• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 399,362 cases, which is a 5.8% increase in cases from Thursday, December 3rd (12/3 had 377,231 cases). In addition, there are 2,240 currently hospitalized and there have been 5,560 deaths related to the virus. The daily percent positive rate of those tested is 10.5%. As of November 30th, there have been 315,979 Patients Presumed to be Recovered. You can view the number of cases and other data Here.

• NEW: Infection Control Policies and Procedures for North Carolina's Emergency Infection Control Rules Related to the COVID-19 Pandemic - Due to the COVID-19 Pandemic, NC DHHS has enacted emergency infection rules for long term care facilities. NCSLA Executive Director, Jeff Horton, has complied a complete set of infection control policies and procedures that are intended to comply with the state's emergency infection control rules. To download the complete set of policies and procedures in PDF format click Here. To download in Word format click Here. You can also access these downloadable documents on the NCSLA website by clicking Here.

• NEW: North Carolina Regional Prevention Support Teams: Public Health Nurses to Begin Making Visits - Regional Prevention Support (RPS) teams have been established to assist LTCFs with infection prevention practices by conducting site visits to identify and address infection control gaps and provide education. These visits are collaborative, not regulatory or punitive, and the goal is to focus on quality improvement and patient safety to ensure your facility is doing everything it can to protect residents and staff from COVID-19. Your RPS team may send a letter or call to introduce themselves and discuss the program. Please take advantage of this great opportunity to work with infection control experts and help protect everyone at your facility. They are supposed to be informational in nature and are supposed to be scheduled with the community in advance.

• NEW: On Tuesday, December 1st, Governor Roy Cooper and NC DHHS Secretary Mandy Cohen Provided an Update On the COVID-19 Vaccine - Governor Cooper and NC DHHS Secretary Mandy Cohen stated that safe, effective COVID-19 vaccines should be available soon. The state is working hard to hit the ground running when these vaccines are approved and shipped. The COVID-19 vaccine will be free regardless of whether someone has health insurance.
• Health care providers are being enrolled in the vaccination program based on the ability to reach priority populations. Trusted providers like hospitals will be among the first to vaccinate people. Initially, this very limited supply of vaccines will go to a small number of hospitals to vaccinate health care workers at high risk of exposure to COVID-19 – those who are caring for or cleaning areas used by patients with COVID-19. As more vaccine becomes available, the state will be able to have vaccine distributed to more of the state’s hospitals and to our local health departments to focus on vaccinating our high-risk health care workers.
• Additionally, long-term care staff and residents are prioritized to receive vaccines. Vaccinations at our nursing homes, adult care homes and other long-term care settings are being managed by the federal government. However, the vaccines used in long-term care will come from our state’s allotment. We hope by January that health departments and community health centers will start vaccinating other high-risk adults who are high risk for complications, meaning they have two or more chronic conditions, and who are at higher risk for exposure.

• NEW: Governor Cooper Issued Executive Order 180 to Tighten Mask Requirements and Enforcements as COVID-19 Cases Continue to Rise In NC - Governor Roy Cooper issued additional COVID-19 safety measures to tighten mask requirements and enforcement as cases continue to rise rapidly in North Carolina and across the country (Click Here to read more). Executive Order 180 went into effect on Wednesday, November 25 and runs through Friday, December 11. The order tightens the existing statewide mask requirement – making it clear that everyone needs to wear a mask whenever they are with someone who is not from the same household. The Order also adds the mask requirement to several additional settings including any public indoor space even when maintaining 6 feet of distance; gyms even when exercising; all schools public and private; and all public or private transportation when travelling with people outside of the household. The Order also requires large retail businesses with more than 15,000 square feet to have an employee stationed near entrances ensuring mask wearing and implementing occupancy limits for patrons who enter. Click Here to read the FAQs.

• NEW: COVID-19 County Alert System - While North Carolina is experiencing high levels of community transmission statewide, the virus is impacting some counties particularly hard. To help local leaders understand how their county is faring and make decisions about actions to take, NCDHHS published a COVID-19 County Alert System today at 3PM. The COVID-19 County Alert System pinpoints counties with the highest levels of viral spread and offers specific recommendations for individuals, businesses, community organizations, and public officials to bring numbers down.

• Yellow: Significant Community Spread
• Orange: Substantial Community Spread
• Red: Critical Community Spread

• Because no one metric provides a complete picture, the COVID-19 County Alert System uses a combination of three metrics: case rate, the percent of tests that are positive, and hospital impact within the county. To be assigned to the red or orange tier, a county must meet the threshold for case rate for that tier AND the threshold for either percent positive OR hospital impact. Counties will remain categorized in these tiers through at least the 2^nd week of December. Going forward, NC DHHS will publish an updated COVID-19 County Alert System report the 2^nd week of every month. There are critical actions we can all take to slow the spread of COVID-19, regardless of whether your county is currently in the yellow, orange, or red tier. Individuals, businesses, community organizations, and public officials all have a responsibility to take these recommended actions, in addition to following the requirements in existing Executive Orders and NC DHHS guidance. Red and orange counties need to do even more to slow the spread of COVID-19 in their communities; it is strongly recommended these counties go further and build upon current requirements as recommended by the COVID-19 County Alert System.

• NEW: NC Medicaid Launches Website for Beneficiaries to Learn More About Medicaid Managed Care - NC DHHS announced on November 6th the launch of NC Medicaid’s managed care enrollment website, www.ncmedicaidplans.gov, in preparation for the launch of Medicaid Managed Care scheduled for July 1st, 2021. The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care. In 2015, the NC General Assembly enacted legislation directing NC DHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services. The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct) and who can choose between the two. It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes. To read the entire press release, click Here.

• NEW: NC DHHS Expands Demographic Data On COVID-19 Dashboard - On November 20th, NC DHHS further expanded the demographic data for North Carolina COVID-19 cases on the NC COVID-19 Dashboard. Demographic data for COVID-19 cases per 100,000 residents and total deaths by week are available by age group, gender, race and ethnicity for the state. In addition, demographic data on deaths is available by county.

• NEW: IMPORTANT UPDATE! ACH & FCH Emergency Rules Effective October 23, 2020 - The emergency rules for adult care homes and family care homes for infection prevention and control have been approved and will take effect on this Friday, October 23rd. To view the ACH Emergency Rules click Here. To view the FCH Emergency Rules click Here. To ensure facilities are prepared for and adequately respond to COVID-19 and influenza, the North Carolina Medical Care Commission approved on October 15, 2020, emergency rules for infection prevention and control in adult care homes and family care homes. The rules require each facility to develop and implement an infection prevention and control program based on guidance from the federal Centers for Disease Control & Prevention (CDC), including:
• Infection prevention and control policies and procedures,
• Timely reporting of suspected communicable disease cases,
• Communication with residents and families, and
• Staff training.

• UPDATE: SPECIAL BULLETIN COVID-19 #141: Reminder To Facilities of Requirement to Report Antigen Test Results - Facilities using a point-of-care antigen test device for detection of SARS-CoV-2 are required by State Health Director Order to report all results, positive and negative, of diagnostic testing for SARS-CoV-2, the virus that causes COVID-19. This includes antigen test results. Facilities that are reporting detailed results through Electronic Laboratory Reporting (ELR) or COVID-19 Laboratory Data Automation (CLDA) should include all Antigen testing in your reporting results. Click Here for more details.

• UPDATE: Status of First Round of PPE Shipments - By now, most all family care homes and adult care homes have received their second round of 3-ply masks purchased with funds allocated to NCSLA by the North Carolina Legislature earlier this year. Please note that shipments of gowns will be sent out in the next 3-4 weeks to all providers and larger adult care homes (7 beds and up) will be receiving additional masks. In Then, in December, NCSLA working together with the NC Assisted Living Association will be sending out additional shipments of more masks, gowns, gloves, ready to use disinfectant, hand sanitizer and infrared thermometers. Providers will be notified prior to these items being sent out. Please adequately prepare space for additional deliveries in the coming weeks and as a final reminder, these deliveries of PPE are of no cost to providers!

• UPDATE: NC Medicaid Extends Support to Providers to Help Maintain Access to Services During COVID-19 To January 21, 2021 - On October 21st, 2020, NC Medicaid announced they are The North Carolina Department of Health and Human Services Division of Health Benefits (NC Medicaid) is extending temporary provider rate increases related to COVID-19 through the end of the federal COVID-19 public health emergency, which goes through January 21st, 2021. This action will extend all COVID-19 rate increases currently in place, which means every Medicaid provider will continue to receive rates that are at least 5% greater than pre-COVID levels and some providers, such as nursing homes, who are experiencing very high additional costs due to COVID-19 will continue to receive even greater financial support. For Medicaid PCS providers, this means the current rate of $4.51/15 minute unit or $18.04/hour remains in effect. NCSLA has worked hard the past number of months with both NC DHHS and the North Carolina legislature to keep enhanced Medicaid funds in place for adult care home and family care home providers as they take care of our high risk resident population. Of course if an adult or family care home has a COVID-19 outbreak (defined as two or more COVID-19 positive residents, staff or combination thereof), it will received a further enhance rate of $33/hour and additional PCS hours. “Medicaid providers have continued to step up to meet beneficiary needs throughout the COVID-19 public health emergency,” said NCDHHS Secretary Mandy K. Cohen, M.D. “We greatly appreciate the efforts of our providers and are committed to supporting them as they care for our most vulnerable beneficiaries.” NC Medicaid will notify providers through special bulletins of any termination of temporary policies if the public health emergency is not extended. If the federal government extends the federal public health emergency or takes other action, NC Medicaid will reassess both needs and available funding for possible further extension of temporary rate increases. Additional details and guidance are available at www.medicaid.ncdhhs.gov/coronavirus.

• UPDATE: SPECIAL BULLETIN COVID-19 #142: REMINDER – Reimbursement for COVID-19-Related Primary Care Services for Uninsured Individuals Living in NC - Following the October 30, 2020, announcement that the NCTracks secure portal is live, providers are encouraged to submit qualifying COVID-19 related primary care services claims for reimbursement through the NCTracks secure portal. Providers can also attend training to learn more about submitting qualifying claims through NCTracks. Remaining training dates are November 12, 17, 18 and 20. Click here for more information and to register for a training session. Funding is available on a first-come, first-served basis until exhausted or by December 30, 2020, whichever comes first. For weekly funding updates, check the COVID-19 Related Services for Uninsured Individuals webpage. For additional details, click Here.

• NEW: BinaxNOW COVID-19 Testing Kits - A number of assisted living providers in North Carolina and throughout the United States have recently received free BinaxNOW COVID-19 testing kits in the mail. These kits were purchased by by the US Department of Health and Human Services (US DHHS) and sent out to assisted living providers that currently have a CLIA Certificate of Waiver (CLIA is the Federal Clinical Laboratory Improvement Amendments law). CLIA Waivers have been in place for years and allow health care providers to conduct basic laboratory testing onsite such as blood glucose testing and other tests without having to go through the process of becoming a CLIA certified laboratory. Since many assisted living providers already have CLIA Waivers, the US DHHS decided to send the BinaxNOW COVID-18 testing kits to these providers including approximately 600 providers in North Carolina.
• For assisted living providers without CLIA waivers that would like to obtain a waiver so they might be eligible to receive the BinaxNOW COVID-19 testing kits free of charge, the Federal Centers for Medicare and Medicaid Services (CMS) is accepting applications. The links below contain information regarding how to apply for and obtain a CLIA Waiver. In addition, providers may also want to partner with a long term care pharmacy to obtain a waiver.
•  How to Obtain a CLIA Certificate of Waiver
• CLIA Application for Certification
• CLIA State Survey Agency Contacts

• In the past week, NCSLA has received calls from providers stating they are not sure what to do with the BinaxNOW testing kits, i.e. use them for staff, residents, visitors, etc. Unfortunately, there was not very much guidance provided with the kits other than basic instructions no how to use them. NCSLA contacted the NC Division of Public Health for guidance regarding the BinaxNOW testing kits and they referred us to the Centers for Disease Control website (Click Here) and recommended using the kits for testing facility health care personnel (HCP) in two specific situations:

1. Testing HCP with signs or symptoms consistent with COVID-19
2. Testing asymptomatic HCP with known or suspected exposure to someone with COVID-19.

• The resources at the following link (Click Here) are designed to provide the training necessary to successfully test individuals using the BinaxNOW COVID-19 testing kits. The BinaxNOW™ COVID-19 Ag Card test has received U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA).*

• NEW: Governor Cooper Announces That North Carolina’s Indoor Mass Gathering Limit Will be Lowered to 10 People - On Tuesday, November 10th, Governor Roy Cooper announced that North Carolina’s indoor mass gathering limit will be lowered to 10 people (reduced from 25) in an effort to drive down North Carolina’s key COVID-19 metrics. Executive Order 176 will go into effect on Friday, November 13th and will be in place through Friday, December 4th. The Order does not change the reduced capacity limits for certain businesses that have already been laid out. Click Here to view Frequently Asked Questions.

• NEW: NC DHHS Releases New Guidance for Thanksgiving Celebrations and Black Friday Shopping - Monday, November 9th, NC DHHS released new guidance for Thanksgiving celebrations and Black Friday shopping to help North Carolinians gauge the risks, protect their friends and loved ones, and slow the spread of COVID-19. Because North Carolina is experiencing high numbers of COVID-19 cases across the state, NC DHHS urges caution when gathering for Thanksgiving and other holiday celebrations, especially for gatherings that include people who are at a higher risk of developing complications from COVID-19, such as anyone over the age of 65. During Black Friday shopping, it is strongly recommended individuals do not participate in any traditional Black Friday shopping where customers gather in large groups waiting for the store to open or are in crowded stores for extended times. Click Here to read the entire press release.

• NEW: POC Testing Resources for Long Term Care Facilities - NC DHHS has developed the attached NC DHHS Resource Compendium for Point of Care Testing Device Use in Long-term Care Settings 10 16 2020 to assist long-term care facilities in their POC testing implementation. This Compendium will be posted under “Other Guidance” at: https://covid19.ncdhhs.gov/guidance#long-term-care-facilities.  

• NEW: Updated Long Term Care Visitation Guidance - CMS and DHHS released visitation guidance a few weeks ago. Note, that while facilities will remain on the DHHS outbreak list for 28 days, a facility's presence on this list does not preclude visitation. Facilities are directed to follow DHHS and CMS guidance for visitation. CMS guidance on visitation specifies that indoor visitation in nursing homes/skilled nursing facilities can occur if there are no cases in the last 14 days and the facility is not located in a county with high percent positivity per federal rates. All large long term care facilities of 7 or more beds, including nursing homes, should follow additional DHHS guidance on visitation here. 

• NEW: PPE Resource Request for Long Term Care Facilities - NC DHHS continues to support Long-Term Care Facilities with Personal Protective Equipment (PPE) through a request process found here: https://covid19.ncdhhs.gov/information/health-care/requesting-ppe. If you have questions about how to put in a PPE request, email OEMSSupportCell@dhhs.nc.gov.

• NEW: NC DHHS Submits COVID-19 Vaccination Plan to CDC - The goal of the plan is to immunize everyone who is eligible for and wants a COVID-19 vaccine. "Leaders from across sectors came together under tight timelines to collaboratively develop a vaccine plan that leads with equity and prioritizes building trust. We will continue to update this plan as we learn more from the science and data on vaccines and in response to the needs of North Carolinians," said NC DHHS Secretary Mandy K. Cohen, M.D. North Carolina’s vaccine plan reflects five principles that guide the planning for and distribution of one or more COVID-19 vaccines in the state.

1. All North Carolinians have equitable access to vaccines.
2. Vaccine planning and distribution is inclusive; actively engages state and local government, public and private partners; and draws upon the experience and expertise of leaders from historically marginalized populations.
3. Transparent, accurate and frequent public communications is essential to building trust.
4. Data is used to promote equity, track progress and guide decision-making.
5. Appropriate stewardship of resources and continuous evaluation and improvement drive successful implementation.

• NEW: The NC DHHS Division of Health Benefits and North Carolina AHEC Are Offering Medicaid Managed Care Webinar Series for Providers - NC DHHS Division of Health Benefits and North Carolina AHEC are offering two monthly evening webinar series to help prepare providers, practice managers, and quality managers for Medicaid Managed Care going live on July 1, 2021. Hosted by Shannon Dowler, MD, Chief Medical Officer of the NC Division of Health Benefits, these two series will feature changing subtopics on Medicaid Managed Care on the first Thursday of each month and clinical quality on the third Thursday of each month through June 2021. Topics will be listed as they become available. To register for the Medicaid Managed Care Fireside Chat Webinar Series (EVERY FIRST THURSDAY OF THE MONTH FROM 5:30 TO 6:30 P.M.), click Here. Upcoming topics include: Medical Home (Thursday, November 5, 2020); Beneficiary Attribution (Thursday, December 3, 2020); Policy Approvals, Process Changes, and Appeals (Thursday, January 7, 2021).

• NEW: NC DHHS Updates Guidance on Visitation - On Monday, September 28th, NC DHHS released Secretarial Order No. 6 and "Guidance on Visitation, Communal Dining, and Indoor Activities for Larger Residential Settings" which are focused on indoor visitation for long-term care facilities. The Order applies to long-term care facilities: nursing homes or skilled nursing facilities and other large residential settings (7 or more beds) including adult care homes, behavioral/IDD, intermediate care facilities, and psychiatric residential treatment facilities. The Secretarial Order is effective immediately. Click Here to view Secretarial Order No. 6. To view the updated guidance on visitation, click Here. Please Note: Although the new guidance now allows for indoor visitation in some instances, as in the previous guidance on outdoor visitation, providers are not obligated to allow visitation and are encouraged only to allow for visitation when able to meet applicable guidelines.

• NEW: Expectation to Comply With Infection Control and Prevention Measures - Strong infection prevention and control practices are critical to reducing the transmission of COVID-19 within long-term care facilities. NC DHHS is reiterating its expectation that providers under the scope of SPECIAL BULLETIN COVID-19 #88: Additional Temporary Rate Increases for Skilled Nursing Facilities, LTSS Personal Care Service Providers and Home Health Providers to support Strengthening Infection Prevention Activities participate in the infection prevention and control activities. Click Here to read more about SPECIAL BULLETN COVID-19 #135.

• NEW: Executive Order No. 165 (Extending Certain Health and Human Services Provision in Previous Executive Orders and Delegation of Authority) and Secretarial Order No. 4 (Mandatory Testing for Staff in Nursing Homes) Have Recently Been Released By The State of North Carolina - SPECIAL BULLETIN COVID-19 #134: Clarification of COVID-19 Temporary Rate Increases and Clinical Policy Changes replaces SPECIAL BULLETIN COVID-19 #119 in its entirety. NC Medicaid is committed to ensuring beneficiaries continue to receive Medicaid and NC Health Choice services with no interruptions or delays due to COVID-19. In August, NC Medicaid released Special Bulletin #119 which provided information on extensions of the COVID-19 rate enhancements and Clinical Coverage Policies in response to the extension of the federal Public Health Emergency declaration. This bulletin clarifies and further updates information provided. Special Bulletin #119 correctly noted that the federal Public Health Emergency was extended on July 25, 2020 for up to 90 days. The current expiration date for the federal Public Health Emergency is Oct. 23, 2020, not Oct. 25, 2020, as previously stated. The federal government may continue to extend the Public Health Emergency at its discretion. Special Bulletin #119 also indicated that temporary rate enhancements would continue through Sept. 30, 2020. NC Medicaid has determined that it is both necessary and feasible to continue temporary enhanced rates related to COVID-19 through the expiration of the Public Health Emergency, currently Oct. 23, 2020. If the federal government extends the federal Public Health Emergency or takes other action, NC Medicaid will reassess both needs and available funding. Please refer to relevant COVID-19 Medicaid Bulletins and Medicaid fee schedules for details. Click Here to read Executive Order No. 165. Click Here to read Secretarial Order No. 4.

• NEW: NC DHHS COVID-19 Support Services Available to Help NC Residents Isolate or Quarantine - The new NC DHHS COVID-19 Support Services Program and Community Health Worker Initiative as announced in late August (press releases are available online Here and Here). Click Here to access an overview of NC DHHS-covered services and the community health worker program in target counties, including: what are the CHW and Support Service programs; what support services are available at no cost to individuals; who is eligible for support services; how you play a role in connecting residents to support; who to contact for more information.

• UPDATE: NC Medicaid Will Cover COVID-19 Testing Costs for the Uninsured - NC Medicaid is reimbursing COVID-19 testing costs for individuals without insurance who enroll in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA). Enrolled MCV beneficiaries will also qualify for coverage of COVID-19 tests retroactive to June 1, 2020 provided they were uninsured at the time of the test. To qualify, individuals must be uninsured, a resident of North Carolina, and meet the citizenship and legal immigration status requirements of the Medicaid program. NC Medicaid is required to verify citizenship and immigration status. Individuals must qualify for MCV at the time the test was obtained. SPECIAL BULLETIN COVID #128: NC Medicaid Optional COVID-19 Testing Program Online Applications Available and a fact sheet (Click Here) describe the program in more detail. Additionally, a one-page flyer/signage (Click Here) is designed to help raise awareness of this program at testing locations, practices, clinics, health systems, Departments of Social Services and any organization that sees uninsured residents. The fact sheet and flyer are attached and also available at: https://medicaid.ncdhhs.gov/about-us/covid-19-guidance-and-resources/providers.

• UPDATE: NC DHHS Developing SlowCOVIDNC Exposure Notification App; Expected to Launch Statewide in September - NC DHHS is developing a COVID-19 Exposure Notification app called ‘SlowCOVIDNC’ that will launch across the state in September 2020. The app will help North Carolinians slow the spread of the virus by alerting them when they may have been exposed to someone who has tested positive for COVID-19. SlowCOVIDNC, which leverages Google and Apple’s Exposure Notification System (ENS), will alert users that have the app if they have been in close contact with an individual who later tests positive for COVID-19. The app is completely anonymous and does not collect, store or share personal information or location data. SlowCOVIDNC is voluntary to download and use and designed to enhance the state’s existing contact tracing efforts. The app, which is currently in Beta testing, will be free of charge and available to download through the Apple App Store and the Google Play Store. “The SlowCOVIDNC app builds on our ongoing efforts to slow the spread of COVID-19 across the state. By proactively notifying app users of potential exposure to the virus, people can act quickly to protect themselves, their loved ones and their communities,” said Sam Gibbs, NC DHHS Deputy Secretary of Technology and Operations. To read more on how SlowCOVIDNC will work, click Here. Update regarding Exposure Notification App: On October 7th, NC DHHS announced that more than 100,000 people had downloaded the SlowCOVIDNC app. SlowCOVIDNC, the official exposure notification of the NC DHHS, alerts North Carolinians when they may have been exposed to someone who has tested positive for COVID-19. It is completely anonymous and does not collect, store or share personal information or location data

• NEW: Governor Roy Cooper Issued an Executive Order Returning Regulatory Authority for Skilled Nursing Facilities to the Secretary of the NC DHHS - Current restrictions remain in place as NC DHHS collaborates with industry and advocacy organizations, monitors progress and evaluates options to best protect the health and well-being of staff, residents and their loved ones. Since the start of the pandemic, North Carolina has taken early and aggressive action to protect residents of long-terms care facilities. Residents in nursing and adult care homes are at higher risk for severe illness from COVID-19, and the nature of long-term care facilities makes it difficult to control an outbreak. You can read the entire press release Here.

• UPDATE: On July 16th NC DHHS Updated Guidance on Visitation, Communal Dining and Indoor Activities for Larger Residential Settings - NC DHHS had revised guidance for residential care facilities (includes Adult Care Homes) in the areas of visitation, dining, and activities. While outdoor visitation is still recommended, the NC DHHS is allowing looser restrictions regarding dining and group activities inside the facility. You can view and download the UPDATED document Here. The guidelines for outdoor visitation essentially remain the same, however, the new guidelines will allow communal dining and group activities as long as social distancing is maintained. (For further information on previous guidance on visitation, please see below article regarding Executive Order No. 147.) 

• NEW: CDC Updates Guidance on Duration of COVID-19 Isolation - Isolation can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with the improvement of other symptoms (removes 27 hour criteria). Also, a test-based strategy is no longer recommended to discontinue isolation except in very specific circumstances in consultation with infectious disease experts. Additionally, for persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection and quarantine is not recommended in the event of close contact with an infected person. You can access the updated guidelines Here.

• (Re-print from earlier communication) Community Care of North Carolina Issues Easy to Understand COVID-19 Testing Guide - Community Care of North Carolina recently released an easy to understand COVID-19 Testing Guide (Click Here). Given the fact there is so much information available regarding COVID-19 and testing, we find their guide provides answers to question, such as when someone should get a viral test or if an antibody test is indicated, in a simple and easy to understand format.

• (Re-print from earlier communication) Governor Cooper Holds Press Conference and Issues Executive Order No. 147 - On June 27th, Governor Cooper held a press conference and announced the following:
• Because of the continued upward trends in COVID-19 related metrics, along with concern for both the public health and for our hospital capacity, North Carolina will remain in Phase 2 (Information Here) until at least Friday, July 17; and
• North Carolina is adopting a face covering requirement to help slow the spread of COVID-19, making it mandatory for people to wear a cloth covering over your nose and mouth when they are indoor and in outdoor public places, where staying 6 feet from people who are not part of their households is impossible.

• Executive Order No. 147 - The Governor also issued a new Executive Order (Click Here) effective June 28th at 5 p.m. that contains new requirements for Long Term Care Facilities and states: "All workers in Long Term Care ("LTC") Facilities, including skilled nursing facilities ("SNF"), adult care homes ("ACH"), family care homes ("FCH"), mental health group homes, and intermediate care facilities for individuals with intellectual disabilities ("ICF-IID"), must wear Face Coverings while in the facility, and those Face Coverings must be Surgical Masks, as long as Surgical Mask supplies are available." To determine what constitutes a "Surgical Mask" we should point out it is NOT an N95 mask but a one time use face mask. You can view/download Centers for Disease Control (CDC) guidance regarding masks Here.
• You can view/download Frequently Asked Questions (FAQs) to Executive Order No.147 Here.
• Executive Order No. 147 also only extends long term care visitation restrictions to nursing homes and nursing homes with assisted living beds (combination homes) and therefore, REMOVES VISITATION RESTRICTIONS FOR ALL OTHER LONG TERM CARE PROVIDERS INCLUDING ADULT CARE HOMES AND FAMILY CARE HOMES.
• As a result, on 6/25 the NC DHHS this released outdoor visitation guidance for adult care homes (Click Here) and indoor and outdoor visitation for family care homes (Click Here). (Note: The family care home guidelines allow for indoor visitation as long as a specially designated area is identified.)
• Since the criteria for allowing outdoor visitation is strict, we strongly encourage providers to read the guidance very closely and only consider allowing outdoor visitation when they are confident they can provide a safe visitation experience for their residents that reduces or eliminates potential exposure and spread of the COVID-19 virus.
• For questions regarding any of the above information, please contact Jeff Horton at jeff@ncseniorliving.org

• UPDATE: Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients - As reported previously, NC Medicaid is directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID-19 residents in a congregate care setting. This targeted assistance is retroactive to April 1, 2020.
• UPDATE: NCSLA vendor member Richard Rutherford has been working through the process of getting the practical details on the Hardship Advance and the increased Medicaid PCS rate and hours and is willing to provide help, free of charge to NCSLA members, any provider that qualifies due to a COVID-19 outbreak in their facility. Richard's contact information is: Email: Medicaidwiz@gmail.com or Cell: (919) 264-2398
• Templates are now available on the Cost Reports and Assessments web page and contain the following documents:
• NC Medicaid COVID Outbreak Report Template Cover (Click Here) provides guidance on completing the following form which is:
• the NC DHB Outbreak Facility Reporting Date Provider Name Template (Click Here)
• For more information, please see SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients
• As noted in earlier NCSLA communications, NC Medicaid will pay providers an Expedited Hardship Advance (payment) based on the adult care home's PCS billings for January and February 2020 and multiplied by a factor of 1.25, the provider can receive a Hardship Advance to help offset the increased costs of caring for COVID-19 residents.
• ACH COVID-Outbreak Site PCS Reimbursement Increase -

1. An ACH COVID-Outbreak site will be assigned NPI-specific rates that allow them to be reimbursed the increased rates for services provided. The current 15-minute unit rate will be increased to $8.25 per unit ($33/hr) for all Medicaid PCS beneficiaries in an ACH COVID-Outbreak site. Providers should bill their usual and customary charges.
2. An ACH COVID-Outbreak site may bill up to 100 additional service hours per month for each beneficiary with current prior approval up to 80 hours per month. 
3. An ACH Outbreak site may bill up to 40 additional service hours per month for each beneficiary with current prior approval greater than 80 hours per month. 

• (Re-print from earlier communication) CDC Web-based Training Available - The CDC is offering web-based training on their Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs) webpage which can be found Here. If you scroll to the bottom of the webpage, you will find a number of short (5-7 minute) videos that can be used for staff training on basic infection control practices.

• COVID-19 Webinars Still Available on the NCSLA Website - Webinars from April 9th and the 14th are still available on the NCSLA Coronavirus Updates webpage. The April 9th webinar focused on "Infection Prevention in Assisted Living Facilities" and the April 14th webinar was on "COVID-19 Pandemic Legislative and Regulatory Changes: An Assisted Living Facility’s Guide." Both webinars are free of charge.

• (Re-print from earlier communication) Centers for Disease Control (CDC) Issues "Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities" - On 5/29, the CDC issued guidance for preventing spread of COVID-19 in assisted living facilities (Click Here). Most of the guidance has been covered in previous NC DHHS communications that NCSLA has disseminated but we new CDC guidance reiterates important issues such as:
• Identify a point of contact at the local health department to facilitate prompt notification of suspected or confirmed COVID-19 infections of residents or staff;
• Educate residents, family members, and personnel about COVID-19;
• Have a plan for visitor and personnel restrictions;
• Encourage source control of PPE;
• Encourage social distancing;
• Provide access to supplies and implement recommended infection prevention and control practices; and
• Rapidly identify and properly respond to residents with suspected or confirmed COVID-19.

• (Re-print from earlier communication) Additional Personal Protective Equipment (PPE) Resources - In order to save space, NCSLA has now put it's list of PPE resources into a PDF document which can be viewed/downloaded Here. The document contains embedded links to emails and websites as were found in previous communications.
• Providers can also request PPE (usually only provider to facilities with COVID-19 outbreaks) via the NC DHHS website Click Here
• UPDATE: Puratize LLC - Has developed a portable, two mask sanitizer using UV/LED technology. It will sanitize two masks every 5 minutes. Contact William Rodgers, Email: brodgers@chantengineering.com www.puratize.com

• (Re-print from earlier communication) Requesting Additional PPE from the Local Emergency Management Agency - For providers that are running low or exhausting their supplies of PPE (masks, gowns, gloves, etc.) that they have contacted their County Emergency Management Agency and have been told the PPE supplies are limited.

• **We encourage members that need PPE to keep checking in with your County Emergency Management Agency on at least a weekly basis to re-emphasize the need for PPE to protect your staff and residents. **

• The COVID-19 Healthcare Coalition for Critical Equipment and Supplies recently provided the following forms (Healthcare Guidance for PPE and PPE Request Process) for providers to use when determining their burn rate of PPE and the request process for PPE. According to the state's Healthcare Coalition for COVID-19, if a long term care facility has a resident with COVID-19 and is at risk of exhausting their supplies of PPE, immediately contact your County Emergency Management Agency, it is imperative that you explicitly communicate this information to the Agency so they can work with their Healthcare Coalition to locate PPE and help get it to your facility.

• (Re-print from earlier communication) NC DHHS Publishes COVID-19 Toolkit for Long Term Care Facilities - The NC DHHS has published a COVID-19 toolkit for long term care facilities on their website which can be found Here. The toolkit contains the following items:
• COVID-19 Outbreak Toolkit for Long-Term Care Settings
• Long-Term Care Infection Prevention Assessment Tool
• Infection Prevention Education Resources for Long-Term Care FacilitiesOpen PDF
• Strategies to Optimize Personal Protective Equipment - FacemaskOpen PDF
• Strategies to Optimize Personal Protective Equipment - GownsOpen PDF
• IP Staffing Worksheet for Long-Term Care Facilities During COVID-19Open PDF
• What to Expect: Response to New COVID-19 Cases or Outbreaks in Long-Term Care Settings

• All long term care providers are encouraged to refer to these resources, particularly in the event a COVID-19 outbreak is discovered in a facility.

• (Re-print from earlier communication) Documents for Use by Adult Care and Family Care Homes Related to COVID-19 - Over the past two months, NCSLA has made available documents providers can use to screen residents and visitors, have hospitals complete prior to discharging someone to an adult care home and other forms that are useful with regards to COVID-19. In addition, NCSLA received additional documents from one of our members yesterday that may prove useful to providers as they strive to provide care during this difficult time to their residents and protect their staff. These documents are listed below and can be downloaded and customized for your facility's use free of charge.
• Daily symptom attestation form - COVID-19
• How facility is responding to COVID-19
• COVID-19 Reporting to work procedures
• COVID-19 Temperature control sheet
• COVID-19 Staff and visitor screening form
• COVID-19 Post-acute care transfer form

• (Re-print from earlier communication) NC DHHS Releases Flow Chart For Discharge from Hospital to Long Term Care - NC DHHS released a number of updated guidance documents on their website in the past week (Click Here) including a flow chart to follow when discharging someone from a hospital to a long term care facility. You can view/download the flow chart Here. While the guidance allows for transfer of patient with COVID-19 or a patient recovering from COVID-19 to a long term care facility, strict CDC guidelines (Click Here) must be adhered to as noted below:
• Patients can be discharged from the healthcare facility (hospital) whenever clinically indicated. If discharged to a nursing home or other long-term care facility (e.g., assisted living facility), AND
• Transmission-Based Precautions are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.
• Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.
• Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.

• (Re-print from earlier communication) Governor Signs Executive Order to Provide Regulatory Flexibility for Health Care System During Response to COVID-19 - On June 26, 2020 Governor Cooper extended Executive Order No. 139 (Click Here), via Executive Order No. 148 (Click Here), which provides additional regulatory flexibility to help ensure capacity in the state’s health care system and improve its ability to effectively respond to the COVID-19 pandemic. (Please note the Executive Order is in addition to the waiver of DHSR licensure rules as noted in the article below titled "DHSR Waives Certain Licensure Rules As a Result of COVID-19" which is still in effect).
• The Executive Order temporarily gives the Secretary of the Department of Health and Human Services (“DHHS”) the ability to waive or modify regulations for accreditation for asbestos and lead testing professionals, accreditation of local health departments, and regulations impacting child care and high-risk health care facilities, which would include adult care and family care homes. 
• The Executive Order ensures that DHHS can utilize certain authority provided by the federal government to respond to the COVID-19 pandemic. The goal of the temporary flexibility will be to ensure capacity and continuity in services in North Carolina’s health care system while the state continues to respond to COVID-19.
• Executive Order 139 remains in effect until 5:00 pm on July 17, 2020. If you have questions regarding how to submit a waiver request, please contact Jeff Horton at NCSLA at: jeff@ncseniorliving.org or Richard Rutherford with SembraCare at: Medicaidwiz@gmail.com or by phone at: (919) 264-2398

• (Re-print from earlier communication) DHSR Waives Certain Licensure Rules As a Result of COVID-19 - As the situation surrounding COVID-19 continues to change rapidly, DHSR approved statewide waivers this past Friday (4/24) for certain licensing requirements applicable to Adult Care Homes and Family Care Homes licensed pursuant to N.C.G.S. § 131D, Article 1, and rules 10A NCAC 13F and 10A NCAC 13G. The waivers will remove the need for providers to make individual requests, subject to the Waiver Terms and Conditions included in the attached Notice (Click Here), waivers are granted pursuant to N.C.G.S. § 131D-7 and the Director of Emergency Management’s request for waiver of certain regulations. This statewide waiver will expire at the conclusion of the Governor’s emergency declaration or sooner as determined by the Department and is subject to the terms and conditions set forth in the Notice. The waivers address the following areas:
• Personnel Requirements and Hiring New Staff
• Tuberculosis Testing
• Criminal Background Checks
• Personal Care Training and Competency
• Training on Care of Diabetic Residents
• Family Care Home Administrator Renewal
• Resident Admissions and Other Requirements
• Tuberculosis Testing Upon Admission
• Annual Medical Exam
• Care Plan
• Medication Orders
• Pharmaceutical Care
• Licensed Health Professional Support Quarterly Reviews and Evaluations
• Visitation and Activities
• Visitation
• Group Activities & Outings
• Nutrition and Food Service
• Disposable Place Settings
• Meal Times & Communal Dining
• Menus
• For questions regarding the Waivers, DHSR asks that providres email them at DHSR.AdultCare.Questions@dhhs.nc.gov . 

• (Re-print from earlier communication) DHSR Announces Additional Temporary Testing Sites for Medication Aide and Administrator Exams - In order to assist adult care home and family care home providers in ensuring there is adequate staff to meet the needs of residents during these challenging times due to COVID-19, the Division of Health Service Regulation Healthcare Personnel Education and Credentialing Section (HCPEC), the DHSR Adult Care Licensure Section (ACLS), and several county Departments of Social Services are partnering to offer additional temporary testing site locations for the medication aide and administrator exams. Throughout the remainder of April and through the end of May, DHSR will be offering multiple testing site locations across the state, on Monday, Wednesday and Friday’s at most sites listed below. Site locations, dates and times are being posted on the HCPEC Branch website https://www.ncnar.org/index1.jsp. Testing schedules can be found at https://info.ncdhhs.gov/dhsr/news.html#hcpr . All individuals who wish to take an exam must register and pay the normal required testing fee. In addition, for the safety of all testers and test proctors, we are taking the following safety and infection prevention measures:
• Tests will be limited to no more than 5 people per scheduled exam.
• Testers will be screened prior to entering the testing location. Any person who exhibits signs or symptoms of respiratory illness or has tested positive for COVID-19 will not be permitted to take the exam and will be asked to reschedule.
• All testers are asked to wear a facemask or other face covering upon entering the exam location and wear the face covering for the duration of the exam. 
• Exam proctors will be disinfecting all tables and writing instruments between exams. 
• Testers will need to remain in the testing room and will not be permitted to travel in other areas of the testing site.

• Below are the temporary additional testing sites. All locations will offer the medication aide exam. Select locations will offer the administrator exam.  Again, please refer to the HCPEC website for details and schedules. 
• Buncombe County – DHSR Black Mountain Office - 952 Old US Hwy 70, Building 17, Black Mountain, NC 28711
• Gaston County DSS - 330 Dr. Martin Luther King Way, Gastonia NC 28052
• Davie County Senior Services - 278 Meroney Street, Mocksville, NC 27028
• Mecklenburg County DSS - Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
• Guilford County DSS - 1203 Maple St. Greensboro, NC 27405
• Cumberland County DSS - 1225 Ramsey Street, Fayetteville, NC 28301
• No testing on Fridays.
• Jones County Civic Center - 832 North Carolina Hwy 58, Trenton, NC 28585
• Pitt County Cooperative Extension - 403 Government Circle Suite 2, Greenville, NC 27834
• Wake County – DHSR, Brown Building, Room 104, Dorothea Dix Campus - 801 Biggs Drive, Raleigh

• (Re-print from earlier communication) Free Music for Resident Listening Activities - North Carolina composer Dave Combs asked NCSLA to share his music with the adult care home and family care home communities as a way to offer residents music listening activities. Dave's soothing and relaxing instrumental music videos are free to use at no charge and many residents in the Winston-Salem area are already familiar with his music, particularly, Rachel’s Song. Dave is a long-time resident of Winston-Salem and a composer of many albums of instrumental music and considers this offer as one way for him to give back. Below are the YouTube links for Dave's video playlists. Feel free to forward this information to any residents that you think might like to watch the YouTube videos on their own devices. For large video screens in your public areas there are four videos that are long-playing (over 6 hours). These videos can be streamed to have beautiful, relaxing music playing in the background all day long. The videos have beautiful photography accompanied by soothing, relaxing instrumental music composed by Dave Combs and arranged and performed by Gary Prim. When you click on the following link it will take you to the YouTube playlist that looks like the below image. Choose your video, and enjoy - https://www.youtube.com/playlist?list=PLGNq0Ky_ylCTwo-jfcxx9k8QBgR2M22HR

• (Re-print from earlier communication) NC DHHS Launches Program to Match Health Care Workers to Facilities Seeking Staff - Due to COVID-19, many health care facilities in North Carolina, particularly long-term care facilities, are seeking to hire staff for temporary, part-time or full-time roles. There is an urgent need for Registered Nurses and Certified Nursing Assistants, among other roles to supplement current workers and in some cases fill in for workers affected by COVID-19. Interested health care employees with the ability to pick up extra shifts or who may have been laid off from facilities and are seeking full-time roles can register at https://nc.readyop.com/fs/4cjq/697b. Local Health care Facilities affected by COVID-19 and in need of support can request assistance through their local (county) Emergency Management agencies (Click Here), which have the ability to fulfill the support requested within the county. You can read more about the program Here.

• (Re-print from earlier communication) NCDHHS to offer relief to essential workers for child care, bonuses to child care staff - The NCDHHS is providing financial assistance to help essential workers afford child care and bonuses to child care teachers and staff who provide care during the COVID-19. Information about the program including the COVID-19 Parent Application for Financial Assistance for Emergency Child Care can be found Here. Since adult and family care home staff are considered essential workers, many adult care home staff with children may be eligible to use this service to assist with child care needs during the COVID-19 pandemic.