three times a week, with new links and documents containing information on a variety of COVID-related topics.  You will find COVID resources here on EMS.gov, and here on 911.gov.

Read Below:

SAFECOM and NCSWIC Guidance on CARES Act Grants

The Cybersecurity and Infrastructure Security Agency (CISA), in partnership with SAFECOM and the National Council of Statewide Interoperability Coordinators (NCSWIC), prepared guidance for emergency communications stakeholders on available funding in the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Stakeholders are encouraged to review this guidance and apply for funding, where applicable. CARES Act money is available to all 50 states, five territories, and the District of Columbia, with several fast-approaching application deadlines

NHTSA EMS Education_Pipeline_Final

National Highway Traffic Safety Administration (NHTSA) staff prepared this summary document on the status of the Emergency Medical Services (EMS) education pipeline during a series of recent conference calls with EMS stakeholder organizations. Included is a list of national, State, and local considerations for EMS stakeholders.

EMS14_EMS Crisis Standards of Care_Final – (Corrected 4/28/2020)

In response to the COVID-19 pandemic, emergency medical services (EMS) agencies (including fire service, third government service, hospital-based, private for-profit, and private non-profit services) may need to adjust operations and standards of care in order to preserve and effectively allocate limited EMS and healthcare system resources in the face of overwhelming demand due to the national pandemic response. This document provides an overview of general considerations, potential strategies, and existing resources that EMS agencies may use to inform changes to their operations and standards of care.

Healthcare Resilience Task Force: Six New Documents Released

Healthcare Resilience Task Force: Six New Documents Released

The Prehospital [911 and Emergency Medical Services (EMS)] Team of the Healthcare Resilience Task Force has released six (6) more documents (attached).  They cover topics including crisis standards of care, PPE, and the behavioral health of 911 and EMS first responders.

These documents will also be posted on EMS.gov and/or 911.gov (as appropriate).  Two portals for COVID Resources were created which we will continue to update three times a week, with new links and documents containing information on a variety of COVID-related topics.  You will find COVID resources here on EMS.gov, and here on 911.gov.

Read Below:

EMS Crisis Standards of Care

Burnout, self-care and COVID-19 exposure for First Responders

Burnout, Selfcare and COVID-19 exposure for families of First Responders

Epidemiology for COVID-19 EMS Providers

Disinfection of Structural Firefighting PPE

COVID-19 Behavioral Health Resources for First Responders

 

Healthcare Resilience Task Force: Three New Documents Released

Healthcare Resilience Task Force: Three New Documents Released

Documents developed by the Prehospital [911 and Emergency Medical Services (EMS)] Team of the Healthcare Resilience Task Force.

Managing Patient and Family Distress Associated with COVID-19
Intended to provide care instructions for the psychological challenges associated with real or perceived exposure to COVID-19. This document includes practices for therapeutic communication between the EMS provider, their patient and the patient’s family to ensure that every aspect of the patient’s well-being is being managed by EMS.

NOTE: this document is based on the previously approved Managing Patient and Family Distress document for healthcare developed by the Behavioral Health Working Group and has been adapted for the EMS population.

Strategies to Mitigate EMS Clinician Absenteeism
This document provides strategies and techniques to maximize EMS capabilities and
service to the public and to hopefully minimize EMS Workforce Absenteeism. The
resilience of our Nation’s healthcare system depends on our healthcare workforce’s
ability to report for duty. Critical supplies, equipment, and surge capacity rely on
dedicated, trained EMS clinicians and support staff to enable care. Prepare now and
take actions, such as those listed below, to help your EMS agency protect your workers’
psychological health and well-being.

Personal Protective Equipment Supply for EMS
This document is intended to clarify for the EMS community the current Personal Protective Equipment (PPE) supply situation as well as the appropriate requisition process to address local shortages of available PPE supplies.

 

Financial Relief for Personnel

Financial Relief for Personnel

Download as a PDF

Families First Coronavirus Response Act (FFCRA)

• Emergency Paid Family & Medical Leave
• Emergency Paid Sick Leave

Tax Assistance Options

• Extension of 2019 Tax Filing Deadline
• $1,200 checks to each individual making $75,000 or less and a sliding scale (downwards) for people
making between $75,000 and $99,000. No one making more than that will get a check

Unemployment Assistance

• Waiver of waiting period
• Waiver of work search requirement
• Unemployment benefits would be expanded from 26 weeks to 39 weeks and freelancers and gig workers would qualify for the first time

Federal School Loan Assistance (US Dept of Education)

• Interest rates on student loans reduced to 0% from 3/13/2020 to 9/30/2020
• Direct Loans
• Federal Family Education Loan (FFEL) Program Loans
• Federal Perkins Loans
• Lender should have information regarding deferral on their website
• Borrower can get a refund if they paid their monthly payment after President signed the CARES Act

Mortgage or Rent Relief (Consumer Financial Protection Bureau)

• FHA/HUD mortgages
• Fannie Mae/Freddie Mac
• Lender or loan servicer may not foreclose on you for 60 days after March 18, 2020
– You won’t incur late fees
– You won’t have delinquencies reported to credit reporting companies
– Foreclosure and other legal proceedings will be suspended
• If you can pay, pay
• If you can’t pay, contact your mortgage servicer
• Get it in writing
• Many states and municipalities have prohibited eviction activities in the next 60 days
• Any HUD/FHA back multifamily rental properties

Credit Card & Utilities Relief

• If you can continue to pay, pay
• Many credit card companies have options to enroll online for delayed payments
• Many cell phone and utility providers are offering waivers of late fees and deferred payments
Health Savings Accounts, Health Reimbursement Accounts, Flexible Spending Accounts
• Retroactively effective as of January 1, 2020, the CARES Act allows participants to now purchase the
following items and services, pre-tax, using their HSA, FSA, or HRA
– Over-the-counter medicines (these treatments no longer require a prescription)
– Menstrual care products (e.g., pads, tampons, liners, and related items)
– Telehealth services, pre-deductible without impacting HSA eligibility (provision in place until December 31, 2021)

Relief Related to Retirement Plans for Individuals

• Waiver of 10% Early Withdrawal Penalty Tax on Early Distributions from Eligible Retirement Plans
– The Act waives the 10% penalty tax on early distributions for distributions up to $100,000 in
2020 made to an individual
– Who is diagnosed with COVID-19,
– Whose spouse or dependent is so diagnosed or
– Who experiences adverse financial consequences as a result of being quarantined, furloughed, laid
off, having work hours reduced due to the virus, or closing or reducing hours of a business owned
or operated by the individual due to the virus

Wellness Benefits

• Health Plan Co-Pay & Deductible Waivers
– Waiver of co-pays and deductibles for testing and diagnosis of COVID-19
• Short Term & Long-Term Disability Insurance
– Your illness may qualify as a compensable illness under many short-term and long-term disability
insurance plans
• Mental Health Benefits
– All employer-sponsored health plans cannot restrict benefit maximums at a level under that which
is provided for other health benefits
– Employee Assistance Programs

 

5 Steps to an Emergency Small Business Coronavirus Loan

Download PDF from Akin Gump – Five Steps to an SBA PPP Loan

Step 1. Does my business qualify?

  • Were you in business on February 15, 2020?
  • Does your business have at least one but no more than 500 employees or do you meet the applicable SBA size standards for your industry?
  • Have you faced economic uncertainty as a result of the COVID-19 pandemic? Will you use the loan to maintain payroll and other business obligations?
  • Will you decline to take the “Employees Retention Tax Credit for Employers?”

If the answer to all of the questions above is “yes,” keep reading.

Step 2. How much of a loan can I get?

First, check your payroll records to see how much you paid in total over the past 12 months:

  • Salary, wages, tips, and commissions (no more than $100,000 per employee)
  • Payments for group health insurance and retirement programs like 401(k) plans
  • Payments to the state unemployment insurance fund

Second, take that total number, divide by 12, and multiply this result by 2.5. This is your loan amount. The loan cannot be more than $10 million.

Step 3. For what can I use the loan money?

You can use the loan proceeds to pay your employees, pay health insurance premiums, pay rent, pay utilities, and pay interest on any debts your business had before February 15, 2020.

Step 4. Do I have to pay the loan back?

If in the eight weeks after the loan is issued, the following is true, the loan will be entirely forgiven:

  1. All loan proceeds have been spent on allowable expenses, and no more than 25 percent of the money has been spent on non-payroll allowable expenses (like rent), AND
  2. You have maintained the same number of employees you had previously, and none of your employees have received a pay cut of more than 25 percent compared to their historical compensation.

*If you are required to layoff employees or reduce payroll during the eight week period, only a portion of your loan may be forgiven. Any portion of the loan that must be paid back will be at an interest rate of 1.0 percent over a two year term with the first payment being deferred six months after such determination is made.

Step 5. How do I apply?

Any bank or credit union will be able to offer these loans, and most will. All you need to do to apply is go to them with proof you were in business on February 15, 2020 and provide evidence of your payroll expenses (as defined in Step 2) for the 12 months leading up to the application. You should be able to get a loan disbursed to you the same day. Deadline is June 30, 2020. Application can be found here: Paycheck Protection Program Application Form.

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