Application Process Live for Small Business Relief Funding

Michigan’s small businesses impacted by the COVID-19 virus can now apply for grants and loans through the Michigan Small Business Relief Program, the Michigan Economic Development Corporation announced today. The program will provide up to $20 million in grants and loans to provide economic assistance to Michigan’s small businesses that have been negatively impacted by the COVID-19 virus, and in turn help support workers and their families facing economic uncertainty during the outbreak. Information on how to apply, as well as eligibility criteria, is available at www.michiganbusiness.org/covid19. The grants and loans under the Michigan Small Business Relief Program will support businesses facing drastic reductions in cash flow and the continued support of their workforce and may be used for working capital to support payroll expenses, rent, mortgage payments, utility expenses, or other similar expenses that occur in the ordinary course of business. Key information to know about the application process includes: -There is one application, regardless of whether a business is applying for a grant or a loan. A business may receive a grant or a loan, but not both. -Businesses who do not receive grants may still be considered for loans. -The grants will be administrated by 15 regional economic development organizations throughout the state, which combined cover all 83 counties in Michigan. All applications or recommendations for Michigan Small Business Relief Program loans will be referred from the partner EDOs to the MEDC for evaluation and disbursement . Businesses should go to https://www.michiganbusiness.org/covid19/ to apply. The Michigan Small Business Relief Program grants, authorized by the Michigan Strategic Fund on March 19, will be administered by 15 local and nonprofit economic development organizations (EDOs) around Michigan, covering all 83 counties in the state. These EDOs are responsible for reviewing applications of small businesses in their region and entering into agreements with eligible small businesses. Each EDO will establish a review committee that may include representatives from local workforce agencies, local SBDC representatives, business and nonprofit leaders, among others. The full list of EDOs administering Michigan Small Business Relief grants and the counties they will serve is below. Local and nonprofit EDOs across Michigan applied for the grant funds and were selected based on capacity to administer the program and ensure coverage to small businesses in all 83 counties in Michigan. The $10 million in loans through the Michigan Small Business Relief Program will be referred to the MEDC from the local EDO partners where it will be reviewed by a loan review committee including the Chief Business Officer and Senior Vice President of Business Development Projects. All loans made through the Michigan Small Business Relief Program will be approved through Michigan Strategic Fund delegated authority. In addition to the Michigan Small Business Relief Program, michiganbusiness.org/covid19 also features other resources for businesses across Michigan to assist them in recovering from economic losses as a result of the COVID-19 virus. This includes U.S. Small Business Administration emergency loans, the Pure Michigan Business Connect virtual procurement and donation platform, support services offered through the SBDC and more. The MEDC has also developed a FAQ for Michigan businesses and communities at michiganbusiness.org/covid19-faq.

Senate Passes Economic Stimulus Package Several Provisions Help Ambulance Services!

The U.S. Senate passed an economic stimulus package in response to the coronavirus (COVID-19) outbreak. The House is expected to consider the legislation in the next few days. As a result of the efforts of the AAA and our members who are also on the front line of the response to COVID-19, we were able to improve the final package. The package includes several provisions that will provide urgent financial assistance and resources to ambulance service organizations and our employees. The provisions are consistent with requests made by the AAA, although they target a broader constituency consistent with much of the rest of the stimulus package. The provisions in the package related to our requests are as follows: Health Care Provider Provisions $100 Billion Grant Program: Direct funding to public entities, Medicare or Medicaid enrolled suppliers and providers, and for-profit entities and not-for-profit entities as the Secretary may specify to reimburse for health care related expenses or lost revenues that are attributable to coronavirus. Ambulance service suppliers and providers will file applicants for funding with the Department of Health and Human Services. Sequestration Delay: Suspension of the 2% sequestration cut in Medicare funding for ambulance service and other providers and suppliers. The suspension would begin May 1 and end December 31, 2020 with sequestration then extended from 2029 to 2030. Telehealth: Authorizes the Secretary to waive any of the current requirements in statute for telehealth services during the emergency. Business Provisions Payroll Tax Deferral: Employers including ambulance service organizations starting upon enactment of the legislation will defer payment of their 6.2% share of the payroll tax through December 31, 2020. Half of the tax will be due by the end of 2021 and the second half by the end of 2022. Small Business Loans: Provides $350 billion in loans under the Payment Protection Program for employers including ambulance service organizations with 500 or fewer employees. Loans available up to $10 million per employer. Emergency Responder Provisions $45 Billion Disaster Relief Fund: Grants made available under the FEMA Public Assistance Program to state and local governments to address the recovery from COVID-19 including reimbursement for medical response, PPE and backfilling positions. The funding highlights the critical need for access by emergency responders to PPE and other resources. For-profit ambulance service organizations would be eligible for funding through their state or local government. If your organization faces an issue with government officials as to eligibility, please provide them the FEMA Fact Sheet: Public Assistance for Ambulance Services which in 2009 the AAA had successfully encouraged FEMA to issue. $3.5 Billion Child Care Grants: Provides funding for childcare programs for essential workers including emergency responders such as paramedics and EMTs. Not all of the provisions the AAA had advocated for inclusion in the package were addressed in some way. This is likely not the last legislative package that the Congress develops to combat COVID-19 and we will advocate for our provisions to be included in future packages. We will also continue to push these issues through regulatory and other legislative efforts as outlined below. Regulatory and Additional Legislative Efforts Coverage of Treatment in Place and Alternative Destination On March 11, the American Ambulance Association (AAA) sent a letter to CMS Administrator Seema Verma asking the agency to wave regulatory restrictions for treatment in place and transport to alternative destinations and for Medicare to cover these services related to potential COVID-19 cases. CMS had initially indicated they do not think they have the authority to wave the restrictions under the 1135 Waiver, but the AAA is continuing to work with CMS to provide payment for these services when provided to Medicare beneficiaries. A press release from the House Republican leadership suggests that this issue is being addressed. Employee Tax Credit for EMS Training and Uniforms While the stimulus package includes reimbursement for training and equipment for first responders, it did not include the specific request for an above-the-line tax credit for paramedics and EMTs for training and uniforms paid by the employee. Earlier this year, AAA representatives had met with staff of Congressman Suozzi (D-NY), who sponsored the tax credit language which passed the House late last year, on how we can press the Senate to consider the provision. The AAA will continue to work with Congressman Suozzi on other opportunities to pursue the tax credit. Federal Benefits during COVID-19 for All Paramedics and EMTs Several paramedics and EMTs who worked for private ambulance service organizations lost their lives on September 11, 2001, while responding to the aftermath of the attacks on the World Trade Center. Then-Attorney General John Ashcroft extended Public Safety Officers Benefits (PSOB) to the surviving family members of those paramedics and EMTs. The AAA is sending a letter to Attorney General William Barr asking him to provide the same consideration for paramedics and EMTs responding to the COVID-19 outbreak. MAAS Will Keep Fighting With our Federal partners, we will continue to press the Congress and federal agencies for help to ensure ambulance service organizations and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic have the necessary resources and financial assistance to serve their communities. We greatly appreciate the efforts of all of our members who contacted their members of Congress in support of relief and resources for ambulance services.

US House Passes Families First Coronavirus Act

The House of Representatives passed H.R. 6201, the Families First Coronavirus Act, in the early hours of Saturday morning. The large-scale economic relief plan aims to support Americans in combatting the spread of the coronavirus through the expansion of paid leave, food assistance, and unemployment assistance and increased federal Medicaid funding.  The Senate is expected to pass the bill early this week, and the President is expected to sign it.

Additional packages are expected to come together in the coming weeks. Today, Senator Schumer proposed at least $750 billion to combat the coronavirus as lawmakers discuss a third legislative package.  See more detail below from Schumer’s office. Those in need of federal regulatory relief or financial support should communicate needs to Congress.  We stand ready to assist if this work is not already underway.  

Additionally, on Friday, March 13, the President issued a national emergency declaration. This declaration led to a 1135 waiver, which gives the CMS the broad authority to waive many rules and regulations, including conditions of participation, program regulations, Emergency Medical Treatment and Labor Act (EMTALA) rules, and Stark regulations.

Accordingly, CMS released a fact sheet, clarified that it would issue several blanket 1135 waivers under the declaration. For instance, CMS said it has made blanket waivers available for items including but not limited to the 3-day inpatient hospital stay requirements for Medicare skilled nursing facility (SNF) coverage and regulations that limit critical access hospitals to 25-bed capacities and lengths of stay to no more than 96 hours.

CMS also will establish a toll-free hotline for non-certified Medicare Part B suppliers and providers to enroll and get temporary Medicare billing privileges.  In addition, CMS said states and U.S. territories can request 1135 waivers for certain Medicaid and CHIP requirements, including:

  • Prior authorization requirements in fee-for-service programs;
  • Provider licensing location requirements; and
  • Provider enrollment and revalidation requirements.

MDHHS Allows Temporary Licenses for EMS Personnel

The Division of EMS and Trauma (DET) is actively involved with response to the COVID-19 pandemic. There are areas of the state that are approaching crisis standards of care. There are no Pearson Vue testing sites open and only essential workers are allowed to leave their homes. EMS providers are critical to the infrastructure of emergency response. Therefore, effective March 23, 2020, and in accordance with Section 333.20952, the department will grant a nonrenewable temporary license to an individual who has made proper application to DET for licensure as a medical first responder (MFR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), or paramedic and who has successfully completed all the requirements for licensure, except for the NREMT cognitive and psychomotor examinations. This temporary license will be valid for 120 days from the date of issue. Due to the exigent circumstances around this pandemic, there will be no fee for this temporary license. An individual holding a temporary license shall practice only under the direct supervision of a licensed EMS provider at the same level or higher, i.e. an EMT can practice under another EMT, etc. All individuals who are issued a temporary license will be eligible for a full license, upon submitting a proper application to DET, with the required licensure fee, and completion of the NREMT cognitive and psychomotor examinations. It is the sincere hope that this measure will help EMS agencies and providers who are working diligently on the front lines to combat COVID-19. If you have any questions or concerns, please contact Sabrina Kerr, EMS Section Manager, at kerrs3@michigan.gov. Your service to Michigan EMS is greatly appreciated.

CMS Approves First State Request for 1135 Medicaid Waiver in Florida

On March 13, 2020, President Trump declared the rapidly evolving COVID-19 situation a national emergency.   This bold action enables the Centers for Medicare and Medicaid Services (CMS) to waive certain requirements in Medicare, Medicaid, and CHIP under Section 1135 authority. This includes the ability to grant state and territorial Medicaid agencies a wider range of flexibilities, and states may now submit Section 1135 waiver requests for CMS approval that will remove administrative burdens and expand access to needed services.

Shortly after the President’s declaration, Florida became the first state to submit a Section 1135 waiver request in response to the COVID-19 national emergency.  In keeping with CMS’s commitment to ensure our state partners have the tools they need to combat COVID-19, the agency acted within days to approve a wide variety of appropriate Medicaid flexibilities.

“I want to thank Governor DeSantis for his leadership in Medicaid and for taking full advantage of federal flexibilities,” said CMS Administrator Seema Verma. “CMS is committed to removing all unnecessary administrative and bureaucratic barriers that may hinder an effective response to this public health emergency, and I have directed my team to expeditiously process these requests.”

The state’s approval letter can be found here, and includes flexibilities that enable the state to waive prior authorization requirements to remove barriers to needed services, streamline provider enrollment processes to ensure access to care for beneficiaries, allow care to be provided in alternative settings in the event a facility is evacuated to an unlicensed facility, suspend certain nursing home screening requirements to provide necessary administrative relief, and extend deadlines for appeals and state fair hearing requests. These flexibilities will enable the state to focus its resources on combatting this outbreak and provide the best possible care to Medicaid beneficiaries in their state. 

“Florida is acutely focused on eliminating unnecessary barriers on our health care providers who are on the front lines serving our communities most impacted by COVID-19,” said Florida Governor Ron DeSantis.  “President Trump recognizes this need and Administrator Seema Verma is providing Florida the critical flexibility for our state’s Medicaid program by waiving prior authorization requirements for essential health care services and expedited provider enrollment.”

CMS provides guidance to states on how to apply for Section 1135 waivers through the Medicaid Disaster Response Tool Kit, which can be found here.  CMS will continue to expeditiously review and approve as appropriate all Section 1135 waivers and other requests that the agency receives to ensure that we are providing our state partners with the maximum flexibility they need to care for their Medicaid beneficiaries during the public health emergency. To support these efforts, CMS is developing checklists and tools to expedite requests and approvals for waivers and other commonly requested flexibilities.

While Florida is the first state to apply for this waiver authority, CMS expects more states will also submit similar requests.  Additional Section 1135 approval letters will be posted here as they are issued.

This action, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov.  For information specific to CMS, please visit the Current Emergencies Website.