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Agencies Issue Guidance on Coverage of OTC COVID-19 Tests

Agencies Issue Guidance on Coverage of OTC COVID-19 Tests

January 12, 2022

On January 10, 2022, the Depts. of Labor, Health & Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.

Legal Requirements

Plans and issuers must cover the costs of COVID-19 tests during the COVID-19 public health emergency without imposing any cost-sharing requirements, prior authorization, or medical management requirements.

Under guidance issued in June 2020, at-home COVID-19 tests had to be covered only if they were ordered by a health care provider who determined that the test was medically appropriate for the individual. At that time, the FDA had not yet authorized any at-home COVID-19 diagnostic tests. Since then, several types of OTC at-home tests have been approved.

As of January 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider. However, the FAQs do not require tests be covered if they are not for individualized diagnosis (such as tests for employment purposes).

Plan Options

Plans and insurance issuers may place some limits on coverage, such as:

  • Requiring individuals to purchase a test and submit a claim for reimbursement, rather than providing direct coverage to sellers.
  • Providing direct coverage through pharmacy networks or direct-to-consumer shipping programs and limiting reimbursements to other sources (the actual cost of the test, or $12, whichever is lower).
  • Setting limits on the number or frequency of OTCCOVID-19 tests that are covered (no less than 8 tests per month or 30-day period).
  • Taking steps to prevent, detect and address fraud and abuse.

Conclusion

Stay tuned as this issue continues to rapidly develop and we will keep you updated on any new developments. CMS Q&A has also provided some guidance. And for a copy of this news brief, click here: Agencies Issue Guidance on Coverage of OTC COVID-19 Tests .

Reach out to Mike Young today for more content on this new coverage for OTC COVID-19 test reimbursements and to discuss how further updates can affect your business at 714.716.4060 or mike@my-EBP.com .

President Biden to Mandate COVID-19 Vaccine for Federal Employees and Large Employers

President Biden to Mandate COVID-19 Vaccine for Federal Employees and Large Employers

September 10, 2021

On Thursday, Sept. 9, 2021, President Joe Biden signed executive orders requiring federal workers and contractors to get vaccinated against COVID-19. Biden also directed the Occupational Safety and Health Administration (OSHA) to draft a new emergency rule requiring all businesses with 100 or more employees to ensure all of their workers are either tested for COVID-19 once a week or fully vaccinated.


These new rules come shortly after the Pfizer-BioNTech coronavirus vaccine was fully approved for use by the Food and Drug Administration, enabling the White House to fight the pandemic more aggressively.
The federal employee mandate will apply to executive branch employees and members of the armed services, among others. Applicable federal employees will not be provided the option for weekly testing in lieu of vaccination.


The OSHA emergency rule—which is expected in the coming weeks—could affect as many as 80 million Americans. It will reportedly require large employers to provide their workers with paid time off to get vaccinated and recover from any vaccination-related side effects (e.g., chills). Companies that fail to comply may be subject to up to $14,000 in fines per employee.


Additionally, COVID-19 vaccinations will be required for more than 17 million health care workers at hospitals and other facilities that receive Medicare or Medicaid reimbursement. This requirement covers a majority of health care workers throughout the country.

What’s Next?

This hardline stance on vaccines is a stark contrast to the hands-off approach taken by most employers earlier in the year. However, as Delta continues to cause upticks in hospitalizations and deaths throughout the country, employers will need to ramp up efforts to protect their organizations.


Health experts and business leaders agree that vaccination is the most effective way to limit the spread of Delta and maintain uninterrupted operations. Employers should expect the Biden Administration to continue to take measures to increase vaccination rates.


Large employers affected by these new rules should begin preparing to comply. Employers with less than 100 employees that are interested in their own vaccine mandates should consult with legal counsel before moving forward.

Conclusion

Stay tuned as this is a rapidly developing situation. We will keep you updated on any new developments. For a copy of this news brief, click here: President Biden to Mandate COVID-19 Vaccine for Large Employers

Reach out to Mike Young today for more content on vaccines and the workplace and to discuss how further updates can affect your business at 714.716.4060 or mike@my-EBP.com .

New Payroll Protection Program flexibility approved

New Payroll Protection Program flexibility approved

June 4, 2020

The Payroll Protection Program (PPP) for employers has been given a boost with enhanced PPP forgiveness. And just in time. Last night the Senate unanimously passed the PPP Flexibility Act that was passed last week by the House. It is expected to be quickly signed into law by President Trump. Some of the general highlights include:

  • The non-forgivable balance of loans will amortize over five years instead of 2 years.
  • The period for allowable forgivable expenses expands to 24 weeks instead of 8 weeks. Borrowers can still choose to use the 8 weeks.
  • The safe harbor for restoring full time employee (FTE) headcount is now 12/31/2020.
  • The threshold for covered payroll expenses is 60%, instead of 40%.

As a positive note, for businesses that have been badly hit by COVID-19, this legislation will give them more of a chance to live to fight another day. And for those businesses who are down a bit, stable or growing and received a PPP, this new extension should give an extra windfall to grow and expand.

Now, before getting too excited, there are two things to keep in mind.

  1. As in all legislation, the devil is in the details, and the details are currently not precisely defined. The law is one thing, the guidance and interpretations of that law are another.  Expect the bureaucrats at both the Treasury Departments and Small Business Administration (SBA) to be spending many late nights, over the next few weeks, trying to explain all of the detailed nuance of all the quasi-English language contained in the new law.
  2. We are also anticipating more legislation coming, so the cycle of flexibility and understanding may start all over again.

Conclusion

As an employer, it is important that you have the resources to navigate this unprecedented time during this crisis. Being able to interpret how to work through the complexity of what is the Payroll Protection Program will ensure your ability to keep your employees paychecks coming, reinforcing your employees’ decision and confidence that made you their employer of choice, while ultimately contributing to continued business growth and success. We are constantly working to keep you updated on these programs and others both now and in the future. Find out more about our expert perspective by starting a conversation here now.

Employers allowed to defer the employer-paid portion of Social Security taxes

Employers allowed to defer the employer-paid portion of Social Security taxes

April 24, 2020

The Cares Act allows employers to defer the employer-paid portion of Social Security taxes which would normally be deposited between March 27, 2020 and December 31, 2020. This relief also applies to the 50 percent of the Social Security portion of self-employment taxes for a self-employed individual.

The deferred deposits of the employer’s share of Social Security tax must be remitted by the following dates to avoid penalties:

  • On December 31, 2021, 50 percent of the deferred amount, and
  • On December 31, 2022, the remaining amount.

Companies who are participating in the Paycheck Protection Program (PPP) and are notified that some of their PPP loan will be forgiven will no longer be eligible to defer Social Security taxes due following this notification date. However, they may still defer deposit on the Social Security taxes otherwise due between March 27, 2020 and the date of the forgiveness notification of the PPP until the dates noted above.

For more information visit the IRS website here

Contact your payroll provider if you wish to take advantage of this relief.

NEW Release – Federal Agencies Provide New Guidance with COVID-19 – Payroll Tax Credit – Easing the Burden for Employers

NEW Release – Federal Agencies Provide New Guidance with COVID-19 – Payroll Tax Credit – Easing the Burden for Employers

March 20, 2020

“…Eligible employers are also entitled to an additional tax credit based on the cost to maintain health insurance coverage for an employee on paid leave…”

The Internal Revenue Service (IRS), U.S. Treasury Department, and the U.S. Department of Labor (DOL) collectively, the agencies issued a press release Friday, March 20 updating employers required to provide paid leave to employees under the Families First Coronavirus Response Act, signed into law by President Trump on March 18, 2020. The update pertained to two new refundable tax credits created by the Act which are designed to reimburse employers for costs associated with the provision of the required paid leave.

Under the Act, eligible employers (generally businesses and tax-exempt organizations with fewer than 500 employees) are required to provide paid leave to employees in a variety of circumstances, including:

  • Two weeks (up to 80 hours) of paid sick leave to employees who are unable to work because the employee is quarantined, and/or experiencing COVID-19 symptoms, and seeking a medical diagnosis-during such leave the employee will receive 100% of the employee’s pay.
  • Two weeks (up to 80 hours) of paid sick leave to employees who are unable to work because of a need to care for an individual subject to quarantine or to care for a child whose school is closed ( or whose child care provider is unavailable) for reasons related to COVID-19. During this such leave, the employee will receive two-thirds of the employee’s pay.
  • In certain circumstances, employees who are unable to work because of a need to care for a child whose school is closed or whose child care provider is unavailable may receive up to an additional 10 weeks of paid leave at two-thirds of the employee’s pay.

The Act, however, exempts businesses with fewer than 50 employees from providing paid leave to employees who are unable to work because of a need to care for a child whose school has closed or whose child care provider is unavailable, if providing such paid leave would jeopardize the ability of the business to continue. In Friday’s press release, the agencies announced that DOL will provide emergency guidance articulating the conditions under which this exemption is available to small employers.

In order to help eligible employers cover the cost of providing paid leave between April 2, 2020, and December 31, 2020, the Act creates two new refundable tax credits: 1. the paid sick leave credit and 2. the paid child care leave credit.

1. Paid Sick Leave Credit

The press release states that with respect to an employee who is receiving paid sick leave because the employee is quarantined or experiencing COVID-19 symptoms and seeking a diagnosis, and eligible employer may receive a refundable paid sick leave credit at the employee’s regular rate of pay, up to $511 per day, for a maximum of 10 days (the total credit is capped at $5,110 per employee).

For employees on paid leave because the employee is caring for an individual who is quarantined or caring for a child whose school is closed (or whose child care providers is unavailable), the eligible employer may claim a credit for two-thirds of the employee’s regular pay, up to $200 per day for a maximum of 10 days ( this total tax credit is capped at $2,000 per employee). Eligible employers are also entitled to an additional tax credit based on the cost to maintain health insurance coverage for an employee on paid leave. The press release does not state if the amount of this tax credit is capped.

2. Paid Child Care Leave Credit

In addition to the paid sick leave credit, eligible employers may receive a refundable paid child care leave credit with respect to an employee who is unable to work because of a need to care for a child whose school is closed or whose child care provider is unavailable due to COVID-19. This credit is equal to two-thirds of the employee’s regular pay, up to $200 per day, for a maximum of 10 weeks (this total tax credit is capped at $10,000 per employee). Eligible employers are also entitled to an additional tax credit based on the cost to maintain health insurance coverage for an employee on paid leave.

Claiming the Tax Credits

Eligible employers may claim the paid sick leave credit and the paid child care leave credit by offsetting the amount of the tax credit to which the employer is entitled against its federal payroll tax liabilities. For example, if an eligible employer is entitled to $5,000 worth of paid leave tax credits and is otherwise required to deposit $8,000 of payroll taxes with the IRS, the employer may retain the $5,000 worth of tax credits and only deposit the remaining $3,000 of payroll taxes on its next regular deposit date.

In circumstances where the amount of an eligible employer’s tax credit exceeds the employer’s payroll tax deposits, the employer will be able to file an accelerated payment of the refundable tax credit from the IRS. The IRS stated in the press release that it expects to process requests for an accelerated payment in less than two weeks. Additional guidance on this point will be released in the near future.

The press release states that the payroll taxes from which an eligible employer may retain paid sick leave or paid child care leave tax credits include withheld federal income taxes, the employee share of Social Security and Medicare taxes, and the employer share of Social Security and Medicare taxes with respect to all employees. Further guidance on retention of tax credits from these amounts are forthcoming and will be released hopefully in the near future.

Non-Enforcement Period

DOL announced in the press release that it will be issuing a temporary non-enforcement policy that provides eligible employers with time to come into compliance with the Act. During the 30-day period covered by the non-enforcement policy, DOL will not bring an enforcement action against any employer for a violation of the Act so long as the employer has made a good faith effort to comply with the Act. Instead of enforcement actions, DOL will be focused on compliance assistance during the 30-day period.

The IRS and DOL recommend that employers check with their legal tax adviser and/or payroll service provider for assistance on checking on their payroll tax credit eligibility.