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CARES Act provides hospitals with emergency funding and policy wins

03.31.20

CARES Act update:

As anticipated, the House of Representatives approved the CARES Act on March 27, 2020, and the President has signed the measure. The provisions highlighted in our prior summary remain intact in the final measure. 

So…how are the emergency relief funds in the legislation accessed by healthcare providers?

  • Public Health & Social Services Emergency Fund (PHSSEF): The guidance on how hospitals will access the $100 billion in PHSSEF funds to offset “COVID-19 related expenses and lost revenue” is expected to be released shortly. Keep an eye on this space for further updates as information becomes available.
  • Medicare Advanced Lump Sum or Periodic Interim Payments: Application is made through the Fiscal Intermediary (FI). It should be noted that healthcare organizations do not qualify if they are in bankruptcy, under active medical review or program integrity investigation, or have outstanding, delinquent Medicare overpayments.
  • SBA Paycheck Protection Program (PPP): This application process begins with your local lender. Do not hesitate—contact your lender immediately as it is anticipated that application volume will be tremendous. For more specifics on this program compiled by BerryDunn experts, visit our blog.

We will continue to provide updates as more information becomes available. In the meantime, please feel free to contact the hospital consulting team. Despite the current circumstances we remain available to support your needs. 


On March 25, 2020 the US Senate unanimously approved the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act (The “Act”). The White House has signaled that it will sign the measure as approved by the Senate. 

Major provisions of the proposed legislation include:

  • $100 billion for hospital “COVID-19 related expenses and lost revenue”
  • $275 million for rural hospitals, telehealth, poison control centers, and HIV/AIDS programs
  • $250 million for hospital capacity expansion and response
  • $150 million for modifications of existing hospital, nursing home, and “domiciliary facilities” undertaken as part of COVID-19 response

The CARES Act also includes the following targeted relief and payment modifications under the Medicare and Medicaid programs:

  • The Medicare 2% sequester will be suspended from May 1, 2020 through December 31, 2020. 
  • “Through the duration of the COVID-19 emergency period”, the Act will increase by 20% hospital payments for the treatment of patients admitted with COVID-19. The add-on applies to hospitals paid through the Inpatient Prospective Payment System.
  • $4 billion in scheduled cuts to Medicaid Disproportionate Share Hospital payments will be further delayed from May 22, 2020 to November 30, 2020.
  • Certain hospitals, including those designated as rural or frontier, have the option to request up to a six month advanced lump sum or periodic interim payments from Medicare. The payments will:
    1. Be based upon net payments represented by unbilled discharges or unpaid bills,
    2. Equal up to 100% of prior period payments, 125% for Critical Access Hospitals
    3. In terms of paying down the “no interest loans”, hospitals will be given a four month grace period to begin making payments and at least 12 months to fully liquidate the obligation.

Non-financing provisions contained in the Act that will impact hospital operations include:

  • Providing acute care hospitals the option to transfer patients out of their facilities and into alternative care settings to "prioritize resources needed to treat COVID-19 cases." That flexibility will come through the waiver of the Inpatient Rehabilitation Facility (IRF) three-hour rule, which requires patients to need at least three hours of intensive rehabilitation at least five days per week to be admitted to an IRF.
  • Allowing Long-Term Care Hospitals (LTCH) to maintain their designation even if more than 50% of their cases are less intensive and would temporarily pause LTCH site-neutral payments.
  • Suspending scheduled Medicare payment cuts for durable medical equipment during the length of the COVID-19 emergency period, to help patients transition from hospital to home.
  • Disallow Medicare beneficiary cost-sharing payments for any COVID-19 vaccine.
  • Ensuring that uninsured individuals could receive free COVID-19 tests "and related service" through any state Medicaid program that elects to enroll them.

Other emergency-period provisions that directly affect other entities but have implications for hospitals:

  • Affording $150 billion to states, territories, and tribal governments to cover their costs for responding to the coronavirus public health emergency.
  • Physician assistants, nurse practitioners, and other professionals will be allowed to order home health services for Medicare beneficiaries, to increase "beneficiary access to care in the safety of their home."
  • Requiring HHS to clarify guidance encouraging the use of telecommunications systems, including remote patient monitoring, for home health services.
  • Allowing qualified providers to use telehealth technologies to fulfill the hospice face-to-face recertification requirement.
  • Eliminating the requirement that a nephrologist conduct some of the required periodic evaluations of a home-dialysis patient face-to-face.
  • Allowing federally qualified health centers and rural health clinics to serve as a distant site for telehealth consultations.
  • Eliminating the telehealth requirement that physicians or other professionals have treated a patient in the past three years.
  • Allowing high-deductible health plans with a health savings account (HSA) to cover telehealth services before a patient reaches the deductible.
  • Allowing patients to use HSA and flexible spending accounts to buy over-the-counter medical products without a prescription.

For more information
If you have questions or need more information about your specific situation, please contact the hospital consulting team. We’re here to help. 
 

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Read this if you are a renewable energy producer, investor, or installer.

As Election Day approaches, much if not all of the nation’s attention is focused on the global COVID-19 pandemic, the millions of people it has affected, and its effect on the global economy. What haven’t been prominent in presidential election news are the different policy approaches of the two candidates. In the renewable energy sector, the differences are stark. Here is a brief look at those differences and tax approaches of the candidates.

General tax information: Trump 

Traditionally at this time in an election year we’re presented with tax plans from both candidates. While these are campaign promises and may not fully come to fruition after the election, they can shed light on what each candidate plans to prioritize if elected. As the incumbent candidate in this election, Donald Trump has not provided much detail on his tax plans for the next four years, as noted by the Tax Foundation’s Erica York:

“While light on detail, the agenda includes a few tax policy items like expanding existing tax breaks, creating credits for specific industries and activities, and unspecified tax cuts for individuals. The president has also expressed support for other policy changes related to capital gains and middle-class tax cuts. Of note, none of the campaign documents so far have detailed a plan for the expiring provisions under the 2017 Tax Cuts and Jobs Act (TCJA).”

The president’s main priorities have been growing the economy and creating jobs, both of which have taken a massive hit in 2020 due to the pandemic. President Trump has had little else to say on his plans for a second term other than extending the sunset of the Tax Cuts and Jobs Act (TCJA) of 2017 to 2025, or the end of this coming term. One of the items that could be considered is an expansion of the Opportunity Zone program, providing a tax deferral for investment in specified economically distressed areas.

Another item is how Net Operating Losses (see our prior blog post on this topic) will be treated and whether or not the TCJA or the Coronavirus Aid, Relief, and Economic Security (CARES) Act rules will be the ones used in the future. With the recent New York Times article detailing the president’s tax filings and showing how he took advantage of the NOL rules, it’s still a guess as to how that could impact the tax policy around NOLs going forward.  

Trump energy plan: fossil fuels first

In the energy sector, Trump’s focus has been on bolstering the oil and gas industry, while also trying to revive the flagging coal industry, and it appears his focus will continue in that vein. His proposed budget continues to provide tax breaks for fossil fuel companies, while planning to repeal renewable energy tax credits. Prior to his election in 2016, the renewable energy sector was somewhat hopeful that the benefits of increased jobs provided by the industry would be appealing to the President. This hasn’t played out over the last four years and with current energy credits scheduled to phase out and unprecedented unemployment, the jobs being provided by this sector may be part of the formula to help sway the administration to extending or expanding these programs.

General tax information: Biden 

Biden, as the challenger, has a much more detailed tax plan laid out. As expected, it is very different from the direction the Trump presidency has taken regarding taxes. A brief summary of his plan:

Raise taxes on individuals with income above $400,000, including:

  • Raising the top individual income tax bracket from 37% back to 39.6%
  • Removing the preferential treatment of long-term capital gains for taxpayers with income over $1 million
  • Creating additional phase outs of itemized and other deductions 
  • Instituting additional payroll taxes related to funding social security
  • Expanding the Child Tax Credit up to $8,000 for two or more children

Biden’s plan would also raise taxes on corporations:

  • Raising the corporate income tax rate from 21% to 28% 
  • Imposing a corporate minimum tax on corporations with book profits of $100 million or higher.

According to the Tax Foundation’s analysis of Biden’s tax plan:  

“[Expectations are that it] would raise tax revenue by $3.05 trillion over the next decade on a conventional basis. When accounting for macroeconomic feedback effects, the plan would collect about $2.65 trillion the next decade. This is lower than we originally estimated due to the revenue effects of the coronavirus pandemic and economic downturn.”…“On a conventional basis, the Biden tax plan by 2030 would lead to about 6.5 percent less after-tax income for the top 1 percent of taxpayers and about a 1.7 percent decline in after-tax income for all taxpayers on average.

Taxpayers earning more than $400,000 a year, and investors who have enjoyed preferential treatment and lower tax rates on capital gains will certainly pause at this proposal. While Trump’s tax policy has been to lower taxes in these areas to spur investment in the economy, Biden’s plan shows the need to generate tax revenue in order to cover the massive amounts spent during the COVID-19 pandemic.  

Biden energy plan: renewables first

Joe Biden’s energy policy is focused on climate change and renewable energy. In addition to ending tax subsidies for fossil fuels, his platform proposes investing $2 trillion over four years for clean energy across sectors, recommit to the Paris agreement, and achieve 100% clean energy by 2035.

Other Biden initiatives include:

  • Improving energy efficiency of four million existing buildings
  • Building one and a half million energy-efficient homes and public housing
  • Expanding several renewable-energy-related tax credits
  • Installing 500 million solar panels within five years 
  • Restoring the Energy Investment Tax Credit (ITC) and the Electric Vehicle Tax Credit

Indeed, over the past decade the Democratic Party has been a proponent of investment in and expansion of renewable energy technologies. While increased taxes will certainly cause many business owners and investors to pause, and any changes will need to be passed by Congress, it is encouraging to the renewable energy sector that Biden’s policy platform states goals related to increasing renewable energy in the United States.

As one might expect during this era of the two main political parties being so far apart from each other on policy, the proposed tax plans of both candidates also stand in fairly stark contrast, as does their approach to the United States’ energy sources in the coming decade. There are benefits and consequences to both plans, which will have an impact beyond the 2020 election.  
 

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The presidential election: two different approaches to energy

Read this if you administer a 401(k) plan.

On December 20, 2019, the Setting Every Community up for Retirement Enhancement (SECURE) Act was signed into law. The SECURE Act makes several changes to 401(k) plan requirements. Among those changes is a change to the permissible minimum service requirements.  
 
Many 401(k) retirement plan sponsors have elected to set up minimum service requirements for their plan. Such requirements help eliminate administrative burden of offering participation to part-time employees who may then participate in the plan for a short period of time and then keep their balance within the plan. Although plan sponsors do have the ability to process force-out distributions for smaller account balances, a minimum service requirement, such as one year of service, can help eliminate this situation altogether.  

Long-term part-time employees now eligible

The SECURE Act will now require that long-term part-time employees be offered participation in 401(k) plans if they are over the age of 21. The idea behind the requirement is that 401(k) plans are responsible for an increasingly larger amount of employees’ retirement income. Therefore, it is essential that part-time employees, some of which may not have a full-time job, have the ability to save for retirement.  
 
Long-term is defined as any employee who works three consecutive years with 500 or more hours worked each year. This new secondary service requirement becomes effective January 1, 2021. Previous employment will not count towards the three-year requirement. Therefore, the earliest a long-term part-time employee may become eligible to participate in a plan under the secondary service requirement is January 1, 2024.  

403(b) plans not affected 

Please note this provision is only applicable for 401(k) plans and does not impact 403(b) plans, which are subject to universal availability. Furthermore, although long-term part-time employees will be allowed to make elective deferrals into 401(k) plans, management may choose whether to provide non-elective or matching contributions to such participants. These participants also may be excluded from nondiscrimination and top-heavy requirements.  
 
This requirement will create unique tracking challenges as plans will need to track hours worked for recurring part-time employees over multiple years. For instance, seasonal employees who elect to work multiple seasons may inadvertently become eligible. We recommend plans work with their record keepers and/or third-party administrators to implement a tracking system to ensure participation is offered to those who meet this new secondary service requirement. If a feasible tracking solution does not exist, or plans do not want to deal with the burden of tracking such information, plans may also consider amending their minimum service requirements by reducing the hours of service requirement from 1,000 hours to 500 hours or less. However, this may allow more employees to participate than under the three-year, 500-hour requirement and may increase the employer contributions each year. 

If you have questions regarding your particular situation, please contact our Employee Benefit Audits team. We’re here to help.

Article
New permissible minimum service requirements for 401(k) plans

Read this is you are a business owner or an advisor to business owners.

With continued uncertainty in the business environment stemming from the COVID-19 pandemic, now may be a good time to utilize trust, gift, and estate strategies in the transfer of privately held business interests. 

As discussed in our May 26, 2020 article 2020 estate strategies in times of uncertainty for privately held business owners, there may be opportunity to free up considerable portions of lifetime gift and estate tax exemption amounts. This is possible due to suppressed values of privately held businesses and the uncertainty surrounding the impact of the 2020 presidential election on tax rates and future exemption and exclusion thresholds.

An element to consider is the ability to transfer non-controlling interests in a business. These interests are potentially subject to discounts for lack of control and lack of marketability. The discounts may further reduce the overall value transferred through a given strategy, potentially offloading a larger percentage of ownership in a business while retaining large portions of the gift and estate lifetime exemption. Part I of this series focused on the discount for lack of control. In Part II, let’s focus on the discount for lack of marketability.

Discount for lack of marketability

In the context of a hypothetical willing buyer and willing seller, the buyer may place a greater value on an ownership interest of an investment that is “marketable.” Marketable investments can be bought and sold easily and offer the ability to extract liquidity compared to an interest where transferability and marketability are limited. 

Simply put, buyers would rather own investments they can sell easily, and will pay less for the investment if it lacks this ability. Non-controlling interests in private businesses lack marketability—few people are interested in investing in a business where control rests in someone else’s hands. Discounts for lack of control commonly reduce the value of the transferred interest by 5% to 15%, discounts for lack of marketability can drop value of the business by 25% to 35%.

Market-based evidence of proxies for discounts for lack of marketability can be found within the following resources, studies, and methods (including, but not limited to):

  • Various restricted stock studies
  • The Quantitative Marketability Discount Model (QMDM) developed by Z. Christopher Mercer
  • Various pre-initial public offering studies
  • Option pricing models
  • Other discounted cash flow models

In addition to these resources, to fully assess the degree of discount applicable to a subject interest, consider company-specific factors when estimating the discount for lack of marketability. The degree of marketability is dependent upon a wide range of factors, such as the payment of dividends, the existence of a pool of prospective buyers, the size of the interest, any restrictions on transfer, and other factors. 

To establish a comprehensive view on the applicable degree of discount, here are more things go consider. In a ruling on the case Mandelbaum v. Commissioner1, Judge David Laro outlined the primary company-specific factors affecting the discount for lack of marketability, including:

  1. Restrictions on transferability and withdrawal
  2. Financial statement analysis
  3. Dividend policy
  4. The size and nature of the interest
  5. Management decisions
  6. Amount of control in the transferred shares

Conclusion

Business owners are knowledgeable of the facts and circumstances surrounding a business interest. They take a close look at what they are buying before they make an offer. Like most people, they prefer investments they can readily convert into cash, and are therefore generally not willing to pay the pro-rata value for a minority interest in a business when the interest lacks marketability. To assess an appropriate discount for lack of marketability, consider resources such as those referred to above, then ensure selected discounts are appropriate based on the factors specific to the company and interest being valued. 

Our mission at BerryDunn remains constant in helping each client create, grow, and protect value. If you have questions about your unique situation, or would like more information, please contact the business valuation consulting team.

Part III of this series will focus on the application of DLOC and DLOM to a subject interest.

1Mandelbaum v. Commissioner, T.C. Memo 1995-255 (June 13, 1995).

Article
Discounts for lack of control and marketability in business valuations (Part II)

Read this is you are a business owner or an advisor to business owners.

With continued uncertainty in the business environment stemming from the COVID-19 pandemic, now may be a good time to utilize trust, gift, and estate strategies in the transfer of privately held business interests. 

As discussed in our May 26, 2020 blog post 2020 estate strategies in times of uncertainty for privately held business owners, there may be opportunity to free up considerable portions of lifetime gift and estate tax exemption amounts through transfers due to suppressed values of privately held businesses, and the uncertainty surrounding the impact of the 2020 presidential election on tax rates and future exemption and exclusion thresholds. 

An element to consider when building on this opportunity is the ability to transfer non-controlling interests in a business. These interests are potentially subject to discounts for lack of control and lack of marketability. This may further reduce the overall value transferred through a given strategy, potentially offloading a larger percentage of ownership in a business while retaining large portions of the gift and estate lifetime exemption. Let’s focus on the discount for lack of control (DLOC).

Discount for lack of control

In the context of a hypothetical willing buyer and willing seller, the buyer may place a greater value on an ownership interest with the ability to make changes at their discretion, compared to an alternative ownership interest lacking control. Simply put, buyers like to be in control, and they will pay less for the investment if the interest lacks these characteristics. 

When valuing non-controlling business interests there is an inherent discount to full value recognized to reflect the fact that the subject interest does not hold a controlling position. As a result of this discount, the value of a non-controlling interest in a company will differ from the pro-rata value per share of the entire company. DLOCs alone commonly reduce the value of the transferred interest by 5% to 15%.

All else being equal, a non-controlling ownership position is less desirable (valuable) than a controlling position. This is because of the majority owner’s right to control any or all of the following activities: managing the assets or selecting agents for this purpose, controlling major business decisions, asset allocation choices, setting salary levels, admitting new investors, acquiring assets, selling the company, and declaring/paying distributions.
 
Market-based evidence of proxies for DLOCs can be found within the following subscription-based databases (including, but not limited to): 

  • Control premium studies published in the Mergerstat® Review series by FactSet Mergerstat/Business Valuation Resources
  • Closed-end fund data
  • The Partnership Profiles, Inc. Minority Interest Database and Executive Summary Report on Re-Sale Discounts for applicable entity types

In addition to these resources, to fully assess the degree of discount applicable to a subject interest, consider company-specific factors when estimating the DLOC. The degree of control for a subject interest may be impacted by relevant state statutes and the governing documents of the subject company. These factors are analyzed in conjunction with the current operational and financial policies established and implemented in practice by management to establish a comprehensive view on the applicable degree of discount.

Conclusion

Hypothetical business owners are knowledgeable of the facts and circumstances surrounding a business interest. They take a close look at what they are buying before they make an offer. Like most people, they like to be in charge, and are therefore generally not willing to pay the pro-rata value for a minority interest in a business when the interest lacks control. To assess an appropriate discount for lack of control, consider resources such as those referred to above, then ensure the selected discounts are appropriate based on the factors specific to the company and interest being valued. 

Our mission at BerryDunn remains constant in helping each client create, grow, and protect value. If you have questions about your unique situation, or would like more information, please contact the business valuation consulting team.

Article
Discounts for lack of control and marketability in business valuations

Read this if you are a home health agency (HHA).

The Centers for Medicare & Medicaid Services (CMS) proposed rule, CY2021, was published on June 30, 2020. The proposed rule indicates that the Request for Advance Payment (RAP) currently permitted will be eliminated for all 30-day home health periods beginning on or after January 1, 2021. If adopted, this proposed rule will impact the timing of cash flow for HHAs. HHAs will no longer receive an advanced payment, but rather will not be paid until approximately 45-60 days after the period of care has begun. The change in timing of the payment should be considered as part of your HHA’s cash flow forecasting.

Note: Although the RAP payment has been eliminated, HHAs will still be required to submit a zero dollar RAP bill at the beginning of each 30-day period to establish home health services. 

Also included in the proposed rule is a transition from a RAP to a Notice of Admission (NOA) in 2022. This is similar to the Notice of Election under the hospice benefit, since there will no longer be a RAP. It is proposed that HHAs would submit a one-time NOA that establishes care in place of the RAP for the patient until discharged. 

There will be a payment penalty if either the zero dollar RAP in CY2021 or NOA in 2022 is not submitted within five calendar days from the start of care. The penalty is proposed to be a payment reduction of 1/30th to the wage and case-mix adjusted 30-day period of care reimbursement for each day late until submitted, reducing the total reimbursement for patient care. HHAs should be monitoring the timeliness of RAP submissions to be prepared for this proposed change and avoid potential reimbursement reduction if this proposed rule is passed. Read the entire proposed rule.

Please contact a BerryDunn Home Health team member to assist you with evaluating the cash flow impact these proposed changes may have to your organization. 

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Medicare Home Health Notice of Admission Proposed Rule CY2021 and its cash flow impact