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  • 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.

    Latest Relief Package: Options for Small Businesses

    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 to small businesses.

    The federal government has acknowledged that small businesses may be especially hard hit by the COVID-19 pandemic and has responded by establishing provisions aimed at lessening some of the impact. The latest measure, known as the CARES Act, includes some of the most extensive small business relief to date. Here's an overview of the small business-related relief provisions in the CARES Act.

    Details on these provisions, as well as on other pandemic-related resources, are available from the U.S. Small Business Administration, the U.S. Chamber of Commerce, the U.S. Department of the Treasury, and the Internal Revenue Service.

    Paycheck Protection Program Loans
    The legislation creates the Paycheck Protection Program, a new loan product within the Small Business Administration’s 7(a) Loan Program. Existing and new SBA lenders will be able offer these loans to eligible small businesses.

    The new loan, with an interest rate of up to 4%, will be 100% guaranteed by the SBA. Funds may cover payroll costs, including continuation of group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums; employee salaries and commissions; payments of interest on any mortgage obligation, rent, and utilities; and interest on any other debt obligation incurred before February 15, 2020.

    Businesses and charitable nonprofits with fewer than 500 employees, sole proprietors, independent contractors, and self-employed individuals are eligible for the loans.

    A business can borrow up to 2.5 times the average monthly payroll based on the business’s prior year’s payroll, capped at $10 million. All borrower and lender fees for Paycheck Protection loans will be waived, as well as collateral requirements, the Credit Elsewhere Test, and all requirements for personal guarantees. Deferrals of principal, interest, and fees for six months will be built into the loans.

    Emergency Economic Injury Grants
    The CARES Act allows $10,000 of SBA economic injury disaster loans (EIDLs) to be provided to small businesses and nonprofits without a requirement for repayment. EIDLs are loans of up to $2 million that carry interest rates up to 3.75% for companies and up to 2.75% for nonprofits, as well as principal and interest deferment for up to four years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll, paid sick leave to employees, increased production costs due to supply chain disruptions, and business obligations, including debts, rent and mortgage payments.

    The $10,000 grant portion of an EIDL does not need to be repaid, even if the grantee is subsequently denied an EIDL for amounts beyond the $10,000. Eligible grant recipients must have been in operation on January 31, 2020. The grant is available to small businesses, private nonprofits, sole proprietors and independent contractors, tribal businesses, as well as cooperatives and employee-owned businesses.

    Loan Forgiveness
    The relief package establishes that the borrower of an SBA loan is eligible for loan forgiveness equal to the amount spent by the borrower on payroll costs, interest payment on any mortgage incurred prior to February 15, 2020, payment of rent on any lease in force prior to February 15, 2020, and payment on any utility for which service began before February 15, 2020. The loan forgiveness period extends to eight weeks after the origination date of the loan.

    Debt Relief for Existing and New SBA Borrowers
    The stimulus package includes $17 billion to provide immediate relief to small businesses through standard SBA 7(a), 504, or microloans. Under this provision, SBA will cover 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 six months after March 27, 2020.

    The measure also encourages banks to provide further relief to small business borrowers by allowing them to extend the duration of existing loans beyond existing limits, and enables small business lenders to provide a temporary extension on certain reporting requirements for new and existing borrowers. While SBA borrowers are receiving the six months of debt relief, they also may apply for a Paycheck Protection Program loan that provides capital to keep their employees on the job. Borrowers may not apply the six months of SBA payment relief to Paycheck Protection loan payments.

    Employee Retention Credit for Employers Subject to Closure due to COVID-19
    The CARES Act provides a refundable payroll tax credit for 50% of wages paid by employers during the COVID-19 crisis. The credit is available to employers whose operations were fully or partially suspended due to a COVID-19-related shut-down order, or whose gross receipts declined by more than 50% compared with the same quarter in the prior year.

    For employers with greater than 100 full-time employees, the credit is based on wages paid to employees while they are not providing services due to the COVID-19-related circumstances described above. For eligible employers with 100 or fewer full-time employees, all employee wages qualify for the credit, whether the employer is open for business or subject to a shut-down order. The credit is provided for the first $10,000 of compensation, including health benefits, paid to an eligible employee between March 13, 2020, and December 31, 2020.

    Delay of Payment of Employer Payroll Taxes
    The stimulus package allows employers and self-employed individuals to defer payment of the employer share of the Social Security tax on employee wages. The provision allows for half of the amount to be paid by December 31, 2021, and the other half by December 31, 2022.

    Modification of Limitation on Losses for Taxpayers Other Than Corporations
    This provision of the act modifies the loss limitation applicable to pass-through businesses and sole proprietors, so they can use excess business losses to access critical cash flow.

    Modification of Limitation on Business Interest
    The relief legislation temporarily increases the amount of interest expense businesses are allowed to deduct on their tax returns from 30% to 50% of taxable income (with adjustments) for 2019 and 2020. This provision allows businesses to increase liquidity with a reduced cost of capital.

    Modifications for Net Operating Losses
    Net operating losses are typically subject to a taxable income limitation, and they cannot be carried back to reduce income in a prior tax year. The legislation allows a net operating loss arising in a tax year beginning in 2018, 2019, or 2020 to be carried back five years. The provision also temporarily removes the taxable income limitation to allow an NOL to fully offset income. These changes will allow companies to amend prior year returns to take advantage of operating losses.

    APTA Wants To Hear From You About Your COVID-19 Experiences

    Are you on the frontlines of the COVID-19 pandemic? APTA would like to hear from PTs, PTAs, and students about their experiences.

    The COVID-19 pandemic continues to change lives in dramatic ways, with more to come even after the crisis ends. APTA wants to know how you're doing.

    For example:

    • How are you meeting the needs of your patients under current conditions?
    • Are you volunteering to make a difference in your community?
    • Are you transitioning to or retraining for a new setting?
    • What challenges are you overcoming in your clinic or facility that are specific to your setting or patient population?
    • What advice would you give to other PTs facing similar challenges?

    “APTA is committed to helping all PTs, PTAs, and students navigate this crisis," says Heidi Kosakowski, PT, DPT, APTA senior practice specialist. "One PT’s experience could help another in their decision-making process — and help APTA elevate the collective voice of our members.”

    If you would like to share your story, you can submit via APTA Engage. Responses may be published in APTA publications or on APTA's website.

    APTA House of Delegates Packet Posted

    The online resource provides information on 41 motions, including seven proposed amendments to the APTA bylaws.

    APTA members can now access the first official packet of motions that will be considered by the 2020 APTA House of Delegates (House) when it convenes June 1-3, 2020.

    Called "Packet 1," the compilation contains 41 motions to the 2020 House of Delegates and is provided as the official notice of all motions. In May, “Packet I” will be replaced with a document titled “Packet I With Background Papers,” which will also include background papers on various motions.

    There are seven bylaws amendments that are coming before the 2020 House of Delegates. These amendments are:

    • RC 1-20 Amend: Bylaws of the American Physical Therapy Association to Grant Life Members the Privilege of Serving as Delegates to the House of Delegates
    • RC 2-20 Amend: Bylaws of the American Physical Therapy Association, Article IX. Finance, Section 3: Dues
    • RC 3-20 Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Change the Date That National Elected Leaders Assume Office
    • RC 4-20 Amend: Bylaws of the American Physical Therapy Association and Standing Rules of the American Physical Therapy Association to Allow a Public Member to Serve on the APTA Board of Directors
    • RC 5-20 Amend: Bylaws of the American Physical Therapy Association, Article XIV. Amendments
    • RC 6-20 Amend: Bylaws of the American Physical Therapy Association to Allow Sections to Vote in the House of Delegates
    • RC 7-20 Amend: Bylaw Amendment and Standing Rule Amendment to Restructure APTA Board of Directors by Removing the Officers of the House of Delegates

    Due to the COVID-19 pandemic, the 2020 House of Delegates will be conducted in a virtual format over the scheduled June 1-3 dates. APTA will share additional information with delegates as it becomes available via the House of Delegates online hub.

    Delegates should continue using the Motions Discussion forum in the House of Delegates online hub to participate in discussion.

    Contact APTA’s Justin Lini with any questions.

    APTA Wants Your Physical Activity Videos

    A new project will collect and share videos that help Americans remain physically active during social distancing and isolation.

    APTA is seeking physical therapists willing to record video of themselves leading exercises specific to their area of practice or clinical expertise that can be safely and easily done at home.

    Approved videos will be posted to ChoosePT.com, APTA’s official consumer information website, and shared on our social media platforms geared toward consumers. Last year, ChoosePT.com attracted nearly 4 million unique visitors.

    Participants can choose to create either a 20-minute video featuring a series of exercises, or several shorter videos featuring one exercise (with possible modifications for various fitness levels). Check out this video, produced by APTA member Megan Brown, PT, DPT, for ChoosePT.com for an example.

    "The goal is to encourage Americans to keep moving while they are at home following the CDC’s guidelines to prevent the further spread of COVID-19," said Jason Bellamy, APTA's executive vice president of strategic communications. "This is also an opportunity to help APTA raise awareness about physical therapists’ roles as movement experts and to connect the public with ChoosePT.com, where visitors can learn about the value of physical therapy and find a PT in their area."

    Interested? Let us know through this dedicated page on APTA Engage, the association's online center for volunteer opportunities. APTA staff will follow up with instructions for recording your video.