COVID-19

Next Steps

We recognize you have many questions regarding your practice and how to best contend with the impacts of COVID-19.

Please review your state-specific recommendations, public health department recommendations, and dental association websites for the most current updates. We’ve put together a resource to help you make informed decisions.

Recommendations and regulations regarding the safe practice of dentistry during the COVID-19 outbreak vary by state and are actively changing as well. However, the ADA and CDC encourage you to understand the risk of transmission in your area. Find details about your area in the CDC’s COVID data tracker.

Please continue to check the ADA’s site, the CDC site, and your local health authority’s site for updates as well.

Legislation

OSHA’s New Emergency Temporary Standard

On June 10, 2021, OSHA released a temporary emergency standard to provide new guidance for healthcare settings. Read the full text from OSHA. The standard applies to healthcare settings that are not screening all employees for signs and symptoms of COVID. Especially in situations where employees and non-employees with suspected or confirmed positive COVID status can enter and receive treatment in the facility. The goal of the temporary emergency standard is to protect healthcare workers from contracting Covid. The ADA released the following statement: “The ADA is pleased that dental practices are mostly exempt from the Occupational Safety and Health Administration’s new emergency temporary standard to protect health care workers from COVID-19. Dental offices most likely to be affected by the new standard include hospital-based oral surgery practices or those dentists who provide care for COVID-19 patients.”

 

American Rescue Plan Act (ARPA)

Congress Passes $1.9 Trillion COVID-19 Bill

The relief package signed March 11th includes:

  • $15 billion for targeted Economic Injury Disaster Loans and designates an additional $7.25 billion for forgivable loans in the Paycheck Protection Program.
  • $10 billion for manufacturing and procuring medical supplies and equipment, including PPE, diagnostic products, and medical devices.
  • Provides paid-leave benefits and tax credits for employers with fewer than 500 employees who voluntarily participate, reimbursing them for the cost of the sick time.
  • Provides $5 million for enhanced Occupational Safety and Health Administration enforcement activities at high-risk workplaces, including health care facilities.
  • Makes all COVID-19 student loan relief tax-free.
  • Covers 100% of the costs of continuing health insurance through September for workers who have been laid off.
  • $1400 stimulus checks for qualified individuals based on income.

Last Updated 3/19/21

 

COBRA Provision Impacting Employers

  • An employer is to pay 100% of the COBRA premiums for medical coverage during April 2021 through September 2021 for an employee (spouse and dependents) who elect COBRA during this time if the employee lost health coverage due to involuntary termination or a reduction in hours (during this time period or earlier).
  • The employer is to notify eligible individuals of this (DOL to have model notices by April 10th) and the employer is able to claim a payroll tax credit for the COBRA premiums.

A few examples of situations where this will have an impact:

  • Separations
  • Reductions in force
  • Asset acquisitions (where employees are terminated and hired by buyers)

Last Updated 3/19/21

 

Consolidated Appropriations Act of 2021

Last Updated 1/11/21

The $900 billion economic relief package offers additional support for dental practices. The SBA and Treasury Department announced last Friday that the new PPP would re-open this week (January 11-15, 2021). Community financial institutions will be exclusively allowed to make first-draw PPP loans starting on January 11th and second-draw PPP loans on January 13th. The PPP will open to all participating lenders shortly after and remain open through March 31, 2020. The SBA guidance includes a commitment from the SBA to make at least the first two days of the PPP application window open exclusively to applications from community financial institutions that serve minority- and women-owned businesses. Apply for the PPP2 through the SBA. The ADA has created a helpful fact sheet to support dentists as they apply for this funding. This document should answer most questions regarding the PPP2 grant and the EIDL loan. 

Highlights include:

  • An additional $284 billion was released to the SBA for more PPP forgivable loans.
  • Eligible businesses with less than 300 employees, who posted a 25% loss in any quarter of 2020 compared to the same quarter in 2019, will qualify. Additional funds are set aside for businesses with 10 or fewer employees.
  • Additional expenses eligible include PPE and modification expenses related to COVID-19.
  • Practices must spend at least 60% of PPP2 funds on payroll costs over the covered period.
  • One caveat for practices who participated in the first round of PPP grants – they need to have used the full amount of their first PPP loan on or before the expected date for the second PPP loan to be disbursed. The Interim Final Rule also clarifies that the borrower must have spent the full amount of the first PPP loan on eligible expenses.
  • The “PPP2” loan is calculated at 2.5 times average payroll costs in the year before the loan or for 2019, capped at $2M.
  • An additional $20 billion in EIDL (Economic Injury Disaster Loan) grants will be allotted. The EIDL grant will no longer reduce the amount of PPP2 funds eligible for forgiveness. Apply for the EIDL grant.
  • An additional $3 billion in Provider Relief Funds will be allotted. Directing HHS to distribute funds to healthcare providers who were under-represented in previous allocations.
  • Additional details from the Treasury Department offer guidance.
  • As always, dentists should consult their tax professional for guidance on their specific situation.

 

CARES Act

Taxpayer Certainty and Disaster Tax Relief Act of 2020

Last Updated 4/30/21

The Taxpayer Certainty and Disaster Tax Relief Act of 2020 was enacted December 27, 2020, and made several changes to the employee retention tax credits previously made available under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Changes included modifying and extending the Employee Retention Credit (ERC) for six months through June 30, 2021. Several of the changes apply only to 2021, while others apply to both 2020 and 2021. Read more from the IRS regarding the tax credit for employers who kept workers on payroll and ERC frequently asked questions.

 

 


Below are some top highlights from the ADA we believe will be most useful to dentists, dental students, and dental team members in light of the Phase 3 legislation passed March 27, 2020. Read the Act in its entirety on the Congress website.

(Please make sure to contact your accountant or other tax or legal professional when looking at these important business decisions.) The IRS has established a special section of their website focused on steps to help taxpayers, businesses, and others affected by the coronavirus.

 

CARES Act – Provider Relief Fund

Last Updated 10/8/20

On October 1, 2020, the U.S Department of Health and Human Services (HHS) announced Phase 3 of the Provider Relief Fund. They are allocating an additional $20 billion in new funding for health care providers, including dentists. In Phase 3, eligible dentists can apply for funding through November 6, 2020. According to HHS, eligible dentists include those who missed the original September 13, 2020 application deadline and dentists who began practicing January 1, 2020-March 31, 2020 (who were not previously eligible).

All dentists who previously applied, accepted, or rejected payments from the Provider Relief Fund will now be eligible to provide additional information to HHS. HHS will review this information to determine if they received a Provider Relief Fund payment equal to 2% of patient care revenue from prior distributions. If not, they will be eligible for additional funding to reach this level. If you previously submitted an application and feel you’ve received an incorrect payment or made a mistake on your previous application – act now.

Most importantly, even if your practice has already applied for and received Provider Relief Fund payments of 2% of your 2019 collections, you can now apply for additional funding, known as an “equitable add-on payment.” HHS will calculate this equitable add-on payment based on your decline in operating revenues and/or increase in operating expenses attributable to the COVID-19 pandemic.

Since funding is on a first-come, first-serve basis, you should apply through the Provider Relief Fund Portal. For questions, contact the DHHS Provider Support Line at 1.866.569.3522 from 7:00AM-10:00PM (Central Time), Monday-Friday. 

 

Last Updated 9/28/20

Health & Human Services has released guidance outlining reporting requirements for those receiving funding from the Provider Relief Fund. According to HHS, recipients who received one or more payments over $10,000 will be required to comply with the requirements when the reporting system opens in early 2021. The ADA has recapped some of the highlights from the new HHS guidance.

 

Economic Injury Disaster Loan (EIDL)

Last Updated 6/18/20

As of June 15, 2020, EIDL funding is open to all qualified small businesses and non-profits, including dental practices. (In early May, the SBA restricted these loans and emergency grants to agricultural businesses only, as those businesses were not eligible to apply for the first round of EIDL funding.)

Dentists can apply for an EIDL and find additional guidance for small businesses on the SBA website.

 

Paycheck Protection Program (PPP)

Last Updated 7/30/21

PPP Loan Forgiveness Deadline Approaching

PPP loans automatically convert to a standard loan at 1% interest if you do not apply for SBA forgiveness. You need to apply for forgiveness within 10 months of the end of the covered period under which you had to spend the money. For some businesses who applied early in April 2020, an eight-week covered period puts that deadline in the middle of July. For most loans operating under the more popular 24-week covered period, that could mean a deadline in September.

After receiving PPP loan proceeds, recipients chose a covered period ranging from 8 to 24 weeks to spend the funds on payroll costs and other eligible expenses. To qualify for complete loan forgiveness, doctors must:

  • Spend at least 60% of the loan proceeds on payroll costs
  • Spend any remaining amounts on other eligible expenses (rent, utilities, interest, personal protective equipment (PPE), and other operating costs.)

PPP borrowers must apply for loan forgiveness within 10 months following the last day of their covered period to avoid having to begin loan repayments.

What happens if the deadline is missed? Loan repayments must begin. However, recipients can still apply for forgiveness at any time up until the maturity date of the PPP loan (either 2 years or 5 years as stated in your promissory note.)

The SBA had intended to conduct Loan Necessity reviews for larger PPP loans. In response to a recent lawsuit, in a notice sent out on July 9, 2021, the SBA has officially eliminated the loan necessity forms and review for PPP loans of $2 million or greater.

Should you have questions about when your forgiveness application period ends or concerning the status of your loan forgiveness application, contact your PPP lender for answers.

 

Last Updated 3/26/21

Biden Signs Law Extending PPP for Small Businesses Until May 31, 2021

On March 30, 2021, President Biden “signed legislation extending a loan program designed to help small businesses adversely impacted by the coronavirus pandemic.” The bill “extends the deadline for businesses to apply for assistance through the Paycheck Protection Program (PPP) by two months, from March 31st to May 31, 2021.” In addition, the Small Business Administration now has “until June 30, 2021 to process loan applications.” Learn more on The Hill.

Last Updated 3/26/21

The Paycheck Protection Program (PPP) application period deadline was to close on March 31, 2021. Congress recently approved a 60-day extension to May 31st, with President Biden expected to sign the change into law. In addition to extending the application deadline, the bill will provide the Small Business Administration (SBA) with an additional 30 days to process pending applications. The SBA recently updated application forms for borrowers and lenders. The Small Business Association also published an interim final rule in The Federal Register on March 22nd, incorporating the American Rescue Plan Act’s changes to the PPP, which apply to loans that are approved and loan forgiveness applications that are submitted on or after March 11, 2021.

Understanding Available Loans – CARES Act

Last Updated 4/9/20

Recent updates and fact sheets from the ADA and Academy of Dental CPAs to help you better understand the loans and grants available.

ADA Recap of Economic Injury Disaster Loan (EIDL) and Paycheck Protection Program (PPP) (Updated 5/19/21)

Small Business Administration Guidance & Resources

Treasury Department Paycheck Protection Program Loans Summary and Answers to FAQs (Updated 4/6/21)

Need additional information to understand your options? Small Business Administration Loans: Understanding the Options for Dentist Owners A 50-minute video from the SBA, Academy of Dental CPAs, and the ADA.

 

Families First Coronavirus Response Act (FFCRA)

Last Updated 1/6/21
FFCRA Extension

Paid leave under the Families First Coronavirus Response Act (FFCRA) was scheduled to expire on December 31, 2020. The FFCRA benefit will not be renewed, meaning employers do not have to provide additional FFCRA paid leave to employees in 2021. However, if an employee did not use up all of their FFCRA time, employers can voluntarily choose to provide paid leave and receive the tax credit through March 31, 2021. As a reminder, employees who meet FFCRA eligibility requirements can take a total of two weeks of paid emergency sick leave and an additional 10 weeks for childcare-related needs.

 

Economic Relief

Relief packages are currently in process through the federal government, check with your CPA and attorney for the latest offerings to take advantage of the programs available to you. In the meantime, many banks are offering 6-month deferments for loan payments without penalty or interest.

  1. U.S. Small Business Administration is offering relief to businesses impacted by COVID-19.
  2. Tax Assistance: Employers experiencing a hardship as a result of COVID-19 may defer Federal tax payments until July 16, 2020.
  3. Many states, counties, and cities are offering additional relief.

Advocacy

ADA Releases COVID-19 Vaccine: Key Facts

The ADA has released some key facts surrounding COVID-19 vaccinations in the US. Their goal is to keep dentists informed of details surrounding evidence-based information so practices can help educate their patients and cohorts. Read More.

 

Dental Offices Can Test for COVID-19

The American Dental Association, in consultation with the ADA’s Advisory Task Force on Dental Practice Recovery, has developed a suite of resources to help guide dentists interested in offering their patients rapid response, point-of-care COVID-19 testing within the practice.

The ADA also released information regarding the FDA list of approved test kits. Learn More.

 

Infection Control Guidance

 

CDC Interim Infection Control Guidelines

Last Updated 12/4/20

The CDC has addressed key concepts around dental settings Guidance for Dental Settings During COVID-19.

Additional CDC Resources

Hand Hygiene in Healthcare Settings

Strategies to Optimize the Supply of PPE and Equipment

 

Economic Support

Financial Next Steps

The coronavirus pandemic quickly altered your dental practice business. Your goal is to emerge from this crisis as “whole” as possible. While there are no easy answers right now, assessing where you are currently and tackling what you can now, will be helpful financially and mentally moving forward.

Financial Resource Links: 

State Labor Offices

Find Your State’s COVID-19 Employer Resource Website

ADP Employment Tax Guide: State Agency Status in Response to COVID-19

SBA Disaster Relief Loan

Disaster Relief in Response to the Coronavirus

IRS Guidance on Families First Coronavirus Relief Act

 

Helpful Resources