The KOA remains committed to sharing as many resources and information with you as possible during these unprecedented times. To the right is a list of helpful resources you may wish to utilize for yourself, your staff and/or your patients.
We know you are faced with a variety of issues. If you need a quick answer or reference to information, submit your question HERE for a response within 24-hours.
Center for Disease Control (CDC): www.cdc.gov – Direct link to helpful resources for health care facilities and providers.
AOA COVID-19 Information: www.aoa.org – Go here to see updated guidance on how to comply with the CDC’s recent recommendation, as well as other valuable information for your practice.
OSHA Guidelines for Office: www.osha.gov
- This resource sets out the compliance regulations, as well as steps to take to educate your employees on expected behavior.
KY COVID-19 Information: kycovid19.ky.gov – Comprehensive site for all action taken and resources available. This is THE primary site to visit for ALL Kentucky COVID-19 information.
Governor Beshear’s Orders: governor.ky.gov – Go to this link for a comprehensive list and summary of all Orders issued by Governor Beshear. These orders will summarize efforts that have been made to protect Kentucky citizens – as well as compliance directives.
CARES Relief – 7(a) PPP Loans
The Paycheck Protection Program prioritizes millions of Americans employed by small businesses by authorizing up to $349 billion toward job retention and certain other expenses.
Small businesses and eligible nonprofit organizations, Veterans organizations, and Tribal businesses described in the Small Business Act, as well as individuals who are self-employed or are independent contractors, are eligible if they also meet program size standards.
For a Broad Summary of the Program CLICK HERE
For Borrowing Information go HERE
The PPP Loan Application is available HERE
For complete information from SBA go HERE
As you continue to determine your next steps, you are HIGHLY encouraged to take the 1.5 hours to view the attached webinar here:
This comprehensive webinar was provided by the AOA on March 31st – and is a tremendous resource. It summarizes Phases 2 and 3 of the federal COVID-19 relief (Phase 1 was covered in a separate webinar). SBA 7(a) PPP loans, unemployment benefits and employee leave are covered in great detail. Although key points are set out below for you in this email, you are urged to view the webinar in its entirety.
CARES 7(a) loans (SBA Payroll Protection Program): (See Webinar, starting at 1:00:50)
- All small businesses are eligible to apply if in existence on February 15th – this includes S-Corp, C-Corp, LLC, sole proprietor, 1099, 501(c)(3), etc.
- Banks will begin processing on April 3, 2020 – the deadline to file is June 30, 2020.
- Loan amount is 2.5x average monthly payroll costs.
- 7(a) loans are eligible to be forgiven – but funds must be used for the purposes they are provided.
- There are no fees to apply for the loans.
- Loans are administered by approved lender banks. Not all banks are approved lender banks.
- The funds received are designed to “keep the lights on” for a 2 month period – and importantly – keep your employees on the payroll. Funds are quickly received.
- Loan recipients have 8 weeks to spend the funds received on eligible expenses.
OTHER THINGS TO KNOW ABOUT 7(a) LOANS:
- 7(a) loan funds can be spent on the following: Wages, salaries (including paid leave time), sent, mortgage (interest only), utilities, health premiums (employer portion), and any interest on debt incurred before February 15th.
- Keep in mind the nature of the loan – to protect payroll. Only 25% of the funds may go to non-payroll expenses during the 8 week period – or it will lose forgiveness.
- Other ways to lose forgiveness of the loan: Using the loan money beyond the 8 weeks, using the loan money for unapproved expenses, using less than 25% on non-payroll expenses, losing the number of Full-Time Equivalent staff (from time approved from the loan and at the end of 8 week loan period), or paying employees less (compares amount paid during loan period vs. certain payroll in 2019).
- The timing of when it is best for YOU to apply for the loan will vary. View the webinar at 1:22:19 to hear great discussion on this. For example, if you have already reduced your employees, you may want to bring them back and then apply for the loan. There is no right or wrong time to apply – the bottom line is that everyone should get the CARES 7(a) loan.
- TIP: Ask your bank if they are an approved lender – and then ask if they are in “preferred lender” status. Applications from preferred lenders will be processed first.
- KY Chamber of Commerce has encouraged small businesses to immediately start compiling information about financial impact from COVID-19 in 2020.
Telehealth Care is Encouraged with Relaxed Requirements:
To the extent possible, all providers are asked to provide health services via telehealth during the declared COVID-19 emergency.
Kentucky’s Department of Insurance has further held that no insurer can require that the patient have a personal relationship with a provider in order to have services delivered by telehealth: DOI Guidance
KY Department of Medicaid Services (DMS) has taken significant steps to make telehealth services more available to the Medicaid population during this time of emergency. DMS will interpret all regulations, executive orders and provider letters as broadly as possible to allow for the most telehealth if safely delivered.
For recently released provider FAQs, please go here: Medicaid Telehealth Provider FAQs
- During this public health emergency, federal and state government have relaxed enforcement of HIPAA for certain technology applications, when used for the “good faith provision” of telehealth. These include, FaceTime, Facebook Messenger video chat, Google Hangouts video and Skype.
- Medicaid MCOs are required to follow the Medicaid telehealth guidelines.
- Coding: DMS has issued specific guidance for vision services. When using POS (Place of Service) 02, appropriate providers may bill using codes 92002, 92012, 92004 and 92014.
The AOA hosted an incredibly helpful webinar on March 16th outlining available Medicare telehealth services and how these services should be coded.
- To view the entire webinar, please go here: Webinar
- To view the webinar documents, please go here: Webinar Handouts
Medicare has already reduced some requirements in order to make telehealth services more accessible. For example, doctors of optometry are permitted to use “everyday communications technologies” – such as FaceTime or Skype – during this declared emergency. Also – Medicare patients from all areas – not just rural areas – qualify for telehealth services.
The codes for telemedicine are the same as the codes for in-person visits because the services that you’re providing should be identical. Bill your office visit code as usual, then add the CPT -95 modifier. You will also change the Place of Service code from 11 (office) to 02 (telemedicine).
Keep in mind:
- 99xxx codes are eligible: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
- 92xxx codes are NOT eligible: 92002, 92012, 92004, 92014
- If you encounter specific billing questions, email your questions to: https://aoa.org/ask-the-coding-experts
For those who offer telehealth services, please remember that VSP covers certain telehealth services under our PEC and DEP Plus plans that may help you provide essential eye care services to patients in the days and weeks ahead. You can access this information in the Provider Reference Manual on VSPOnline. Doctors must log in to Eyefinity to get the telehealth codes covered by PEC and DEP Plus.
Specific services that CMS is allowing to be performed via telemedicine during the coronavirus emergency are not covered services under EyeMed’s routine vision benefits. The services involved are covered under several full eyecare carve out programs that we administer (medical/surgical care in addition to routine vision care), but at present none of those programs are active in Kentucky. EyeMed will communicate to providers who participate in those plans.
Available In-Person Optometric Services
In-Person Care You Determine is Urgent, Emergent or Essential:
The Kentucky Board of Optometric Examiners urges all optometrists to adhere to the CDC guidelines and you should “postpone all routine eye care visits.” See here: KBOE Advisory
This does not mean all optometric services must stop. What constitutes “urgent” and/or “essential” care is determined by your professional judgment, and should always take into account individual patient medical and social circumstances.
Kentucky doctors of optometry are recognized as serving in essential health care roles – and provide essential health care to vulnerable citizens. It remains within your professional judgment and discretion on how best to operate an individual office or clinic. If possible, remaining available to provide care can help those patients needing urgent and/or essential care – which will also be a great benefit to our local hospital emergency rooms otherwise limited to treat eye emergencies at this time.
If remaining open to provide essential care, review and keep these practices in mind:
If you need to provide any medically necessary medical equipment to your patients (such as glasses or contacts), you should make EVERY EFFORT to use delivery or curbside assistance. Every effort should be made to minimize the individuals coming in and out of your office.
Financial Assistance Information
With the passage of the CARES Relief Act, the federal government is providing additional unemployment benefits in excess of what state governments provide. Below is information regarding Kentucky’s unemployment benefits and additional information on the federal relief now provided.
During this time, Governor Beshear has made multiple changes to the state unemployment program in order to provide more relief for Kentuckians. Some of these changes include:
- Individuals are eligible to receive benefits for a reduction in wages (a “total” loss of income is not required);
- There is no waiting requirement before – so individuals can have quicker access to these funds;
- Eligibility has been expanded to individuals typically not eligible for unemployment insurance, including self-employed, independent contractors, freelance workers, substitute teachers, childcare workers employed by religious affiliated organizations and non-profits; and
- there is no longer a equirement that a person keeps looking for other employment opportunities while receiving the benefits.
To apply, individuals should go to Kentucky Career Center’s site: https://kcc.ky.gov/career/Pages/default.aspx
Applicants may also call (502) 875-0442.
Due to the increased number of applicants over the past couple of weeks, applicants are asked to apply on the day corresponding with the first letter of the applicant’s last name.
See application schedule below:
Friday: V-Z and if you missed your day
Not everyone will qualify for these benefits, and the amount received is often based on the applicant’s average pay. The Kentucky Center for Economic Policy says this usually comes out to about 45% of a person’s lost wages.
If you have questions as an employer, here is a helpful Employer Guide to review: GUIDE
CARES Relief – Federal Unemployment:
The recently passed CARES Relief provides an additional $600 per week from the federal government, in addition to the state benefits received. Listed below are some other key points:
- All employees are eligible – full-time, part-time, self-employed, sole proprietors, OD owners, associates, etc.
- Unemployment benefits are triggered for usual reasons (laid off, reduced hours, etc.). The CARES Act also triggers the federal unemployment benefits for many other reasons due to COVID-19, such as if the employee or a member of the household has been diagnosed with COVID-19, if the employee has symptoms and is seeking medical care, if employee has suddenly become the breadwinner of the household, etc.
- All unemployment claims should be submitted here: https://kcc.ky.gov/Pages/default.aspx
- An individual is not eligible for unemployment benefits if they can work via telework or they are getting paid sick leave.
- An individual must be willing to return to work in order to receive unemployment benefits. If an employee does not want to return to work (in some cases they may actually be earning more through their unemployment benefits) – they are ineligible to continue receiving unemployment benefits.
For additional information, you are encouraged to view the helpful webinar conducted by the AOA: WEBINAR
Refundable Payroll Tax Credits:
The U.S. Treasury Department, Internal Revenue Service and the U.S. Department of Labor announced that small and midsize employers can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.
This relief to employees and small and midsize businesses is provided under the Families First Coronavirus Response Act, signed by President Trump on March 18, 2020.
The act will help the United States combat and defeat COVID-19 by giving all American businesses with fewer than 500 employees funds to provide employees with paid leave, either for the employee’s own health needs or to care for family members.
The legislation will enable employers to keep their workers on their payrolls, while at the same time ensuring that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus.
Things to know:
- Employees are eligible for paid leave in certain circumstances.
- Employers receive 100% reimbursement for paid leave pursuant to this Act. Employers face no payroll tax liability, and self-employed individuals receive an equivalent credit. Health insurance costs are also included in the credit.
- Funds should be fast – reimbursement will be quick and easy to obtain. An immediate dollar-for-dollar tax offset against payroll taxes will be provided. When a refund is owed, the IRS will send the refund as quickly as possible.
- If an employer has less than 50 employees, they may be eligible for an exemption.
- Requirements are subject to a 30 day non-enforcement period for good faith compliance efforts.
For more information, view the Department of Labor’s release here: DOL Release
The IRS has complete information on all Tax Relief available here: IRS Page
Small Business Administration Emergency Loans:
The U.S. Small Business Administration (SBA) has increased access to targeted, low-interest loans for impacted businesses in light of COVID-19. These Economic Disaster Loans offer up to $2 million in assistance for a small business that has been severely impacted by the situation.
On March 20, 2020, Kentucky received its SBA Declaration that practices in all Kentucky counties (and many bordering counties) can qualify for an Economic Disaster Loan.
For a Fact Sheet on loans available in Kentucky, go HERE.
The deadline to file for this loan is December 21, 2020. These loans can help pay fixed debts, payroll, accounts payable and other bills that a business otherwise cannot pay due to the state of emergency. The interest rate is 3.75% for small businesses without credit available elsewhere; businesses with credit available elsewhere are not eligible. The interest rate for non-profits is 2.75%.
For comprehensive information, go to the SBA website: https://disasterloan.sba.gov/ela/
We understand this may be a complicated process, and the KOA is working with the AOA to determine additional resources that can be provided during the application process. The AOA is also pursuing additional SBA relief for health care providers. The KOA will continue to update you with this information.
Federal Student Loans:
Federally held student loans will automatically remain at a 0% interest rate at least 60 days. Additionally, there is an option to suspend payments for at least 2 months – to allow an individual to stop payments without worrying about interest.
Federal and State Tax Deadline Moved:
The filing and payment deadline for both Federal and Kentucky taxes has been moved to July 15, 2020.
- See Governor Beshear’s action moving Kentucky’s tax deadline consistent with the federal deadline: https://kentucky.gov/Pages/Activity-stream.aspx?n=GovernorBeshear&prId=99
- For tax guidance for optometrists, helpful information is available from Covalent Careers here: OD Tax Guidance
Resources available include personal loans, potential lines of credit and options for supply disruption.
Go to the site to review the resources available to you if you are already an AOAExcel member – or for information on how to sign up for these benefits.
Advanced Medicare Payments
UPDATE: CMS announced recently it was suspending the acceptance of any new applications for the Advanced Payment Program. For additional information about various forms of relief from HHS, please go here: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html
CMS has taken action which will accelerate Medicare payments you can receive due to the effects of the COVID-19 pandemic. These advanced payments may help your immediate cash flow.
Practices can apply now to their Medicare Administrative Contractors (MACs) to receive 100% of their Medicare payment amount for a 3-month period based on historical payments. MACs will issue the advanced payments within 7 days. Recoupment of these advance payments will begin 120 days after the accelerated payment is made.
See below for important information:
According to CMS, to qualify for the payments, the provider or supplier 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 overpayments.
To apply, practices must obtain an accelerated advance payment request form from their MAC’s website. CMS also has COVID-19 hotlines at each MAC to help with the requests.
- Kentucky’s Medicare Contractor is CGS Administrators, LLC – download the advance request payment form here: https://cgsmedicare.com/jb/index.html
- CGS Hotline: 1-855-769-9920; 7:00 am – 4:00 pm CT
We encourage you to visit the ThinkHR website, which routinely updates COVID-19 guidance and resources to apply within your offices. Over 2,000 questions have been compiled and answered in the FAQs. Additionally, webinars on specific HR topics will be frequently provided.
The AOA has updated information on its website on the new Sick Leave and FMLA leave relating to COVID-19. You are encouraged to go HERE.
Coronavirus-related Leave for Employees:
Effective April 2, 2020 – December 31, 2020, there are two new types of Coronavirus-related Leave for employees. These changes impact all employers who employ less than 500 employees.
- Full-time employees are entitled to 80 hours of paid sick time if they are personally affected by COVID-19. There are specific requirements that must be met, and the employee must not be able to telework. Part-time employees are also eligible for a certain number of paid sick time based on average number of hours they work. This additional sick time is in addition to any other benefits the employer has in place.
- FMLA is also extended if someone is long-term affected. An employee can take up to 12 weeks with 2/3 salary pay if certain requirements are met. As is the case with regular FMLA extended leave, certain things must exist in order for an employee to qualify for this extended leave.
IMPORTANT THINGS TO KEEP IN MIND:
- It is important that you familiarize yourself with the details of these changes. The AOA has helpful information, FAQs and webinar details at their site: AOA COVID-19 Leave Info
- Here is a good summary of the changes to review: https://www.wnj.com/Publications/HR-6201-–-Updated-COVID-19-Leave-Law-Signed-by-Pre
- You should handle these issues the same way you handle other sick leave situations, and consult your attorney or HR expert.
- If you are an employer of less than 50 employees, there is an ability to request an exemption. This is a specific exemption request that must be federally approved.
- IMPORTANTLY – An employer can recover what is paid with refundable payroll taxes: https://www.dol.gov/newsroom/releases/osec/osec20200320
The KOA remains committed to being a dedicated resource to its members during this time. We recognize you are being overwhelmed with updates and information from various sources. Feel free to submit your coronavirus questions directly below and we will respond within 24-hours. To the extent possible, we will provide the answer or at least point you to the best resource to review for your specific issue.
Click here to submit questions!
Optometric services were included within Phase 1 of Kentucky’s reopening of healthcare facilities. The gradual and phased return began April 27, 2020.
Governor Beshear issued a directive on April 27, 2020 which outlines the standards to which all healthcare providers must adhere. View the directive here: April 27 Directive
- The directive clarifies that prior orders which required optometrists to postpone routine, non-urgent vision care no longer apply.
- The Guidelines for Kentucky Optometrists are consistent with Governor Beshear’s directive.
The KY Department of Public Health issued Return Work Guidance for Healthcare Providers. This is a helpful resource on how to manage your office and staff if there is potential exposure or confirmed cases of COVID-19.
The KOA will continue to keep you updated as changes may occur.
RESOURCES FOR PERSONAL PROTECTIVE EQUIPMENT (PPE)
The KOA has compiled the following list of potential resources for PPE. We will continue to update this information as resources become available. Supply levels for PPE change often – some sources below may have equipment immediately available, others may not. We recommend checking these sources routinely, after utilizing your normal resources for PPE.
This is not an endorsement of any company or product, and the KOA is not attesting these resources meet CDC or Kentucky Department of Public Health requirements. Offices are responsible for the appropriate use and adherence to all PPE requirements.
For your reference, the following resources may prove helpful as you purchase and utilize PPE:
CDC Resource on Reduced Availability of PPE:
CMS Guidance on Reopening and Use of PPE:
FDA Resource Outlining Types of PPE:
Disinfecting Guidance: Zeiss issued some helpful information on cleaning and disinfecting their devices.
OSHA Coronavirus Protocols:
CDC: Cleaning and Disinfecting Your Facility:
The KOA would like to assist you as much as possible during this time. Please contact the KOA if your office does not have any PPE. As resources become available, we will strive to make them available for you.
Please send your request for PPE to the following link: kyeyes.org/contact
N95 masks, surgical masks, shields, gloves – https://ncppe.com/shop/
Premier Ophthalmic Services:
Surgical masks, equipment shields, face shields – https://premierop.com/prevent-cross-infection/
ODs United Supplies:
KN95 masks, thermometers, safety goggles, hand sanitizer – https://supplies.odsunited.com/
Bluegrass Cut and Sew:
100% cotton masks and gowns sewn in Kentucky: Email Stacey@bluegrasscutandsew.com or call 606-706-3976.
Custom PPE from Deluxe Corporation:
Masks, gloves, shields and customizable PPE: https://www.deluxe.com/products/promotional/workplace-safety/
N95 face masks and other shields – www.rochesteroptical.com/covid-response/Luxottica:
“Medical grade masks” can be requested by practices with an Essilor account by emailing: firstname.lastname@example.org
Masks, shields, hand sanitizer, safety kits – https://www.odmdsafety.com/
Town & Country Pharmacy:
KN95 masks, surgical masks, gloves and gowns – Call 270-407-3434.
Face Shields: https://xodusmedical.com/FaceShield
Phoropter Breath Shields:
Disposable Face Mask:
KN95 Masks, Disposable Masks, etc.: https://disposable-face-mask.life/
KN95 masks: www.snowjoe.com
Surgical-type masks: wyze.com
Namify: 3-ply protective face masks
Masks, cleaning supplies, and hand sanitizer inventory:
iHealthLabs: infrared No-Touch forehead thermometer
ODs United Supplies: infrared No-Touch forehead thermometer
VSP: Comprehensive list of gloves, sanitizer, etc.
SN Optical (Stormin Normans):
SmartPractice: germicidal wipes
SNEEZE GUARDS FOR OPTICAL AND STAFF:
Sneeze guards, face shields – https://www.isgonlinestore.com/
SLIT LAMP BREATH SHIELDS:
Marco is offering free breath shields for customers with Marco slit lamps:
Zeiss: Free Breath Shield
Topcon: Offering free breath shields that work with Topcon slit lamps
Haag-Streit: no more free shields, but some for purchase:
SUBMIT REQUESTS FOR PPE:
Requests for hand sanitizer by KY Distillers:
Requests for equipment by health care providers:
Long-term PPE Resources from AOAExcel:
The urgent nationwide shortage of supplies of PPE for frontline, essential care providers, including doctors of optometry, is placing America’s health care workforce and the public at further risk. The AOA is among the leading national health care organizations actively urging the president, congress and equipment suppliers to immediately focus on and fix this dire situation.
DURING THE NATIONWIDE SHORTAGE: Due to the efforts of states, localities and public health organizations, and through federal prioritization and targeting efforts, PPE supplies are being directed to outbreak hotspots and potential future hotspots. Doctors are advised to explore current availability of quality PPE through state and local agencies as well as other
immediate term sources.
NEXT STEPS FOR SECURING PPE FOR OPTOMETRY PRACTICES: Looking beyond the current nationwide shortage, AOA doctors are advised that AOAExcel’s (www.ExcelOD.com) exclusive group purchasing organization (GPO) partner, Intalere, is positioned to gain assured, long-term access to steady supplies of hospital-grade, quality controlled PPE at competitive pricing. This is an AOA member benefit.
• For doctors/practices already enrolled in AOAExcel’s GPO program: You may directly contact Intalere’s Operational Continuity & Emergency Management team at 877-711-5600 for the latest information on PPE availability and access. (Intalere member number is required. If not known, it can be accessed by contacting the AOAExcel team at email@example.com).
• For doctors/practices not yet enrolled in AOAExcel’s GPO program: Click here to provide basic registration information. The enrollment process will be completed within four business days. To get started or for other assistance, contact the AOAExcel team at firstname.lastname@example.org.