By Alex King

NEMT and the CARES ACT

March 31, 2020

Last week, President Trump signed the Coronavirus Aid, Relief and Economic Security Act (“CARES”) into law. This $2 trillion relief legislation provided $25.0 billion in relief for urban and rural public transit systems impacted by the COVID-19 pandemic. For FTA funded 5311 and 5307 public transportation systems, these dollars will provide coronavirus-related reimbursements (Read CTAA’s review of the legislation here).

However, for providers in the NEMT space, the CARES Act did not provide any special consideration or benefits. Despite this, there are still a few components where the passed relief and assistance programs could benefit NEMT providers:

Outlined below are selected relief assistance programs available under the CARES Act that could applicable/of interest to our NEMT members.

  • Paycheck Protection Plan: The CARES Act allocates $350 billion to the Paycheck Protection Plan, which is intended to aid small businesses with under 500 employees make payroll and cover expenses from February 15 to June 30. Small businesses may qualify for up to $10 million in loans. These loans may be used for payroll, rent, utilities, interest payments on mortgages and debt obligations. The U.S. Small Business Administration (“SBA”) is required to enact these programs no later than 15 days after The CARES Act is signed into law.
  • Direct Payments: Whether you own the transportation company, are an employee, or are an independent contractor, you may also receive direct payments in the next few weeks – depending on your income. Direct payments of $1,200 would be sent to most middle-income and lower-income individual taxpayers ($2,400 for joint taxpayers). $500 would be paid for each child under 17. The payment amount begins to phase out at $75,000 for singles and $150,000 for joint taxpayers at 5 percent per dollar of qualified income, or $50 per $1,000 earned. It phases out entirely at $99,000 for single taxpayers and $198,000 for joint taxpayers.
  • Loan Forgiveness: Under the CARES Act, if the employer maintains payroll for the covered period, then the portion of the loans used for covered payroll costs, interest on mortgage obligations, rent, and utilities would be forgiven. This proposal would be retroactive to Feb. 15, 2020, and would encourage employers to rehire workers who were laid off or reinstate salaries that were cut due to the virus outbreak.
  • Tax Benefits: The CARES Act includes tax benefits to provide relief for businesses that have been impacted by the spread of COVID-19, including a decrease in gross receipts of 50 percent or more (compared to the same quarter of the prior year); these businesses may receive a 50% refundable payroll tax credit on wages paid up to $10,000. Social Security payroll tax payments paid by employers can now be delayed until Jan. 1, 2021.
  • Expanded Eligibility for Economic Injury Disaster Loans (EIDLs): EIDLS (administered by the Small Business Administration(SBA)) are now available to any business with no more than 500 employees, operating under a sole proprietorship or as an independent contractor, tribal businesses, all non-profit organizations, and individuals operating as sole proprietors or independent contractors. Within three days of submitting an EIDL application, applicants may request a cash advance of up to $10,000, subject to verification that the entity is eligible for an EIDL. The advance does not have to be repaid if used for maintaining payroll costs, paid leave, increased costs due to supply chain disruption, mortgage or lease payments, or repaying obligations that cannot be met due to revenue losses. Note: Small businesses may receive an EIDL and a loan under the Paycheck Protection Program (PPP) as long as the EIDL is not being used to pay for the same expenses as the PPP loan. EIDLs may be refinanced into a Paycheck Protection Program loan.
  • Public Health and Social Services Emergency Fund: The CARES Act included $100 billion to remain available 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. Recipients of this funding include public entities, Medicare or Medicaid enrolled suppliers and providers, and such for-profit entities and not-for-profit entities, and funds shall be available for building or construction of temporary structures, leasing of properties, medical supplies and equipment. This includes personal protective equipment and testing supplies, increased workforce and trainings, emergency operation centers, retrofitting facilities, and surge capacity. While this likely was not written with NEMT operators in mind, CTAA is curious to see if Medicaid enrolled NEMT providers can leverage these funds. Without further guidance from HHS, CTAA will wait to provide additional instructions for leveraging any funds through this bucket at this time.

CTAA acknowledges that while the provisions and relief opportunities above may be applicable, they do not provide the scale of support that other transportation providers saw within the CARES Act. Part of this is due to the fact that Medicaid itself was largely left unaddressed within the CARES Act. There has already been rumors of a Part IV bill that would potentially provide additional funding directly to states to support their pandemic responses. This is where CTAA sees flexibility and support for NEMT being included. While this bill is still a ways off, both the House and Senate have adjourned for the time being, CTAA is already working with our partners to draft ideas and come up with ways that we can advocate for increased support for our NEMT members.

In the meantime, as we await clearer guidance and support for NEMT, CTAA recommends looking into the guidance available for EMS providers. While NEMT providers are not the same as EMS, many NEMT providers are currently driving high-risk, and/or potentially positive patients, and therefore the guidance for transporting patients made available to EMS providers may be able to offer helpful information. There is a new COVID-19 resource page on EMS.gov provides easy to find links to the most relevant and up-to-date information from the US Centers for Disease Control and Prevention (CDC), NHTSA Office of EMS and other Federal agencies involved in the response to the pandemic. This includes guidance for treating potential COVID-19 patients, information on PPE use and supplies and processes for handling healthcare providers who have been exposed to coronavirus. In addition, materials such as the ASPR EMS Infectious Disease playbook, the IOM Crisis Standards of Care framework and the NHTSA EMS Pandemic Guidelines are all available for download.

CTAA is currently drafting additional content specifically for our NEMT members. If you are an NEMT member and have questions, concerns, or would like to share how COVID-19 is impacting your services, please reach out to CTAA’s Health Care and Transportation Specialist, Alex King at king@ctaa.org.

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The Community Transportation Association of America (CTAA) and its members believe that mobility is a basic human right. From work and education to life-sustaining health care and human services programs to shopping and visiting with family and friends, mobility directly impacts quality of life.