COVID-19 RESOURCES

Welcome to the COVID-19 Resources.

Please utilize this page for the most up-to-date information regarding all things COVID-19. The NCCA has been providing important information to all NC chiropractors from the very beginning of the pandemic. Since information and guidelines change we are currently auditing this page and the FAQ for relevant and consistent information. Please contact Heather Wrenn directly with any questions at heatherw@ncchiro.org.

NCCA Members can also join the NCCA Facebook Forum to connect with your colleagues and get advice on the most pressing issues. In order to access the group, please make sure you are logged into your Facebook account. The URL will take you to the Group page, where you will see an "Ask to Join Group" button. Click it, and an admin will verify your NCCA membership and approve.

For more information please click here to view the Google Doc.

Things You Should Know

Payroll Tax Deferral

On August 8, 2020, President Donald Trump signed an executive memo directing the U.S. Department of the Treasury to defer certain payroll tax obligations amid the ongoing COVID-19 pandemic. On August 28, the Treasury & IRS issued Notice 2020-65 with further guidance to employers on how to implement this payroll tax deferral. Any employer required to withhold and pay the employee share of Social Security tax is deemed to be affected by the COVID-19 pandemic and may take advantage of this executive order. It appears employers have discretion (even on an employee-by-employee basis) on whether to stop withholding starting September 1, 2020.

Please click here to see pros and cons of tax deferral from QuarterMaster Tax Management.

North Carolina Financial Resources

Did you know there are grants available for businesses that did not get PPP? Check out this and other grants at www.nccommerce.com

North Carolina Pauses in Safer At Home Phase 2, Adds Statewide Requirement for Face Coverings

Governor Roy Cooper and North Carolina Department of Health and Human Services Secretary Dr. Mandy Cohen today announced that North Carolina will remain in Safer at Home Phase 2 for three more weeks. Cooper also announced that face coverings must be worn when people are in public places as officials seek to stabilize concerning trends of increasing viral spread.

The NC Board of Chiropractic Examiners, in the pursuit of its mission to protect the public, also expects every North Carolina licensed chiropractic physician to maintain a standard of practice consistent with best practices.Click here to view their official position.

Does a Doctor of Chiropractic or Chiropractic Staff Need to Quarantine Due to Notice That a Patient Has Tested Positive for COVID-19 ?

Whether a quarantine is necessary depends on factors such as length of exposure, proximity, and presence of face covering. If the patient diagnosed with covid and the health care provider were both wearing face masks then there are no work restrictions. Click here for more details from CDC.

Advertising & Marketing

Use care in advertising at this time and refrain from making claims that are not substantiated by peer-reviewed, empirical evidence about COVID-19.

The NCCA has created various graphics that you can post to your Social Media pages. If you have any questions, contact sasha@ncchiro.org. Click here to access the Google Folder.

Resources for COVID-19

Please utilize these dropdowns to get access to the related information. Please note, information below is subject to change.

Telehealth

Telehealth is now being encouraged by most county and state leaders as a way to decrease exposure of patients and spread of COVID-19. While telehealth is relatively new to chiropractic and treatment options are somewhat limited, nonetheless, telehealth provides a way for providers to provide care to their patients and to generate revenue. HNS has added a new section to their website to provide important information regarding telehealth visits for BCBS & Cigna. It will be updated as new information is obtained. If you have questions regarding telehealth visits, please first review all the information provided. Items included on their page include a FAQ, telehealth informed consent, guidance/requirements, documentation and NCMIC on telemedicine.

COVID-19 Compliance Manual Template

This document in no way should be considered legal or malpractice advice. This was shared by another doctor and ChiroFutures to use as a template. This manual very well may be incomplete and is only a part of what needs to be done to keep your office safe and compliant with CDC and health department standards. Modify and personalize this manual as needed to suit your individual practice as well as state and local laws. Please read the first page of this manual before usage.

Microsoft Word Template. You will need to copy/paste it to personalize.

Checklist for DCs on COVID-19

It seems like there is constantly something doctors are supposed to be doing when it comes to COVID-19. ChiroCongress heard the request from multiple states and developed a checklist for doctors to utilize as a resource.

Click here to view the document.

Families First Coronavirus Response Act

The “Families First” law is federal and applies to all employers of 500 or fewer, so the information pertaining to employee leave under Families First will apply to most, if not all, of our doctors. Here is a summary from the Scott Benefit Services regarding Families First.

Click To Read the Summary

Webinar: COVID-19 What Employers Need to Know About the Families First Coronavirus Response Act

Prepare to Care for COVID-19: Get Your Practice Ready

CDC’s Prepare to Care for COVID-19 is a resource with practical tools clinicians can use to care for patients with COVID-19, and will be regularly updated to help clinicians adapt as the outbreak unfolds.

Newly Released DOL Poster

The Department of Labor has released a new poster outlining employees rights under the new Families First Coronavirus Response Act. Employers are required to post this notice in a conspicuous place where it can be viewed by all employees and applicants.

Have You Complied with the FFCRA April 1st Posting Deadline?

As of April 1, 2020, covered employees, which includes offices of less than 500 employees, are required to provide their employees notice of the COVID-19 paid leave laws under the Families First Coronavirus Response Act (which includes the Emergency Paid Leave Act and the Emergency Family and Medical Leave Expansion Act). Employers of health care providers may be excluded from the paid leave requirements of the Acts at the employer’s discretion, but, you are not exempt from the notice requirements.CLick here for summary.

Claiming an Exemption? Click here for the Sample Notice.

If you are choosing to treat an employee under the FFCRA (providing them paid leave under the Act), you may post the Notice provided by the Department of Labor.

Use of Cloth Face Coverings to Slow the Spread of COVID-19

The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

Malpractice & Insurance

If you have questions regarding malpractice, please refer to NCMIC resources. To discuss malpractice issues involving the virus, please contact your malpractice carrier and speak to someone in claims.

What are you doing to prepare for interruption of income? Start contacting your insurance providers for conversations regarding your insurance and what it covers in case of business closure, economic hardship, etc.

HIPAA & COVID-19 Impact

The Office for Civil Rights (OCR) has been very active this past month, going above and beyond to help mitigate the risk COVID-19 poses to public health privacy. Certain HIPAA regulations were updated in March to allow for health care practices to better work with patients in need of healthcare services as well as providing guidance on how to best disclose PHI without risk of a data breach. View these resources for the HIPAA related updates.

Advertising & Marketing

Use care in advertising at this time and refrain from making claims that are not substantiated by peer-reviewed, empirical evidence about COVID-19.

The NCCA has created various graphics that you can post to your Social Media pages. If you have any questions, contact sasha@ncchiro.org. Click here to access the Google Folder.

The Latest Guidance for Employers

How are you talking to your patients about COVID-19?

Misinformation and fear can result in bad decisions. Make sure you are up to date on facts and have the ability to dispel myths. Assure patients that your office has done all the necessary things to maintain cleanliness and hygiene. Focus on what patients can control and will help today and everyday, regardless of coronavirus, that can keep them healthy. These items include improving one's overall health with a good diet, adequate sleep, hydration, exercise, washing hands and of course regular chiropractic care. As doctors you need to reach your patients and assure them before they cancel appointments or do not make appointments.

Helpful Patient Information

Helpful Webinar Recordings

Reopen Guide by NCMIC

This guide is meant to be a tool box, intended to give you a starting framework you can apply and customize to your specific situation, to provoke some thought and possibly highlight ideas or opportunities you hadn’t thought of yet.

Updated CDC Reopening Guidance for Cleaning and Disinfecting

This plan is part of the larger United States Government plan and focuses on cleaning and disinfecting public spaces, workplaces, businesses, schools, and can also be applied to your home.Click here for more information.

Screening Documentation

Patient Screening Template

Employee Screening Template

Donning and Doffing PPE

Wearing PPE is paramount - but it's also important to know how to properly put it on (don) and take it off (doff) to reduce contamination.Click hereto learn more.

Reopening Guidance from attornies at Manning Fulton:

Hiring During COVID-19: An Employer’s Guide

To adapt to the changing environment created by COVID-19, employers who need to hire new employees right now may need to reevaluate their traditional hiring practices. How you interview, screen and onboard new hires may be different during a pandemic. Here are some answers to frequently asked questions about hiring in the age of COVID-19.Click here to learn more.

Q&A Regarding PPP Forgiveness From the Department of Treasury (May 4th, 2020)

Question: Will a borrower's PPP loan forgiveness amount (pursuant to section 1106 of the CARES Act and SBA's implementing rules and guidance) be reduced if the borrower laid off an employee, offered to rehire the same employee, but the employee declined the offer?

Answer: No. As an exercise of the Administrator's and the Secretary's authority under Section 1106(d)(6) of the CARES Act to prescribe regulations granting de minimus exemptions from the Act's limits on loan forgiveness, SBA and Treasury intend to issue an interim final rule excluding laid-off employees whom the borrower offered to rehire (for the same salary/wages and the same number of hours) from the CARES Act's loan forgiveness reduction calculation. The interim final rule will specify that, to qualify for this exception, the borrower must have made a good faith, written offer of rehire, and the employee's rejection of that offer must be documented by the borrower. Employees and employers should be aware that employees who reject offers of re-employment may forfeit eligibility for continued unemployment compensation.

COVID-19 Practice Recovery Resource Center by BTC

Breakthrough Coaching has created several resources to help you navigate the financial considerations resulting from the COVID-19 pandemic and speed your recovery from its impact. Get your tools here.

Employer and Employee Rights About Returning to Work During the Pandemic - Fear and Coronavirus (April 29, 2020)

COVID-19 has raised questions from both employers and employees about whether and under what circumstances an employer may force an employee to return to the workplace, even when the employee has expressed fear about being exposed to the virus. May an employer terminate an employee who refuses to return due to fear of becoming infected? Does an employee who fears to contract the virus have a right to work off-site during the pandemic? The answers are not always obvious and will require the parties to thoughtfully evaluate the facts of each situation. Click here to read more.

Small Business Economic Injury Disaster Loan Program

In response to the crisis, Congress enacted the CARES ACT (Coronavirus Aid, Relief and Economic and Security) which includes several provisions offering relief to small businesses. Click here to read a summary of the ACT. Unlike the disaster loans that are typically available through the Small Business Association (SBA), these loans are potentially forgivable up to 100% of the principal amount borrowed. They are also not tied directly to establishing losses suffered during a disaster - there is a presumption of negative impact from COVID-19.

SBA Paycheck Protection Program

The Paycheck Protection Program is a loan designed to provide a direct incentive for small businesses to keep their workers on the payroll. SBA will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for payroll, rent, mortgage interest or utilities. 75% must be used for payroll in order to be forgiven. Loan payments will be deferred for six months. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees.

Guidance for PPP and Forgiveness (5/28/20)

The Small Business Administration (SBA) and U.S. Department of the Treasury released long-awaited guidance on how loans obtained through the Paycheck Protection Program (PPP) can be forgiven. Two new interim final rules – one addressing requirements for loan forgiveness, the second outlining loan review procedures and borrower and lender responsibilities.

Relevant highlights of the guidance released Friday, May 22nd include:

  • Loan forgiveness available for owner-employees and self-employed individuals’ own payroll compensation is capped at the lesser of 8/52 of 2019 compensation or $15,385 per individual in total.
  • No additional forgiveness for is available to self-employed individuals (including Schedule C filers and general partners) for retirement or health insurance contributions.
  • Advance payments on mortgage interest are not eligible for loan forgiveness.
  • PPP loan borrowers are required to notify the state unemployment office within 30 days of an employee’s rejected offer to return to work.
  • Bonuses, hazard pay, and payments (salary, wages, and commissions) to furloughed employees are eligible for loan forgiveness.
  • SBA can review any loan, regardless of size, for borrower eligibility, loan amount and use of proceeds, and loan forgiveness amounts. This review can be undertaken at any time at the SBA’s discretion.

SBA Update (5/15/2020)

The U.S. Small Business Administration (SBA) released an application form on May 15, 2020, for Paycheck Protection Program (PPP) loan forgiveness along with instructions for borrowers to complete the form.The PPP Loan Forgiveness Application and instructions expand on FAQs and interim final rules issued by the SBA over the past few weeks in conjunction with the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Explanation of Three Tests for PPP Forgiveness, definition of FTE's and 5 step forgiveness calculator

Application.The NCCA was advised by Quartermaster Tax Management that the more lenders you start your application process with, the better.

1. You can apply through any existing SBA 7(a) lender or through any federally insured bank that is participating in the program. List of participating lenders by state.

2. If you wish to begin preparing you application, you can download a copy of the PPP borrower application form to see the information that will be requested from you when you apply with a lender.

3. If you would like to submit loan authorization requests via our the online Paycheck Protection Lender Gateway, follow the steps below:

  • Create an account on SBA Connect.
  • Request authorization to the Paycheck Protection Lender Gateway by providing your FRS, FDIC, or NCUA number as well as your authorization number.
  • Proceed to the Paycheck Protection Program Lender Gateway to begin submitting loan authorization requests.

SBA Update PPP program Video update by Don Rasmussen (April 3, 2020)

PPP Significant Forgiveness Changes (6/4/2020)

The President signed legislation last week to provide greater flexibility and time for borrowers to use the funds as intended - keeping employees on the payroll. Key points:

  • Extends forgiveness period that borrowers can spend funds from 8 weeks to 24 weeks and lessens the payroll expenditure requirement from 75% to 60%.
  • If borrowers are unable to restore to full workforce levels, there are two exceptions including the inability to rehire past employees and find new employees or the inability to return to the same level of business activity due to compliance with safety operating requirements.
  • Repayment of the loans can be extended to five years instead of two, and some payroll taxes can be deferred.

For more detailed information check out this article and this Baker Donelson web-post.

Explanation of Three Tests for PPP Forgiveness, definition of FTE's and 5 step forgiveness calculator.

SBA Economic Injury Disaster Loan Program

This program includes an emergency advance of up to $10,000 to small businesses affected by COVID-19. To access the advance, you must first apply for an EIDL and then request the advance. The advance does not need to be repaid under any circumstance. The funds may be used to keep employees on the payroll, to pay for sick leave, meet increased production costs due to supply chain disruptions, or pay business obligations, including debts, rent, and mortgage payments. You may also qualify for funds above the emergency advance to help your practice.On June 15, SBA resumed accepting new Economic Injury Disaster Loan (EIDL) applications from all qualified small businesses, including agricultural businesses, and non-profit organizations.

CARES Act Provider Relief Fund

Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution. Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019. The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.

Click here to view the details of CARES Act Provider Relief Fund.

$20 Billion More Under Provider Relief Fund From Cares Act (Updated 4/28/20)

HHS announced and began the next round of payments under the Provider Relief Fund. The first $30 billion was distributed according to Medicare payments (see the next section). This round is $20 billion and is based on your net revenue in 2018 against the entire estimated healthcare net revenue amounts from 2018 (some estimating $2.5 trillion total). Additionally, most providers are required to submit information via a portal to receive their portion of the $20 billion. HHS stated, “Any provider who has already received a payment from the Provider Relief Fund as of 5:00 pm EST Friday, April 24th can and should apply for additional funding via the Provider Relief Fund Application Portal.” Additionally, before submitting your information to receive the additional payment, you must have already attested to the terms and conditions for the first disbursement.

To receive your funds, you must submit your application through the portal. You can find the link for the general distribution application portal on the Provider Relief Fund page or by direct link here.

According to the General Distribution portal FAQ, HHS is collecting four pieces of information for use in allocating these remaining General Distribution funds:

  • A provider’s “Gross Receipts or Sales” or “Program Service Revenue” as submitted on its federal income tax return
  • The provider’s estimated revenue losses in March 2020 and April 2020 due to COVID
  • A copy of the provider’s most recently filed federal income tax return
  • A listing of the TINs any of the provider’s subsidiary organizations that have received relief funds but that DO NOT file separate tax returns.

Like the first $30 billion, these funds can be used to cover additional COVID-19 expenses OR lost revenues. Thus, if you had lower revenue in March and April that are greater than the funds received from HHS from the initial disbursement and this disbursement combined, that will satisfy the usage portion of the requirement.

General Distribution Portal

General Distribution Portal FAQ Full Provider Relief Page

CMS Accelerated and Advance Payment Program

The CMS has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the COVID-19.The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months. The advance and accelerated payments are a loan that providers must pay back. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively. It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Click here to continue reading.

Coronavirus and Forbearance Info for Students, Borrowers & Parents

On March 27, 2020, the president signed the CARES Act into law, which, among other things, provides broad relief for federal student loan borrowers. Click here to view the answered questions about several provisions of the Act. Questions that have been added or updated are identified with “NEW” or “UPDATED” before each question.

Q:OSHA-Do Chiropractors have to wear PPE?

A: According to the state and federal OSHA offices, the answer is no unless they are dealing with identified or potential COVID patients (confirmed 4/1/20). PPE can be worn if the HCP or staff would like but it is not required at this time. Please check with your malpractice carrier as I have heard of them stating different requirements.

Q: If a doctor of chiropractic has been exposed to the virus (via a person who tested positive) do they need to notify all patients the doctor has seen in recent weeks?

A: Answer from the NC DHHS: The CDC’s guidance regarding the assessment and need for work exclusion for healthcare provided (HCP) with exposures to COVID-19 patients can be found here. If work exclusion is recommended based on the identified risk exposure category for the HCP, there is no need to notify all the providers patients from recent weeks if the HCP is asymptomatic per current CDC guidance. Testing of an exposed but asymptomatic HCP is not recommended, but if the exposure risk is considered medium or high, self-quarantine and monitoring for signs of infection (i.e. fever, cough, SOB or sore throat) is recommended for 14 days post the last exposure to the confirmed COVID-19 case.

Q: How can I help my community and volunteer?

A: DHHS: The State Medical Response System is Seeking Volunteers. The are recruiting volunteers to supplement NC’s health care workforce during this pandemic. Clinical, clinical support & non-clinical support (facility maintenance, safety & administrative) volunteers are needed. You can register by clicking here.

Q: What is COVID-19?

A: COVID-19 is the infectious disease caused by the recently discovered novel (new) coronavirus. Several coronaviruses are known to cause respiratory infections in humans. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. On January 30, 2020 the International Health REgulations Committee of the World Health Organization (WHO) declared the outbreak a “public health emergency of international concern.” On March 11, 202 the WHO declared the outbreak a pandemic.

Q: How does COVID-19 spread?

A: People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales if one breathes in these droplets. Another way is when these droplets land on objects and surfaces and one touches these surfaces, then touch their eyes, nose or mouth, they can catch COVID-19.

Q: How long is the incubation period for COVID-19?

A: The “incubation period” means the time between catching the virus and beginning to have symptoms of the disease. Most estimates of the incubation period for COVID-19 range from 1-14 days, most commonly around 5 days. These estimates will be updated by WHO as more data becomes available.

Q: What are the symptoms of COVID-19

A: The most common symptoms are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestions, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell.

Q: What do I do if I think someone presents at my office with COVID-19?

A: Contact your local health department or state health department at 919-733-3419 immediately.

Q: How do I keep my office safe? What do I clean with?

A: Specific Lysol products have demonstrated effectiveness against viruses similar to 2019 Novel Coronavirus (SARS-CoV-2) on hard, non-porous surfaces. In accordance with the EPA Viral Emerging Pathogen Policy. Some Lysol products can be used against 2019 Novel Coronavirus (SARS-CoV-2) when used in accordance with the directions for use.

Q: What does a state of emergency mean?

A: On March 11, 2020 Governor Roy Cooper declared a state of emergency. For your reference attached is a link to the NC Department of Public Safety, that describes exactly what that means and what it does not mean. As stated in the NC Department of Public Safety link “Though ‘State Emergency’ may sound ominous, the impact it has on citizens is anything but threatening”. As the Governor stated, the main purpose of declaring a state of emergency is increased flexibility to respond and allocate funds when needed. It can also speed supplies and give health and emergency management more flexibility as well. A state of emergency also protects consumers against price gouging.

Q: What is a pandemic?

A: Declaring a pandemic has nothing to do with the characteristics of the disease but is instead associated with concerns over is geographic spread. According to WHO, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations. Once a pandemic is declared it becomes more likely that community spread will eventually happen, and governments and health systems need to ensure they are prepared for that.

NCCA Partner and Affiliate COVID-19 Offers

Check out this list of offers from our business partners. We are updating this list as more information becomes available.

WHO Resources

CDC Resources

Additonal Resources

NCMIC Webinar Recordings

Click here to access the webinars and hepful resources listed below.

  • NCMIC Leadership Team Update
  • Malpractice Defense in the Time of COVID-19
  • HIPAA Matters During the Coronavirus Crisis
  • Mental Health Support for Your Patients (and you)
  • How Your State Association Can Help: ChiroCongress Leadership
  • Clinic Operations in the Time of COVID-19
  • The Swiftly Changing Telehealth Environment
  • NCMIC Leadership Discusses COVID-19

North Carolina Chiropractic Association

8412 Falls of Neuse Rd., Suite 106, Raleigh, NC 27615  |  919-832-0611  919-832-0612  |  contact@ncchiro.org