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CORONAVIRUS (COVID-19) IN THE CHIROPRACTIC PHYSICIAN OFFICE

Thursday, May 21, 2020   (0 Comments)
Posted by: Sheri Ryan
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ACS affirms that Doctors of Chiropractic are essential healthcare providers, ready to serve their communities both in daily care and in times of urgent need.  The services you offer your patients are more important today than ever before.  In a time where hospital and urgent care facilities are being inundated with sick people in need of life saving care, our doctors continue to provide chiropractic care for neuromusculoskeletal conditions, reducing the need for these patients to spill into a health care system that we know will continue to be strained in ways not previously experienced. 

At this time, we keep all health care professionals in high regard as they care for our sick community members and as always, the ACS is proud of our Doctors of Chiropractic.  

The Alaska Chiropractic Society along with the Board of Chiropractic Examiners has been working diligently with the Governor's office and Department of Health and Social Services to ensure that chiropractors can continue to provide medically necessary care to Alaskans.  

ACS Executive Board and Staff
Dr. Todd Curzie, President            Debbie Ryan, Chief Executive Officer
Dr. Kelly Ryan, Vice President      Sheri Ryan, Chief Operating Officer
Dr. John Pairmore, Treasurer
Dr. Joel Adkins, Secretary


Editors Note: This article is being constantly updated as new information is made available. Please continue checking this article for updates.

The ACS has been carefully monitoring the CDC and other information on the COVID-19 (coronavirus 2019).  Although the ACS is not and cannot be a primary source on this subject, we want to make our members aware of relevant information that has been published by the CDC.  The spread of this virus has particular implications for physician offices, as both health care providers and as employers. 

The COVID-19 outbreak is rapidly evolving, and information is constantly changing.  For that reason, the ACS strongly recommends that physicians stay up to date with guidance issued by the U.S. Centers for Disease Control and Prevention (CDC).  

Disclaimer: The Alaska Chiropractic Society is a professional association advocating for the rights of chiropractors and their patients across the state of Alaska. We are not a state agency or regulatory body. We are merely informing our membership regarding what they are allowed to do during this difficult and confusing time.

The information we provide during this pandemic is derived in conjunction with governmental relations and legal experts, developed after examination of all official releases of information from the State of Alaska and in consultation with said experts and representatives from state government. Please refer to our emails and website for the latest information, free from speculation and the rumors currently circulating in the wake of official state actions.

Rest assured that we will continue to advocate for the profession at the highest levels, with the health and well-being of you and your patients, as well as the overall stability of the healthcare system, foremost in our efforts.


TABLE OF CONTENTS:

The following section is a listing of the many topics covered in this article. Each listing is a link that will take you to that section when clicked. Find the section that pertains to the information you need and click the link to jump to your information directly.

ACS to Host 2020 Virtual Alaska State Convention June 1 - December 30 (05/21/2020)

ACS Cancels 50th Anniversary Convention Scheduled for October 1-4, 2020 (05/21/2020)

Board of Chiropractic Examiners Makes Changes to Continuing Education Requirements for License Renewal Period ending 12/31/2020 (05/21/2020)

Additional Funding Available to AK Businesses/Non-Profits under CARES Act (05/21/2020)

Governor Mike Dunleavy Announces Phase 3 of Reopen Alaska Responsibly (05/20/2020)

Health Mandate 15 - Appendix 01 Massage Therapists (05/08/2020) 

Board of Chiropractic Examiners Mandate 15 Compliance Guidance (05/06/2020)

Medicare Providers - Additional Funding Available through CARES Act (04/29/2020)

Board of Chiropractic Examiners Mandate 015 Clarification (04/20/2020)

Health Mandate 015 - Reopening of Health Care starting April 20 (04/15/2020) 

AK Workers' Compensation Presumption of Compensability for Emergency Response and Health Care Employees (04/11/2020) 

CMS Assistance for Healthcare Providers (04/10/2020)

Action Alert (04/08/2020)

Health Mandate 012 - Intrastate Travel and the Chiropractic Office (03/28/2020)

Health Mandate 011 - Social Distancing and the Chiropractic Office (03/28/2020)

Paid Sick Leave and Tax Credits for Coronavirus-Related Employee Leave (03/27/2020)

Relevant Webinars and On-Demand Courses (04/17/2020)

Does Malpractice Insurance Cover Claims of Coronavirus Exposure in a Chiropractic Physician Office?  Does Workers' Compensation Insurance Cover Claims by my Employees?  (03/27/2020)

Economic Recovery Resources for Businesses (03/30/2020) updated with CARES Forgivable SBA Loan Program 

Unemployment Information for Employees and Employers (03/27/2020)

State of Alaska Health Mandate 9.1 - Statewide - All Massage Therapy Operations in Chiropractic Offices Should Cease Effective March 24, 2020 at 5:00 pm (03/24/2020)

ACS Patient Neuromusculoskeletal Care Recommendation (03/24/2020)

ACS Advertising and Marketing Recommendation (03/24/2020)

Anchorage Municipality Hunker Down Order (03/22/2020)

Telemedicine in Alaska Resources for the Chiropractic Office (03/27/2020)

Fairbanks North Star Borough + Ketchikan Gateway Borough Massage Therapy Mandate (03/20/2020)

Closing of Offices (03/19/2020)

Offices Remaining Open (03/19/2020)

State of Alaska Information (Updated 03/22/2020)

CDC Environmental Cleaning and Disinfection Recommendations (03/19/2020)

CMS Release for Providers (03/19/2020)

Resources for Your Office (03/18/2020)

Information for Clinicians (03/06/2020)

Information for Employers (03/06/2020)

Additional Resources for Offices (03/24/2020)


ACS to Host 2020 Virtual Alaska State Convention June 1 - December 30 [05/21/2020]

We realize that many of you were planning on attending our event for your continuing education needs this year and for that reason, our staff have been working non-stop since the BOCE vote on Friday to put together a virtual CE event for you with quality education on an easy to use platform at a competitive price. We are thrilled to offer you a one-stop online solution for ALL your CE needs! We've put together an on-demand library with top-notch speakers and all the required credits INCLUDING CPR!

Turning lemons into lemonade.Making the best of a bad situation.Every challenge is an opportunity.

Pick your favorite cliché,but the Alaska Chiropractic Society is not letting the circumstances of the world keep us from our mission!

We will be hosting a 2020 Virtual Alaska State Convention and we hope we can count on your support!

Here’s how this will work.Our virtual conference is hosted by SIDECAR, a chiropractic business development and training firm. SIDECAR operates a web-based training system that allows us to offer continuing education and it's PACE APPROVED!!!!

We will have 24 hours of CE credits available“on demand” to choose from through our ACS virtual training platform.

  • ACS Member cost $299 for 16 hours of CE
  • Non-Members cost $399 for 16 hours of CE
  • a la carte per CE credit pricing available



The credits available include:

  • Dr. Heidi Haavik: 9 hours of Clinical education:The Reality Check: Simplifying Chiropractic for your Patients
  • Dr. Jeff Rich: 4 hours of Radiology education:Impacting Patient Care with Chiropractic Radiology
  • Dr. Robert Silverman: 3 hours of Nutrition education: Nutritional Protocols
  • Dr. Ken Kaufman: 3 hours of Sports Medicine
  • Dr. Evan Gwilliam: 2 hours of Documentation training
  • James Marsh: 1 hour each - Business Ethics or Sexual Boundaries
  •  Speaker TBA: 1 hour of CPR training

Lemons, hard times, challenges- however you want to frame it – we're in it together. The Alaska Chiropractic Society is proud to offer this virtual convention.

We wish we were all getting together.

But we know better days are ahead.


Registration and Speaker information coming next week!

2020 Virtual Alaska State Convention to open June 1!


ACS Cancels 50th Anniversary Convention Scheduled for October 1-4, 2020 [05/21/2020]

Due to the "unknowns" associated with planning an event in today's COVID-19 climate, potential travel restrictions for both speakers and attendees, and new reduction in required CE hours + increase to all online credits, it is with a very heavy heart that the Alaska Chiropractic Society has made the decision to cancelour biennial 50th Anniversary Convention on October 1-4, 2020 at the Hotel Captain Cook in Anchorage, Alaska.

The cancellation of our event is a huge blow to the association, both from a networking stand point for the doctors in our state and for our association financially. Like you, we are looking at the defunding of many of our initiatives for the remainder of this year and next.

But fear not, ACS is going lean and mean and will do what it takes to continue to support and fight for the chiropractic profession in Alaska!


Board of Chiropractic Examiners Makes Changes to Continuing Education Requirements for License Renewal Period ending 12/31/2020 [05/21/2020]

On Friday, May 15th, the Alaska Board of Chiropractic Examiners made changes to the continuing education requirements for Doctors of Chiropractic for the licensing renewal period ending 12/31/2020. Here is the statement issued:

Due to the COVID-19 emergency and in line with SB241, the Alaska Board of Chiropractic Examiners have modified the continuing education requirements for the December 31, 2020, renewal. The required 32 credit hours, for chiropractors that have been licensed for more than two years, is reduced to 16 and all of them can now be done online, except for specific hands-on competency, such as dry needling. For all licensees, specific credit requirements, such as X-ray, ethics/boundaries, coding/documentation, etc., are now reduced to half.

Download the official BOCE statement at:
https://www.commerce.alaska.gov/web/Portals/5/pub/CHISB241CEModifcations.pdf

What does this mean for you?

  • You have to earn 16 credits instead of 32
  • You only have to earn 4 credits in radiology minimum
  • You only have to earn 1 credit in documentation or coding minimum
  • You only have to earn 1 credit in ethics minimum
  • You only have to earn 1 credit in CPR minimum
  • AND you can earn ALL your credits ONLINE! (except specific hands-on competency, such as dry needling)

*DCs who have been licensed for one year but < two years still have to earn 16 credits but the same reduced subject matter list above applies.

**DCs who have been licensed <one year do not have to earn continuing education credits but must still file and pay for renewal.


Additional Funding Available to AK Businesses under CARES Act [05/21/2020]

Download Summary Sheet - On May 20, Governor Mike Dunleavy thanked the Alaska Legislature for approving his administration’s plans to distribute CARES Act funding for local communities, businesses, non-profits and Alaskans that have been impacted by the public health emergency. He stated that these funds will be critical to assisting our state’s economy in getting back on track, businesses open, and individuals back to work.  See Press Release dated 05/20/2020.  


Governor Mike Dunleavy Announces Phase Three of Reopen Alaska Responsibly [05/20/2020]

See full Press Release dated May 19, 2020 - Alaska Governor Mike Dunleavy today announced plans for Phase Three of the State’s approach to reopening segments of the Alaskan economy in an effort to balance the ongoing need to slow the spread of COVID-19 with the critical need to resume economic activity in a reasonable and safe manner.

 

Beginning 8:00am Friday, May 22, 2020, Phase Three of the Reopen Alaska Responsibly Plan will take effect, allowing all businesses to open at 100 percent capacity.

 

  • All businesses may open
  • All houses of worship and religious gatherings may open
  • All libraries and museums may open
  • All recreational activities may open
  • All sport activities may open

 

The following guidance remains in effect:

  • Health Mandate 10 on International and Interstate Travel – Order for Self-Quarantine
  • Health Mandate 13 on K-12 Public and Private Schools
  • Health Mandate 14 on Non-Congregate Sheltering Order
  • Health Mandate 15 on Services by Health Care Providers
  • Health Mandate 17 on Protective Measures for Independent Commercial Fishing Vessels
  • Health Mandate 18 on Intrastate Travel
  • The State will continue to work with large industries to protect their workforce and the communities in which they operate.
  • Limited visitation access to senior centers, prisons, and institutions.

 

Official guidance will be available on May 21, 2020 at https://covid19.alaska.gov/reopen/.

 

The Governor’s COVID-19 Health Mandates can be found here.

For the latest information on Alaska’s response to COVID-19, please visit https://covid19.alaska.gov/  

 


Health Mandate 015 Appendix 01 - Massage Therapists [05/08/2020]

Issued May 7, 2020

After reviewing the recommendations of the board, the governor’s office has issued Appendix 01 for Health Mandate 15 applying to the licensees of the Board of Massage Therapists. Appendix 01 stipulates the minimum requirements for massage therapists to return to the practice of massage therapy.

Additionally, as Standards of Practice under 12 AAC 79.900 states that massage therapists must “provide a setting that is safe and meets all applicable legal requirements for health, safety, sanitation, hygiene, universal and standard precautions, in accordance with local, state, and federal regulatory bodies including guidelines set by the Centers for Disease Control and Prevention (CDC)…” the Board of Massage Therapists requires all licensed massage therapists to wear surgical masks while treating a client in accordance with CDC guidelines stating “cloth face coverings are not considered PPE because their capability to protect healthcare personnel is unknown…for visitors and patients, a cloth face covering may be appropriate.”

Mandate 15 does not require that licensees return to practice massage therapy; however, LMTs should expect to return to work if required by their employers.

All licensed massage therapists and their employers are advised to follow Appendix 01 and the board guidance on masks to ensure public safety and compliance with state law. If you do not have the equipment and ability to follow these stipulations, per Health Mandate 15, you may not practice.

Download a copy of Health Mandate 015 Appendix 01 - Massage Therapists

Download a copy of Mandate 15 Practice Decision Guide

Or visit the CBPL COVID-19 Information for Professional Licensees & Businesses website at https://www.commerce.alaska.gov/web/cbpl/CBPLCOVID-19Information.aspx


Board of Chiropractic Examiners Mandate 15 Compliance Guidance [05/06/2020]

Adopted May 1, 2020 - Effective during Mandate 15; Posted on state website 05/06/2020

Download a copy of BOCE Mandate 15 Compliance Guidance

Or visit the CBPL COVID-19 Information for Professional Licensees & Businesses website at https://www.commerce.alaska.gov/web/cbpl/CBPLCOVID-19Information.aspx


Medicare Providers - Additional Funding Available through CARES Act Provider Relief Act [04/29/2020]

APPLY TODAY for Your Possible Share of Additional $20 Billion in Funding!

Contrary to previous guidance from the U.S. Department of Health and Human Services (HHS), Medicare providers who received a payment from the CARES Act Provider Relief Fund ARE ELIGIBLE to receive additional funds allocated in the legislation signed into law by President Trump last week.

Congress has appropriated $100 billion to reimburse providers for lost revenues and increased expenses due to the coronavirus pandemic. The first of these funds - $30 billion – were distributed by HHS beginning April 10, 2020, in proportion to providers' Medicare Fee for Service payments in 2019. Payments were sent directly to providers by automatic deposit or by paper check, and recipients did not have to fill out an application or engage in any other activity in order to receive the funds (aside from signing an attestation if they decided to keep the funds after reading the Terms and Conditions). Additionally, some providers were sent a second payment based on their Medicare Cost Reports.

New Funding Available
Medicare providers who have already received a payment from the Provider Relief Fund are now eligible to APPLY for additional funds by submitting data about their annual revenues and estimated COVID-related losses via the Provider Relief Fund Application Portal.

If you have not received any payment from the Provider Relief Fund as of 5:00 pm EST Friday, April 24, 2020, you are not eligible for these funds and should NOT use the General Distribution Portal. HHS notes that providers who have not yet received any payments from the Provider Relief Fund may still receive funds in other distributions, but the process for this has not been outlined as of this writing.

Further Information

  • A detailed description of the entire Provider Relief Fund program can be found here.
  • A Frequently Asked Questions document from HHS on the General Distribution Portal can be found here. It answers such questions as:
    • How does this program work?
    • Who is eligible to receive additional payments by submitting an Application to the Provider Relief Fund Application Portal?
    • Who is eligible to receive payments from the Provider Relief Fund?
    • Could you give me an overview of the application process?
    • What information do I need to have before I start the application process?
    • Will I be penalized if I take several days to collect the necessary information?
    • I received payment and have already attested, am I eligible to request more funds?
    • How long does it take for HHS to make a decision on additional funding?
    • Is this a loan or a grant?

Thank you to the Michigan Association of Chiropractors (MAC) for sharing this information with the Alaska Chiropractic Society!


Board of Chiropractic Examiners Mandate 015 Clarification [04 20 2020]

Governor Dunleavy stated  on April 15, 2020 that Health Mandate 15 was being modified to allow “all providers defined in statute and listed in Section 1” (which includes chiropractors and massage therapists) “will be able to resume services that require minimal protective equipment and follow the guidance below:”

  1. “Every effort to avoid being in the same space with patients is continued, including telehealth, telephone consultations, and maintaining physical barriers between providers and patients;
  2. “All health care, delivered both in and out of health care facilities, (this includes hospitals, surgical centers, long-term care facilities, clinic and office care, as well as home care) shall deploy universal masking procedures in coordination with the facility infection control program. This may be a combination of cloth face coverings (for employees not present for provision of services or procedures, such as front desk staff) and surgical masks for those involved in non-aerosolizing direct-patient care (bold added);
  3. “Regardless of symptoms, all health care facilities should screen all patients for recent illness, travel, fever, or recent exposure to COVID-19, and to the extent that is possible, begin testing all admitted patients”;

(Items 4-6 not listed here.  Refer to Health Mandate 15, Modified April 15, 2020 for full text.)

The above list level-of-care is the MINIMUM acceptable standard to continue caring for our patients. 

 

Provision for Resuming Non-Urgent/Non-Emergent Elective Services

1. Health care delivery can meet all of the standards outlined in Section II of this mandate(listed above);. 2. Health care is delivered by a provider listed in statute (chiropractor, massage therapist);

3. Health care can be safely done with a surgical mask, eye protection and gloves.

4. (Not applicable to chiropractic);

5. There are to be no visitors in health care facilities except for: a parent of a minor. (Other examples not applicable to chiropractic clinical care.) Any of the allowed visitors must wear a fabric face covering; 

6. Workers must maintain social distancing of at least six feet from non-patients and must minimize contact with the patient;

7. Exceptional environmental mitigation strategies must be maintained, including the protection of lobbies and front desk staff; 

8. Unlicensed assistive personnel necessary to procedures under this section may be included in service delivery/direct patient care.  (Certified Clinical Chiropractic Assistant, Chiropractic Assistant, Interns.)

(The previous lists are directly from Health Mandate 15, Revised April 15, 2020.)

The first take-home message here is that any patient care that does not require direct contact with the patient must be performed via various communications media.

Additionally, the provisions for resuming Non-urgent or Elective patient care requires (meaning non-optional):

  • all COVID-19 telephone and in-office screening procedures continue for Non-Urgent/Elective patients.Failure to document these screenings is evidence of negligence;
  • All clinic staff will wear appropriate PPE, which means face coverings--clerical staff may wear cloth, patient-care staff will wear surgical masks (n95 masks not required), and; [1]
  • all Social Distancing protocols are continued in clinics.6’/10 persons applies everywhere.

Care that can safely be provided to our Emergent, Urgent, Non-Emergent and Elective care patients will be performed with surgical masks, gloves, and eye protection as of April 20, 2020.  This includes all chiropractic treatment, including physiotherapies, and massage. Those are the terms of performing ongoing patient care.  Failure to wear all required PPE, or to provide it to clinical staff (including massage therapists) is evidence of gross negligence and reckless disregard of Public Health Emergency Declaration issued March 11, 2020. 

 The Alaska Board of Chiropractic Examiners is scheduling a telephonic Emergency Board Meeting to review these requirements and other issues related to the ongoing COVID-19 crisis.  You are welcome to attend and your input will always be considered.  Please demonstrate the greatest of professional integrity as we wade through these issues that neither our profession nor our government has ever faced.  May God bless each of us and our families, our patients and fellow Alaskans, our Governor and Staff, and all who suffer and struggle at this time.

 Brian E. Larson, D.C., DACBSP
Chair, Alaska Board of Chiropractic Examiners



 

[1] If you are operating under the federal guidelines that stipulate if commercial surgical face masks are not available, health care providers may use cloth face masks, a new cloth face mask must be used for each patient being seen.  Washing of hands before seeing and immediately after treating each patient is also required. 


Health Mandate 015 - Reopening of Health Care starting April 20 – [4/15/2020]

Tonight, Governor Mike Dunleavy issued Health Mandate 015 that states effective Monday, April 20, chiropractors, massage therapists, acupuncturists, and physical therapists can resume services provided in a health care provider office that require minimal protective equipment as long as you follow the guidance listed below.

The Governor stated several times during his briefing that as this first sector of the economy is re-opened across the state, they will be closely monitoring any increases in new COVID-19 cases by area and tracing them back to their origins. The State of Alaska reserves the right to amend this Mandate at any time.

It is very important for offices to maintain safe clinical environments.

Click here to download a PDF of the full COVID-19 Health Mandate 015

Health Mandate 015 supersedes Mandate 005 and 006 and affects the health care providers directly addressed in Mandate 009.

A special thank you to Governor Dunleavy who said a several times at tonight's briefing - "If you need to go see your chiropractor, now you can!"

  1. Every effort should continue to be made to deliver care without being in the same physical space, such as utilizing telehealth, phone consultation, and physical barriers between providers and patients.
  2. All health care, delivered both in and out of health care facilities, (this includes hospitals, surgical centers, long-term care facilities, clinic and office care, as well as home care) shall deploy universal masking procedures in coordination with the facility infection control program. This may be a combination of cloth face coverings (for employees not present for provision of services or procedures, such as front desk staff) and surgical masks for those involved in non-aerosolizing direct-patient care.
  3. Regardless of symptoms, all health care facilities should screen all patients for recent illness, travel, fever, or recent exposure to COVID-19, and to the extent that is possible, begin testing all admitted patients.
  4. Every effort shall be made to minimize aerosolizing procedure (such as a nerve block over deep sedation or intubation).
  5. Other urgent or emergent procedures with an increased risk of exposure, such as deliveries, dental work, aerosolizing procedures such as suctioning, intubation, and breathing treatments, should have patients tested for SARS CoV-2 prior to the procedure or birth, to the extent that is reasonably possible, after considering available testing capacity and any other relevant constraints. In the alternative, clinicians should use rigorous screening procedures and treat suspicious patients as if they are positive for COVID-19.
  6. It is the duty of the provider to ensure the health considerations of staff and patients. This includes the health of the provider, ensuring providers not come to work while ill, minimizing travel of providers, and adequate personal protective equipment. They are also encouraged to utilize the following means of protection:
    1.  Pre-visit telephonic screening and questionnaire.
    2. Entry screening.
    3. Lobbies and waiting rooms with defined and marked social distancing and limited occupancy.
    4. Other personal and environmental mitigation efforts such as gloves, exceptional hand hygiene, environmental cleaning, and enhanced airflow.

V. Other Considerations

a. Patients traveling for medical procedures and health care services is allowed under Health Mandate 012 to travel within Alaska as a critical personal need.

b. Patients whose communities have established quarantines for return from intra-state travel as outlined in Attachment B - Alaska Small Community Emergency Travel Order, should have a plan in place, developed with their local community, for return home after their procedures.

c. Transportation may be arranged on behalf of individuals who must travel to receive medical care and must be able to return home following the medical treatment or must arrange for their own accommodations if they are unable to return home.

d. Every effort should be made to minimize physical interaction and encourage alternative means such as telehealth and videoconferencing. For many licensed health care professionals, this will mean continued delays in care or postponing care.

e. Every effort should be made in the outpatient and ambulatory care setting to reduce the risk of COVID-19 and follow the following guidelines:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html

 

ALASKA WORKERS' COMPENSATION - COVID-19 VIRUS GUIDANCE - PRESUMPTION OF COMPENSABILITY FOR EMERGENCY RESPONSE AND HEALTH CARE EMPLOYEES SB241, Sections 15 and 39 – [4/11/2020]

Download AK Work Comp Bulletin Number 20-05

On April 9, 2020, Governor Dunleavy signed SB241 into law.  To view the bill, go to:  http://www.akleg.gov/PDF/31/Bills/SB0241Z.PDF

SB241 established a presumption of compensability under the Workers' Compensation Act for emergency response and health care employees who contract COVID-19 during the public health disaster declared by Governor Dunleavy on Mach 11, 2020, if the employee:

  1. is employed as a firefighter, emergency medical technician, paramedic, peace officer, or health care provider; 
  2. is exposed to COVID-19 in the course of employment; and 
  3. receives a 
    1. COVID-19 diagnosis by a physician;
    2. presumptive positive COVID-19 test result; or
    3. laboratory-confirmed COVID-19 diagnosis.

 The following terms are defined in the SB241:

  1. "emergency medical technician" has the meaning given in AS 18.08.200;
  2. "firefighter" means
    1. A person employed by a state or municipal fire department or who is a member of a volunteer fire department registered with the state fire marshal; or
    2. A person registered for purposes of workers' compensation with the state fire marshal as a member of a volunteer fire department; 
  3. "health care provider" has the meaning given in AS 13.52.390; (see below)
  4. "paramedic" has the meaning given in AS 12.55.185;
  5. "peace officer" has the meaning given in AS 11.81.900.

The presumption is retroactive to March 11, 2020.

If you have questions regarding the information in this bulletin, please contact the Department of Labor and Workforce Development, Workers' Compensation Division at (907) 269-4980, or by email at workerscomp@alaska.gov.  

AS 13.52.390 - (20) “health care provider” means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession; 


CMS ASSISTANCE FOR HEALTHCARE PROVIDERS – [UPDATED 4/10/2020]

PROVIDER RELIEF FUND PROVIDING $30 BILLION AND INCLUDES CHIROPRACTIC PHYSICIANS UNDER CARES ACT

Yet another provision of the “Coronavirus Aid, Relief, and Economic Security Act” (CARES Act) will directly impact doctors who billed Medicare in 2019. Although initial indications were this provision would focus on hospitals, the federal government has allocated $30 billion in “relief funds” that will include individual providers including chiropractic physicians. This is NOT a loan. Instead, it is an automatic grant.

To determine your portion of the funds, you would take your Medicare reimbursable billings (i.e. Medicare allowed charges for 98940, 98941, 98942) divided by $484 billion (total Medicare billings in 2019) and multiply by $30 billion. A doctor who had $32,250 in Medicare allowed charges billings in 2019 would receive approximately $2,000 (32,250 / 484,000,000,000 x 30,000,000,000 = 1,999).

Beginning Friday, April 10, the funds will be automatically deposited into your bank account via Optum Bank (CMS partner in this project) with “HHSPAYMENT” as the payment description. If you are typically paid by Medicare via check, then your funds will arrive in the next 2 weeks.

HHS has placed “terms and conditions” on the funds that must be accepted within 30 days of receipt through the HHS portal starting sometime in the week of April 13 which will be located on the provider relief fund page. Included in those conditions:

  • “Providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider;”
  • “The Recipient certifies that it will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.” This would include funds for PPP loans or EIDL loans;
  • “shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.” Thus, lost revenues are a component of these funds that would NOT be included in the PPP or EIDL funds.
  • Recipient must also keep documentation regarding the use of the funds.
  • The ACS will continue to monitor and seek further clarification on all of the terms and conditions required for these funds and update this section as more information becomes available.

More information is available on the HHS provider relief site.

Is this different than the CMS Accelerated and Advance Payment Program?

Yes. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers to help ensure providers and suppliers have the resources needed to combat the pandemic. The CMS accelerated and advance payments are a loan that providers must pay back. For more information from CMS, click here.  (Information regarding this program will be sent in a separate message)

How this applies to different types of providers

All relief payments are being made to providers and according to their tax identification number (TIN).

  • Employed Physicians: Employed physicians should not expect to receive an individual payment directly. The employer organization will receive the relief payment as the billing organization.
  • Physicians in a Group Practice: Individual physicians and providers in a group practice are unlikely to receive individual payments directly, as the group practice will receive the relief fund payment as the billing organization. Providers should look to the part of their organization that bills Medicare to identify details on Medicare payments for 2019 or to identify the accounts where they should expect relief payments.
  • Solo Practitioners: Solo practitioners who bill Medicare will receive a payment under the TIN used to bill Medicare.

CALL YOUR MEMBER OF CONGRESS TODAY! [UPDATED 4/8/2020]

Please contact your U.S. Senator and U.S. House Representative, using the links below, and ask them to support the Immediate Relief for Rural Families and Providers Act. Legislation has been introduced in both the U.S. Senate and the U.S. House of Representatives that would allow relief specifically for healthcare providers. The Immediate Relief for Rural Families and Providers Act (H.R. 6365 and S. 3559) would allow a grant and low-interest loan for rural health care hospitals and providers which includes chiropractic physicians. Please contact your U.S. Senator and U.S. House Representative, using the links below, and ask them to support these very important pieces of legislation.

Click here to send a letter to our U.S. Senators

Click here to send a letter to your U.S. Representative


Health Mandate 12 - Intrastate Travel 

Health Mandate 12 - Intrastate Travel - issued March 27, 2020 effective at 8:00 am, Saturday, March 28, 2020 and in effect until April 21, 2020.  The purpose of this mandate is to control the movement of individuals within Alaska in order to prevent, slow, and otherwise disrupt the spread of the virus that causes COVID-19. While chiropractic offices are considered essential health care services, the requirement within this mandate to submit a travel plan or protocol for maintaining critical infrastructure will NOT apply to 99% of chiropractic offices in our state unless you have staff that will need to travel within the state to multiple locations from one community to another.

To clarify:  

  • If you have one location, you do not need to submit a plan
  • If you have multiple locations but staff do not travel between locationsyou do not need to submit a plan.    
  • If you have multiple office locations AND staff travel from one community to another between your locationsyou will need to submit a plan.

As a private individual, this mandate affects you. As a single chiropractic office location, this mandate does not apply.  

For more information, see COVID-19 Health Mandate 12 - Intrastate TravelFAQs 11 + 12Alaska Essential Services List


COVID-19 Health Mandate 11 - Social Distancing

Health Mandate 11 - Social Distancing - issued March 27, 2020 and effective at 5:00 pm today, Saturday, March 28, 2020 and in effect until April 21, 2020, mandates that all persons in Alaska, except for those engaged in essential health care services, public government services, and essential business activities, are mandated to remain at their place of residence and practice social distancing.

Chiropractic is considered an essential health care service in Alaska.  As primary care physicians practicing in the smallest to the largest towns statewide, our role during this public health emergency is to remain open to treat patients with urgent/emergent health care needs.  You are key during this pandemic in treating non-COVID-19 urgent/emergent neuromusculoskeletal conditions.  In the absence of a chiropractic physician's care, our patients would need to turn to emergency rooms which has the potential to burden/overtax the healthcare system needed to directly deal with the COVID-19 situation.  

As a designated essential service/business under both Health Mandate 9 + 11, your chiropractic office can remain open to see patients experiencing urgent/emergent health care needs.  Chiropractors should exercise caution and must follow the best practices outlined by the CDC, do a risk assessment screening of all patients prior to entering your health care facility and adhere to designated State of Alaska social distancing requirements for staff.  

Currently, there is no required permit to travel to/from your place of essential business according to the FAQs.  If it would make you feel more comfortable when commuting, make a copy of your current chiropractic license and have it in your vehicle/on your person.  

Here are some additional resources and suggestions for your chiropractic office:  

CDC Website - 

Here are some additional suggestions from a malpractice provider:   

  1. Establish and follow a thorough cleaning process for all areas of your office, including the waiting room, reception area, exam rooms, and restrooms.
  2. Do not allow staff members who are sick, have been sick or have sick family members to come to the office.
  3. Have a detailed conversation by phone with the patient on the day they’re scheduled to come in, and ask:
    1. If they or anyone in their family has a fever or has had one in the last two weeks. The incubation period can be as long as 24 days.
    2. Have they or family members had any symptoms of a cold or flu? Symptoms include fever, tiredness and a cough that isn’t necessarily productive. They may also have or have had aches and pains, runny nose or nasal congestion, and vomiting or diarrhea.
    3. Have they traveled abroad in the last two weeks?
    4. Have they been near anyone who has potentially had the virus through their own family or work contacts? People can be contagious without symptoms.
  4. Ask high-risk patients to delay if possible. High-risk patients are those who:
    1. Are undergoing chemotherapy.
    2. Are immunocompromised.
    3. Are diabetic.
    4. Have heart disease.
    5. Have high blood pressure.
    6. Have asthma or another respiratory issue.
    7. Are over 60 years of age.
  5. Stagger appointments to allow time for thorough cleaning between sessions.
  6. Ask patients to wait in their car (rather than the waiting room) until it’s time for their appointment.
  7. Ask anyone accompanying the patient to wait in the car during the appointment if possible.
  8. Remove magazines and other printed reading material.
  9. Remove toys or other diversions you may have in the office for children.

To help patients and communities locate a chiropractic office open during the COVID-19 pandemic, the Alaska Chiropractic Society is developing a COVID-19 Find a Chiropractor search engine for our website so ACS member offices can indicate if they are open or closed, hours of operation, providing telehealth services, on-call services, etc.  We will send more information on this feature soon.  

Ask questions, find support and share the procedures+measures your office is doing in the ACS Facebook Group!    

For more information, see Health Mandate 11FAQs 11 + 12Alaska Essential Services List


The Families First Act provides relief for both employees and employers affected by Coronavirus.  Affected employees can receive up to two weeks (80 hours) of paid sick leave, at either 100%, 80%, or 2/3 of their regular pay, depending on the reason they are unable to work.  However, employers are to receive full reimbursement for amounts paid for this type leave, in the form of an immediate dollar-for-dollar tax offset against payroll taxes.  Where a refund is owed, the IRS will send the refund as quickly as possible.  These provisions apply to employers of less than 500. 

There is one possible exemption for the requirement to pay employee leave, in one specific circumstance:  employers with fewer than 50 employees may be eligible for exemption if the employee requests leave to care for a child whose school is closed, or child care is unavailable in cases, and if paying that leave would threaten the viability of the business.  We awaiting details from the Department of Labor as to how the exemption may be obtained (i.e., application, self-determined, etc.).  We anticipate some type of guidance soon and will update this information as soon as it is available.

The IRS issued a release summarizing in easy-to-understand terms the law’s provisions about paid leave, employer credits, prompt payment, and small business exemptions, with links to detailed information. Click here for that information.

Employers must post the Families First poster at their places of business. Download the poster here.  


DOES MALPRACTICE INSURANCE COVER CLAIMS OF CORONAVIRUS EXPOSURE IN A CHIROPRACTIC PHYSICIAN OFFICE?  DOES WORKERS’ COMPENSATION INSURANCE COVER CLAIMS BY MY EMPLOYEES? [UPDATED 3/27/2020]

A professional liability (malpractice) policy is a legally binding contract.  As a contract, the terms of each policy will determine what is covered and what is excluded, so it is important to review your individual policy for these items.  Sometimes exclusions are added in riders (attachments) to the document, so you should review the full policy.

However, there are some general provisions that usually apply in malpractice policies.  One of the most important is that insurance covers “ordinary negligence” but does not cover more extreme forms of negligence, nor does it cover criminal acts.  Ordinary negligence occurs when someone does something that a reasonably careful doctor would not do under similar circumstances or fails to do something a reasonably careful doctor would do.  Negligence law requires reasonable measures to protect oneself and others from harm.  

The ICS has carefully reviewed information provided by two major chiropractic liability carriers.  Both strongly urge that physicians who choose to keep their offices open must follow guidelines recommended by the CDC and other authorities to reduce possible transmission of the virus.  Following these steps MAY comply with policy requirements for the company to cover claims that a patient or employee contracted COVID-19 in your office. However, once it is determined that the insurer will cover you for a claim, whether the claim is compensable (i.e., whether your office committed the type of negligence covered by the policy) is determined on a case-by-case basis that will include expert opinions on the standard of care for your office, your practice, and your geographical area.  Remember that simply because an individual has an unwanted outcome (e.g., contracts the virus) does not mean the office failed to meet the standard of care, so meeting the recommended protocols may greatly mitigate or defeat damages in these cases.

 For reference, the following steps are recommended by one malpractice insurer:

  1. Establish and follow a thorough cleaning process for all areas of your office, including the waiting room, reception area, exam rooms, and restrooms.
  2. Do not allow staff members who are sick, have been sick or have sick family members to come to the office.
  3. Have a detailed conversation by phone with the patient on the day they’re scheduled to come in, and ask:
    1. If they or anyone in their family has a fever or has had one in the last two weeks. The incubation period can be as long as 24 days.
    2. Have they or family members had any symptoms of a cold or flu? Symptoms include fever, tiredness and a cough that isn’t necessarily productive. They may also have or have had aches and pains, runny nose or nasal congestion, and vomiting or diarrhea.
    3. Have they traveled abroad in the last two weeks?
    4. Have they been near anyone who has potentially had the virus through their own family or work contacts? People can be contagious without symptoms.
  4. Ask high-risk patients to delay if possible. High-risk patients are those who:
    1. Are undergoing chemotherapy.
    2. Are immunocompromised.
    3. Are diabetic.
    4. Have heart disease.
    5. Have high blood pressure.
    6. Have asthma or another respiratory issue.
    7. Are over 60 years of age.
  5. Stagger appointments to allow time for thorough cleaning between sessions.
  6. Ask patients to wait in their car (rather than the waiting room) until it’s time for their appointment.
  7. Ask anyone accompanying the patient to wait in the car during the appointment if possible.
  8. Remove magazines and other printed reading material.
  9. Remove toys or other diversions you may have in the office for children.

Another chiropractic liability insurer provides the following information regarding physician liability for COVID-19 transmission in the office:

In regard to patients:

Physicians ALWAYS have a duty to utilize “universal precautions” notwithstanding the current crisis. Universal precautions, standard precautions, and contact precautions should ALWAYS be utilized with all patients – those are the standards to prevent cross-contamination. To the extent a physician is not following current generally accepted guidelines, they may be held liable to a patient or staff member.

Offices should already have policies in place to aid in the prevention of all respiratory diseases, but if not, the office should immediately put into effect strict respiratory hygiene/cough etiquette guidelines.

More on the CDC website:

In regard to staff:

OSHA’s General Duty Clause, Section 5(a)(1) of the Act, requires an employer to protect its employees against “recognized hazards” to safety or health which may cause serious injury or death. While there is no specific regulation dealing with COVID-19, it is the General Duty Clause which mandates that you must act to protect your employees.

You are obligated under OSHA to develop a written plan to protect your employees from this risk. The plan assessing the “hazard” should include, but is not limited to:

  • Training employees with regard to the hazard
  • Revisiting the procedures utilized with personal protective equipment (PPE)
  • Recording (logging) any illness which is occupationally related
  • Documenting all efforts and training on this hazard

More information from OSHA:

NCMIC is offering a webinar on 3/30/2020 that will cover Risk management policy coverage and recent changes, Telemedicine, and Best practices if you’re seeing clients in your office. Register here.


ECONOMIC RECOVERY RESOURCES FOR BUSINESSES [UPDATED 3/30/2020]

Governor Dunleavy's Alaska Economic Stabilization Plan Website

Many useful resources for Alaskans impacted by COVID-19. This site contains information on unemployment insurance, small business assistance (including loans available from the Division of Economic Development-Investments), homeowner information, and federal government resources.   

Coronavirus Aid, Relief, and Economic Security (CARES) Act Forgivable SBA Loan Program 

Source:  The National Law Review article March 30, 2020 - https://www.natlawreview.com/article/covid-19-update-key-provisions-coronavirus-aid-relief-and-economic-security-cares  and March 29, 2020 - https://www.natlawreview.com/article/summary-cares-act

Unlike the disaster loans currently available through the Small Business Administration, these loans are potentially forgivable up to 100% of the principal amount borrowed. Additionally, unlike the disaster loans, these forgivable loans are not tied directly to establishing losses suffered during the national disaster — there is a presumption of negative impact from COVID-19. These loans do not require collateral or guarantees. What this means to you is that the other eligibility requirements of the SBA loan participation (e.g., average annual receipts) are not applicable, and this program is available (i) to many new businesses not otherwise able to avail themselves to the SBA loan programs, and (ii) provides much friendlier terms than traditional SBA loan programs.

Note: You do not apply for these loans directly through the SBA, but instead through an affiliated bank. Click here to find an SBA-affiliated bank.

Eligibility
Businesses with less than 500 employees are eligible (unless the applicable industry has a higher size standard under the SBA rules). The loan program is even available to sole proprietors, independent contractors, and self-employed individuals (subject to additional requirements).

Amount of Loan
Generally, the amount of the loan is capped at the lesser of $10 million and 2.5 times the average monthly payroll costs incurred in the one-year period before the date of the loan. Payroll costs include salary/wages/tips, sick/family leave/PTO, severance payments, group health benefits (including insurance premiums), retirement benefits, and state or local taxes assessed on employee compensation. However, for any employee who is paid more than $100,000 salary, only the amount up to $100,000 (prorated for the covered period) is calculated into the number.

Terms of Loan
An eligible borrower may receive one covered loan, and such proceeds may be used for: payroll costs; continuation of group health care benefits during periods of paid sick, medical, or family leave, or insurance premiums; salaries or commissions or similar compensation; interest on mortgage obligations; rent; utilities; and interest on other outstanding debt. The terms of the amount of any portion of the loan that is not forgiven will be for a term not to exceed 10 years and at an interest rate of no more than 4%.

Forgiveness
The amount of the loan that is forgivable is the sum of the payroll costs, mortgage interest payment, rent, and utilities incurred or paid by the borrower during the 8-week period beginning on the loan origination date. Any portion of the loan that is forgiven is excluded from taxable income. If the recipient of the loan laid off employees or reduced wages/salaries of its workforce in the period between February 15, 2020 and June 30, 2020, the amount of forgiveness is reduced proportionally by (i) any reduction in employees retained compared to historical levels, and (ii) the decrease in pay of any employee beyond 25% of their historical compensation. Notably, furloughs would necessarily impact this loan forgiveness analysis as well. To encourage workforce stabilization, the CARES Act takes into account that many businesses might already have or are planning to lay off personnel or cut salaries. If those changes were made between February 15, 2020 and April 26, 2020, those changes are not counted if the business rehires the number of personnel or returns the adjusted salary, as applicable, by June 30, 2020.

Related Assistance
The CARES Act also creates a new grant program under the SBA’s Office of Disaster Assistance to provide quick relief for applications awaiting processing of SBA Economic Injury Disaster Loans (“EIDL”). Loan applicants can get up to $10,000 to cover immediate payroll, mortgage, rent, and other specified expenses. This grant does not have to be repaid. A business that receives an EIDL can apply for, or refinance its EIDL into, the forgivable loan product.

Further, lenders on existing SBA backed loans are encouraged to provide payment deferments and extend maturity dates to avoid balloon payment or requirements that would increase debt as a result of deferment. The SBA will pay lenders the deferred principal and interest for a period.

For a full review of tax credits and other parts of the CARES Act, click here.
 

SBA COVID19 Disaster Loan Program Open for Applications

The Small Business Administration (SBA) is offering Small Businesses impacted by Coronavirus (COVID-19) up to $2 million in Economic Injury Disaster Loan Assistance (EIDL). Small businesses in Alaska are now eligible to apply for low interest U.S. Small Business Administration (SBA) Economic Injury Disaster Loans.

Under the EIDL program the SBA makes loans available to small businesses and private non-profit organizations in designated areas of a state or territory to help alleviate economic injury caused by the Coronavirus (COVID-19).

Applicants may apply online, receive additional disaster assistance information and download applications. Applicants may also call SBA's Customer Service Center at (800) 659-2955 or email disastercustomerservice@sba.gov for more information on SBA disaster assistance. Individuals who are deaf or hard of hearing may call (800) 877-8339. Completed applications should be mailed to U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155.

FOR ALL APPLICATIONS THE FOLLOWING ITEMS MUST BE SUBMITTED. For your convenience, we have links to several of these documents so you can have the information gathered prior to going to the loan portal.

  • Loan application (SBA Form 5), completed and signed (this is electronic/online in the portal) but I've attached here so you can see what information is asked prior to going to the portal.

    See https://disasterloan.sba.gov/ela/Home/OfflineApply for more info.
  • Tax Information Authorization (IRS Form 4506-T), completed and signed by each applicant, each principal owning 20 percent or more of the applicant business, each general partner or managing member; and, for any owner who has more than 50 percent ownership in an affiliate business. Affiliates include, but are not limited to, business parents, subsidiaries, and/or other businesses with common ownership or management - Also attached here.
  • Complete copies, including all schedules, of the most recently filed Federal income tax returns for the applicant business; an explanation if not available
  • Personal Financial Statement (SBA Form 413) completed, signed, and dated by the applicant, each principal owning 20 percent or more of the applicant business, and each general partner or managing member
  • Schedule of Liabilities listing all fixed debts (SBA Form 2202 may be used)

Relevant Webinars and On-Demand Courses


UNEMPLOYMENT INFORMATION FOR EMPLOYEES AND EMPLOYERS [UPDATED 03/27/2020]

Governor Dunleavy signed legislation 03/26/2020 waiving the one-week waiting period to receive benefits and increasing the weekly benefit amount for dependents from $24/w to $75/w.  Read More.  

Unemployment information related to the COVID-19 emergency for employees and employers can be found HERE.  

Here's some pertinent Q+A info I found on the FAQ that you may find of interest.  Read more at https://labor.alaska.gov/unemployment/COVID-19.htm

EMPLOYEE

If I am no longer working as a result of COVID-19, can I file for UI benefits? Yes. The quickest way to file an unemployment insurance claim is through our online service which is available 24 hours a day, seven days a week. You can file a claim at https://my.alaska.gov/

Will I be required to register for work and actively search for work if my hours have been reduced or I am no longer working as a result of COVID-19? No, you will not be required to register or search for work. Legislation has been passed to waive this requirement specifically due to COVID-19. If you are instructed to register for work or actively search for work when you file, or if you receive similar instructions in the mail, it is because our system is working as designed under normal circumstances and will continue to do so until the system is updated.

EMPLOYER

 Do I have to “sever” the relationship with my employee for them to be eligible for UI benefits?  No. The UI application requires that the individual provide a reason for separation, which could be working on-call, part-time, laid-off due to lack of work, voluntary quit, or discharge. The employer/employee relationship does not have to be severed for a claim to be valid.

Will my employees be required to register for work and actively search for work if their hours have been reduced or they are no longer working as a result of COVID-19? No, your employees will not be required to register or search for work. Legislation has been passed to waive this requirement specifically due to COVID-19. If they are instructed to register for work or actively search for work when they file, or if they receive similar instructions in the mail, it is because our system is working as designed under normal circumstances and will continue to do so until the system is updated. 


STATE OF ALASKA COVID-19 HEALTH MANDATE 9.1 [UPDATED 03/24/2020]

STATEWIDE – ALL MASSAGE THERAPY OPERATIONS IN CHIROPRACTIC OFFICES SHOULD CEASE EFFECTIVE MARCH 24, 2020 AT 5:00 PM [UPDATED 03/24/2020]

The Alaska Chiropractic Society supports the Governor’s Health Mandate #9 issued March 23, 2020, that massage therapy services should cease effective March 24, 2020 at 5:00 pm statewide in all locations, including the chiropractic office. The purpose of this mandate is to limit all close contacts (people outside of a family unit) to be farther than six feet from each other to prevent the spread of the virus that causes COVID-19.  The ACS agrees that due to the prolonged and intimate contact that massage therapy services incur, the risk to patients and providers for the spread of COVID-19 is too high.  We believe that, for all physicians, limiting in-person patient encounters is an ethical and medically responsible way to comply with the Governor’s Health Mandate 9.1 and will assist in facilitating in leveling off the spread of Coronavirus in the coming weeks.

This order remains in full force and effect until the Governor rescinds or modifies the order.  

The basis of our recommendation:

1.    The Governor’s COVID-19 Health Mandate 9.1 – State of Alaska – Personal Care Services and Gatherings issued March 23, 2020 that orders that personal care services where individual are within six feet of each other must stop all operations. Link to Health Mandate here.  Please see (1)(g) Massage therapy locations.  This would include any massage therapy performed in a chiropractic office location + (3) This Mandate prohibits the delivery of services in any of the above business locations by individuals holding licenses issued by the Board of Barbers and Hairdressers and the Board of Massage Therapists. 

2.    Alaska Board of Chiropractic Examiners’ Interpretation of Health Mandate 9.1 (see below)

Board of Chiropractic Examiners Interpretation of Health Mandate 9.1

Massage therapy is closed in all locations, including the chiropractic office. 

Brian E. Larson, D.C., DACBSP

Chair, Alaska Board of Chiropractic Examiners


ACS PATIENT NEUROMUSCULOSKELETAL CARE RECOMMENDATION [UPDATED 03/24/2020]

Based on the Governor’s Health Mandate #9 issued March 23, 2020, the ACS strongly recommends that our doctors postpone or cancel any appointments for in-office maintenance care.  During this Public Health Disaster Emergency, patient care should be limited to emergent/urgent care only. Please see the Board of Chiropractic Examiners clarification listed below for guidance. 

Our doctors should continue the process of moving to telehealth for any services that may be provided as an alternative to in-person care, including functional medicine, rehab services (e.g. range of motion and therapies), and some primary care services.  We believe that, for all physicians, limiting in-person patient encounters to the extent practicable is an ethical and medically responsible way to comply with the Governor’s Health Mandate 9.1 while helping patients in need and facilitating the leveling off of the Coronavirus in the coming weeks.

ACS believes that chiropractic care is extremely important to the health care of patients, and in the current COVID-19 environment, chiropractic care is essential for musculoskeletal pain patients.  In the absence of our doctors’ care, these patients would need to turn to emergency rooms, which would tax and already-overly burdened system or may not even be able to serve them, or they would turn to non-contact treatment such as opioids and other addictive medications, resulting in increased opioid use disorder cases.

The basis of our recommendation:

  1.  The Governor’s COVID-19 Health Mandate 9.1 – State of Alaska – Personal Care Services and Gatherings issued March 23, 2020 that orders that personal care services where individual are within six feet of each other must stop all operations. Link to Health Mandate 9 here.  While this mandate does not list chiropractic offices under the business locations in #1, the intent for the chiropractic profession is clear with the last line – “this mandate does not include urgent, and emergent health care needs, nor health care facilities; however, health care facilities must do risk assessment screening prior to entering the facility.”  
  2. Alaska Board of Chiropractic Examiners’ Interpretation of Health Mandate 9.1 (see below). 
  3. CMS announced through the Task Force, “All elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.”

Offices that continue to provide in-person services must comply with the Governor’s Health Mandate regarding social distancing, including by maintaining social distancing for employees as possible and six-foot requirements for members of the public in waiting rooms, in addition to other CDC infection prevention protocols.

All healthcare workers are at some risk of exposure to Coronavirus.  They should self-monitor and isolate themselves at the first sign of any symptom.  In the setting of a pandemic with community transmission, healthcare workers are at some risk for exposure to COVID-19, whether in the workplace or in the community. Healthcare workers, regardless of whether they have had a known SARS-CoV-2 exposure, should self-monitor by taking their temperature twice daily and assessing for COVID-19-like illness. If healthcare workers develop any signs or symptoms of a COVID-19-like illness (for healthcare workers, fever cutoff is 100.0oF), they should NOT report to work. If any signs or symptoms occur while working, healthcare workers should immediately leave the patient care area, inform their supervisor per facility protocol, and isolate themselves from other people.

 
Board of Chiropractic Examiners Interpretation of Health Mandate 9.1


Physiotherapies are acceptable, providing for brief but precise set up and take down, and where efficacious, unattended therapies over attended therapy, i.e. electrical stimulation over ultrasound as long as outcomes would be expected to be equal;

Teaching/demonstrating exercises or assisting patients with exercise, maintaining appropriate distances;

Limit close contact to precise and concise manipulations without excessive traction, stretching, etc.--get in, get out;

Patient care should be limited to emergent/urgent care; maintenance and wellness need to be deferred for the time being.  Traumatic care refers to automotive injury case, industrial injury/workers compensation, slip/trip/fall injuries still prevalent with ongoing winter/break-up time; and the “Oooh! I slept wrong/lifted wrong and need help to get back to work, caring for my family”, etc.  Give appropriate care and then terminate.  If patient is reporting no limitations on activity and pain levels of 1/10, they should be in "watchful waiting" status.

Hang in there!  Good luck to all--we will get through this together!

 

Brian E. Larson, D.C., DACBSP

Chair, Alaska Board of Chiropractic Examiners

 


ACS ADVERTISING AND MARKETING RECOMMENDATION [UPDATED 03/24/2020]

The ACS strongly recommends that our members exercise extreme care in advertising at this time and refrain from making claims that are not substantiated by peer-reviewed, empirical evidence about COVID-19. Federal regulators are on high alert for the exploitation of the pandemic. Due to a lack of research at this time, it is almost impossible to make any claims for treatment or cure related to COVID-19. For example, it would be misleading and prohibited to advertise that adjustments, nutritional supplements, or homeopathic remedies can cure or lessen the illness. It is imperative that our profession communicate factually with our Alaska communities.

SOURCES:

World Federation of Chiropractic Press Release 03/17/2019 - There is no credible scientific evidence that chiropractic spinal adjustment/manipulation confers or boosts immunity. Chiropractors should refrain from any communication that suggests spinal adjustment/manipulation may protect patients from contracting COVID-19 or will enhance their recovery. Doing otherwise is potentially dangerous to public health.

World Federation of Chiropractic The Effect of Spinal Adjustment / Manipulation on Immunity and the Immune System: A Rapid Review of Relevant Literature 03/19/2020

International Chiropractors Association Statement 03/20/2020 - As of March 2020, there are no cures for COVID-19 accepted in the scientific community. There are no recognized cures in conventional medicine or alternative health approaches for COVID-19. There are no vaccines, no drugs, no natural remedies, no alternative therapies that have been tested and the outcomes peer reviewed to meet any credible evidence-based standard in science. This includes chiropractic.


MUNICIPALITY OF ANCHORAGE OFFICES [UPDATED 3/23/2020]

Late Friday, Mayor Ethan Berkowitz issued EO-03 - "Hunker Down" order for the Municipality of Anchorage including the cities of Anchorage, Eagle River, Chugiak and Girdwood to prevent the spread of COVID-19.
 
 Chiropractic offices are considered healthcare facilities under the emergency order and serve critical roles that are necessary to combat this public health emergency or provide critical community functions and cannot be put on hold. Chiropractic offices are encouraged to remain open to serve their patients in need of urgent care.
 
 Per the MOA FAQS - Physical therapy, chiropractic care and massage therapy businesses may continue with urgent, health-care equivalent appointments only. All other appointments must be canceled or postponed. Link to MOA FAQs here.
 
 Per EO-03 - "While open, offices should comply with social distancing guidelines as much as possible, including by maintaining six-foot social distancing for employees and for members of the public, including when any customers are standing in line as well." You should continue to maintain all CDC guidelines and pre-screen your patients when making appointments.
 
 ACS is receiving reports that some offices in the MOA are making the choice to cease providing all (even medically necessary) massage therapy services during the emergency order.

 

MUNICIPALITY OF ANCHORAGE
 PROCLAMATION OF EMERGENCY 

 

ISSUED BY THE MAYOR OF THE MUNICIPALITY OF ANCHORAGE PURSUANT TO ANCHORAGE MUNICIPAL CODE SECTION 3.80.060H.

THE FOLLOWING EMERGENCY REGULATIONS BEGIN AT 10:00 P.M. ON SUNDAY, MARCH 22, 2020 AND REMAIN IN EFFECT UNTIL 11 :59 P.M. ON TUESDAY, MARCH 31, 2020.

Summary (see EO-03 for full order)

1. Everyone currently in the Municipality of Anchorage (the "Municipality") shall stay at home as much as possible, except to work in certain critical jobs, listed below; to buy, sell, or deliver groceries or other important goods; to receive or provide health care; and to get fresh air without contacting others. On the limited occasions when individuals leave home, they should maintain social distancing of at least six feet from any person outside their household whenever possible. Individuals are also encouraged to practice recommended hygiene, including regular hand washing.

3. Some businesses and entities serve critical roles that are necessary to combat this public health emergency or provide critical community functions and cannot be put on hold while we address the emergency. These businesses and entities are encouraged to remain open. While open, those businesses and entities should comply with social distancing guidelines as much as possible, including by maintaining six-foot social distancing for employees and for members of the public, including when any customers are standing in line. A list of businesses defined as critical is listed below at paragraph number five.

5. Critical businesses (to include non-profit and other entities) include: a. "Healthcare Operations" including hospitals, clinics, dentists, pharmacies, other healthcare facilities, home healthcare services providers, mental health providers, companies and institutions involved in the research and development, manufacture, distribution, warehousing, and supplying of pharmaceuticals, biotechnology therapies, consumer health products, medical devices, diagnostics, equipment, services, or any related and/or ancillary healthcare services. "Healthcare Operations" also includes veterinary care and healthcare services provided to animals. "Healthcare Operations" does not include fitness and exercise gyms and similar facilities. Healthcare operations remain subject to the restrictions in the Mayor's Emergency Order EO-02. To expand the capacity and supply of Healthcare Operations necessary for the response to the COVID-19 pandemic, all Healthcare Operators shall postpone appointments that are non-urgent or non-emergency whenever possible, and consider alternatives to face-to-face visits, in accordance with CDC guidance for Healthcare Facilities.


MASSAGE THERAPY - MANDATE TO CEASE SERVICES IN FAIRBANKS NORTH STAR BOROUGH AND KETCHIKAN GATEWAY BOROUGH [UPDATED 3/27/2020]   
 
COVID-19 Health Mandate 9.1 effective 03/24/2020 supersedes Health Mandate 7.1.  


Governor Mike Dunleavy issued COVID-19 Health Mandate 7.1 - Fairbanks North Star Borough and Ketchikan Gateway Borough - Personal Care Services and Gatherings today at 6:00 pm. 

It is the understanding of the Alaska Chiropractic Society and Dr. Brian Larson, Chair with the Board of Chiropractic Examiners that this mandate does NOT affect chiropractic services - only massage therapy when performed in a chiropractic office.

Per Health Mandate 7.1 - Given the increasing concern for new cases of COVID-19 in the Fairbanks North Star Borough and the Ketchikan Gateway Borough, the State of Alaska is issuing the following mandate to go into effect March 21, 20120 at 8:00 am:  

This order remains in full force and effect until the Governor rescinds or modifies the order.  

All business in the Fairbanks North Star Borough and the Ketchikan Gateway Borough where individuals are within six feet of each other must stop all operations.  This includes:

               • Hair salons
               • Day spas and esthetics locations
               • Nail salons
               • Barber shops
               • Tattoo Shops
               • Body piercing locations
               • Massage therapy locations
               • Tanning facilities

Additionally no gatherings of more than 10 people may take place, and if a gathering does take place people must be six feet apart from each other.

 This Mandate prohibits the delivery of services in any of the above business locations by individuals holding licenses issued by the Board of Barbers and Hairdressers, Board of Chiropractic Examiners, and Board of Massage Therapists. 

This Mandate prohibits operations for rolfing, reiki, acupuncture, acupressure, and similar services.

This Mandate prohibits licensed massage therapist services spas.

This Mandate prohibits business operations to continue at tanning facilities.

The prohibitions in this Mandate apply to services that may be delivered in the customer's home or in the home of the licensee.

This order shall take effect March 21, 2020 at 8:00 am and remain in full force and effect until the Governor rescinds or modifies the order.  

This mandate does not include urgent, and emergent health care needs, nor health care facilities; however, health care facilities must do risk assessment screening prior to entering the facility.  

Board of Chiropractic Examiners Interpretation of Health Mandate 7.1

Upon reviewing COVID-19 Health Mandate #7 Issued by Governor Mike Dunleavy and Dr. Ann Zink, Chief Medical Officer of the State of Alaska, I interpret this closure requires absolute cessation of all massage therapy services offered anywhere within the Fairbanks North Star Borough and the Ketchikan Gateway Borough in any location, including spas, chiropractic offices, Physical Therapy offices, house calls, or within the therapists home, or over the garage spa. Chiropractors cannot perform massage therapy services.  Additionally, all extended-time intimate therapies, such as acupuncture, acupressure, dry needling, Graston/scraping techniques, or extended stretching should be immediately ceased.  Any therapy or contact that requires longer than 1 minute of intimate contact should probably be set aside during the course of this health emergency. 

Consider gowning, gloves and facemasks if the situation dictates.  If treating any suspected or confirmed infectious patients, they must be treated in a portion of the health care facility that is isolated from the rest of the patient base--back or side door entry, separated clean room, personal protective equipment including gown, glove, respirator and eye protection.  Proper state report of infected patient is also required to be filled out and submitted to the state medical office. 

Physiotherapies that allow maintaining appropriate distance are still available, and an emphasis should be geared toward unattended therapies such as electrical stimulation and passive light therapies.  Care and discretion should be used in delivering ultrasound or other attended therapies where provider/patient distance is less than 6 feet apart, and such precautions as working from arms distance, not direct face-to-face positioning and limiting treatment to minimum billable time frames is appropriate.  Use discretion and proper technique.  Rather than performing stretches on the patient, demonstrate the stretches and have the patient perform them on their own at home. 

All chiropractic offices remaining open and serving patients are required to limit patient populations so that not more than 10 people are "gathered" in an area, and spacing can be maintained at a minimum of six feet apart.  Consider having patients arrive and notify the front desk by cell phone, and then the front desk call/text the patients on order of arrival to enter for treatment.

Keep patient visits to a courteous minimum time frame.  Consider having nutrition and auxiliary therapy procedures in handout or email formats rather than face-to-face sharing of this kind of information.  All chiropractic physicians are responsible to maintain appropriate provider and patient safety procedures, and be up to date daily on changes in healthcare mandates. 

The care we provide as chiropractic physicians, while usually not lifesaving, is critical in keeping our society and economy functioning.  The physical treatment we provide can and will keep many first-responders and law enforcement personnel functional, energy and critical services workers capable.  Alaskans are still a basic work-for-a-living blue-collar life style of people, who watch out for their neighbors, stop to help stranded motorists and care for the stranger as members of our families.  We can only continue this contribution to our great State and lifestyle if we remain healthy and continue to keep those we care for healthy. 

Brian E. Larson, D.C., DACBSP
Chiropractic Sports Physician
Chair, Alaska Board of Chiropractic Examiners


TELEHEALTH & TELEMEDICINE IN ALASKA [UPDATED 3/23/2020]

The Alaska Telemedicine Business Registry applies to all health care professions regulated by DCCED that have the capacity and/or authority (within program statutes/regulations) to provide telemedicine services.  Chiropractors have authority under our scope of practice to deliver telemedicine services in the State of Alaska.  

During the COVID-19 public health emergency, a qualified provider may deliver telehealth and telemedicine services upon the division’s receipt of a complete application. If your chiropractic office is interested in doing Telehealth - you need to register your business with the State of Alaska now.  (see the Telemedicine Business Registry link below).

The Alaska Board of Chiropractic Examiners issued a position statement regarding telemedicine 03/26/2020.  Click here to download the ABOCE Telemedicine Position Statement.  

The Governor has issued a mandate or the board has issued guidance for this program. (issued 03/18/2020).  Overview - Anyone providing telehealth must hold an Alaska license to perform services.  Don't be concerned that chiropractors aren't on the list for "courtesty licenses for emergency situations".  That just means that any out of state DC that doesn't currently have an AK license can't get one.  All currently licensed DCs in Alaska are authorized to apply to provide telemedicine by registering their business.  

The HHS Office for Civil Rights (OCR) announced on March 17, 2020, that it will waive potential HIPAA penalties for good faith use of telehealth during the nationwide public health emergency. Normally, providers would have to use a secure means of communication. However, with this announcement, non-HIPAA approved technologies like Skype and FaceTime can be used. (Facebook Live, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers). See HHS Notice for HIPAA for more details. 

  • Telehealth & Telemedicine in Alaska - great overview about providing telehealth services in Alaska with helpful resources for providers.  
  • Telemedicine Business Registry 
    • To be included on the telemedicine business registry established and maintained under AS 44.33.381, a business performing telemedicine services must submit to the Division a complete registration on a form provided by the Division; the registration must include the business's name, active Alaska business license number, address, and contact information. Please do not email the application.  Click HERE to access the application.  If you are mailing, ACS recommends sending certified/return receipt.  An online application is now available through your myAlaska accountACS recommends using the online application.  
    • A business performing telemedicine services must register with the name it is using to perform telemedicine services in this state. A business operating under multiple names to perform telemedicine services shall file a separate registration for each name.
  • Telemedicine Business Registry Information Packet - some items from "Quick Points" in the packet:
    • An applicant for placement on the Telemedicine Business Registry may be submitted by an employee or representative of the business. 
      • The applicant is a business; the applicant is not a professional licensee (but can submit an application on behalf of a business). 
      • Business must have a valid Alaska business license.
      • Corporations applying for placement on the registry that do not hold an Alaska business license must obtain one to gain eligibility.
    • If the business is a sole proprietorship or a partnership AND the owner(s) hold a professional license, DCCED updates the professional licensee's file to include telemedicine as a specialty designation.  
    • There is no renewal requirement associated with placement on the registry.
  • Telehealth and Home Care for Chiropractic and Physical Medicine Practices - Here's an article by David Klein from PayDC Chiropractic Software with information on billing/coding for telemedicine services in the chiropractic office.  (article updated 03/27/2020)
  • ACS held a "Telehealth in Alaska 101" webinar on Thursday, March 26 at 1:00 pm AKDT sponsored by ChiroUP.  

CLOSING OF OFFICES [UPDATED 04/09/2020]

At this time, there is no State of Alaska mandate to close chiropractic offices. There have been reports of mandatory closures of chiropractic offices in others states.  The Alaska Chiropractic recommends that doctors use their best professional judgment, applying relevant guidelines, such as those of the CDC and the White House Coronavirus Task Force, to determine whether to close offices. 

  • The ACS recommends closing any office that does not have staff or resources to maintain strict CDC disinfecting protocols, social distancing, and other prevention tools. 
  • Today the Governor did issue the following Health Mandates.  Please visit the Governor's site for more information on these health mandates:  
    • Health Mandate 5.1 - Elective Procedures - requiring all patients, providers, hospitals and surgical centers to postpone or cancel all non-urgent or elective procedures for three months until June 15, 2020 to decrease the overall impact on the Alaska health care structure and preserve personal protective equipment. 
      Per FAQs Does this mandate prohibit in-person treatment by licensed health care providers—such as chiropractic, physical therapy, naturopathy or prescribed massage therapy?
      Yes. As outlined in Mandate 5.1, all elective, routine, non-urgent or non-emergent in-person health care and personal services are prohibited. The goal is to reduce physical touch or proximity within six feet unless in an emergency or diagnostic setting within a health care facility. It is especially important to reserve personal protective equipment for use by primary care providers. Providers are encouraged to deliver telehealth services as appropriate.
      ACS clarification - as essential health care providers, chiropractic offices are allowed to be open for urgent/emergent patient care.  
    • Health Mandate 6.1 - Elective Oral Health Procedures - requiring that elective oral health care procedures are required to be postponed for a period of one month until rescinded.    
  • The ACS notes the Alaska Dental Society has joined the American Dental Association and recommended closing offices for elective dental treatment. Dental offices are encouraged to provide emergency dental care through patients' regular dental home, including after-hours where possible, except in the case of a life-threatening emergency.  

OFFICES REMAINING OPEN [UPDATED 3/20/2020]

For offices that remain open, the ACS recommends:

  • Apply all CDC guidelines regarding the screening of patients who call with concerns that they may be infected with Coronavirus and follow the protocol from the Alaska Reporting form;
  • Pre-screen patients when making appointments for treatment.  Develop a checklist for pre-screening taking into consideration the Governor of Alaska's Mandate 4.1 Travel.  
  • Reschedule staff and patients so that no more than 10 persons are in the office at a time
  • Conduct “pre-screening” of staff at the beginning of the shift and prior to any patient contact, using CDC guidelines for assessing the presence of symptoms and risk, and sending staff home or referring for testing where appropriate
  • All healthcare workers are at some risk for exposure to COVID-19, whether in the workplace or in the community. It is recommended that all healthcare workers, regardless of whether they have had a known SARS-CoV-2 exposure, to self-monitor by taking their temperature twice daily and assessing for COVID-19-like illness. If healthcare workers develop any signs or symptoms of a COVID-19-like illness (for healthcare workers, fever cutoff is 100.0oF), they should NOT report to work. If any signs or symptoms occur while working, healthcare workers should immediately leave the patient care area, inform their supervisor per facility protocol, and isolate themselves from other people.
  • Apply all CDC guidance and standard of care regarding infection prevention (see links below), including using single-use only medical exam gloves that should be disposed of after EACH patient to avoid potential cross-contamination. Additionally, practice regular disinfection of patient surfaces and facilities while using appropriate gloves (see CDC guidelines for cleaning)
  • Suspend restrictions on cancellations and do not apply penalties for cancellations and no-shows
  • Begin to plan for the possibility of remote employment; i.e., consider whether some of your staff, such as billers, could work from home
  • The ACS has reached out to the Board of Chiropractic Examiners for clarification surrounding telemedicine services and will update members when available

STATE OF ALASKA [UPDATED 4/15/2020]

 

The Alaska Chiropractic Society recommends you visit the website of the Office of the Governor for up to date information regarding the State of Alaska as the COVID-19 situation changes rapidly.  Here are some links that you should find helpful:     


CDC ENVIRONMENTAL CLEANING AND DISINFECTION RECOMMENDATIONS [3/19/2020]

The ACS is not aware of a specific CDC-issued cleaning and disinfection protocol for physician offices.  However, the CDC has provided standards for cleaning community facilities with suspected or confirmed Coronavirus Disease 2019 here.

Additionally, the CDC has provided “Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings” here.  The numbered recommendations may be useful to our members in their offices.


CMS RELEASE FOR PROVIDERS [UPDATED 03/19/2020]

The Center for Medicaid and Medicare Services (CMS) has issued a number of releases containing information for disease mitigation in specific settings. The following link is a good, detailed strategy for community mitigation based on the level of community transmission:  https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf.


RESOURCES AVAILABLE FOR USE IN YOUR OFFICE – [UPDATED 3/18/2020]

The ACS is making available to our members a template letter for our doctors to provide to their patients regarding the COVID-19 virus (coronavirus).  The letter explains the steps you are taking in your offices to protect your patients, as well as your recommendations for measures your patients should take outside of the office. The template will need to be tailored to reflect your individual office procedures and policies. The template letter developed by the CS can be found here.

COVID-19 Infection Control Policy [i]

Handouts & Posters (CDC print resources)


INFORMATION FOR CLINICIANS [UPDATED 3/06/2020]

The CDC has provided a number of links (below) to general information about the virus, as well as information for healthcare professionals and businesses. CDC updates these sites continually as information becomes available. The CDC presented a one-hour live webinar for clinicians on March 5th. It is now available at no cost on-demand at https://emergency.cdc.gov/coca/calls/2020/callinfo_030520.asp. The presenters reported on important updates, including recommendations for office protocols for control of the spread of the virus. The experts recommend similar protocols for other infectious diseases, such as influenza. Aside from the obvious standards for the physical facility and staff (sanitizing surfaces, handwashing, etc.), if a patient presents to the office with symptoms, the patient should be separated from others in the waiting area and masked to prevent the spread of droplets.

The CDC also discussed how to determine which patients to refer for testing. CDC recommends using professional judgment to assess the presence of the following factors in presenting patients:

  • Epidemiological factors such as being in close contact with a diagnosed patient or having been in an area of known community transmission
  • Symptoms including:
    • Fever
    • Acute respiratory illness – cough, shortness of breath, difficulty breathing
    • Myalgia
    • Fatigue
  • Persons over 65 years of age
  • Persons with underlying conditions and comorbidities

Physicians are to use their best judgment in assessing patients and refer those for testing as appropriate.  The CDC is aware that testing kits may be in short supply, but they report that more may be made available soon through a private company.  In any event, the potential testing kit shortage did not change CDC’s recommendations for testing referrals as outlined above.

Although it was not part of the CDC webinar, in addition to evaluating symptomatic patients, many physicians are choosing to screen all patients by asking at each visit if patients fall into any of the above categories.  It may be appropriate for some asymptomatic patients to be referred for testing if they have been in close contact with an infected person and/or are positive for some of the other factors (age and comorbidities).


INFORMATION FOR EMPLOYERS [UPDATED 3/06/2020]

The CDC has provided a number of links (below) to general information about the virus, as well as information for healthcare professionals and businesses.  CDC updates these sites continually as information becomes available. The CDC recommends the following strategies for employers to use now.  The ACS has summarized the strategies here but strongly urges clinic owners to click on the link at the end of this article to review the details provided for businesses by the CDC:

  • Actively encourage sick employees to stay home;
  • Separate sick employees;
  • Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees;
  • Perform routine environmental cleaning:
  • Advise employees before traveling to take certain steps as outlined in the employer link below
  • Additional Measures in Response to Currently Occurring Sporadic Importations of the COVID-19:
    • Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
    • If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

ACS will continue to monitor CDC and other resources, but we encourage members to regularly check CDC information in the links below, as they are revised to update the public, healthcare providers, and employers on this rapidly developing issue. 

General Information on Coronavirus (COVID-19)

Healthcare Professionals

Businesses


ADDITIONAL RESOURCES FOR OFFICES [UPDATED 3/24/2020]


[i] Thank you to Best Practices and ChiroArmor for providing these resources to ACS Members.


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Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org