• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 9948 cases, which is an 3.9% increase in cases from yesterday (4/28 had 9568 cases). In addition, there are 551 currently hospitalized (19% increase from yesterday, 4/28), there have been 354 deaths related to the virus and it is in 98 counties. You can view the number of cases and other data Here

• UPDATE: NCSLA Continues to Work for YOU! - As communicated previously, during the COVID-19 pandemic, NCSLA has continued to work with officials at the NC DHHS and with legislators to communicate our industry's needs during these unprecedented times. Currently, there are two very important initiatives we are working on with legislators at the NC General Assembly, which will convene for it's short session on April 28, 2020.
• The first issue is to continue to communicate that adult care homes in our state that receive public money (Special Assistance and Medicaid) are severely underfunded. Last week, we sent the following communication (Click Here) to members of the House Select Committee on COVID-19 Health Committee to prioritize funding needs and recommended amounts for SA and Medicaid.
• Update: The Health Committee met today and introduced House Bill 1038 - Section 6.3, (Click Here) that would provide for a one time payment of $1325 for each SA resident that is residing in a residential facility that serve SA residents during the period of March 10, 2020 - July 30, 2020. This is the same language that appeared in the Health Committee draft that NCSLA sent out last week.
• In addition, the Senate Appropriations Committee introduced a bill today, Senate Bill 704 (Click Here) that would provide a one-time payment to facilities that accept SA to offset the increased costs of serving residents during the COVID-19 emergency. The Bill states that each eligible facility will receive an amount equal to 33 nine hundred thirty-seven dollars ($937.00) for each resident of the facility, 34 as of April 1, 2020, who is a recipient of State-County Special Assistance. 
• The second issue we have been working on is to seek liability protection for adult care homes and other health care providers related to COVID-19. Due to the limitations in PPE, finding sufficient direct care staff to provide care, etc., we believe providers should not be held liable for events related to COVID-19 that are beyond their control.
• Update: The Health Committee met yesterday and House Bill 1037 - Section 4.7 was introduced (Click Here) that contains much of the liability protection language that NCSLA had worked on in the past two weeks with other health care trade associations. In addition, Senate Bill 704 - Section 6.6 (Click Here) contains similar liability protection language. NCSLA will continue to make every effort to get a common sense law passed that will protect providers as they address COVID-19 issues in their facilities.

• UPDATE: Information Regarding Medicaid PCS Rate Increase for Facilities with COVID-19 Outbreaks - Yesterday (4/27) NC Medicaid issued "SPECIAL BULLETIN COVID-19 #68: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients" which can be found Here. The Bulletin addresses the issue we previously reported where NCSLA had been working close with NC Medicaid on an additional rate increase (on top of the 5% PCS increase that went into effect 3/10/20) for those adult care homes with identified COVID-19 outbreaks. The payments can help adult care homes in two ways:
• 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. The Bulletin contains instructions of how to apply for the Hardship Advance.
• UPDATE: NCSLA vendor member Richard Rutherford has been working through the process of getting the practical details on the Hardship Advance and has prepared a formal request letter. Richard is willing to provide help, free of charge to NCSLA members, to any provider that qualifies for the Hardship Advance. Richard's contact information is: Email: Medicaidwiz@gmail.com or Cell: (919) 264-2398

• 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 $7.50 per unit ($30/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. 

• For more information including criteria for receiving the additional COVID-19 rate(s), please refer to the Special Bulletin COVID-19 #68

• NEW: Instructions for Collecting COVID-19 Specimens with NC State Laboratory for Public Health (State Lab) Collection Devices - NCSLA received information today from the State Lab that will help providers in collecting specimens for COVID-19 testing. Currently, the State Lab has a system in place to distribute COVID-19 specimen collection materials to the county health departments, which they use in-house and/or share with the community as needs arise. On occasion, when specimens are being collected at residential/long-term care facilities, they are finding their instructions on how to use the specimen collection devices are not reaching those collecting the specimens, which is often the facility’s healthcare staff. The State Lab has asked NCSLA to distribute the below specimen kit instructions (these are half-sheets that go in each of our kits), which are also on the State Lab website under Key Resources. If you have questions, please do not hesitate to contact the State Lab at Phone: 919-733-3937 or email at: slph.covid19@dhhs.nc.gov.
• State Lab Kit Instructions
• State Lab Cooler Instructions

• (Re-print from earlier communication) NC DHHS Posting Names of Facilities with COVID-19 Outbreaks - NC DHHS posted the names of the facilities with COVID-19 outbreaks and other information on their website yesterday. You can view/download the information Here. Adult care homes and family care homes are in the Facility Type labeled "Residential Care Facility" which also includes behavioral health group homes and other residential settings. Nursing homes, corrections facilities and others have their own specific categories. According to the release "In a congregate living setting, a COVID-19 outbreak is defined as two or more laboratory-confirmed cases in persons who did not have COVID-19 diagnosed before arrival at the facility. An outbreak is considered over after 28 days have passed since the date of symptom onset of the last case. In situations where all persons in a congregate living setting test positive for COVID-19, the outbreak will be considered over when all persons have recovered or been released from isolation." In addition, beginning May 1, 2020, the data will be updated on Tuesday and Friday by 4 p.m.

• (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) Governor Extends Stay At Home Order Through May 8, Plans Three Phase Lifting of Restrictions Based on Virus Trends - Governor Cooper held a news conference yesterday to discuss social restrictions based on COVID-19. During the news conference, the Governor announced that the stay at home order that expires on April 29th will be extended until May 8th. In addition, a number of other items were discussed including the three Phases that will be used to eventually return the state to some level of normalcy depending on COVID-19 trends.
• You can read more about Governor Cooper's news conference Here.
• In addition, the Governor's Task Force on COVID-19 met this morning, which NCSLA is a partner, and a more in depth review of the data for North Carolina and the three Phase Plan can be viewed/downloaded Here

• (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.

• 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.

• Personal Protective Equipment (PPE) resources - In order to save space, NCSLA has now put it's list of PPEf resources into a PDF document which can be viewed/downloaded Here. The document contains embedded links to emails and websites as were found previously in previous communications. Please note that many of the suppliers are obtaining their PPE from overseas; therefore, it may take up to 2 - 3 weeks for the PPE to arrive after an order has been placed. In addition, many of the suppliers require payment for the PPE prior to submitting order for fulfillment as opposed to invoicing and getting paid at a later date.

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• (Re-print from earlier communication) Tuberculosis Testing (TB) Deferred for New Hires and Residents - Yesterday (4/16), the Division of Public Health issued guidance regarding TB testing in a number of settings including adult care homes. The new TB guidance can be found Here and allows for the following deferrals of TB screening:
• Staff of licensed nursing homes or adult care homes upon employment
• Residents of licensed nursing homes or adult care homes
• The guidance also encourages facilities to defer baseline employee screening as well.
• The guidance as states "People belonging to the groups above should undergo a baseline symptom screen, and appropriate evaluation including chest radiography should be performed for persons with symptoms of tuberculosis. Agencies should have a plan to track people for whom testing is deferred and to test such persons once social distancing measures are relaxed."

• (Re-print from earlier communication) Beneficiary Letter Announcement - The North Carolina Department of Health and Human Services is mailing a letter to Medicaid and NC Health Choice beneficiary households with information on COVID-19. The 1.2 million letters will be mailed in batches through April 22, 2020. To keep providers informed of communication to your Medicaid and NC Health Choice patients, you can find the letter template in English Here and the letter in Spanish Here.

• (Re-print from earlier communication) Executive Order 131 Now in Effect - This past Monday at 5 p.m. Executive Order 131 (Click Here) went into effect which contains a number of provisions, including for long term care providers. The provisions include:
• Policies for distancing in retail stores
• Lowering the risk in long term care facilities
• The Order sets public health and safety requirements for nursing homes during the public health emergency. The Order encourages (not explicitly required) other long-term care facilities, including adult care and family care homes, to follow the same guidance. Some of the directives include:
• Canceling communal activities, including group meals;
• Taking the temperature of employees and essential personnel when they enter the facility;
• Requiring specific personal protective equipment in the facility;
• Requiring close monitoring of residents for COVID-19 health indicators like body temperature; and
• The Order states these requirements will last until this order is repealed.
• You can read more about lowering the risk in long term care facilities on page 7 of the Order Here

• (Re-print from earlier communication) Additional Information Regarding Canceling Communal and Group Meals: NCSLA has received a number of calls from adult care home providers regarding communal dining issues and the difficulty of ending communal dining and serving residents meals in their rooms. This creates a lot of challenges related to having sufficient staff to perform this function and also providing adequate supervision to residents who require it during meals. As noted above discontinuing communal dining is encouraged/recommended for adult care homes but is not explicitly required. However, below are some things providers have implemented which helps achieve keeping residents separated during meal times: 
• Some facilities have bought the rolling tray tables or other tray tables to be able to serve meals to residents in their rooms. However, other facilities have indicated that this is not feasible for them for whatever reason. In those cases, it is recommended providers considering doing the following:
• Staggering meal times to allow for less number of residents in the dining room at one time
• Utilize other rooms not normally used for dining to be able to space residents further apart and still allow for social distancing and supervision of those residents who need it (activity room, living room, etc.)
• Serve meals to residents who are independent and do not need supervision or feeding assistance in their rooms, and serve those who do need assistance and supervision in the dining room.
• And obviously, serve any residents who are sick in their rooms.

• Facilities are encouraged to adhere to these recommendations the best they can and to the greatest extent possible. 

• (Re-print from earlier communication) Governor Cooper Issues Executive Order 130 - Governor Cooper issued Executive Order 130 (Click Here) which has a number of provisions including, but not limited to the following:
• Provides insulation from liability for health care workers providing services related to COVID-19 (page 4)
• Loosens regulations on expanding bed capacity for hospitals, nursing homes, adult care homes, and behavioral health providers to allow flexibility in meeting the needs of caring for COVID-19 patients (must be approved by DHSR)(pages 6, 7, 8)
• Allows dialysis centers to expand or relocate dialysis stations in response to COVID-19 (page 8)
• Waivers on certain regulations for child care facilities (page 10)
• Allows additional time to screen new hires because of disruptions to fingerprinting as long as certain conditions are met (Page 18 - see Section 6, C)

• In addition to the Executive Order 130, a more complete summary of the Order can be found Here.

• (Re-print from earlier communication) Positive Media About Assisted Living and COVID-19 - With all the negative press regarding COVID-19 affecting long term care facilities, we encourage you to watch the below videos which show the hard work and support assisted living communities are receiving in parts of our state:
• Community Rallies to Support Hendersonville Assisted Living Facility - Cherry Springs Village (WLOS, ABC 13, Asheville. Featuring Kasey Taylor, supportive family member and Chris Lewis, staff member) - Watch story here

• While highlighting work done by 1st responders and health care workers, COVID-19 pandemic yields unexpected heroes (CBS 17, Raleigh - Featuring Geraldine Yancey) - Watch story 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.

• (Re-print from earlier communication) Division of Health Service Regulation (DHSR) Releases New Guidance for Long Term Care Facilities - The DHSR notified NCSLA last evening that they have adopted the latest guidance from the Centers for Medicare and Medicaid Services (CMS) for nursing homes (long term care facilities) to also be used for adult care and family care home providers. The guidance can be viewed/downloaded Here (Note: The guidance document contains links to the referenced materials below, i.e. CDC guidance, etc.) The new guidance addresses five areas:

1. Nursing Homes (long term care facilities including adult and family care homes) should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
2. As long-term care facilities are a critical part of the healthcare system, and because of the ease of spread in long-term care facilities and the severity of illness that occurs in residents with COVID-19, CMS urges State and local leaders to consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests.
3. Long-term care facilities should immediately implement symptom screening for all
4. Long-term care facilities should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
5. To avoid transmission within long-term care facilities, facilities should use separate staffing teams for COVID-19-positive residents to the best of their ability, and work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status. 

• (Re-print from earlier communication) NC Department of Public Safety (DPS) Issues Guidelines for Allocation of Personal Protective Equipment (PPE) - The DPS, which includes the state Division of Emergency Management and is coordinating the state's response to COVID-19, issued guidance yesterday regarding the allocation of PPE. As NCSLA has previously communicated, supplies of PPE are low and we have learned that North Carolina only received approximately 33% of the PPE they requested from the Federal Government. As a result, the DPS has issued guidelines (Click Here) that show the priority of how the state's supply of PPE will be distributed. The guidelines are divided into three groups with Group 1 being the highest priority. Adult care homes with identified COVID-19 infections are in Group 1 and should receive priority if a request is made for PPE. Because state supplies of PPE are limited, it is highly recommended that providers attempt to obtain their own PPE (resources identified below) since it is possible as the COVD-19 outbreak becomes more severe, the state's supply of PPE will be depleted.

• (Re-print from earlier communication) Requesting PPE from the Local Emergency Management Agency - We continue to hear from providers that have run out of or running low on 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) Hospital to Post-Acute Care Facility Transfer – COVID-19 Assessment - As many acute care hospitals discharge patients to the post-acute environment, i.e. adult care homes, NCSLA has received calls from adult care providers that are questioning how to assess patients prior to agreeing to admit them in light of COVID-19. NCSLA received a tool (Click Here) that is being used in Florida, which providers, in collaboration with the hospital requesting to discharge the patient, may consider using to help assess and screen patients prior to admitting them into their adult care homes. The tool provides an algorithm, which we believe may be useful to providers.