COVID-19: Frequently Asked Questions
Last Updated Thursday, March 26, at 2:00 PM Central
Should I temporarily close my chiropractic clinic?
As of 12:00 PM on March 26, the Texas Board of Chiropractic Examiners (TBCE) maintains that there is no statewide requirement for chiropractors to close their practices. However, there are several important caveats that doctors should consider:
- TBCE has reiterated that "all chiropractors must abide by local county or city orders that are more stringent than orders issued by the state or federal governments." Many local jurisdictions have imposed regulations that are more stringent than the statewide rules, so doctors should check with their city and county governments to determine the best course of action.
- Chiropractors should, according to TBCE, "restrict treatment of chronic- and wellness care patients and focus only on patients requiring essential treatments."
- Doctors should abide by U.S. Centers for Disease Control and Prevention (CDC) and Texas Department of State Health Services (DSHS) guidelines, where possible. This includes the 10-person limits and six-foot distance recommendations.
Finally, doctors should exercise their professional judgment and exercise prudence. As always, the safety and well-being of patients should be the primary concern. State and local rules may permit certain actions that, although lawful, are not prudent under the circumstances.
My local jurisdiction has issued a shelter-in-place order that exempts certain "essential" business functions? Is chiropractic an "essential" service?
TBCE has opined that "Chiropractors provide essential care, especially to other health care providers currently working as emergency care providers." However, TBCE has also made clear that doctors should restrict their activities to essential treatments only, while temporarily "restrict[ing] treatment of chronic- and wellness care patients."
This means that, even if your clinic is exempt from a local shelter-in-place order, the types of procedures you may perform is limited. While there is a great deal of similarity between many of the city and county orders, each must be examined carefully on its own merits to determine the extent to which a chiropractic clinic is allowed to operate. If you have questions about your local rules, contact an attorney.
My clinic is closed and I may not be able to make my lease payment. What should I do?
Consider negotiating a rent reduction or abatement with your landlord. For more information, read Commercial Leases and COVID-19: What You Need to Know.
Can chiropractic clinics continue offering in-office massage services while Executive Order GA-09 is in effect?
“Massage parlors" are closed statewide by order of the Governor. Consequently, the Texas Department of Licensing and Regulation (TDLR) has shuttered all licensed “massage establishments” in Texas. However, chiropractic clinics that employ/contract with massage therapists are exempt from licensure as a “massage establishment” under TDLR rules. Therefore, it is unclear whether massage therapy rendered as a health care service is subject to the ban. However, in light of the Governor’s executive order and TBCE’s guidance, in-office massage therapy is likely prohibited. If you have questions about specific services rendered in your clinic, contact an attorney.
I believe that chiropractic adjustments positively impact the immune system. Can I communicate this to my patients?
TBCE's position on this matter is crystal clear:
All licensees are advised that anyone making claims that adjustments can provide immunity to the flu or coronavirus is likely in violation of statute and rule relating to both scope of practice and advertising claims.
Although there exists in academic literature some evidence that chiropractic adjustments may benefit the immune system, doctors must realize that regulators will not look favorably on any advertisement that appears to prey on the public's fear or lack of understanding of the novel coronavirus. Chiropractors should refrain from making such claims in advertisements and on social media platforms.
I have questions about the federal tax deadline and related rules.
You should visit the Internal Revenue Service (IRS) web site dedicated to this topic. It contains helpful information.
Am I required to compensate my employees for missed work due to COVID-19?
The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide their employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. The Department of Labor's web site contains a concise overview of this law and its requirements.
The law applies to employers with fewer than 500 employees. According to the Department of Labor, "small businesses with fewer than 50 employees may qualify for exemption from the requirement to provide leave due to school closings or child care unavailability if the leave requirements would jeopardize the viability of the business as a going concern." This means that most chiropractic clinics may be exempt from the law's requirements.
The FFCRA requires covered employers to provide all employees with:
- Two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay where the employee is unable to work because the employee is quarantined (pursuant to federal, state, or local government order or advice of a health care provider), and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or
- Two weeks (up to 80 hours) of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a bona fide need to care for an individual subject to quarantine (pursuant to federal, state, or local government order or advice of a health care provider), or care for a child (under 18 years of age) whose school or child care provider is closed or unavailable for reasons related to COVID-19, and/or the employee is experiencing a substantially similar condition as specified by the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor.
It also requires covered employers to provide employees that they have employed for at least 30 days with up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay where an employee is unable to work due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.
|The good news is covered employers qualify for dollar-for-dollar reimbursement through tax credits for all qualifying wages paid under the FFCRA. Chiropractic clinic owners must therefore determine a) whether they can be exempted from these requirements, and b) whether they want to be exempted. The FFCRA may enable you to continue paying employees during the COVID-19 crisis and receive reimbursement from the federal government.|
Where can I obtain a "Paycheck Protection Loan" from the SBA?
Virtually all SBA certified lenders are now offering these loans. However, due to extremely high demand, some banking institutions are offering the loans only to existing customers, so check with your bank first. Your local chamber of commerce may also have a list of local lenders participating in the program. To meet demand, PayPal, Intuit (the makers of Quickbooks and TurboTax), and other nationwide companies are undergoing certification and intend to offer these loans in the near future. Program funds are limited, so it is important to act quickly.
Below are some helpful articles that explain the FFCRA and its implications:
- What the Families First coronavirus relief bill means for small-business owners and self-employed people
- Here's what the Families First Coronavirus Response Act means for your small business
- Coronavirus response act takes effect April 2, expands FMLA and paid sick leave requirements
If you have questions about how these laws will affect your business, contact an attorney or human resources professional. Darla Sees, an organizational development and human resources specialist, recently conducted a webinar for TCA that included helpful information on FFCRA.
Where can I learn more about SBA disaster loans for my business?
Visit disasterloan.sba.gov to apply. The online application tool has been intermittently available due to high demand and the Small Business Administration (SBA) appears to be encouraging paper applications at this time. The SBA will provide long-term, low interest loans to many small businesses affected by the COVID-19 pandemic.
I have questions about the “stimulus” bill winding its way through Congress.
Join the club. The U.S. Senate recently passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the U.S. House of Representatives is expected to do the same on Friday, March 27. Here is an article detailing the bill’s contents.
Disclaimer: The Texas Chiropractic Association (TCA) is a professional association advocating for the rights of chiropractors and their patients across the state of Texas. We are NOT a state agency or regulatory body. We are merely informing our membership regarding what they are allowed to do during this challenging and confusing time.
The information TCA provides during this pandemic is derived in conjunction with our governmental relations and legal experts, developed after examination of all official releases of information from the state of Texas and other state government departments and agencies. Please refer to our emails, website and social medial channels for the latest updates. Rest assured that TCA 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 health care system, foremost in our efforts.