COVID 19: New and Updated Information and Resources
NJAASC has curated authoritative information and a list of resources for our Membership’s reference. We will continue to update this as more information becomes available.


PAST COVID E-BLAST HAVE BEEN ARCHIVED DUE TO SPACE RESTRAINTS AND TO KEEP THINGS CURRENT. 
TO VIEW PREVIOUS E-BLASTS, CLICK HERE

AMBULATORY ASSESSMENT NEWS – 5/28/20
A bill is expected to be introduced today in both Houses regarding the ACF.

No introductions are reported until after the session is gaveled to an end, so as of now cannot say for certain, but all indications are that this should occur.

The bill reportedly would postpone for 9 months the assessment.

Now before everyone gets excited, I doubt very much considering his recent record, the Governor would sign off on something like that. There would have to be negotiation between the legislature and Governor’s Office for him to sign a bill like this.

I realistically would expect the postponement to be in the neighborhood of 2-3 months, in particular for the June 15 th  quarterly due. That is what I proposed to Senator Sarlo and Assemblyman Greenwald in correspondence, and what I testified to before the Senate Select Committee. I made it very clear that we need immediate relief, in particular for the June 15 th  installment.

Stay tuned for more information tomorrow.

PLEASE BE CAREFUL WITH YOUR TESTING – 5/28/20
I know that everyone is looking for a light at the end of the testing tunnel for electives, but please do not just jump in and use anyone or anything.
New Jersey has rules and regulations, including out of state labs with you mailing to them.
Today I had them investigate a particular test and as I suspected, they could not recommend it.
The test was FDA approved, but for patients with COVID symptoms, not for our use- pre-op screening of asymptomatic patients. 
I would suggest that you contact the Department before you jump in.
Melanie Rinaldi
Manger, NJ CLIA Program
Clinical Lab Evaluator

PRIVATE TESTING SITES – 5/28/20
While the COVID portal has information on community based and the like testing, they do not for private sites.
We have questioned this, and so have some legislators who are trying to help us.
 
Here is the response from the Governor’s Office to one legislator’s query:
 
We are exploring options to broaden information to include private testing site data, and hope to have an update on the COVID-19 portal in the coming days.

ICAR UPDATE -5/28/20
Information on damaged/degraded head straps on stockpiled NIOSH-approved Filtering Facepiece Respirator (FFRs)
 
The National Institute for Occupational Safety and Health (NIOSH) is aware that many different NIOSH-approved filtering facepiece respirator (FFR) models were stockpiled for prolonged times and are now distributed for use during the COVID-19 response. These FFRs are made using different materials (e.g., filtering media and strap material), which may age or degrade over time and become damaged. Generally, FFRs are not designed for long-term storage, and many models may have shelf lives designated by the NIOSH approval holder. The shelf life information is generally found on the packaging or the approval holder’s website.
NIOSH has received multiple inquiries concerning the identification and replacement of damaged straps on large caches of NIOSH-approved N95 FFRs that have since passed their designated shelf life. Users should perform a visual inspection of each respirator prior to donning per the user instructions. Additional questions and concerns related to the condition of the respirator should be directed to the approval holder.
For more information, see the  NIOSH conformity assessment notice 2020-1028 , dated May 2020.
 
Possible cases of recurrent COVID-19
China and South Korea have reported possible cases of recurrent SARS­ CoV-2 RNA detection, both with or without symptoms, among patients who have recovered from COVID-19; whether these cases represent re-infection versus intermittent viral RNA shedding is still to be determined. The extent to which such cases are occurring in the United States is currently unknown.

In order to learn more about clinician-suspected cases of reinfection, the Centers for Disease Control & Prevention (CDC) are requesting information from any clinician who may have identified a confirmed COVID-19 patient with clinical recovery for approximately 1O days after symptom onset or diagnosis (if asymptomatic), and subsequently had any of the following:
 
·      Two documented negative PCR results followed by a positive result
·      Recurrence of symptoms with a positive PCR result
·      Positive PCR results for ≥30 days after recovery (without any recurrence of symptoms)

If so, please use the attached link to enter a case description:  https://ein.idsociety.org/surveys/survey/125/

Additional questions should be directed to the Emerging Infections Network at  ein@uiowa.edu

OSHA Guidance for Employers
 
The latest  COVID-19 OSHA Alerts  provide recommended practices for protecting workers at  nursing home and long-term care facilities retail pharmacies , and  rideshare , taxi and car services .

Please monitor CDC and NJDOH COVID-19: Information for Healthcare Professionals  https://www.nj.gov/health/cd/topics/covid2019_healthcare.shtml  for additional information 

Melody Lee, MS
Infectious and Zoonotic Disease Program | Communicable Disease Service
Division of Epidemiology, Environmental, and Occupational Health | New Jersey Department of Health
Phone 609-913-5065 |Email  melody.lee@doh.nj.gov  | ICAR Email  CDS.ICAR@doh.nj.gov

UPDATE ON GOINGS ON – 5/27/20
All:
It has been trying for all of us, but rest assured NJAASC is working on a lot of the issues we are facing.
 
We should have an answer very soon as regards PPE and case load reporting. It appears that we are going to co-opt the hospital portal- have a click for ASCs on there, being finalized.
 
We have also approached the Department as regards pediatric patients, as it appears labs are choosing not to test them, refusing.
 
This AM I sent a letter to the Department as regards all the major pharmacies. Walgreens, CVS, Walmart etc., are not doing pre-op COVID testing- these patients do not meet their criteria. We of course knew this would happen as we tried prior to the guidelines to register just to see what would happen!
 
Tomorrow or Friday, NJAASC will have a reporting tool to send to all ASCS wherein you can record issues you are having with testing.
This will allow NJAASC to collate all the data and present it to the Department, to hopefully get things changed.
 
Finally, we are still working on the Ambulatory Assessment, several options are in the offing right now.

THE ASC GUIDELINES ARE NOT SUGGESTIONS! – 5/27/20
I just want to make sure everyone understands that the ASC Guidelines issued by the Department are not optional, or suggestions.
THEY ARE NOT DISCRETIONARY!

You need to make this clear to your doctors and anesthesia.
I have heard that some are taking the position that; ‘they are only guidelines’.
Well go right ahead with that line of thought and see where it gets you!
The guidelines are part of an Executive Order- EO 145, they are not recommendations.
 
If anyone has knowledge of this occurring, I would suggest that you make sure NJDOH knows about it.
We cannot afford to have bad apples spoil our ability to do elective cases, and trust me if enough abuse occurs I have no doubt the Governor would rescind.
We may not like the guidelines, but that is not the point. They are here for the time being. There is no way cases are going to be allowed to be performed without testing.
Thus, we must work with the Department, Governor’s Office, DCA -everyone, to try to make them practical.
And that is exactly what NJAASC has been doing for the past several weeks.

PPP Update: The Regulation Relating to Loan Forgiveness - 5/27/20
Shortly after the Small Business Administration (SBA) issued the Paycheck Protection Program (PPP) loan forgiveness application form, it issued the  regulation relating to loan forgiveness . Here are the main takeaways from the regulation that we learned in addition to what was provided for in the loan forgiveness application form:

The Forgiveness Process
  • At least 75% of the loan forgiveness amount must be for payroll costs. 
  • For loans that are not reviewed by the SBA prior to the lender forgiveness decision, the lender will have 60 days from receipt of a loan forgiveness application to issue its forgiveness decision to the SBA. The lender will be responsible to notify the borrower of the forgiveness amount. Any amount not forgiven must be repaid by the borrower on or before the two-year maturity of the loan. 
Forgiveness Reduction
  • Employers will not lose forgiveness for employees whom are offered rehire, or who are offered restoration of an hours reduction at the same rate of pay, even if the employee does not accept the offer. Employers must document the offer to the employee and the employee’s rejection of same. 
  • Employers will be required to inform the state unemployment insurance office of the employee’s rejected offer of reemployment within 30 days of rejection of the offer (more guidance is expected on this new item).
  • Employers that restore, by June 30, 2020, any reduction in FTEs that occurred between February 15 - April 26, 2020 as compared to one of two statutory periods, will not lose forgiveness based upon the FTE reduction.
  • Loan forgiveness will not be reduced if an employee is fired for cause, voluntarily resigns, or voluntarily requests a schedule reduction. 
FTE Calculation
  • The SBA is using a 40-hour workweek standard for FTE calculation. Any employee who works 40 hours or more each week is considered as one FTE.
  • An employee who works less than 40 hours per week may be counted as a half (.5) FTE. 
  • Alternatively, as to employees who work less than 40 hours per week, the employer may calculate the average number of hours per week during the covered period compared to the 40-hour workweek. For example, if the average number of hours per week is 30, then that employee would count as a .75 FTE, and if the average number of hours per week is 10, then that employee would count as a .25 FTE. 
Payroll Costs
  • Payroll costs are generally incurred on the day the employee’s pay is earned. Employee pay is generally “earned” on the day the employee worked. For employees who are on the payroll but not working, the payroll costs are incurred on the schedule established by the borrower (typically the day the employee would have worked).
  • Only borrowers with a payroll cycle that is bi-weekly or more frequent may use the alternative covered payroll period. That is, the eight-week period that begins on the first day of the first payroll period beginning after receipt of the loan proceeds.
  • Bonuses or hazard pay paid to employees during the covered period are permissible payroll costs (subject to the annualized cap of $100,000 per employee, or $15,385/employee).
  • Owner-employees and self-employed individuals’ forgivable payroll compensation can be no more than eight weeks of their 2019 compensation or $15,385 per individual in total across all businesses. And no additional forgiveness is provided for retirement or health insurance contributions for self-employed individuals, including Schedule C filers and general partners, because such expenses are paid out of their net self-employment income.
  • Owner employees’ loan forgiveness request is capped by the amount of 2019 employee cash compensation and employer retirement and healthcare contributions made on their behalf.
  • Schedule C filers’ loan forgiveness is capped by the amount of their owner compensation replacement, calculated based on 2019 net profit. 
  • General partners’ loan forgiveness is capped by the amount of their 2019 net earnings from self-employment (reduced by claimed section 179 expense deduction, unreimbursed partnership expenses, and depletion from oil and gas properties) multiplied by .9235. 
Nonpayroll Costs
  • Nonpayroll costs are eligible for forgiveness if paid during the covered period or, incurred during the covered period and paid on or before the next regular billing date, even if the billing date is after the covered period.
  • The SBA’s example relates to a borrower who has a covered period of June 1 - July 26. According to the SBA, the borrower pays its May and June utility bill during the covered period and should be forgiven. The SBA also allows the borrower to be forgiven for the portion of its July utility bill (through July 26) because it was incurred during the covered period and paid on the next regular billing date after the covered period.
  • Advance payments of interest on a covered mortgage obligation are not eligible for loan forgiveness.  
Questions? Contact Jeff Shanton at  jshanton@jssurgctr.com