COVID-19 UPDATE
CARES ACT
KEY TAKEAWAYS FOR
HEALTHCARE ORGANIZATIONS
CITRIN COOPERMAN WEBINAR
evolutionApril 9, 2020
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PRESENTED BY:
Michael Criscione, CPA, Partner and Healthcare Co-Practice Leader
Ron Hegt, CPA, Partner
Mitzi Hollenbeck, CPA, CFE Partner
Kate Broderick, Manager

evolution COVID -19 UPDATE
AGENDA
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Introduction | Michael Criscione
Healthcare Provisions | Kate Broderick
Loan Provisions | Mitzi Hollenbeck
Tax Provisions | Ron Hegt

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Healthcare Provisions: Coverage
Provision Details
Testing
Section 3202: Group health plans and health insurance issuers shall reimburse providers for COVID-19
tests at an agreed-upon rate with providers, or if not agreed to, then at the cash price for such service
as listed by the provider on a public internet website (which is now a mandated requirement)
Preventative Services
Section 3203: Group health plans and health insurance issuers are required to cover all qualifying
coronavirus preventative services (any item or service meant to mitigate or immunize against the virus)
Vaccine Cost-Sharing Section 3713: Eliminates cost sharing for COVID-19 vaccine under Medicare Part B
Flexibility around Care outside of Hospitals
Section 3711: Acute care hospitals have flexibility during COVID-19 emergency period to transfer
patients to alternative settings, eliminating the 3-hour rule for inpatient rehab facilities and 50% rule
for long term care facilities and pauses the LTCH site-neutral payment methodology.
Section 3715: Allows state Medicaid programs to pay for home and community-based support services
to reduce LOS and free up beds in hospitals
On March 30, CMS issued sweeping regulatory changes pursuant to these and other provisions of the CARES Act

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Healthcare Provisions: Reimbursement
Provision Details
Medicare Sequester Suspension
Section 3709: Ends the Medicare sequester from May 1 through December 31, 2020, boosting
Medicare payments by 2%
20% Add-On Hospital Payment
Section 3710: 20% add-on for hospital reimbursement (does not apply to physician services) for
patients with a primary or secondary diagnosis of COVID-19 during the COVID19 emergency period
DME Payment Reduction Prevention Section 3712: Prevents reduction in Medicare payments for DME through the emergency period
Lab Reimbursement
Section 3718: Pushes the Medicare payment reduction for clinical diagnostic laboratory tests furnished
to beneficiaries in 2021 to 2022
FMAP Increase
Section 3720: Increases the Federal Medical Assistance Percentage by 6.2% for each qualified state and
territory from January 1, 2020 through the end of the quarter in which the public health emergency for
COVID-19 ends
DSH Payment Reduction Delay Section 3813: Funding reductions to Disproportionate Share Hospitals (DSH) delayed until 11/30/2020

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Healthcare Provisions:
Medicare Advance Payments
Provision Details
Medicare Advance Payment Option
• Most providers/suppliers: Up to 100% of the Medicare payment amount for a three-month period. 120 days
following the issuance of the payment, recoupment begins and providers have 90 days to repay the balance.
• Acute inpatient hospitals, children’s hospitals, and certain cancer hospitals: Up to 100% of the Medicare payment
amount for a six-month period. 120 days following the issuance of the payment, recoupment begins and providers
have until the anniversary of the payment date to repay the balance.
• Critical Access Hospitals: Up to 125% of Medicare payment amount for a six-month period. 120 days following the
issuance of the payment, recoupment begins and providers have until the anniversary of the payment date to repay
the balance.
• Application: Providers can apply through their MAC’s website
Key Details
• Intended as a cash advance, versus a subsidy; should be tied to services already performed
• For most providers, any amount not repaid 31 days after the end of the 210-day payment period will begin accruing interest at 10.25%
• For acute inpatient hospitals, children’s hospitals, and certain cancer hospitals, this interest accrual will begin 31 days after the end of one-year payment period

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Healthcare Provisions:
Medicare Advance Payments
Advance
Payment Made
120 days
Recoupment
Begins
Outstanding
Balance Due
90 days
Interest Accrual
Begins on Any
Balance
Outstanding
31 days
120 days
Recoupment
Begins
Outstanding
Balance Due
245 days
Interest Accrual
Begins on Any
Balance
Outstanding
Advance
Payment Made
31 days
Year 1
Year 1
Year 2
Most Suppliers and Providers
Most Hospitals

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Healthcare Provisions: Funding
Provision Details
$100B Public Health and Social Services Fund
$100 billion has been allocated, until expended, “to prevent, prepare for, and respond to coronavirus,
domestically or internationally, for necessary expenses to reimburse, through grants or other mechanisms,
eligible health care providers for health care related expenses or lost revenues that are attributable to
coronavirus.”
• Eligible Providers: Public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-
profit entities and not-for-profit entities not otherwise described in this proviso, within the United States
(including territories), that provide diagnoses, testing, or care for individuals with possible or actual cases
of COVID-19
• Use of Funds: Lost revenues and expenses attributable to COVID-19, including building or construction of
temporary structures, leasing of properties, medical supplies and equipment, increased workforce and
trainings, emergency operation centers, retrofitting facilities, and surge capacity
• Timing of Distribution: According to Appropriations Chairman Blunt indicated $35-$50B will be
distributed within three weeks, following a conversation with Secretary Azar
• Distribution Methodology: AHA is urging HHS to distribute $25K per bed to MACs in most areas and $30K
per bed in hot spots.
• Application Process: Guidance has not been released as of this webinar

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Healthcare Provisions: Funding
UPDATE – 4/7/2020: CMS announced that it will distribute the first $30 billion in grant funding from the $100B
appropriated through the CARES Act to the Public Health and Social Services Emergency fund.
Key Details
• “No strings attached” – these dollars can be spent as healthcare organizations see fit.
• Distributed via direct deposit. If a provider does not receive direct deposit from CMS, a basic registration will be required.
• Distribution will be based on Medicare revenue, rather than on a first-come, first-served basis.
• For providers who receive minimal revenue from Medicare (OB/GYNs, pediatricians, nursing homes) – those providers will be
addressed in the second tranche of funding in the coming weeks.
The exact distribution methodology is unclear at this point. CMS has not issued guidance as to whether all Medicare providers and
suppliers will receive a portion of this distribution. Based on the language in the CARES Act, the funding may target providers who are
providing testing, diagnoses, and care for patients with confirmed and suspected COVID diagnoses.

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Telehealth: Regulatory Changes
Provision Details
HIPAA
Due to the need for healthcare providers to scale telehealth capabilities quickly, the Office of Civil Rights (OCR) will not be
enforcing certain aspects of HIPAA to allow providers to communicate with patients using technologies that may not be HIPAA
compliant.
• There is no timeline on when OCR will begin enforcing again
• Providers must act in good faith and do their utmost to protect PHI
• Providers and patients will be able to use services like Apple FaceTime, Skype, Zoom, and Facebook video chat to communicate
via their personal devices
• Usage of certain public communication platforms, like Tik Toc or Facebook Live, will still be considered violations of HIPAA
• Some services like Skype for Business or Microsoft Teams already provide HIPAA-compliant video communications as well as
BAAs. The OCR encourages providers to use these more secure platforms where possible.
Licensing
• Under the Section 1135 Waiver issued by the Secretary of Health and Human Services, the requirement that healthcare
professionals hold a license in the state in which they provide services has been waived, so long as the provider has an
equivalent license in another state
• CMS has not issued guidance on how this will be implemented, however, the ability to provide telehealth across state lines is
critical, as patients may have travelled or may reside in a different state than the practice where they are normally seen,
particularly in areas like New York City and Washington, D.C.
• CMS is currently reviewing how the CARES Act may allow for them to relax rules around providing physical, occupational, and
speech therapies via telehealth
Additional Changes
• Medicare has expanded flexibility around telehealth, eliminating the need for a patient to have seen the provider within the
past three years and permitting audio-only visits
• Providers may also use telehealth for visits with chronic kidney disease patients who are on home dialysis
• Providers may use telehealth to recertify patients for hospice
• The Department of Health and Human Services must issue clarifying guidance on the use of telecommunications systems for
home care, e.g., remote patient monitoring services

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Telehealth: Reimbursement Changes
Provision Details
High Deductible Health Plans
Telehealth visits for patients enrolled in high deductible health plans with HSAs can be covered by payors before the patient
meets his/her deductible
CMS Reimbursement Rate Medicare will be reimbursing for telehealth visits at the same rate as face-to-face
Reimbursable Services Medicare has added an additional 85 codes that it will be reimbursing via telehealth, including emergency department visits
Setting Flexibility
For the duration of the emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas
of the country in all settings. This flexibility also allows providers to furnish services from their homes
Cost-Sharing Under Medicare, healthcare providers have the option to waive coinsurance and deductible requirements
Medicare Advantage &
Part D Plans
CMS has also issued flexibility to Part D plans, allowing them to add services, like telehealth, that were not included in their bid

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FCC COVID-19 Telehealth Program
Provision Details
Appropriation $200M through the CARES Act
Eligible Providers
Non-profit and public eligible healthcare providers in rural or non-rural areas:
• Post-secondary healthcare education providers, including teaching hospitals and medical schools
• Community health center and health centers providing care to migrant populations
• Local health departments or agencies
• Community mental health centers
• Not-for-profit hospitals
• Rural health clinics
• Skilled nursing facilities
• Consortia of health care providers consisting of one or more entities falling into the first seven categories
Eligible Expenses
• Purchase of telecommunications, information services, and connected devices
• Will provide full funding for eligible services and devices, but do not anticipate awarding more than $1M to a single applicant
• Awards will be made based on estimated cost in application, but to provide flexibility, providers will not be tied to purchases
outlined in their application
• Applicants who exhaust funds may reapply
Application
• Awarded on a rolling basis
• Will target hardest-hit areas
• Will not target toward specific conditions, patient populations, or geographic areas
• Applicants should document hardships like provider shortages or limited access to Internet in their applications
• FCC will consider programs’ ability to directly aid in the prevention of pandemic spread
• Devices and services funded must be integral to patient care
In addition to this program, the FCC is also going live with their Connected Care program, which targets projects that would
primarily benefit veteran and low-income patients

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Telehealth:
Programmatic Considerations
Programmatic Considerations
• Telehealth Platform: If you do not already have a telehealth platform in place, are you able to consider standing up telehealth using readily available
technologies like FaceTime or Skype, under the relaxed regulatory environment, to provide telehealth immediately?
• Cybersecurity and Compliance: Have you consulted with counsel and cybersecurity experts to understand risk exposure and mitigation strategies?
• Malpractice Coverage: Have you checked with your malpractice provider to ensure telehealth coverage?
• Bookkeeping: Have you established a separate cost center for telehealth programming under the current emergency so you can track costs and revenues
and prepare yourself for any current or future government funding opportunities? Tracking should include any waived cost-sharing.
• Physical Footprint: If providers are able to provide care outside of the clinic setting, is there an opportunity to consolidate space and reduce costs
associated with physical space?
• Staffing: If a significant portion of your volume has moved to telehealth, are you able to shift your staffing needs?
• Patient Awareness: How are you making patients aware of telehealth options?
• Scheduling: If your providers are still seeing patients in clinic, how are you integrating tele-visits and face-to-face visits to maximize flexibility and fill
providers’ schedules as much as possible?
• Commercial Reimbursement: Have you worked with your top commercial payors to understand what telehealth services they are reimbursing?
• Revenue Cycle: Are you working with payors and your revenue cycle function to understand documentation requirements for telehealth to ensure
collections?
• Privacy: For providers taking tele-visits in clinic, have you designated office or exam room space to maximize privacy?

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PPP Overview: PPP Loan Forgiveness:
For small Businesses < 500 employees
No collateral / no personal guarantee
Determination of loan size:
 Your max loan is equal to the lower of 250% of your average monthly
“payroll costs”, or $10M.
 Borrowers can use either average monthly payroll costs for the preceding
calendar year (2019) or trailing 12 months
Payroll Costs:
 Employee wages (not to exceed $100,000, or $8,333.33 per month) plus
 Group health care coverage, including health insurance premiums, net of
employee contributions
 Payment of any retirement benefit
 Payments to Independent Contractors are not included
Loan Terms:
 The interest rate of the PPP loan will be 1%
 The maturity date of the PPP loan is 2 years from the loan origination date.
6 month deferral period to begin making payments.
Loan Administration and Application:
 Administered through banks under the SBA 7(a) loan program.
 Currently, SBA issued Interim Final Rule and Q&A on 4/6/20, subject to
interpretation and change.
 Some banks pushed back application process to Monday, 4/6
Eligibility for Loan Forgiveness:
Up to a business’ costs during 8 weeks following date of loan’s origination for the
following categories:
 Compensation to employees
 Group health benefits
 Rent and utility payments
At least 75% of the loan proceeds must to be used on payroll costs in 8 week
period following receipt of the loan in order to be eligible for full loan forgiveness.
Criteria for Loan Forgiveness:
 FTE Headcount: The portion of the loan that will be forgiven will be based
on a ratio of your full-time equivalent employee headcount during the 8
week period compared to the FTE headcount during the test period
February 15, 2019 - June 30, 2019 or from January 1, 2020 until February 29,
2020.
 Salaries and wages: Employee salaries must be maintained to at least 75%
of the test period salary in order for the employee to be counted.
Declines in headcount or wages between February 15, 2020 and April 26, 2020
will not trigger a reduction in loan forgiveness if the business reverses the decline
and returns to pre-decline levels by June 30, 2020.
***Loan forgiveness will not be included in a business’s taxable income***
Section 1102:
Paycheck Protection Program (“PPP”)

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• Qualified small businesses (as defined by the SBA, less than 500 employees )
• Loan proceeds up to $2M for working capital funding
• The SBA will determine the exact amount a business can borrow based on cash flow projections and demonstrated need
• Collateral required for loans over $25,000
• Personal guarantees for loans over $200,000
• Proceeds can be used for working capital, including payroll, accounts payable, inventory, equipment and machinery purchases,
real estate payments, and other operating expenses
• This program is not eligible for loan forgiveness
• Interest rate is 3.75%, and borrower can defer principal and interest for the first 11 months of the loan.
• Administered through SBA website
• Short form application for $10,000 advance, convertible to a grant
• If applying for EIDL grant and/or loan and applying for PPP, the PPP loan will be less the EIDL grant amount and the EIDL loan
amount will be added, not to exceed $10M
Economic Injury Disaster Loan (“EIDL”)

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Section 2301: Employee Retention Credit for Employers Subject to Closure or Experiencing Economic Hardship Due to COVID-19
• Refundable payroll tax credit for 50% of qualified 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
• For employers with greater than 100 full-time employees, qualified wages are wages paid to employees when they are not providing
services due to the COVID-19-related circumstance. Smaller employers—all wages qualify.
• The credit is provided for the first $10,000 of compensation, including health benefits, paid to an eligible employee.
• The credit is provided for wages paid or incurred from March 13, 2020 through December 31, 2020.
• Credit claimed on quarterly 941 against payroll taxes. Excess claimed using new Form 7200
• Cannot be claimed if PPP loan taken.
Section 2302: Delay of Payment of Employer Payroll Taxes
• Allow employers to defer paying the employer portion of certain payroll taxes from 3/27/2020 to 12/31/2020, with deferred
amounts due in two equal installments:
• 50% at December 31, 2021
• 50% at December 31, 2022
• Payroll taxes that can be deferred include the employer portion of Social Security taxes
• 50% of payroll taxes incurred by self-employed individuals (i.e. partners) also qualify for the deferral.
• Not available if PPP loan is forgiven
Key Tax Provisions

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Section 2303: Modification of Net Operating Losses (NOLs)
• Modification of the treatment of NOL carrybacks
• In the case of taxable years beginning before 2021, taxpayers will be eligible to carry back NOLs to the prior five taxable years
• Effectively, this delays the 80% taxable income limitation until 2021 and temporarily extends the carryback period from zero to five years
• C corporations may elect to file for an accelerated refund to claim the carryback benefit
• For taxable years beginning before 2021, taxpayers will be entitled to an NOL deduction equal to 100% of taxable income (rather than the 80% limitation in present
law)
• In the case of taxable years beginning after 2021, taxpayers will be eligible for: (1) a 100 percent deduction of NOLs arising in tax years prior to 2018, and (2) a
deduction limited to 80% of modified taxable income for NOLs arising in tax years after 2017
Section 2304: Modification of Limitation on Losses for Taxpayers other than Corporations
• Retroactively suspends the excess active business loss limitation rule implemented with 2017 Tax Law by amending the provision to apply to tax years beginning
after December 31, 2020 (rather than December 31, 2017)
Section 2306: Modification of Limitation on Business Interest
• This provision generally allows businesses to increase the interest limitation from 30% of Adjusted Taxable Income (“ATI) to 50% of ATI for 2019 and 2020, and
allows businesses to elect to use 2019 ATI in calculating their 2020 limitation
Section 2307: Qualified Improvement Property Technical Correction
• The CARES Acts corrects a Congressional oversight by defining Qualified Improvement Property as 15-year property, thus allowing 100% of improvements to be
deducted in the year incurred.
• The change was made as if it included in the original TCJA and, thus, is effective for property acquired and placed in service after September 27, 2017
Key Tax Provisions (continued)

evolution COVID -19 UPDATE
Q & A
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evolution COVID -19 UPDATE
FOR MORE INFORMATION:
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Michael Criscione, CPA
Partner, Co-Practice Leader
mcriscione@citrincooperman.com
401.421.4800
Kate Broderick, MBA, MSIS
Manager
kbroderick@citrincooperman.com
419.367.6334
Ronald Hegt, CPA
Partner
rhegt@citrincooperman.com
914.949.2990
Mitzi Hollenbeck, CPA, CFE
Partner
mhollenbeck@citrincooperman.com
401.421.4800