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Coronavirus resources

Managing your business


The Academy’s Ad Hoc Task Force on COVID-19 is monitoring pandemic developments daily, assessing the impact on practices, and providing guidance most relevant to dermatologists. The most current information is being posted to these pages as we have it. Check back for updates.

In response to the COVID-19 pandemic, the federal government has taken several measures to help small business and families recuperate some of the financial impact that will result in the aftermath of this global disaster. Looking for a quick checklist of steps you should take? The AAD has created one you can download.

This page includes details on:

Visit your local FDIC approved bank, credit union, or Small Business Administration (SBA) lender and fill out an application for paycheck protection. This program allows you to receive a forgivable loan to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8-week period after the loan is made.

Apply for an economic injury disaster loan from the Small Business Administration.

Apply for an express bridge loan. These loans are up to $25,000 and processed quicker than an economic injury disaster loan.

Paycheck Protection Loan Program

The Coronavirus Phase III Response Legislation passed on March 27, 2020 allows for $350 billion for 100% federally guaranteed, zero-fee loans, up to $10 million, to small businesses (less than 500 employees, sole-proprietors, independent contractors, and other self-employed individuals) to maintain up to 8 weeks of existing workforce and help pay for other expenses like rent, mortgage, and utilities. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs.

When can I apply?

Dermatologists can begin applying for these loans on April 3, 2020.

Where do I apply?

Visit your local FDIC approved bank, credit union, or Small Business Administration (SBA) lender and fill out an application for paycheck protection. You will need to provide payroll documentation. If you are interested in applying through an SBA lender, find one in your state.

When is the deadline to apply?

You have until June 30, 2020 to apply for this program.

What can I include in my loan?

  • Payroll costs include:

    • Salary, wages, commissions, or tips (capped at $100,000 on an annualized basis for each employee);

    • Employee benefits including costs for vacation, parental, family, medical, or sick leave; allowance for separation or dismissal; payments required for the provisions of group health care benefits including insurance premiums; and payment of any retirement benefit;

    • State and local taxes assessed on compensation; and

    • For a sole proprietor or independent contractor: wages, commissions, income, or net earnings from self-employment, capped at $100,000 on an annualized basis for each employee.

  • Interest on mortgage obligations, incurred before February 15, 2020;

  • Rent, under lease agreements in force before February 15, 2020; and

  • Utilities, for which service began before February 15, 2020.

For additional guidance, see this Fact Sheet.

What is the maximum amount I can receive in my loan?

Loans can be for up to two months of your average monthly payroll costs from the last year plus an additional 25% of that amount, and the total amount is capped at $10 million.

How much of my loan will be forgiven?

All of the loan will be forgiven as long as you use it for payroll, mortgage interest, rent, and utilities over the 8-week time period that the loan is given. You will be required to pay back the loan if you do not maintain your staff and payroll or decrease salaries and wages by more than 25% for any employee that made less than $100,000 annualized in 2019. You have until June 30, 2020 to restore your staff levels for any changes made between February 15, 2020 and April 26, 2020.

How do I apply for my loan to be forgiven?

You must apply through your lender or bank that you received the loan from. You will be required to submit documentation and a decision will be provided within 60 days.

If my loan is not forgiven, how much interest will I be charged?

Interest will be at 1.0% fixed and all payments are deferred for 6 months; however, interest will continue to accrue over this time period. The entire loan amount will be due in two years and there are no borrower or lender fees payable to SBA.

Economic Injury Disaster Loan available

Looking for help keeping your practice going right now? The U.S. House Small Business Committee has summarized major provisions of the Coronavirus Aid, Relief, and Economic Security Act that may be beneficial to you.

The declaration of COVID-19 as a national emergency on March 13, 2020 allows the U.S. Small Business Administration (SBA) to make Economic Injury Disaster Loans available. These targeted, low-interest loans to small businesses and private non-profits will provide working capital loans of up to $2 million to help respond to the temporary loss of revenue. An additional $10 billion in emergency grants of up to $10,000 to provide immediate relief for small business operating costs and $17 billion to cover 6 months of payments for small businesses was also included in recent legislation.

Additionally, express bridge loans are available up to $25,000 to small business owners who have an existing relationship with an SBA express lender. These loans will be processed quickly and can provide immediate cash flow while waiting for an economic injury disaster loan.

How do businesses get the assistance?

Each state or territory’s governor must request the SBA to issue an Economic Injury Disaster declaration that will make the loans available to small business and private, non-profit organizations. Once the declaration is made, the SBA’s office of Disaster Assistance will work with the respective governor to submit the request for assistance and make information on the application process available to all affected communities as well as updated on the SBA web site.

Who is eligible for these loans?

A small business defined by the SBA can qualify for this assistance but it varies by industry. Size standards are mostly based on the average annual receipts or the average number of employees. You can contact the Office of Size Standards by email at sizestandards@sba.gov or by phone at 202-205-6618.

What are the interest rates and terms for the loans?

The interest rate for the loans are:

  • 3.75% for eligible small businesses

  • 2.75% for eligible private, non-profits

The loans may be used for:

  • Fixed debts

  • Payroll

  • Accounts payable

  • Other bills that cannot be paid because of the disaster impact

Terms for the loans will be determined on a case-by-case basis with most loans being offered with long-term repayment of up to a maximum of 30 years.

Other assistance to help practices stay afloat

The Coronavirus Phase III Response Legislation also creates an employee retention credit for employers subject to closure due to COVID-19. You may be eligible for a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The credit is available to employers whose (1) operations were fully or partially suspended, due to a COVID-19-related shut-down order, or (2) gross receipts declined by more than 50% when compared to the same quarter in the prior year.

You may also defer payment of employer payroll taxes, which includes the employer share of the Social Security tax you otherwise are responsible for paying to the federal government with respect to your employees. You may also carry net operating losses from 2020 back five years. Please note, you cannot take both a tax credit and a loan through the paycheck protection program. You can only apply for one program.

Additionally, CMS is expanding its accelerated and advance payment program for all Medicare physicians; see below.

The Academy recommends you consult your tax advisor or accountant for help in implementing these provisions.

Medicare offers physicians advance payments to address COVID-19 cash-flow issues

As part of the recently enacted CARES Act, CMS is expanding its accelerated and advance payment program for all Medicare physicians throughout the country to ensure they have the resources needed to combat COVID-19. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted physicians and suppliers. To qualify for accelerated or advance payments, the physician or supplier must:

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the physician’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.

Physicians are asked to request a specific amount of 100% payment for three months using an accelerated or advance payment request form provided on each MAC’s website. Medicare will start accepting and processing the accelerated/advance payment requests immediately. CMS anticipates that the payments will be issued within seven days of the physician’s request.

Participants in the program will be required to start paying back the loan 120 days after receiving the loan and will need to pay back the full amount of the loan 210 days after receiving the loan. Read more from CMS. The Academy has reached out to CMS for more information on implementation of this extended program. The AMA has developed a list of FAQs on the program.

Emergency paid sick leave update

The Emergency Paid Sick Leave Act immediately requires employers with fewer than 500 employees to provide 80 hours (or two weeks) of paid emergency leave — on top of any other existing paid leave program — to all employees based on urgent needs related to the coronavirus public health emergency.

The sick leave is available for immediate use by employees, regardless of length of employment. An employer may not require an employee to use existing paid leave provided by the employer before the employee uses paid leave provided under Division E (see table below) and cannot change their existing leave policy after the date of enactment to avoid compliance.

What are the requirements for paid sick leave?

The employer should immediately provide each employee two weeks of paid sick leave if the employee is unable to work (or telework) because of the following reasons related to COVID-19:

  1. The employee is subject to a federal, state, or local quarantine or isolation order;

  2. The employee has been advised by a health care provider to self-quarantine;

  3. The employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis;

  4. The employee is caring for an individual to which points 1 or 2 apply;

  5. The employee is caring for a child (under age 18) if the child’s school or place of care has been closed due to COVID-19 precautions; or,

  6. The employee is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretaries of Labor and the Treasury.

Additionally, you must post this poster in a conspicuous place in your practice. If you are unable to work physically in your practice, you must email the poster to all of your staff or post this notice on an existing employee information website.

How is the leave pay calculated?

Pay is calculated based on which circumstance noted above the employee qualifies for. See table below:

Reason (see corresponding # above)Compensation

(1), (2), and (3)

Full wages not to exceed $511/day and $5,110 in the aggregate

(4), (5), and (6)

Two-thirds of wages not to exceed $200/day and $2,000 in the aggregate

Are all businesses eligible for a tax credit for the paid leave they will provide the employees

The requirement to provide the paid leave (both sick and FMLA) would apply to all public sector employers and those private sector employers with less than 500 employees; however, the tax credit eligibility would only apply only to those private sector employers with less than 500 employees. Those employers would receive a 100 percent refundable payroll tax credit on the wages required to be paid.

Is anyone exempt?

The Secretary of Labor has been given the authority to:

  • issue regulations for good cause to exempt businesses with fewer than 50 employees from the requirements if such requirements would jeopardize the viability of the businesses as an ongoing concern;

  • exclude certain health care providers and emergency responders from these requirements, including by allowing such employers to opt out.

The Department of Labor has created FAQs on requirements for sick leave.

Paid FMLA leave update

The Emergency Family and Medical Leave Expansion Act will amend the Family and Medical Leave Act (FMLA) and require employers with fewer than 500 employees to provide all employees paid leave based on urgent needs related to the coronavirus public health emergency.

Do small practices have to comply?

If you are a practice that employs fewer than 500 employees, you are mandated to comply with this act; however, the Secretary of Labor has the authority to issue regulations to exempt small businesses with fewer than 50 employees if the requirements would jeopardize the viability of the business.

Are all employees covered under this act?

An employee who has been employed for at least 30 days by the employer is eligible for the new leave entitlement which is in contrast to FMLA which requires that an employee be employed for at least 12 months and for at least 1,250 hours.

Are health care providers or emergency respondents included in this act?

The law gives the Secretary of Labor authority to issue regulations to exclude certain health care providers and emergency responders from the definition of eligible employee.

For the purposes of employees who may be exempted from paid sick leave or expanded family and medical leave by their employer under the FFCRA, a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.

This definition includes any individual employed by an entity that contracts with any of the above institutions, employers, or entities to provide services or to maintain the operation of the facility. This also includes anyone employed by any entity that provides medical services, produces medical products, or is otherwise involved in the making of COVID-19 related medical equipment, tests, drugs, vaccines, diagnostic vehicles, or treatments. This also includes any individual that the highest official of a state or territory, including the District of Columbia, determines is a health care provider necessary for that state’s or territory’s or the District of Columbia’s response to COVID-19.

To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA.

What is the total duration of the paid leave?

The paid leave mandate under Division C requires that the employer cover 10 weeks of qualifying paid emergency FMLA to an eligible employee. The employee may choose to take the first 10 days (prior to the 10 weeks covered by the employer) as unpaid; elect to substitute with any accrued vacation, medical, personal, or sick leave provided by the employer; or (if eligible) utilize 2 weeks of the Emergency Paid Sick Leave (covered by Division E).

How is the paid leave calculated?

Paid leave must be at least two-thirds of an employee’s regular rate of pay and reflect the number of hours an employee would otherwise be normally scheduled to work. The paid leave shall not exceed $200/day and $10,000 in aggregate. Employers would receive 100% refundable payroll tax credit for the wages required to be paid by the Emergency Family and Medical Leave Expansion Act for each employee (capped at $200/day and $10,000 for the calendar year).”

How do employees know if they qualify?

Employers are required to provide notice of eligibility to employees. The Department of Labor is required to create model notification within 7 days after enactment of the bill (not yet available).

Are there any special provisions for employers with less than 25 employees?

Under the current FMLA, an employee taking FMLA leave is entitled to be restored to their position or an equivalent position with equivalent pay and benefits. However, under the new act, employers with fewer than 25 employees are not required to restore the employee to their position upon completion of emergency FMLA leave if:

  • the position does not exist dues to economic conditions caused by the public health emergency;

  • the employer makes reasonable efforts to restore the employee to an equivalent position; and

  • an equivalent position does not become available in the following year.

OVERVIEW EMPLOYER PAID LEAVE REQUIREMENTS AND TAX CREDIT PROVISIONS
(Prepared by Ways and Means Republicans)

EmployersCovered EmployersDuration of LeaveQualifying Reasons for LeaveRequired Wage ReplacementApplicability of: Division G – Tax Credits for Paid Sick and Paid Family and Medical Leave

Division E – Emergency Paid Sick Leave

Effective 15 days after enactment.

Expires 12/31/2020

Private sector employers with fewer than 500 employees.

Public sector employers with 1 or more employees.

Good cause exemption for employers with fewer than 50 employees. Applies to reason #5 only. (DOL Rule)

Employer must provide 2 weeks of paid sick leave for full-time covered employees.

Special rule for part-time employees.

1. Employee is subject to a Federal, state or local quarantine related to COVID-19.

2. Employee has been advised by a health care provider to self-quarantine.

3. Employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis.

4. Employee is caring for an individual who is subject to quarantine pursuant to 1 and 2.

5. To care for a child or children whose school or care provider is unavailable due to COVID-19.

6. Employee is experiencing a similar condition as specified by HHS, DOL or Treasury.

Reasons #1-3: Employee’s regular rate of pay. Capped at $511/day and $5,110 total.

Reasons #4-6:

2/3 of employee’s regular rate of pay. Capped at $200/day and $2,000 total.

Special rule for part-time employees.

Private sector employers with fewer than 500 employees may obtain a credit for wage replacement:

Employers receive 100% payroll tax credit (refundable as needed) for required paid sick leave wages plus certain health care expenses of the employer.

Special rule for self-employed.

Division C – Emergency Family and Medical Leave

Effective 15 days after enactment.

Expires 12/31/2020

Private sector employers with fewer than 500 employees.

Good cause exemption for employers with fewer than 50 employees.

(DOL rule)

Employer must provide 10 weeks of paid family and medical leave for employees (employed for at least 30 days).

Special rule for part-time employees.

Employee is unable to work (or telework) due to a need for leave to care for a son or daughter under 18 years of age if the school or place of care has been closed, or the child care provider is unavailable, due to a public health emergency.

Not less than 2/3 of regular rate of pay based on # of hours scheduled to work. Capped at $200/day and $10,000 total.

Special rule for part-time employees.

Private sector employers with fewer than 500 employees may obtain a credit for wage replacement:

Employers receive 100% payroll tax credit (refundable as needed) for required paid family and medical leave wages plus certain health care expenses of the employer.

Special rule for self-employed.

Tax credits for paid sick and paid family and medical leave

A refundable tax credit is available for employers equal to 100 percent of qualified paid sick leave wages required to be paid by the Emergency Paid Sick Leave Act for each calendar quarter. The tax credit is allowed against the tax imposed by section 3111(a) of the Internal Revenue Code (the employer portion of Social Security taxes).

The highlights of these tax credits include:

  • The tax credits would be administered by the IRS and be creditable against employer-side payroll tax liability, with any excess refunded to the employer

  • Self-employed workers facing the same employment disruptions would be eligible for refundable tax credits similar in scope and amount

  • Payments to employees would be taxable income to the employees and subject to employee-side payroll taxes, but not subject to the employer portion of payroll taxes

Guidance on receiving tax credits for paid sick and family leave

The U.S. Treasury Department, Internal Revenue Service, and Department of Labor have published guidance that small and midsize employers can begin taking advantage of the two new refundable payroll tax credits described above to be immediately and fully reimbursed, dollar-for-dollar, for the cost of providing COVID-19-related leave to their employees. The IRS website contains guidance on how to obtain the payroll tax credits. The Department of Labor published guidance on the employer paid leave requirements, employees’ rights to paid leave, and FAQs.

For a more detailed summary of the above changes, download the AADA’s full analysis.

Help available from AAD preferred providers

Bank of America

Bank of America is offering assistance to members through its Client Assistance Program (PDF download) and Payment Check Protection (PDF download) program while continuing to provide access to important financial services.

CareCredit

CareCredit is committed to helping people (PDF Download) get the care they need without delay due to cost concerns during this difficult time.

Laurel Road

Laurel Road is working with federal agencies and servicing partners. In the meantime, borrowers should plan to make regular payments and should frequently check for updates online or browse the FAQ section of their site.

Disclaimer: This material is provided for informational purposes only based on current understanding of applicable guidance. This material does not include state-specific changes and you should consult your state’s laws on this matter. This material should not be construed as legal or tax advice and members should consult with their personal legal, tax, and other advisors for guidance specific to the individual practice.
(Updated 4/3/20)

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