COVID-19 and CRNA Employment

Unemployment insurance is a joint state-federal program that provides cash benefits to eligible workers. Each state administers a separate unemployment insurance program, but all states follow the same guidelines established by federal law.  Generally, you should file your claim with the state where you worked.  If you worked in a state other than the one where you live or if you worked in multiple states, the state unemployment insurance agency where you now live can provide information about how to file your claim with other states.

The CARES Act expanded unemployment to self-employed individuals who would otherwise not qualify for regular unemployment compensation benefits. These workers may receive up to 39 weeks of federally-funded unemployment benefits but must apply through the state’s unemployment agency. In order to demonstrate eligibility, an individual must provide self-certification that the individual is otherwise able and available to work, except for the fact that the individual is unemployed, partially unemployed, or unable or unavailable to work due to COVID-19-related circumstances.

Before you file, check with your state unemployment for details on the documentation you need to file to open a claim

Go to CareerOneStop to look up your state’s unemployment site.

You should contact your state’s unemployment office to determine whether you are eligible for unemployment through the state or the expanded federal unemployment.  

Go to CareerOneStop website to look up your state’s unemployment. 

Yes, there is no harm in applying when you are unemployed or underemployed and those denials may be based on particular circumstances that do not apply to your situation.  

You should contact the unemployment agency in the state where you live for instructions about how to apply given that you have not worked in that state. You should also contact the agency through which you work for guidance. 

You should apply for unemployment in the state where you live. The CARES Act has expanded benefits to certain self-employed individuals. You should also check whether you are eligible for small business loans through the SBA.

States generally provide some partial benefits for qualified unemployed workers who accept part-time employment while looking for their next full-time job. Many states also have underemployment provisions to assist full-time employees with reduced hours. Check with your state’s unemployment agency.

It depends.  You should check your state unemployment website to see if that falls within the parameters of unemployment for your jurisdiction.

Generally, yes, your employer should provide you with written notice of a furlough.  You should ask your employer how long the furlough will last; if you are entitled to use PTO during the furlough; and how long benefits will continue.   

You should apply for unemployment through your state’s agency as soon as possible. You may also consider having an attorney review your contract to see whether the company breached your agreement.

If you are uninsured, or are losing your insurance due to recent unemployment, you have options to regain health coverage.  

State health insurance exchanges are where you can directly buy family and individual health insurance plans. If you experience a qualifying life event, such as losing employer-sponsored health insurance, you can shop for health plans through your state’s insurance marketplace. You have 30 to 60 days to sign up after a qualifying life event before the special enrollment period closes.  

If you miss this sign up period, you will need to wait for the period of open enrollment (usually from November to January). But due to COVID-19, some states that operate their own health exchange are reopening their enrollment period so check with your state.  

If you live in a state that operates through the federal marketplace at Healthcare.gov, federal legislation will determine whether or not you have a new opportunity to enroll. 

You might also qualify for Medicaid or CHIP. There is no enrollment period for either, as long as you’re eligible, you can sign up any time. The Medicaid Planning Assistance website provides links to each state’s Medicaid program. 

If you recently lost your employer-sponsored health insurance, you are eligible for coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA gives you an option to continue the same health insurance coverage you had under your employer, but you will be responsible for the costs your employer used to cover. It can last for up to 18 to 36 months. 

Finally, you may be able to obtain coverage through your spouse’s or family’s insurance plan. 

There are two major programs in the CARES Act that can help CRNAs. One is the Paycheck Protection Program (PPP), a small business loan that helps businesses maintain payroll and cover other business expenses with conditions for loan forgiveness. The other is the Health & Human Services Provider Relief funds, which are direct payments (not loans) to those who bill Medicare Fee for Service (FFS). 

You can still apply for assistance under the paycheck protection program. Unemployment is not a criterion for loan consideration. The loan funds however will only help make up a portion of your salary, limited to $100,000/year. 

• Small Business Tax Credits: Tax credits are available to help small businesses and the self-employed offset the costs of paid sick leave, and family leave for their employees.
• Unemployment Expansion: The CARES Act significantly expands existing unemployment benefits in three ways:
  • Recipients receive an extra $600 per week.
  • More workers are eligible for benefits, including self-employed, independent contractors, furloughed workers, and workers affected by COVID-19.
  • Recipients are eligible for an additional 13 weeks beyond the typical 26 weeks offered.

As noted above, the CARES Act expanded unemployment to self-employed or IRS form 1099 individuals. To receive these benefits, you must apply through your state’s unemployment agency.  

Go to the CareerOneStop website to look up your state’s unemployment. 

For more see the AANA Infographic:  How the CARES Act Helps CRNAs. 

To check your eligibility, review the listed criteria and information on the websites below.

• SBA Coronavirus Relief Options
• Paycheck Protection Program

Go to the U.S. Small Business Administration website to check your eligibility for CARES Act loans and for information about applying.

Hazard pay means additional pay for performing hazardous duty or work involving physical hardship. Work duty that causes extreme physical discomfort and distress which is not adequately alleviated by protective devices is deemed to impose a physical hardship. Hazard pay is addressed by the employer and not by federal regulation.

You should check with the worker’s compensation agency for your state. Whether this is covered may depend on how you contracted the virus and the nature of your occupation. Generally, communicable diseases like COVID-19 are not workers’ compensation claims because people are exposed in a variety of ways. However, if you work in a job that poses a special hazard or risk and contract COVID-19 from the work exposure, the agency will likely allow your claim (subject to variations in state law). Receiving a recovery will vary according to the adjudication of your claim.

The amount of your stimulus check will be based on your adjusted gross income from your 2019 federal tax filing or -- if you haven't filed this year -- your 2018 filing. You will qualify for a stimulus check if:

• If you're a single U.S. resident and have an adjusted gross income less than $99,000. 
• If you file as the head of a household and earn under $146,500.
• If you file jointly without children and earn less than $198,000. For each child age 16 or younger in the family, parents will get a payment of $500.

In your situation, if you filed jointly and the combined salary was more than $198,000, you will not receive a stimulus check. However, there may be other relief available such as expanded unemployment benefits.

You should contact the worker’s compensation agency for your state. You may also qualify for paid sick leave under the new Family First Coronavirus Response Act.

You should carefully consider whether or not you wish to be employed under these circumstances. If you are not covered for any liability, you will likely be opening yourself up to potential claims.   

Some states, like Illinois, have provided immunity for volunteers, but this issue is going to be specific to your community and your situations and requires thoughtful analysis.

If your employer employs less than 500 employees, they may provide sick leave and also leave to care for a child.  You should inquire into whether or not your employer offers such leave.  If they do not, you should feel free to ask for the basis for this assessment.

This program is open to small businesses under 500 employees, including sole proprietorships, independent contractors and self-employed persons as well as 501(c)(3) non-profit organization, 501(c)(19) veterans’ organization, or Tribal business concern.

There are four main steps you need to follow to apply for a PPP loan:

• Download and complete the SBA PPP loan application. You will need your business information (address, contact info, etc.) as well as your business TIN (EIN, or SSN). You must also certify that your business was in operation prior to February 15, 2020.
• Determine your Average Monthly Payroll Costs. This will be the basis for your loan amount. For purposes of calculating “Average Monthly Payroll,” most Applicants will use the average monthly payroll for 2019, excluding costs over $100,000 on an annualized basis for each employee.
• Answer the 8 eligibility questions for you and your business, these require a simple yes or no check mark. Also complete the 8 certifications that you are required by simply initialing regarding eligibility and loan use.

Once your form is complete, submit your form to your SBA participating lender. You can find SBA participating lenders in your area through the SBA website.

If you are not eligible to apply for a Paycheck Protection Program (PPP) loan yourself (If you are a W2 CRNA for example) your employer can still apply for funding to help keep you on the payroll. This funding is forgivable for your employer. If your employer receives funding from the program and does not rehire you, they will be required to pay back the loan with applicable interest.

If you are a 1099 Independent Contractor, you are eligible to apply for a loan through PPP. The PPP program specifically covers independent contractors, with loans to cover salary costs up to an equivalent of $100,000/year. 

Yes, PPP loan funds can be used to cover other business expenses, including lease or mortgage interest, rent, and utilities. It’s important to note that salary can include wages, commissions, or similar compensation; payment for vacation, parental, family, medical, or sick leave; allowance for separation or dismissal; payment for the provision of employee benefits consisting of group health care coverage, including insurance premiums, and retirement; payment of state and local taxes assessed on compensation of employees; and for an independent contractor or sole proprietor, wage, commissions, income, or net earnings from self-employment or similar compensation. 75% of the loan must be used for salary in order to be eligible for forgiveness, however.

You should ask the lender that you applied to for the reasoning for rejecting your application. Some banks may prioritize applications from individuals and groups with whom they have a prior relationship. Some banks may have already exhausted their allotment of funding. Many financial intuitions are struggling with overwhelming demands and may themselves being struggling with understanding how to administer this new program. The SBA offers local assistance for those who still have questions regarding the program. You can find local SBA Assistance here.

The U.S. Department of Health and Human Services (HHS) is delivering $30 billion in relief funding to providers in support of the national response to COVID-19. CRNAs will receive relief funding based on their share of 2019 Medicare fee-for-service (FFS) reimbursements. If facilities are the ones who bill Medicare, then they will receive the relief funding. This $30 billion is the first disbursement of $100 billion made available in the CARES Act. The relief funding is intended to help providers and facilities keep their lights on during the COVID-19 pandemic.  This relief funding is not a loan, so it does not need to paid back.

In short, if a CRNA already bills Medicare for FFS reimbursements, then they will receive a payment. Here is what to expect, based on a CRNA’s employment type:

• CRNAs practicing solo, such as 1099 employees, who bill Medicare will receive a payment under the tax identification number (TIN) used to bill Medicare. CRNAs who normally receive a paper check for reimbursement from the Centers for Medicare & Medicaid Services (CMS) will receive a paper check in the mail for this payment as well within the next few weeks.
• Employed CRNAs should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
• Hospital-employed CRNAs should not expect a direct payment. Facilities that bill Medicare will receive the relief funding.
• CRNAs working as part of a larger medical group will see their payment sent to the group's central billing office.

CRNAs, their hospital, or their medical group, will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019.

• A CRNA can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000 and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
• As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
• $121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000

HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.

• Eligible CRNAs, their hospitals, or their medical group, will be paid via Automated Clearing House account information on file with UHG or the CMS.
• The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
• CRNAs who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
• Within 30 days of receiving the payment, CRNAs must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked from hhs.gov/providerrelief.
• HHS' payment of this initial portion of funds is conditioned on the CRNA’s acceptance of the Terms and Conditions - PDF, which acceptance must occur within 30 days of receipt of payment.  If a CRNA receives payment and does not wish to comply with these Terms and Conditions, the CRNA must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed.  Appropriate contact information will be provided soon.

Yes, the CMS accelerated and advance payments are a loan that providers must pay back. These advanced payments to providers are to ensure that providers, such as CRNAs, have the resources needed to combat the pandemic. 

No, you do not need to apply to receive this funding as it will be applied automatically. You will need to go to the portal to sign the attestation statement the week of April 13^th at the link available at: hhs.gov/providerrelief. 

If you are employed by a hospital or a medical group, there is no real way of guaranteeing that you will see this funding.

For more information on your state's unemployment benefit program, visit the U.S. Department of Labor's website for more information on your state. For more information on unemployment benefits expanded by the CARES Act, please see this government fact sheet for full details.

This will depend on the specific terms of the agreement.  In order to cancel a contract due to a disaster declaration, there must be a term in the agreement that allows for this, such as a force majeure term.  You should also look through the termination provisions of the agreement.

You should review the agreement to determine if the terms have been violated by the termination, and if so, reach out to your employer to inform them that they have violated the agreement.  You should also consider filing for unemployment as soon as you can.

You should request a detailed explanation as to which exact clause the company is referring to and consider whether the company has breached the agreement. If you believe that the company breached the contract, consider consulting an attorney.

Terms of restrictive covenants are enforced under state law. You could consider reaching out to the company and asking whether they would waive or modify enforcement of the non-competition clause due to the unprecedented situation.  There are also legal arguments that could be made.  For example, you could also point out that the terms relating to time, geography and scope are over-broad and that you have not received sufficient consideration for the restrictive covenant. If your former employer agrees to waive or modify your obligations, make sure that you execute an amendment to the agreement in writing.  Without this release in writing, working for a competitor in the capacity that is prohibited in your agreement may put you (and your new employer) at risk of being sued for breach of the contract.  Even with a restrictive covenant agreement, you still may be able to work for another employer in a different capacity, depending on the specific terms of your agreement.  

This will depend on the specific terms of the agreement. You should ask your employer to waive or modify enforcement of the non-compete provision given the circumstances and always get the waiver in writing as an amendment to the agreement.  If it is not in writing (and done as an amendment to the agreement) it may not be enforceable.

This will depend on the specific terms of the contract, including whether these benefits are promised throughout the term of the contract or can be amended at the company’s discretion. The company may have breached your agreement.

If you believe that the employer breached the contract, you should request a copy of your personnel file from your employer and inform the employer that they have breached the contract. If you believe that the company breached the contract, consider consulting an attorney.

This depends on the specific terms of the agreement, such as whether the agreement sets a minimum number of hours worked.  If you believe the terms of your agreement have been violated, you should inform your employer right away. This may also depend on whether you are a salaried, exempt employee or hourly, nonexempt pursuant to the Fair Labor Standards Act.

If you believe the terms of your agreement have been breached, it might be worthwhile to consult with an attorney.  However, please understand that these are unprecedented times and there is no certainty as to how the legal system is going to handle issues that have arisen amidst the COVID-19 outbreak and response.  It is important to assess what is the likelihood of your claim “succeeding,” whether you will be able to obtain the relief you are seeking, and whether the cost (in money and emotionally) make the undertaking worthwhile.  A good lawyer should be able to help you walk through that evaluation.

If your employer retaliates against you for refusing to perform dangerous work, you may have a whistleblower claim against your employer depending on the claim and where you work.  You should also contact the Occupational Safety and Health Administration (OSHA). To contact OSHA call 1-800-321-OSHA (6742) and ask to be connected to your closest area office.

This depends on your employer’s policies as well as state law. Some states are requiring individuals traveling from other states to self-quarantine.

If you are a salaried employee, your employer can reduce your salary on a prospective basis due to financial concerns, if it does not violate an employment agreement that you currently have.  However, as a salaried employee, you have a right not to have your salary adjusted on a daily or even weekly basis due to a financial downturn.  As an hourly employee, an employer has more freedom to reduce your hourly rate, but some states and localities limit this right with predictive scheduling and show up to work laws.  With both salaried and hourly employees, many states require advance notice of the reduction.

It depends.  If the work explicitly violates a state order, then there is a right not to work.  However, if the order is merely advisory, then your employer could deem your refusal to work to be insubordination and put you on a unpaid or paid leave.  You also could be terminated.  If you are truly uncomfortable, the best initial course of action is to negotiate with your employer.

During this time of a pandemic, an employer may take your temperature and may inquire into any physical symptoms to assess your risk for COVID-19; however, an employer must keep that information confidential.

Unfortunately, unless you have an employment agreement addressing these reductions in pay or furloughs, your employer can take these actions (with some limitations, such as not paying less than minimum wage) in these unprecedented times. If you are furloughed, you likely qualify for unemployment and may even retain your employer provided benefits (depending on the specific terms set by your employer and/or the benefit plans). You could also look for other employment but keep in mind any noncompetition provisions from your current employer.

The AANA is continuing to coordinate with all market participants, including large anesthesia companies, to both advocate for CRNAs and assure that the value of CRNAs is understood and CRNAs are protected. 

Some anesthesia companies posted information on their websites related to COVID-19: 

• NorthStar Anesthesia
• North American Partners in Anesthesia
• MEDNAX
• TEAMHealth
• Envision Physician Services