COVID-19 Practice Management – Federal Stimulus Package Summary

On Wednesday, March 25, 2020, the U.S. Senate unanimously adopted a $2.2 trillion bipartisan agreement to address the needs of the American people and health care providers confronting the coronavirus pandemic. The House passed the stimulus package on Friday, March 27, 2020, and it was later signed by the President. It is the biggest economic rescue package in U.S. history. CMA aggressively advocated for additional financial assistance for physician practices, and increased funding for public health and the production of personal protective equipment.

This comprehensive package provides new resources to address all aspects of the COVID-19 pandemic:

  • More than $150 billion to help strained state governments combat the pandemic;
  • $100 billion in direct funding for hospitals and physicians on the front lines;
  • 2% Medicare physician payment increase;
  • $377 billion in support to small businesses, including low-interest and forgivable loans and grants for small businesses (less than 500 employees), including physician practices;
  • Tax credits and assistance for small businesses and physician practices;
  • Additional telehealth funding and coverage;
  • Funding to spur the production and distribution of more personal protective equipment, medical equipment, testing kits and related supplies;
  • Support for law enforcement, firefighters, and first responders;
  • Funding for public health and scientific research for COVID-19 treatments and vaccines;
  • Support for both small businesses and large industries impacted by the crisis;
  • Assistance for schools and universities and at-home learning technology; and
  • Funding for social services including nutrition programs, more child care, affordable housing and programs that assist the homeless.

To view the full CMA press release, click here. To view the full AMA press release, click here . The ACCMA has highlighted aspects of the stimulus package that may be helpful to your practice and will continue to look into the mechanics of how a physician can utilize aspects of the stimulus package:  
Medicare Accelerated and Advance Physician Payments

The Centers for Medicare & Medicaid Services (CMS) on March 28, 2020, announced an expansion of its accelerated and advance payment program for participating Medicare physicians and hospitals. This
expansion is intended to lessen the financial hardship of providers facing extraordinary challenges
related to the COVID-19 pandemic and help with cash flow problems that many physician practices are
experiencing. To qualify for accelerated or advance payments, the physician must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form;
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation; and
  • Not have any outstanding delinquent Medicare over-payments.

Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately.

California physicians should submit a request to Noridian, California's Medicare contractor . Physicians can request 100% of their historical Medicare payment amount for a three-month period. CMS anticipates that the payments will be issued within seven days of the provider’s request. Repayment of the advance payments are due 120 days after the issuance of the advance payment. Physicians have 210 days from the issuance of the advance payment to repay the entire balance due to CMS.

For more information, see the CMS fact sheet on the application process.
New Paycheck Protection Program

The federal economic relief law includes nearly $350 billion in funding to create a Paycheck Protection
Program (PPP) that will provide small businesses and other entities with zero-fee loans of up to
$10 million. Up to 8 weeks of average payroll and other costs will be forgiven if the business retains its
employees and their salary levels. Principal and interest are deferred for up to a year and all borrower
fees are waived. This temporary emergency assistance through the Small Business Administration
(SBA) and the Department of Treasury can be used in coordination with other COVID-financing
assistance established in the bill or any other existing SBA loan program. The bill requires the SBA
Administrator to set a cap on how much a bank can earn to process loan applications and prioritize
under-served borrowers, including those in rural communities, minorities, women and veterans.
Economic Injury Disaster Loan Program and New Grant

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.

The federal economic relief law includes $10 billion in grant funding to provide an advance of $10,000 to
small businesses and nonprofits that apply for an SBA economic injury disaster loan (EIDL) within three days of applying for the loan. 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 4 years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll and other operating expenses. The new $10,000 EIDL grant does not need to be repaid, even if the grantee is subsequently denied an EIDL, and may be used to provide paid sick leave to employees, maintaining payroll, meet increased production costs due to supply chain disruptions, or pay business obligations, including debts, rent and mortgage payments. 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.

A business that receives an EIDL between January 31, 2020, and June 30, 2020, as a result of a COVID-19 disaster declaration is eligible to apply for a PPP loan or the business may refinance their EIDL into a PPP loan. In either case, the emergency EIDL grant award of up to $10,000 would be subtracted from the amount forgiven in the payroll protection plan. To apply for a COVID-19 Economic Injury Disaster Loan, click here .
Express Bridge Loans

Express Bridge Loan Pilot Program allows small businesses who currently have a business relationship
with an SBA Express Lender to access up to $25,000 with less paperwork. These loans can provide vital
economic support to help small businesses overcome the temporary loss of revenue and can be term
loans or used to bridge the gap while applying for a direct SBA Economic Injury Disaster loan. If a small
business has an urgent need for cash while waiting for decision and disbursement on Economic Injury
Disaster Loan, they may qualify for an SBA Express Disaster Bridge Loan.
Financial Assistance Resources

AMA Tips for Keeping Your Practice in Business During the COVID-19 Pandemic:
Physician practices managing patients during the COVID-19 pandemic are confronting new and unique operational and business challenges. This checklist provides high level guidance for practice owners and administrators. Check out the AMA COVID-19 checklist to stay up to date.


Webinar on Financial Assistance Available to Practices (Tuesday, March 31 from 12:15 - 1:15 PM)
This webinar will provide a layout out of financial assistance programs available to physician practices and small businesses, offered by both the federal government and the State of California. These programs are intended to help practices maintain their financial viability while dealing with the influx of patients into their offices and the moratorium of non-essential procedures due to the COVID-19 pandemic. CMA staff will direct physicians to specific resources they can take advantage of during this crisis. To register please click here . 
Questions/Concerns?  

Please contact ACCMA and 510-654-5383 or  [email protected]   with any questions or concerns you have. Although we may not currently have an immediate answer to all questions, we want to know the information and resources that you need to continue to provide care for our community during this difficult time.  
 
This information will also be posted online at  www.accma.org/COVID-19 and will be updated frequently. Please check the ACCMA website regularly for updates.