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COVID-19 Public Info

COVID-19 Resources for All Chiropractors

Update May 7, 2020


May is here and we’re still working to move through this pandemic together. Iowa is still seeing increasing cases and certain areas are now experiencing increased infection rates. While it may take extra time and effort, it is imperative to continue to follow CDC guidelines to protect you, your patients, and the entire profession. As programs and resources are updated and become available, ICS works to get the tools and resources in your hands as quickly as possible. Below are important resources as you continue to care for your patients, manage clinic operations, and serve in your critical role in our health care system.

Should you have specific questions on the programs and how it relates to your clinic be sure to consult your CPA or legal counsel. This information has been provided on our ICS COVID-19 Resource page at https://www.iowadcs.org/page/COVID-19Public.  Be sure to check this page regularly as ICS updates this continuously. 

The following are resources ICS is providing to the chiropractic community. More specific and detailed information and webinars are available to members covering the following topics:

  • HR liability around COVID-19
  • Practice and insurance related issues
  • CDC guidelines and your how to run your practice
  • Unemployment considerations
  • How to keep your practice open and stay compliant
  • Understanding compliance with Emergency FMLA and Sick Leave
  • Resources to bring your employees back to work

LOGIN to access more information. JOIN to become a member.

 

Online Webinar Resources

ICS will be hosting webinars on these different topics.

 

You Can't Control the Virus - But You Can Control the Host

 

If you are confused, concerned, or overwhelmed with the information that has emerged in recent weeks, join us on Thursday, April 23, 2020, at 12:00 am CST for this webinar.
  • Discover the COVID-19 antibody test and what it means for your practice
  •  Antibody Testing: A natural approach to improving the host
  • The latest updates on the health pandemic
  • Natural approaches to immune support
  • Learn how to boost your business following the pandemic

 

 

 

 

Become a Member or Login To Your Member Access Webinar Link and Meeting ID.

    

 

 

 

 

 

 

Thursday, April 2 12:30 pm

Financial Resources During COVID-19

Quartermaster Tax Management

NCMIC Webinars 

Become a Member or Login To Your Member Access Webinar Link and Meeting ID.

 

 

Click here to access webinars NCMIC is hosting to addressing different concerns on how to stay open, liability issues and leadership.


Tuesday, March 24th from 12:30 - 1:30 pm  Tuesday, March 31st from 12:30 - 1:30 pm

March 24:
Join from a PC, Mac, iPad, iPhone or Android device:

 

Member Only Recording

Click to see sample of webinar recording

SAMPLE RECORDING

 

March 31:
Join from a PC, Mac, iPad, iPhone or Android device:

 

Members Only

Log In To Member Portal To Gain Access

MEMBER LOGIN

 

 

 

 

 

 

 

 

Presenter: Susan Freed (ICS Legal Counsel)

Ms. Freed will provide an update on the pandemic and share guidance with members on what is known at that point. We will also have time for questions and answers.

 


State Restrictions Relaxed in 77 Counties 

May 7, 2020

Governor Reynolds is allowing businesses in 77 Iowa counties to open up again beginning today, May 1. Restaurants, fitness centers, malls, libraries, racetracks, and certain other retail establishments may reopen in a limited fashion with public health measures in place. For the other 22 counties where COVID-19 is more active, all previous restrictions and closures remain in place through Friday, May 15.

State and Federal COVID-19 Update

 


IWD Guidelines on Unemployment Eligibility 

May 1, 2020

The Iowa Workforce Development (IWD) released guidelines on April 27th, 2020 that address unemployment eligibility for those refusing to return to work without good reason. ICS wants to make you aware of these guidelines as they may have implications for your staff. This is information only. Should you have questions on how to interpret or apply this as it relates to your clinic please contact your legal counsel directly. 

READ FULL ANNOUNCEMENT HERE

 


Additional CARES Act Money to Be Distributed to Medicare Providers on Friday

April 24, 2020

HHS announced earlier this week that it will distribute an additional $20 billion from the Public Health and Social Services Emergency Fund to health care providers starting Friday, April 24. Providers who file cost report data with CMS will receive an automatic deposit; however, they will still have to submit revenue information to HHS for verification. Providers without adequate cost report data will need to submit revenue information directly to HHS in order to receive funds. Any provider receiving funds will need to sign an attestation confirming receipt of funds and agree to the terms and conditions of payment. Information regarding the additional funding, including the terms and conditions is available on the HHS website

Additionally, HHS announced it would be disbursing additional funding in a more targeted fashion to providers harder hit by the pandemic, including hospitals in high impact areas, rural providers, and providers treating the uninsured. 
$10 billion is allocated to rural health clinics and hospitals with funding being disbursed as early as next week. According to HHS the methodology for distribution will be proportionate to each hospital and clinic. 
$10 billion is allocated to hospitals in high impact areas but they must apply for this additional funding and include their total number of ICU beds as of April 10 and total number of positive COVID-19 admissions from January 1, 2020 to April 10, 2020.
Providers who provided treatment to uninsured COVID-19 patients on or after February 4 may seek reimbursement from Medicare for these services.

More information on the additional funding, including the targeted allocations, is available on the HHS website

Please reach out if you have questions about the disbursements or the attestation requirements.

 


Emergency Funds to All Medicare FFS Providers

April 21, 2020

It was the consensus of the Board of Chiropractic to draft a statement on COVID-19 and advertising.   Attached is the statement in final form  that will be posted to the Board's web site and distributed to all active licensees.

Read the Statement Here


Emergency Funds to All Medicare FFS Providers

April 10, 2020

Today the United States Department of Health and Human Services announced it is releasing $30 billion of the $100 billion Public Health Emergency & Social Services Fund. The funds will go to Medicare Fee For Service Providers in an amount based on their share of the total 2019 Medicare reimbursements to Fee for Service Providers. 

The money is being direct deposited today (April 10, 2020) via ACH unless the provider receives checks from Medicare, in which case the checks are being mailed. 

This money does not have to be repaid; however, providers receiving money have 30 days to attest they meet the terms and conditions for receipt. Attestation will open on April 13, 2020. 

More information about the Emergency Fund is available on the HHS Website


 


COVID-19 - In-Person Continuing Education WAIVED

March 27, 2020

On March 22, 2020, Governor Kim Reynolds issued a Proclamation of Emergency Disaster. In this Proclamation, Governor Reynolds temporarily suspended a number of regulatory provisions applicable to a number of professions, including those professions regulated by the Board of Chiropractic. The Proclamation eases administrative rules relating to renewal of licenses, continuing education, and background checks. The suspension of rules identified in the Proclamation is effective through April 16, 2020, unless the Governor terminates or extends the Proclamation.

As required in the Proclamation, the Board of Chiropractic issues this guidance relating to the temporary suspension of administrative rules in these areas: 
 
License Renewal 
Your license is not scheduled to expire until June 30, 2020. The Board does not anticipate the Proclamation having an impact on your license renewal. In the event the Proclamation is extended in a manner that does impact your license renewal, the Board will send additional information at that time. 
 
Continuing Education 
Any Board rules that require you to complete any continuing education in-person are waived for the next license renewal. 
 
To the extent possible, you are encouraged to take distance education courses and try to meet all continuing education requirements in accordance with your renewal deadline. There is currently no limit on the number of continuing education hours that may be obtained through distance education.

The guidance may be found here .

As a reminder, Mandatory Reporting CE requirements can only be taken through the Department of Human Services Mandatory Reporter Information. ICS offers online CE opportunities for many courses and also offers the required hours for Iowa Code and Professional Boundaries. Please refer to the links found under the EDUCATION tab . 

Due to the cancellation of the 2020 ICS Annual Convention, ICS is considering additional options for online continuing education opportunities. Stay tuned and connected to ICS!



Proclamation on Additional Restrictions

March 27, 2020

Communities across the country continue to be confronted with the global COVID-19 pandemic. The U.S. now has more confirmed cases than China at this time, https://www.bing.com/covid  This is a staggering reality for our country. In Iowa, cases continue to grow. https://coronavirus.iowa.gov/

Yesterday, Governor Reynolds signed a new proclamation (link on word “proclamation) https://governor.iowa.gov/press-release/gov-reynolds-signs-new-proclamation-continuing-state-public-health-emergency-0) continuing the State Public Health Emergency Declaration. The new proclamation enforces additional restrictions and is asking for strict compliance with regulatory provisions. Compliance will be critical in managing the spread of COVID-19.

While the proclamation does not specifically address chiropractic clinics, essential health care providers are asked to follow CDC and WHO guidelines and Iowa regulatory provisions. Doctors of Chiropractic are essential health care providers and play a vital role in the health care team.  If you have chosen to continue to serve in this important capacity and care for your patients during this pandemic, ICS encourages doctors to review the  tools and resources provided by ICS legal counsel, Susan Freed. Please refer to the webinar to obtain further examples on precautionary measures.

 

Ms. Freed will be holding another webinar for members on Tuesday, March 31, 2020 from 12:30 – 1:30 pm. You may find the information here by logging in as a member. Please join us if you are able. The webinar will be recorded and will also be posted on the ICS COVID-19 Update page.  Following the completion of the meeting, you may find this recording at www.iowadcs.com

As you manage the spread of the virus within your clinic, ICS encourages you to consider the following.

·        Comply with CDC and WHO guidance and screen staff and patients on a regular basis.

·        Ensure proper protocols are in place and are consistently followed. In the event a patient becomes sick with COVID-19, please follow state and federal guidelines.  https://www.polkcountyiowa.gov/health/programs/covid-19/healthcare-covid-19-resources/

·        To stop the spread, Governor Reynolds’ 3-26-2020 proclamation, in support of the CDC guidelines, recommends delay of non-emergency services or care without undue risk to the current or future health of the patient.

·        Build positive public perception by following strict compliance with CDC requirements and Iowa law and regulatory provisions. Illustrating your professional commitment may be demonstrated by putting processes in place such as:

o   Prioritizing patients based on health acuity and only taking essential patients

o   Practicing distancing in waiting rooms by managing patient scheduling

o   Implementing a consistent staff and patient screening process

 

As an essential health care provider, this is the time to demonstrate your commitment to stopping the spread when caring for  your patients.

Thanks for all you do.

 


Financial Resources to Help Your Practice

March 27, 2020

CARES Act

Congress has passed the CARES Act that provides billions of dollars for Iowa hospitals, businesses, workers, and farmers – and authorizes direct payments to Iowans.

The programs and initiatives in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was just passed by Congress are intended to assist business owners with whatever needs they have right now. When implemented, there will be many new resources available for small businesses, as well as certain non-profits and other employers. The guide below provides information about the major programs and initiatives that will soon be available from the Small Business Administration (SBA) to address these needs, as well as some additional tax provisions that are outside the scope of SBA.

To keep up to date on when these programs become available, please stay in contact with your local Small Business Administration (SBA) District Office, which you can locate here.

Struggling to get started? The following questions might help point you in the right direction. Do you need:

  • Capital to cover the cost of retaining employees? Then the Paycheck Protection Program might be right for you.
  • A quick infusion of a smaller amount of cash to cover you right now? You might want to look into an Emergency Economic Injury Grant.
  • To ease your fears about keeping up with payments on your current or potential SBA loan? The Small Business Debt Relief Program could help.
  • Just some quality, free counseling to help you navigate this uncertain economic time? The resource partners might be your best bet.

 

Paycheck Protection Plan (7A)

 

Click to Download the Guide

Click to Download PPP Calculator

 


With the CARES Act being passed, there are a few programs that chiropractors could take advantage of such as the Paycheck Protection Program (PPP). These programs are loans which do have loan forgiveness provisions within them. The program has just been released but you will need to do the following to apply:

  1. Qualify - Use the relief guide and the PPP calculator to calculate your potential loan amount.   For the PPP it is around 250% of your average monthly payroll. View our recorded webinar to learn which entities are eligible and how to calculate your total amount.
  2. Get Organized – Organize and make sure you have digital copies of your corporate resolutions, financials and payroll records. You will need these to submit your application.
  3. Relationship with your Lender – Remember these are loans you will procure from a qualified lender, most likely your bank or credit union. Reach out now to make sure your lender can do these types of loans and make sure you understand the process. 

 

Economic Injury Disaster Loan Program

Small business owners in all U.S. states and territories are currently eligible to apply for a low-interest loan due to Coronavirus (COVID-19). Click here to apply.

Find more information on the SBA’s Economic Injury Disaster Loans at: SBA.gov/Disaster.

The SBA will work directly with state Governors to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19). The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. 

 

Iowa Small Business Relief Fund - Iowa Economic Development Authority - $25,000 max

On March 23, Governor Reynolds announced a new Iowa Small Business Relief Program to provide financial assistance to small businesses and tax deferrals to Iowa businesses economically impacted by the COVID-19 pandemic. The program is NOT first-come, first-served. All applications received by the deadline, March 31 at 12:00 p.m. (noon), will be reviewed for consideration. Please review the required documents before starting the online application. Click here to learn more and apply.

Targeted Small Business Sole Operator Fund - $10,000 max

A fund has been created to support Targeted Small Businesses (TSB) with zero employees that have been economically impacted by the COVID-19 pandemic. The program will process applications in order of receipt of application and submission of all required documents until funds are exhausted. Please review the requirements and eligibility guidelines here before starting an application. Click here to learn more and apply.

 


 

Get Your Clinic Ready for COVID-19

March 26, 2020

America’s medical providers deliver the best care possible and are trusted sources of health information for their patients and the community. CDC is committed to arming them with the accurate and helpful information they need to treat patients with COVID-19, keep other patients and staff safe, and empower patients to protect their own health. Leveraging telemedicine whenever possible is the best way to protect patients and staff from COVID-19. However, when telemedicine is not possible, simple actions can help to reduce the risk of spread and keep people safe.

CDC’s Prepare to Care for COVID-19 is a resource with practical tools clinicians can use to care for patients with COVID-19, and will be regularly updated to help clinicians adapt as the outbreak unfolds. 

Download the PDF Flyer

 

Essential Worker Letter for Your Employees

Download Essential Worker Letter .Word Doc

 


Guidance For Employers Who Do Provide Paid Leave to Employees and Ability To Take Employment Tax Credit

March 25, 2020

IRS came out with guidance and a plan to allow employers who do provide the paid leave to their employees the ability to take the employment tax credit when they submit their payroll taxes monthly and semi monthly rather than quarterly.

Click Here To Access the Davis Brown Resource Page For Employment Tax Credits

 


Massage Therapy Establishment Mandatory Closures

On Sunday, March 22nd, Governor Reynolds signed a new proclamation continuing State Public Health Emergency Declaration. The proclamation closes the following from Sunday, March 22nd, 2020 at 10:00 pm until 11:59 pm on Tuesday, March 31st, 2020: 

  • Salons
  • Medical spas
  • Barbershops
  • Tattoo establishments
  • Tanning facilities
  • Swimming pools
  • Massage therapy establishments – Massage therapists are not allowed to practice after 10pm Sunday evening through 11:59 on March 31. If you have a massage therapist in your office, they need to shut down.

    The proclamation also suspends all foreclosures on residential, commercial, and agricultural real estate property.

 


CDC Information for Clinicians

 

The CDC presented a one-hour live webinar for clinicians on March 5th.    It is now available at no cost on-demand here. The presenters reported on important updates, including recommendations for office protocols for control of the spread of the virus.  The experts recommend similar protocols for other infectious diseases, such as influenza. Aside from the obvious standards for the physical facility and staff (sanitizing surfaces, handwashing, etc.), if a patient presents to the office with symptoms, the patient should be separated from others in the waiting area and masked to prevent the spread of droplets. 
The CDC also discussed how to determine which patients to refer for testing.  CDC recommends using professional judgment to assess the presence of the following factors in presenting patients:
Epidemiological factors such as being in close contact with a diagnosed patient or having been in an area of known community transmission.
Symptoms including:

  • Fever
  • Acute respiratory illness – cough, shortness of breath, difficulty breathing
  • Myalgia
  • Fatigue
  • Persons over 65 years of age
  • Persons with underlying conditions and comorbidities

Physicians are to use their best judgment in assessing patients and refer those for testing as appropriate.  Due to the general scarcity of testing kits, the CDC currently recommends that physicians should refer “persons under investigation” (PUI) to state and local public health laboratories in their areas.  Additionally, the CDC states that “Healthcare providers should immediately notify their local or state health department in the event of a PUI for COVID-19.”  

There has been a concern across the country regarding the availability or non-availability of testing kits. Of course, the availability or non-availability of testing kits should not change physician office protocols for identifying and handling of possibly exposed or infected persons.  In any event, we encourage physician offices to review CDC information daily for updates to their recommendations for in-office procedures.  In addition to evaluating symptomatic patients, many physicians are choosing to screen all patients by asking at each visit if patients fall into any of the following categories per CDC:

  • Recently returned from international travel or from a cruise
  • Have interacted with an infected person
  • Older adults
  • People who have serious chronic medical illnesses such as; heart disease, diabetes, lung disease

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html

It may be appropriate for some asymptomatic patients to be referred for testing if they have been in close contact with an infected person and/or are positive for some of the other factors (age and comorbidities).

 


CDC Information for Employers

 

The CDC recommends the following strategies for employers to use now.  
The ICS has summarized the strategies here but strongly urges clinic owners to click on the link at the end of this article to review the details provided for businesses by the CDC:

  • Actively encourage sick employees to stay home;
  • Separate sick employees;
  • Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees;
  • Perform routine environmental cleaning:
  • Advise employees before traveling to take certain steps as outlined in the employer link below;
  • Additional measures in response to currently occurring Sporadic Importations of the COVID-19:

Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

 


CMS Release For Providers

 

The Center for Medicaid and Medicare Services (CMS) has issued a number of releases containing information for disease mitigation in specific settings. The following link is a good, detailed strategy for community mitigation based on the level of community transmission:  

https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf.

 As the ICS continues to monitor CDC and other resources, we again encourage members to regularly check CDC and IDPH information in the links below, as they are revised to update the public, healthcare providers, and employers on this rapidly developing issue. 

 


 

Additional Resources

 

Guidance for Businesses and Organizations: 

ChiroArmor Hand Hygiene Policy

 

ChiroArmor Infection Control Policy

 

Patient Handout Flyer

 

Appointments: COVID-19 Phone Screening

 

NCMIC Insurance Company COVID-19 Information


Iowa Department of Public Health Business Guidance 

 
Iowa Department of Public Health FAQ for Businesses 

 

Iowa Department of Public Health Presentation on COVID-19


 
Updates from The Iowa Department of Public Health (IDPH)


Updates from the Centers for Disease Control and Prevention

 

Davis Brown Law Firm Legal Guidance For Employers 

 

Board Recommended Links:

World Federation of Chiropractic Coronavirus PDF

American Chiropractic Association Coronavirus Information

International Chiropractic Association Coronavirus Information



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