The physical therapy profession's focus on the Omnibus Appropriations and Emergency Coronavirus Relief legislation approved by Congress has largely been on what the included $900 billion COVID-relief package doesn't contain — namely, sufficient measures to fully offset a planned 9% cut to payment under Medicare (now down to about 3.6%). But there are several other provisions in the bill, some supported by APTA, that are relevant to the physical therapy community.
Here's a look at some notable parts of the bill.
Additional Support for Medicare Payments
Extension of the Medicare Sequestration Moratorium. The Coronavirus Aid, Relief and Economic Security Act — also known as the CARES Act — signed into law on March 27 included a temporary reprieve of the -2% sequestration applied to all Medicare payments. As a result, PTs experienced a 2% boost to their payments beginning May 1, 2020. In a changed supported by APTA, the temporary sequestration moratorium provision set to expire on Dec. 31, 2020, was extended through March 31, 2021.
Extension of the Work Geographic Practice Cost Index 1.0 Floor. GPCIs play an important role in determining Medicare payment amounts for services paid under the Medicare Physician Fee Schedule by attempting to reflect the relative costs of work, practice expense, and malpractice in an area compared with national average costs. The bill extends a provision raising the work GPCI to 1.000 for all localities that currently have a work GPCI of less than 1.000 through December 31, 2023.
Vaccine Support, Provider Relief, Unemployment
Coronavirus vaccine support. The bill includes $19.6 billion for the manufacturing and procurement of COVID-19 vaccines, therapeutics, and ancillary supplies necessary for administration; $8.75 billion to the Centers for Disease Control and Prevention to support states and local public health agencies in distribution and administration of the vaccine (including $4.5 billion for state, local tribal, and territorial public health departments, and $300 million directed to high-risk and underserved areas for distribution, including communities of color); and $3.25 billion for the Strategic National Stockpile of medical supplies and equipment.
Provider relief. Providers including eligible PTs, hospitals, and other facility-based providers that lost revenue directly attributable to the public health emergency will receive an additional $3 billion in grants. At least 85% of the unobligated funds will be made available via the Provider Relief Fund portal.
Unemployment insurance. All workers receiving unemployment benefits will get an additional $300 a week through March 14, 2021. The Pandemic Unemployment Assistance program, which includes expanded coverage to the self-employed, gig workers, and others in nontraditional employment, will expand the number of weeks the benefits can be claimed, from 39 weeks to 50. The bill also provides full federal financing of the Share Work programs that allows employers to avoid layoffs during the downturn by connecting employees who are working reduced hours with partial unemployment compensation, through March 14, 2021.
Help for Small Businesses
Expansion of the Employee Retention Tax Credit. The bill extends and expands the refundable Employee Retention Tax Credit, which was established in the CARES Act to keep additional employees on payroll and more small businesses and nonprofits afloat. Among other changes, the new package:
- Increases the credit rate, from 50% to 70% of qualified wages.
- Raises the limit on per-employee creditable wages from $10,000 for the year to $10,000 for each quarter.
- Expands eligibility for the credit by reducing the required year-over-year decline in gross receipts from 50% to 20%.
- Modifies the threshold for treatment as a "large employer" by increasing the 100-employee delineation for determining the relevant qualified wage base to employers with 500 or fewer employees.
Paycheck Protection Program. The relief package extends the Paycheck Protection Program through March 31, 2021, and includes over $284 billion in new funds for first and second draw (see below) forgivable PPP loans, dedicated set-asides for very small businesses, and loans through community-based lenders. Additionally, the bill:
- Adds PPE expenses and supplier costs as eligible and forgivable expenses.
- Creates a second loan from the Paycheck Protection Program, called a “PPP second draw” loan for smaller and harder-hit businesses, with a maximum amount of $2 million. To be eligible entities must have fewer than 300 employees, have used or will use the full amount of their first PPP, and demonstrate at least a 25% reduction in gross receipts in any quarter of 2020 relative to the same 2019 quarter. $25 billion is specifically set aside for business with 10 or fewer employees (as of Feb. 15, 2020).
- Specifies that forgiven Paycheck Protection Program loans will not be included in taxable income.
- Repeals the requirement of deducting an Economic Injury Disaster Loan advance from the PPP forgiveness amount.
Economic Injury Disaster Loans. The relief package includes $20 billion for new EIDL grants for businesses in low-income communities, $3.5 billion for continued Small Business Administration debt relief payments for small business made under the SBA 7(a), 504, and Microloan programs, and $2 billion for enhancements to Small Business Administration lending.
Schools and Education
Flexible funds available to states, K-12 institutions, and higher ed. The bill provides $81.88 billion in flexible education funding. These funds can be used on a variety of things to provide educational services to students and support the ongoing functionality of school districts and colleges and universities The education funding includes $4.05 billion to the Governors Emergency Education Relief Fund, $54.3 billion to the Elementary and Secondary School Emergency Relief Fund (Public K-12 schools), and $22.7 billion to the Higher Education Emergency Relief Fund.
Expanded Broadband Access
Pilot program to expand access. The relief package includes $285 million for a pilot program to award grants to institutions, businesses, and nonprofit organizations in the community to support connectivity, with at least 20% of the funds to be used to ensure that students have internet service and devices.
Emergency broadband benefit program. The bill sets aside $3.2 billion to establish the Emergency Broadband Benefit Program at the FCC, under which eligible households may receive a discount of up to $50 (or up to $75 on tribal lands) off the cost of internet service, and receive subsidies for low-cost devices such as computers and tablets. Internet service providers that offer the discounted service or devices to customers can receive a reimbursement from the FCC for such costs. Households that qualify for the benefit include those with children who qualify for the free and reduced lunch program, Pell grant recipients, recently laid-off or furloughed workers, individuals who qualify for the Lifeline program, or individuals who qualify for a low-income or COVID-19 discount program offered by internet service providers.
Office of Minority Broadband Initiatives. The bill establishes an Office of Minority Broadband Initiatives within the National Telecommunications and Information Administration to focus on broadband access and adoption at historically black colleges or universities, tribal colleges and universities, and other minority-serving institutions.