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  • PTs, PTAs Could Be 'Exempted' From Receiving Additional COVID-19 Leave

    A final rule from the Department of Labor includes PTs and PTAs among the health care providers whose employers — depending on the setting — could opt to deny expanded sick and FMLA leave.

    In this review: U.S. Department of Labor, Temporary Rule: Paid Leave under the Families First Coronavirus Response Act
    Fact sheet: employee paid leave rights
    Fact sheet: employer paid leave requirements
    Families First Coronavirus Response Act: Questions and Answers

    Emergency paid sick leave and expanded family and medical leave provisions will be implemented broadly in response to the COVID-19 pandemic, but PTs, PTAs, and other health care providers employed in certain settings can be prevented from receiving the additional relief if their employers say so: That's how the U.S. Department of Labor has laid out its plans for implementing the Families First Coronavirus Response Act signed into law on March 18. The exemption provisions could also be applied to first responders.

    At issue is a requirement in the Families First Act that employers with fewer than 500 employees provide up to 80 hours of paid sick leave and additional FMLA leave related to COVID-19—and in particular, instances in which an employer would have the option to exempt employees from the extra leave provisions. In health care, DOL is allowing that option to be exercised by employers from a list of health care settings, to be applied on a case-by-case basis to any of their health care providers.

    For the physical therapy profession, the term "health care provider" is key, because PTs and PTAs fall into that category for purposes of the rule.

    The rule provides the exemption option to employers in the following settings:

    • Doctor’s office.
    • Hospital.
    • Health care center.
    • Clinic.
    • Post-secondary educational institution offering health care instruction.
    • Medical school.
    • Local health department or agency.
    • Nursing facility.
    • Retirement facility.
    • Nursing home.
    • Home health care provider.
    • Facility that performs laboratory or medical testing, pharmacy, or "any similar institution."

    The list applies to any permanent or temporary institution, and extends to any listed setting that contracts with a health care provider or contracts with an entity that employs a health care provider. Bottom line: PTs and PTAs employed or under contract with a facility on the list could face the possibility of being exempted from receiving the additional leave.

    It's Optional and Intended for Case-by-Case Use
    According to the DOL, the agency is encouraging employers to be "judicious" in use of the exemption "to minimize the spread of the virus associated with COVID-19." Additionally, DOL says that the exemptions are intended to be used on a "case-by-case" basis, meaning that employers could apply the exemptions to certain types of health care providers and allow others to receive the extended benefits.

    It's Not the Only Exemption Path
    The requirements to provide the extended leave don't apply to business with 500 or more employees, and employers with 50 or fewer employees can apply to opt out if providing the extra leave would jeopardize the viability of the business.

    The "Health Care Provider" Definition is Intentionally Broad
    In the rule DOL states that it considered using a more narrow definition of "health care provider," but decided to go with the broad definition to give employers flexibility to maintain staffing to respond to the health emergency. According to DOL, a more narrow definition could leave health care facilities without staff to perform critical services needed to battle COVID-19.

    New CMS Nursing Home Recommendations Stress Collaboration, Consistent Staffing Assignment

    The new recommendations underscore existing CDC and CMS guidance and call for extensive use of masks and other PPE.

    The U.S. Centers for Medicare & Medicaid Services issued new recommendations for nursing homes around the COVID-19 pandemic that urge states to attend to the personal protection equipment needs of long-term care facilities, and press nursing homes to establish separate staff teams for COVID-19-positive residents. The recommendations also include universal testing in the facilities and use of PPE "to the extent PPE is available."

    According to CMS, the recommendations were created after CDC and CMS experts working in nursing homes "emphasized that even more must be done" to underscore guidance already provided by CMS around response to the pandemic.

    The recommendations address five major areas:

    Compliance with existing CDC and CMS guidance. The recommendations stress the importance of following instructions from the CDC and CMS in areas such as hand hygiene, infection control, and conservation of PPE.

    Collaboration between states and nursing homes to meet PPE needs. CMS emphasizes the importance of state and local health departments to stay in close communication with long-term care facilities to "address … needs for PPE and/or COVID-19 tests."

    Symptom screening for all. The agency reiterates its position that every person entering a nursing home be asked about COVID-19 symptoms and have their temperature checked. Symptom assessment and temperature checks should also be performed on every resident.

    Appropriate PPE use. The recommendations urge the use of facemasks by all nursing home personnel on site, as well as donning of full PPE when caring for any resident known or suspected to have COVID-19. CMS also calls for all residents "to cover their noses and mouths when staff are in their rooms," and suggests that they could use tissues or non-medical masks to do this.

    Separate staff teams for residents with COVID-19, and consistent assignment. CMS recommends that facilities try to assign the same staff to the same residents to increase the chances of "detect[ing] emerging condition changes that unfamiliar staff may not notice" and to decrease the number of different staff interacting with residents. Residents diagnosed with COVID-19 should be separated from other patients, and have separate staff teams "when possible."

    CMS also recommends that state agencies, hospitals, and nursing home associations help to "ensure coordination among facilities to determine which facilities will have a designation [as a facility for COVID-19 patients] and provide adequate staff supplies and PPE."

    Latest Relief Package: Unemployment Provisions

    The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here's what the package offers related to unemployment benefits.

    The recently enacted CARES Act aimed at providing relief during the COVID-19 pandemic contains some important provisions related to unemployment that include relaxing some of the qualifications to receive benefits, allowing for circumstances specifically related to the pandemic, and adding $600 to weekly benefit checks.

    Called the Pandemic Unemployment Assistance Program, the new provisions allow for financial assistance to individuals who wouldn't ordinarily receive unemployment benefits, such as the self-employed, independent contractors, part-time workers, and those who have already finished their unemployment benefits. This new offering is effective January 27 through December 31, 2020.

    To receive the benefit, individuals in categories that normally wouldn't qualify for benefits must prove that they can no longer work due to activity related to COVID-19. Examples include:

    • Diagnosis of COVID-19, a COVID-19 diagnosis of a member of the household, or providing care for a member of the household who has been diagnosed with COVID-19.
    • Primary caregiving responsibility for a family member who is unable to attend school or another facility that has been closed due to the national emergency.
    • Inability to work because of a quarantine imposed by the national emergency or self-quarantine advised by a health care provider.
    • Inability to begin recently gained employment or being forced to end employment as a direct result of the national emergency.

    In addition to the expanded range of individuals who may qualify for unemployment benefits, the program adds $600 per week to regular unemployment benefits for up to 39 weeks. The additional money will be provided to everyone receiving unemployment benefits.

    Individuals able to telework or receive paid sick leave are ineligible for the program. If a state has a defined workshare program or short-time compensation, the CARES Act provides additional funding to keep employees working on a reduced-hours schedule and receive prorated unemployment benefits.

    For more information visit the U.S. Department of Labor website, which includes an unemployment benefits finder by state.

    Aetna Now Covers Telehealth Delivered by PTs

    Aetna joins UnitedHealthcare among the commercial insurers that have expanded coverage from more limited e-visit provisions.

    UPDATE (April 3): Aetna has advised that telehealth services delivered by physical therapists may be billed on a UB04 using the modifier GT or 95. Please contact advocacy@apta.org with any issues or questions associated with this billing.

    Private insurer Aetna announced that it will now cover a range of services delivered by PTs through telehealth—a significant expansion of its earlier COVID-19-related policy that limited coverage to e-visits. The change comes after APTA engaged in collaborative work with the company to rethink its temporary benefits policy.

    The insurer, officially known as CVS Health/Aetna, will cover the telehealth-based delivery of the services and procedures by PTs for CPT codes 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97535, 97755, 97760, and 97761. The telehealth care must be provided as a two-way synchronous (real-time) audiovisual service. Providers are required to append the GT modifier to the codes. Aetna's expansion follows a similar move by UnitedHealthcare.

    Aetna will also continue its policy that reimburses PTs for the provision of e-visits, virtual check-ins, and telephone services. The use of the GT or 95 modifier is not required for e-visit CPT codes (98970, 98971, 98972), the store-and-forward code (G2010), virtual check-in codes (G2012), and telephone assessment CPT codes (98966, 98967, 98968). Visit Aetna's provider website and follow instructions for accessing detailed policy information on the provider portal.

    Check out APTA’s frequently updated telehealth webpage for the latest information on payer and regulatory changes.

    Coronavirus Update: April 1, 2020

    CMS moves toward telehealth for physical therapy, FCC announces telehealth initiative, new resources available for physical therapy educators, and more.

    Practice Guidance

    March 31: CMS Rule Includes Therapy Codes in Telehealth, But Stops Short of Allowing PTs to Conduct Telehealth Services
    Rule changes recently announced by CMS in response to the COVID-19 pandemic add codes commonly associated with therapy to those that may be delivered through telehealth, but CMS has made no related changes to allow PTs, occupational therapists, and speech-language pathologists to actually provide services through telehealth.

    The apparent contradiction may be partly because the new rules were written prior to the passage of the CARES Act last week — the $2 trillion COVID-19 relief package that granted CMS the authority to use waivers to expand the range of providers permitted to conduct services through telehealth. To date, CMS has not extended telehealth authority to PTs, OTs, and SLPs. But with coding rules now in place, such an expansion would be easier to implement quickly. APTA is pursuing the CMS disconnect.

    March 31: Joint Commission Statement Supports Provider Use of Personal Face Masks From Home
    The commission issued a statement supporting the use of standard face masks and/or respirators provided from home when health care organizations cannot provide access to protective equipment that is commensurate with the risk that health care workers are exposed to amid the COVID-19 pandemic.

    Telehealth

    March 30: FCC Announces $200 Million Plan for Telehealth
    The Federal Communications Commission announced a COVID-19 Telehealth Program to support health care providers responding to the ongoing coronavirus pandemic. As part of the CARES Act, Congress appropriated $200 million to the FCC to support health care providers’ use of telehealth services in combating the COVID-19 pandemic. If adopted by the commission, the program would help eligible health care providers purchase telecommunications, broadband connectivity, and devices necessary for providing telehealth services.

    Physical Therapy Education

    March 31: American Council of Academic Physical Therapy Establishes Collaboration Center
    A new offering from ACAPT offers possibilities for open-source resource sharing and communication among the clinical education community.

    Advocacy

    March 31: Tell Congress That Improvements in Telehealth, Reimbursement Should be Part of Pandemic Response
    The COVID-19 relief package signed into law last week wasn't the last word on temporary changes that could help blunt the impact of the pandemic: There's another package being worked on in Congress right now, and the physical therapy community needs to make its voice heard. Visit a dedicated page in the APTA legislative action center to quickly contact your lawmakers and remind them to help the profession respond to the pandemic by establishing telehealth for PTs and addressing reimbursement reductions.

    Research

    March 30: Case Fatality Rate for COVID-19 Near 1.4 Percent, Increases With Age
    A new study published in The Lancet shows that both hospitalization and fatality rates in patients with COVID-19 are higher in older patients. In an analysis of patient data from inside and outside of China, researchers estimated that it takes 17.8 days on average from onset of symptoms until death, and 24.7 days until hospital discharge. The fatality rate in China was 1.38%, but substantially higher in patients older than 60 years of age and as high as 13.4% among those aged 80 years and up.

    March 13: PubMed Central Provides Links to Open-Access COVID-19-Related Research
    The online archive is providing links to all research that has been designated as open-access by various publishers.

    In the Media

    March 31: U.S. Stockpile of PPE Nearly Gone
    From Reuters: "An emergency stockpile of medical equipment maintained by the U.S. government has nearly run out of protective gear that could be useful to combat the coronavirus pandemic, according to two officials with the U.S. Department of Homeland Security."

    Visit APTA's Coronavirus webpage for more information and updates.

    New CMS Rule Includes Therapy Codes in Telehealth, Stops Short of Allowing PTs to Conduct Telehealth Services

    CMS has announced "sweeping" temporary changes that give a nod to the potential for true telehealth by PTs even though regulatory barriers still prevent that from happening. Could it be a sign of more to come?

    In this review: Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (interim final rule)
    Effective date: March 1, 2020 (backdated)
    CMS press release
    CMS fact sheet
    Additional CMS guidance


    It's true that the rule changes recently announced by CMS in response to the COVID-19 pandemic add codes commonly associated with therapy to those that may be delivered through telehealth. But there's one problem: CMS has made no related changes to allow PTs, occupational therapists, and speech-language pathologists to actually provide services through telehealth, even though the codes have now been okayed for that use.

    The apparent contradiction may be partly because the new rules were written prior to the passage of the CARES Act last week — the $2 trillion COVID-19 relief package that granted CMS the authority to use waivers to expand the range of providers permitted to conduct services through telehealth. To date, CMS has not extended telehealth authority to PTs, OTs, and SLPs. But with coding rules now in place, such an expansion would be easier to implement quickly.

    APTA is pursuing the CMS disconnect, urging the agency to use it waiver authority to expand telehealth recognition to PTs. In the wake of the interim rule just released, APTA is requesting a meeting with CMS, and will submit formal comments on the interim rule in the weeks ahead. APTA has also joined with the American Occupational Therapy Association and the American Speech-Language-Hearing Association in a statement calling on CMS to "take immediate steps to ensure patient safety and protect health care providers."

    In the meantime, APTA advises members to assume that PTs are not recognized as telehealth providers by CMS, and the association calls on member to press the agency to expand telehealth waivers, using an APTA-developed template letter. In addition, the association is pushing for permanent inclusion of PTs in telehealth through advocacy for the CONNECT Act.

    More from the Interim Rule

    In addition to the nod toward therapy delivered via telehealth, the rule makes it easier for PTs to conduct some forms of digital communications with patients, and relaxes some supervision requirements. The changes also include allowances in home health and inpatient rehabilitation facilities, and they allow for hospitals to provide services outside existing facilities. Those hospital changes would make it possible for hospitals to transfer COVID-19 patients to ambulatory surgery centers, inpatient rehabilitation hospitals, and hotels.

    Video and Virtual Check-Ins, Telephone Assessments and Management
    Medicare routinely pays for many kinds of services that are furnished by way of telecommunications technology but are not considered Medicare telehealth services. These communication technology-based services (CTBS) include, for example, certain kinds of remote patient monitoring (either as separate services or as parts of bundled services) and interpretations of diagnostic tests when furnished remotely — essentially, services ordinarily furnished in person but are routinely delivered using a telecommunications system.

    The interim rule includes PTs among the providers eligible to provide remote evaluations (G2010) and virtual check-ins (G2012), as well as so-called "e-visits" that were earlier permitted through a waiver process to established patients, although the agency notes that “while some of the code descriptors refer to 'established patient,' during the [emergency] we are exercising enforcement discretion on an interim basis to relax enforcement of this aspect of the code descriptors.” The codes are designated by CMS as “sometimes-therapy” services that require the GP modifier, with patient consent able to be obtained at the same time the service is furnished.

    Supervision
    For the duration of the COVID-19 public health emergency, CMS is allowing direct supervision to be provided using real-time interactive audio and video technology. The change clearly applies to "incident to" situations in which PTs are working under the direct supervision of physicians; APTA is seeking clarification as to whether it also applies to PTAs working under the supervision of PTs in private practice.

    Similar allowances are applied to supervision services associated with pulmonary rehabilitation, cardiac rehabilitation, and intensive cardiac rehabilitation services.

    The interim rule makes it clear that the change only deals with the method used to provide the supervision; it doesn't alter policies related to the scope of Medicare benefits or any rules around safe transportation and proper waste disposal.

    Home Health
    The rule expands the definition of a "homebound" patient as someone whose physician advises them to not leave home because of a confirmed or suspected COVID-19 diagnosis, or who has a condition that makes them more susceptible to COVID-19. The change means that home health agencies will be able to provide services under the Medicare Home Health benefit. The allowance does not apply to a patient who is self-quarantining but doesn't have the physician acknowledgement of COVID-19 or risk factors associated with COVID-19.

    The announced changes also allow HHAs to use additional telecommunications technologies in conjunction with in-person visits but stop short of allowing telecommunications-delivered communications to replace in-person visits.

    CMS also is pausing the "Review Choice Demonstration" for home health services in Illinois, Ohio, and Texas, the program that requires home health providers in those states to participate in preclaim or postpayment reviews, or to choose a third option that would involve reduced postpayment review but cut payment by 25%. The demonstration will not begin in North Carolina and Florida on May 4, 2020, as previously scheduled.

    See the CMS guidance on home health changes for more details.

    Inpatient Rehabilitation Facilities
    CMS is allowing IRFs experiencing staffing shortages and disruptions to back away from following the "three-hour rule," which requires that the IRF patients participate in three hours of rehabilitation therapy per day, five days per week—or, in certain well-documented cases, at least 15 hours of intensive rehabilitation therapy within a 7-consecutive day period that begins on the date of admission to the IRF.

    See the CMS guidance on IRF changes for more details.

    Medical Reviews
    The interim rule suspends most Medicare medical review during the emergency period, including prepayment medical reviews conducted by Medicare Administrative Contractors under the Targeted Probe and Educate program, as well as postpayment reviews. In addition, CMS announced that it won't issue additional documentation requests through the emergency period and will suspend all Targeted Probe and Educate reviews in process, and claims will be released and paid. Other postpayment reviews will also be suspended and released from review. CMS warns, however, that it may still conduct reviews during the emergency period if it finds indications of potential fraud.

    Tell Congress: Improvements in Telehealth, Reimbursement Should be Part of Pandemic Response

    As lawmakers craft the next COVID-19 relief package, now's the time to make the case for the profession's role in telehealth services and the need for easing reimbursement cuts.

    The COVID-19 relief package signed into law last week wasn't the last word on temporary changes that could help blunt the impact of the pandemic: There's another package being worked on in Congress right now, and the physical therapy community needs to make its voice heard.

    APTA is making it easy. Visit a dedicated page in the APTA legislative action center to quickly contact your lawmakers and remind them to help the profession respond to the pandemic by establishing telehealth for PTs and addressing reimbursement reductions.

    Your patients can do the same, by way of APTA's patient action center.

    Take a few minutes now to create long-lasting change.

    Coronavirus Update: March 30, 2020

    Practice guidance for pediatric physical therapy, a new volunteer resource, accelerated Medicare payments, and more.

    Practice Guidance

    March 30: APTA Offers General and Pediatric-Focused COVID-19 Guidance for PTs, PTAs, Students
    Two new resources from APTA can help PTs, PTAs, and students looking for more detailed, profession-specific guidance related to providing care during the COVID-19 pandemic: one focused on general PT management of patients, and a second that specifically addresses pediatric physical therapy.

    March 30: New COVID-19 Volunteer Resource Connects PTs, PTAs, Students With Facilities in Need
    APTA has launched a new online service that helps connect members of the physical therapy profession with facilities looking for volunteers. The service offers two points of entry — one for facilities in need of PT, PTA, or student volunteers, and another for PTs, PTAs, and students willing to offer their services, by way of the APTA Engage volunteer portal.

    From CMS

    March 30: 39 States Have Been Granted Medicaid Waivers
    As of March 30, 39 states have received federal 1135 waivers on a range of Medicaid requirements including prior authorization, provider enrollment, public notice mandates, and fair hearing request timelines. A CMS press released dated March 27 reported that 34 waivers had been issued; by the afternoon of March 30, the number had risen to 39.

    March 28: CMS Expands Accelerated and Advance Payment Program for Medicare 
    "CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19," CMS states in a press release. "The payments can be requested by hospitals, doctors, durable medical equipment suppliers and other Medicare Part A and Part B providers and suppliers." Qualifications include billing timelines and a requirement that the provider not be in bankruptcy, not be under active medical review or program integrity investigation, and not have outstanding delinquent Medicare overpayments.

    March 27: CMS Offers Long-Term Care Nursing Homes Telehealth, Telemedicine Toolkit
    According to CMS: "Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well." Resources include guidance on choosing telemedicine vendors, equipment, and software, as well as developing documentation tools.

    From the Department of Health and Human Services

    March 27: HHS Office for Civil Rights Issues Bulletin on Nondiscrimination Requirements
    The HHS OCR is reminding entities covered by civil rights authorities that the current COVID-19 national emergency does not change civil rights laws. "These laws, like other civil rights statutes that OCR enforces, remain in effect," the bulletin states. "As such, persons with disabilities should not be denied medical care on the basis of stereotypes, assessments of quality of life, or judgments about a person’s relative 'worth' based on the presence or absence of disabilities."

    Visit APTA's Coronavirus webpage for more information and updates.

    Coronavirus Update: March 27, 2020

    A Medicare payment increase, PT telehealth for UnitedHealthcare, APTA tracks telehealth payment changes, and more.

    Practice Guidance

    March 27: COVID Stimulus Package Includes Payment Increase, Opens Telehealth Possibility
    An increase to Medicare payment, temporary relief for some student loans, the potential expansion of telehealth allowances, and help for small businesses are among the provisions that are especially relevant for physical therapy.

    March 27: UnitedHealthcare Allows Telehealth for Physical Therapy
    UnitedHealthcare, the country's largest commercial health insurer, announced a major shift in its coverage policies during the COVID-19 pandemic: Beginning immediately, the payer will reimburse physical therapy delivered via telehealth services. The change is the most wide-ranging payer acknowledgement of PTs as qualified telehealth providers to date, and it moves UHC well past CMS' and a few other payers’ current waivers allowing for limited "e-visit" digital communications between PTs and patients.

    March 27: Charts From APTA Track Payer, Government PT Telehealth Policies
    Now available from APTA: a regularly updated set of resources that track payment and regulatory policies related to the provision of telehealth by PTs.

    March 30, 3 pm: APTA Hosts Facebook Live Event, "Implementing Telehealth in Your Practice STAT"
    APTA will host a Facebook Live version of its sold-out March 26 webinar that featured a panel discussion with experienced telehealth PTs providing insight on how they implement telehealth in their practices.

    From CDC

    March 25: CDC Releases PPE "Burn Rate Calculator"
    A new app helps providers calculate the rate at which PPE will be used in their facilities.

    In the Media

    March 27: What's Inside the Senate’s $2 Trillion Coronavirus Aid Package
    From National Public Radio: a breakdown of the six main groups that will receive relief through the stimulus.

    Visit APTA's Coronavirus webpage for more information and updates.

    COVID Stimulus Package Includes Payment Increase, Opens Possibility of Increased Telehealth, More

    An increase to Medicare payment, temporary relief for some student loans, the potential expansion of telehealth allowances, and help for small businesses are among the provisions that are especially relevant for physical therapy.

    The $2 trillion stimulus package passed by Congress and signed into law by President Trump is comprehensive in its scope, and includes everything from sending direct payments to many individual Americans to some $32 billion in grants to airlines and airports. [Editor's note: check out these articles from National Public Radio and Axios for good summaries of the entire package]

    The legislation also includes provisions that may be of particular interest to PTs, PTAs, physical therapy students, and physical therapy patients.

    Medicare payment will increase.
    Normally, mandatory across-the-board cuts in federal spending enacted into law, known as sequestration, would require Medicare to reduce payments to providers by 2%. The stimulus temporarily lifts that reduction from May 1 through December 31, 2020. The effect: increased payments to PTs, hospitals, home health, and other care. The legislation also prevents scheduled reductions in Medicare payments for durable medical equipment through the length of the COVID-19 emergency period.

    Telehealth could expand under Medicare (if HHS can be convinced to do it).
    The package gives the Secretary of the Department of Health and Human Services the authority to waive restrictions on telehealth for providers, including PTs, who aren't currently allowed to provide and bill for telehealth services to Medicare beneficiaries. So far, that waiver hasn't happened, and APTA is urging its members and stakeholders to join a grassroots effort to press for the change.(Note that while CMS has approved the use of "e-visits" by PTs, that's a limited type of digital communication and not same as telehealth.)

    Federal student loan borrowers will be able to defer payments, and employers can offer repayment benefits tax-free.
    Payments on federal student loans can be deferred through September 30, 2020, with no accrual of interest during that period. Additionally, the stimulus allows employers to contribute up to $5,250 annually toward an employee's student loans without the benefit being taxed as employee income. The employer provision applies to any employer payments made between now and January 1, 2021.

    Providers able to order home health services now include PAs, NPs, and CNSs, potentially reducing delays in care.
    Until now, only physicians were able to certify the need for home health services. The legislation allows physician assistants, nurse practitioners, and clinical nurse specialists to order home health services for beneficiaries, reducing delays and increasing beneficiary access to care in the safety of their home.

    New loans are available to small businesses, along with payroll tax credits to boost employee retention and a deferment of Social Security tax payments.
    The stimulus creates a new type of loan through the Small Business Administration that could help to cover payroll costs (including health care), rent, utilities, and other debt obligations, at a 4% interest rate. Businesses and 501(c)(3) organizations with fewer than 500 employees are eligible, as are sole proprietors, independent contractors, and self-employed individuals.

    Some employers will also be able to take advantage of a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The offer is limited to employers whose operations were fully or partially suspended due to the pandemic, or whose gross receipts declined by more than 50% compared with the same quarter of 2019.

    The package also offers a payroll tax deferment. Employers (and the self-employed) are also able to defer payment of the employer share of the Social Security tax. The provision requires that the deferred employment tax be paid over the following two years, with half of the amount required to be paid by December 31, 2021, and the other half by December 31, 2022.

    Small businesses can receive grants and may be able to get limited debt relief on SBA loans.
    Small businesses and nonprofits that apply for an SBA economic injury disaster loan could receive an advance of $10,000 within three days of applying for the loan. Additionally, the stimulus includes $17 billion to provide immediate relief to small businesses with standard SBA 7(a), 504, or microloans, with the SBA covering all loan payments for existing SBA borrowers, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out an SBA loan within the next six months.

    Transfers from acute care hospitals to IRFs will be easier.
    During the emergency period, acute care hospitals can transfer patients to inpatient rehabilitation facilities more easily, thanks to a waiver of the requirement that patients must participate in at least three hours of intensive rehabilitation at least 5 days a week in order to be admitted to the IRF.

    Higher education will get some relief, too.
    The legislation makes $14.2 billion available to higher education institutions to prevent, prepare for, and respond to the pandemic. The funds can be used to defray expenses associated with lost revenue, technology costs of transitioning to distance education, and providing grants to students for food, housing, course materials, and technology.

    APTA Vice President of Government Affairs Justin Elliott said that this package, though the largest, is actually the third set of relief measures enacted. And there's more to come.

    “Work has already begun on a fourth legislative relief a package that we expect will be considered by Congress in April," Elliott said. "APTA will continue to advocate for provisions that will help physical therapists, physical therapist assistants, physical therapy students, and the patients they serve.”