Benchmarks' Written Friday Update
Sept 11, 2020
NC Cases: 180,754
Cases Hospitalized: 928
NC Deaths: 2,990
Positive Tests: Between 6% and 7.7% since Aug. 12
Pandemic Meeting
LYNN BONNER AND BEN SESSOMS, THE NEWS & OBSERVER, 9/10/20
Dr. Deborah Birx, the White House coronavirus response coordinator, supports North Carolina's new campaign on mask wearing, but "lamented" seeing people not wearing masks during her Wednesday visit, the state's top health leader said Thursday. Birx met with Dr. Mandy Cohen, secretary of the Department of Health and Human Services, and Gov. Roy Cooper in Raleigh. Cohen said Birx is visiting 30 states, with the meetings focused on cases at colleges and universities.
Cooper's office provided a written summary after the meeting, which included a list of requests for federal funding and support as well as a timeline on vaccine plans. Birx supports North Carolina's request for surge coronavirus testing on college campuses, Cohen said at a Thursday news conference. But the state's top priority remains prevention, Cohen said. "We are simmering," Cohen said. "We have a high level of viral spread, and we need to get that down, so we can make progress in opening other businesses. We can make progress on further easing of restrictions. We need leadership, and I think that this is an important moment for our leaders to recognize the importance of their own personal actions in this time."
A White House coronavirus task force report dated Sunday and sent to the nation's governors said North Carolina was in the "red zone" for new cases last week, with more than 100 new cases for every 100,000 people. Cohen and Cooper considered state trends stable enough to enter Phase 2.5 Friday to allow gyms, museums, playgrounds and other attractions to open at limited capacity and with health safety measures. Although North Carolina is in the red zone, Cohen said case rates are among the lowest in the region. DHHS reported 1,222 new COVID-19 cases on Thursday, for a total since March of 180,754.
The meeting summary said Cooper requested national leaders wear masks and social distance when visiting the state. Cohen said Thursday that the request is for candidates, surrogates and for people who attend events. At a Trump campaign rally in Winston-Salem this week, people in the crowd were packed together. The GOP chairman in Forsyth County asked before the rally for Trump to wear a mask. Trump did not wear a mask, The Washington Post reported, and he mocked the state limit on crowd sizes.
"We know we're in the middle of a pandemic," Cohen said Thursday. "We know that COVID-19 is here in our communities. I would hope that our leaders would demonstrate and role model the kind of activities that we know slow the spread of the virus, whether there's a mandate or not."
Scaled-back GOP stimulus plan fails in Senate
WASHINGTON Senate Republicans on Thursday failed to advance their substantially scaled-back stimulus plan amid opposition by Democrats who called the measure inadequate, further darkening the already dim prospects that Congress will enact another economic recovery measure to address the toll of the coronavirus pandemic before November's election.
After months of struggling to overcome deep internal divisions over the scope of another relief package, Republicans presented a near-united front in support of their latest plan, while Democrats opposed it en masse, denying it the 60 votes it would have needed to advance.
The result was never in doubt, and Republicans held the vote largely in an effort to foist blame on Democrats for the lack of progress on a compromise.
The 52-47 vote was mostly along party lines, with Democrats uniformly in opposition and one Republican, Sen. Rand Paul of Kentucky, joining them in seeking to block the measure from advancing.
Sen. Mitch McConnell of Kentucky, the majority leader, said of the Democrats before the procedural vote, "They can tell American families they care more about politics than helping them," adding, "Senators who want to move forward will vote yes. They will vote to advance this process so they can shape it into a bipartisan product and make a law for the American people."
The plan, which slashed billions of dollars from the original $1 trillion Republican proposal unveiled in July, included federal aid for unemployed workers, small businesses, schools and vaccine development.
But Democrats, who have refused to accept any proposal less than $2.2 trillion, argued that it did little to address the economic devastation of the pandemic.
It did not include another round of stimulus checks for U.S. taxpayers or aid to state and local governments, omissions that cut down the overall price tag of the legislation in an effort to appease fiscal conservatives. And while it would have revived weekly federal jobless benefits that lapsed at the end of July, it set them at $300 - half the original amount.
Democrats are pressing to reinstitute the full $600 payment.
"This bill is not going to happen because it is so emaciated, so filled with poison pills; it is designed to fail," Sen. Chuck Schumer of New York, the minority leader, said on the Senate floor. "It's insufficient. It's completely inadequate."
Treasury Secretary Steven Mnuchin, who has been a point man in negotiations with Democrats on a recovery package, cast doubt Wednesday on whether any agreement could be reached, saying he was not sure whether there was still a chance.
"We'll see," Mnuchin said. "I hope there is. It's important to a lot of people out there."
Unemployment Increase
Travis Fain, WRAL NEWS, 9/10/20
The state unemployment office doesn't have a start date yet for the $50-a-week boost North Carolina lawmakers added last week to unemployment benefits. "We are beginning the process of re-programming our system," Division of Employment Security spokeswoman Kerry McComber said Thursday. "It's somewhat complicated."
The General Assembly passed a wide-ranging coronavirus bill last week, and Gov. Roy Cooper signed it into law late Friday. That bill included the $50-a-week benefits bump, payable for every week this year from September 5 to December 26. Payments will be made retroactively as needed, McComber said. DES officials are seeking more details about how to implement the change and have both accounting and eligibility questions, she said. "It's pretty technical stuff, but there are things that we need to know," she said.
This boost is for the state portion of unemployment benefits. A federal boost, of $300 a week, has largely been paid out in North Carolina, McComber said Thursday. That federal program only guaranteed enough money to pay the increase for three weeks, all of which have passed. It's possible another week, or weeks, will be added. McComber said to expect news on this program soon. Congress has discussed a longer-term federal boost, but those talks have not gone on for weeks now with limited movement.
Health Forum
Bill Poteat, GASTON GAZETTE, 9/10/20
The COVID-19 pandemic, which has gripped the country since the early spring, has inspired the increased use of "virtual" doctor visits and other online care appointments. But even when, and if, the coronavirus is defeated and resigned to history, telehealth options will continue to play an increasing role in the United States healthcare system. That telehealth is here to stay was the universal opinion of doctors, health care administrators, and White House Coronavirus Task Force member Seema Verma, who gathered Thursday at CaroMont Regional Medical Center.
Verma also serves as administrator of the Centers for Medicare and Medicaid Services CMS and her visit here was hosted by the Greater Charlotte Healthcare Executives Group. Before discussing telehealth and its future, Verma had toured CaroMont, including talking with those doctors and nurses directly involved in caring for COVID-19 patients. "I just want to thank all of those who are serving on the front lines in this battle," she said. "This is where the innovative work gets done. This is where we figure out what works and what doesn't."
Medicaid Poll
Colin Campbell, THE INSIDER, 9/10/20
A coalition of groups lobbying for Medicaid expansion is touting the results of a poll that found that 77% of voters support the move. The group Care4Carolina commissioned the poll from Harper Polling and The Stewart Group to assess voter sentiments on Medicaid expansion, including in four key swing Senate districts. Voters were asked "would you favor or oppose the state of North Carolina expanding Medicaid so that more people can qualify - helping to close the coverage gap?" About 77% said yes, while 17% said no, and the others weren't sure. About 91% of registered Democrats were in support, along with 75% of unaffiliated voters and 61% of registered Republicans. Support ranged from 60% to 68% in the four swing Senate districts surveyed.
"The results of this poll confirm what we at the NC Rural Center have known for a while: that closing the health insurance coverage gap is a moral and economic imperative, and in light of the COVID-19 pandemic, now more than ever is the time for decisive action," Rural Center President Patrick Woodie said in a news release. The poll also asked voters what they think is the "most important issue or problem facing North Carolina that the governor and state legislature should make a top priority." Not surprisingly, COVID-19 was the most popular answer at 28%, followed by unemployment at 14%, education and social justice issues at 13% each, healthcare at 8%, budget and taxes at 6% and crime at 6%.
Census Problems
Colin Campbell, THE INSIDER, 9/11/20
North Carolina is "on the verge of a failed 2020 Census operation," the leader of the nonprofit N.C. Counts Coalition told members of Congress on Thursday. The group, which is working to support the Census count in the state, blames inadequate field operations by the Census Bureau and a rush toward a deadline later this month.
Executive director Stacey Carless told the U.S. House Committee on Oversight and Reform that the deadline must be extended to Oct. 31, according to a transcript of her remarks released by N.C. Counts Coalition. Gov. Roy Cooper has also called on the federal government to extend the deadline as North Carolina lags behind the national response rate and its response rate from the 2010 Census.
"With a rushed timeline and the current COVID-19 environment, it will be close to impossible for enumerators to knock on the doors of the estimated 1.5 million households that have yet to respond to the Census," Carless said. She said one of the problems is a Census Bureau policy that limits the activities of door-to-door Census takers in counties classified as "red" for having a high COVID-19 infection rate. In late July, that classification system put 83% of North Carolina counties in the "red" category. That meant that Census employees would only pass out information at events, instead of actively helping people complete the Census questionnaire. Carless also described anonymous reports from Census takers who said they were provided with technology that proved useless in mountainous and rural areas without cell phone service, and that some people hired as Census takers were never actually put to work.
"NC Counts Coalition and partners are particularly concerned about the reliability and accuracy of the non-response follow-up operation due to allegations of inadequate training of enumerators, reports of termination of employees and witnessed accounts of enumerators not knocking on doors," Carless said. Communities with low response rates so far "have greater proportions of residents that identify as American Indian, Black, or Hispanic/Latino; populations historically undercounted by the census." Also at high risk of being undercounted are areas of the state with limited internet access, college towns where students have been sent home due to COVID-19 and communities with a high number of children under age five, Carless said.
Legislative Change to Child Care Licensing
LUCILLE SHERMAN, THE NEWS & OBSERVER, 9/7/20
When a version of the state coronavirus relief package began circulating Tuesday, headed for a vote by the North Carolina Senate the next day, it was too late for much public input about a provision that loosens licensing requirements for child care facilities. Now set to become law, it will allow some child care facilities to operate during the school day with little oversight during a state of emergency. No background checks for employees will be required. Reporting confirmed COVID-19 cases to public health officials won't be mandatory, as it is in all other licensed child care facilities. Staff members will not need to be certified in CPR or first aid.
"In a rush to pass this bill in two days without a lot of input, we've created these huge loopholes," Rep. Julie von Haefen, a Democrat from Wake County, said in an interview. "Child care to me is a huge issue during the pandemic. The system operates on very thin margins. Now we're allowing more child care with less parameters." Every Republican in the Senate Wednesday voted to set aside a proposed amendment that would have required these facilities have safeguards in place. "We saw it when it was introduced, when everybody else got to see it," said Sherée Vodicka, CEO of the NC Alliance of YMCAs. Vodicka's organization was among those that requested legislation allowing them to operate full-time during the school day. "I didn't get any advance look at anything."
The provision, which has raised concerns among advocates, state officials and legislators, was included in House Bill 1105, a bill that distributed federal coronavirus relief money across North Carolina. The legislature returned on Tuesday to take it up, the Senate passed it swiftly Wednesday with few dissenting votes, the House followed suit on Thursday and Gov. Roy Cooper announced Friday he would sign it into law. The provision makes changes to child care facility licensing requirements, allowing "community-based organizations" like YMCAs, YWCAs, Boys and Girls Clubs and parks and recreation programs to provide care for school-aged children at a "remote learning facility" during the coronavirus pandemic or any other state of emergency.
Previously, these community-based organizations could operate unlicensed only as full-day summer programs or after-school care programs, with some exceptions. But to provide care for school children who needed to participate in remote learning, they needed the legislature's help.
"We were trying to find an avenue where we could serve," Vodicka said. "The statute defines very specifically what child care is, which was making it challenging, and I think the other challenging thing about this particular area is that we're not really talking about child care, we're talking about an alternative to school. We've just never been in this place before. This is not normal."
Under rules recently changed by North Carolina's Childcare Commission, community-based organizations like the YMCA can contract with a school to operate full-time during the coronavirus pandemic without a license. "The very sensible solution was that if kids are in their school day, they'll have a connection to the school and they would have some oversight for these programs," said Susan Gale Perry, chief deputy secretary of the Department of Health and Human Services. "That was the way we had chosen to solve the problem." But child care facilities said they needed more flexibility to serve school-aged children all day and provide a remote learning experience, so they turned to the legislature.
HB 1105, as it's currently written, seems to allow more than just a local YMCA or Boys and Girls Club to operate unlicensed during the school year because community-based organizations are so broadly defined in the bill. With the expanded definition, state health officials and legislators say it could include nonprofits, churches and possibly more. "We agree, we're grateful for the flexibility, but there are some basic protections that we really think parents will assume they have and they won't have the way the legislation is written," Sen. Terry Van Duyn, a Democrat from Asheville, said advocates told her.
So Van Duyn introduced an amendment that would have implemented some of those protections. "Many of them were reaching out to me, but they were never given an opportunity to express their concerns about what was happening," Van Duyn said.
Van Duyn's amendment, if it had passed, would have ordered facilities caring for K-12 students to have at least one CPR and first-aid certified staff member on the premises, notify local health authorities of COVID-19 cases among children or staff and ensure staff or volunteers working there pass a background check, including a check of the child abuse and neglect registry.
With only two days to pass a spending bill worth nearly $1 billion, a majority of legislators voted to bar any debate on the amendment. "I reached out to members, and they just weren't willing to change anything. I got to speak my piece and they got to do what they get to do, and hopefully children will nevertheless remain safe and we'll fix it next year," Van Duyn said.
Sen. Jim Perry, a Kinston Republican, championed the provision, arguing that parents in rural areas need choices for child care. "We don't have the choices for child care that you have in many of the more urban areas," said Perry, who received calls from multiple parents concerned about their limited child care options. "These are real world scenarios that have been thrust upon these people. They asked for relief, I think we need to give it to them. The current regulations were not written with this in mind." Perry also emphasized that the legislation will require facilities to comply with state COVID-19-related sanitation requirements.
It also requires that community-based organizations register with the state health department. But state officials said there is not currently a registration process in place. NC YMCA Alliance CEO Vodicka said she hopes that registration requirements will allow the department to ensure facilities are following COVID-19 requirements.
A second provision included in the bill expands the definition of child care. State officials said it's unclear how the language will be interpreted, but it seems to allow the arrangements being called "home-based learning pods" to operate with little state oversight. The provision would exempt from the definition of child care "arrangements between a group of parents ... to provide for the instructional needs of their children, provided the arrangement occurs in the home of one of the cooperative participants."
DHHS COVID App
WTVD NEWS, 9/04/20
The North Carolina Department of Health and Human Services announced on Friday that it is developing a COVID-19 exposure notification app called 'SlowCOVIDNC' that will launch across the state in September. The app will alert North Carolinians when they may have been exposed to someone who has tested positive for COVID-19.
SlowCOVIDNC will use Google and Apple's Exposure Notification System (ENS). It 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 anonymous and does not collect, store or share personal information or location data, NCDHHS says.
Rural Healthcare
Liora Engel-Smith, NC HEALTH NEWS, 9/08/20
Camden County's health care workforce is as lean as it comes. There are no psychologists or nurse practitioners in the rural bedroom community in the far northeastern corner of the state. No podiatrists or nurse-midwives. No physician assistants either. It's a problem that many rural counties in North Carolina face, despite decades of federal and state efforts to bolster the health care workforce in some of the state's most remote areas. "I am a hopeful person, but when I look at the data I become cynical because we have been trying to address this for 40 years," said Erin Fraher, who studies the state's health care workforce at Sheps.
Among the state and federal government's oldest tools to combat the shortage is loan repayment. Both the North Carolina and federal programs began forgiving a portion of school loans of health professionals in the 1980s in exchange for service in areas of high need for a few years. But assessing the success of this financial incentive approach in addressing North Carolina's rural provider shortage can be difficult. In theory, North Carolina's rural areas should have gained more than 250 new providers - doctors, nurses, dentists and nurse practitioners - in the last fiscal year. But the actual number is far lower in practice.
The federal government invested just under $10 million in loan repayments and scholarships for almost 200 providers in North Carolina in FY2019. Of these, 168 providers signed up for loan repayment. Exactly how many of them actually serve in rural areas is hard to ascertain. Cities such as Durham, Charlotte and Raleigh also have pockets of high need and providers can choose a placement there and still receive loan repayment; the federal database does not list service locations for loan repayments on its site. That same year, the state of North Carolina invested roughly $2 million for 106 placements in underserved areas - both rural and urban.
According to the Office of Rural Health, Pitt and Buncombe counties, both urban, attracted 25 placements between them. By comparison, many rural counties - including Camden - had no placements. Other remote locales, such as mountainous Clay and Macon counties, got one placement apiece.
Increased Access to Student Internet
T. KEUNG HUI, THE NEWS & OBSERVER, 9/09/20
North Carolina will hand out 100,000 hot spots that students can use at home and will also turn some school parking lots and state parks into high-speed internet connection sites. Gov. Roy Cooper announced Wednesday that the new NC Student Connect partnership is getting $40 million, with most of the money going toward helping students connect to the internet at a time when many schools are only offering online classes. The effort is meant to address how the lack of high-speed internet access in rural areas is preventing some students from effectively learning from home.
"Long before COVID-19, expanding access to high-speed internet has been a top priority for my administration, and this pandemic has made the need even more urgent," Cooper said in a news release. "NC Student Connect will make critical investments in high-speed internet access and remote learning that will help students, health care and businesses in our state."
The bulk of the money, $30 million, will be used to distribute 100,000 wireless high-speed hot spots for students to connect with their remote learning classes. Superintendents across the state have estimated that at least 100,000 students still lack a reliable internet connection at home. Thousands of hot spots will be shipped to school systems throughout the month, according to the news release.
NC Student Connect also is getting $8 million to set up free high-speed internet connection points across the state in public locations such as state parks, museums and historic sites; school parking lots and municipal areas. Students without a hot spot at home will be able to go to those locations to connect to the internet to download lessons and complete assignments offline.
Cyber Safety
Joe Fisher, WRAL NEWS, 9/07/20
The FBI is helping students develop good online habits at a time when kids are spending more hours each day on the internet. The Safe Online Surfing program uses quizzes, puzzles and other games to teach students how to spot scams, protect passwords, report corrupt links and avoid predators. "What we don't want them to do is not understand how the internet works," said Shelley Lynch, public affairs specialist for the FBI's Charlotte division. "These predators pretend to be another child," said Lynch. "It's almost like a grooming process where they will get that child to trust them, and it may progress to something like asking for inappropriate photos."
Lynch said giving out personal information, including banking numbers and photos, has long-lasting consequences. "I can't begin to count the times we have had parents come in and ask us to take their child's picture off the Internet. It's just not possible. You can't take anything off the internet," Lynch said. The Safe Online Surfing program is free and tailors lessons to students in 3rd though 8th grade. Students are challenged to understand terms like malware, spam and phishing and recognizing trusted sites and networks.
Lynch said the training does not replace the role of parents in monitoring their children's activities online. "Do spot checks on their social media. Make them tell you if they met that person in real life, not just someone that they met online ... It's very easy to pretend to be somebody else on the Internet," she said. Lynch said hackers, scammers and predators use multiple techniques to lure victims, but she said their goal is usually to obtain money. Those who participate in the Safer Online Surfing program will learn to think twice the next time they click, send or reply. "Bad guys are trying to find ways to change their game just a little bit so that maybe you will fall for that next scheme," Lynch said.
Medicaid False Billing Settlement
NEWS RELEASE, 9/09/20
Attorney General Josh Stein on Wednesday reached a $900,000 settlement with two former managers, Michael Smith and Codey Brown, and the former owner, Dr. Harrison Frank, of the now-defunct Carolina Comprehensive Health Network PA (CCHN) to resolve allegations that they violated the False Claims Act and billed the Medicare and Medicaid programs for medically unnecessary diagnostic tests and procedures.
Before it ceased operations, CCHN consisted of a group of health care practices that provided family medicine, immediate care and pain management services.
The settlement resolves allegations that from May 1, 2015, through Nov. 30, 2015, CCHN billed the Medicare and Medicaid programs for unnecessary diagnostic procedures including positional nystagmus testing, rotational axis testing, nerve conduction testing, and autonomous nervous system testing. The allegations stem from a whistleblower lawsuit filed under the federal False Claims Act.
The settlement is a result of the coordinated effort between the Department of Health and Human Services Office of the Inspector General, the North Carolina Attorney General's Medicaid Investigations Division, and the United States Attorney's Office for the Western District of North Carolina.
