| Benchmarks' Friday Update: April 3, 2020 NC Cases 2,023 NC Cases Hospitalized 184 NC Deaths 18 Counties with Cases 83
09% are 18-24 years of age 42% are 25-49 years of age 27% are 50-64 years of age 20% are 65 or older
Latest on Quarantine Recommendations Patients should self-isolate until they can say yes to all three questions • Have at least 7 days passed since symptoms first appeared? • Have at least 3 days (72 hours) passed without fever without the use of fever reducing medications? • Have at least 3 days (72 hours) passes since resolution of respiratory symptoms
In general, patients with clinical COVID-19 infection do NOT need a negativeCofid-19 test result to document recovery.
Close contacts of a person should self-monitor their temperature and symptoms of Covid-19, limit outside interaction as much as possible for 14 days, and self-isolate if they develop symptoms.
Local Health Departments are still doing identification, contact tracing and control measures, but may have to prioritize to high risk settings and outbreaks.
Status of PPEs North Carolina expected its third disbursement from the federal Strategic National Stockpile of medical personal protective equipment (PPE) this week.
North Carolina has requested “half a million” each of N-95 masks, procedure masks, gowns, gloves, face shields and coveralls. NC National Guard members are coordinating the receipt, warehousing and distribution of PPE as they arrive in the state. NC has already placed PPE orders totaling about $19 million from private companies.
Unemployment More than 300,000 people have filed for unemployment in North Carolina since March 16th, a span of about two weeks. The number is approaching twice what the state Division of Employment Security saw in all of 2019, when claims averaged about 3,200 a week.
The division took in more than 17,800 new claims on Monday. More than 370,000 of state’s restaurant and hotel employees are out of work. Those trying to file continue to report some difficulty using the filing website and extreme difficulty reaching anyone in DES’ call centers on the phone.
The first $3.4 million in unemployment checks have already been issued. The Division of Employment Security are already receiving questions about how the state system will dovetail with a new federal provision, passed last week, to add $600 a week to unemployment checks. DES has released a fact sheet and FAQ on that program, along with answers to other questions.
FYI – while there is over $2 billion in the rainy day fund, the amount of tax revenue being lost during the Covid-19 quarantine time is expected to exceed that amount.
CARES Act On April 1, 2020, the U.S. Department of Labor announced new action regarding how American workers and employers will benefit from the protections and relief offered by the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both part of the Families First Coronavirus Response Act (FFCRA). FFCRA helps the United States combat the workplace effects of COVID-19 by reimbursing American private employers that have fewer than 500 employees with tax credits for the cost of providing employees with paid leave taken for specified reasons related to COVID-19. The law enables employers to keep their workers on their payrolls, while at the same time ensuring that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus.
The Department is promulgating regulations to implement public health emergency leave under Title I of the Family and Medical Leave Act (FMLA) and emergency paid sick leave to assist working families facing public health emergencies arising out of the COVID-19 global pandemic. The leave provisions are created by a time-limited statutory authority established under the FFCRA and are set to expire on December 31, 2020. The temporary rule is effective from April 1, 2020 through December 31.
Small Business Administration We have shared links in our updates to the Small Business Owner’s Guide to the CARES Act. The programs and initiatives in Act are intended to assist business owners with whatever needs they have right now. There are many new resources available for small businesses, as well as certain nonprofits and other employers.
Paycheck Protection Program (PPP) Loans The program would provide cash-flow assistance through 100 percent federally guaranteed loans to employers who maintain their payroll during this emergency. If employers maintain their payroll, the loans would be forgiven, which would help workers remain employed, as well as help affected small businesses and our economy snap-back quicker after the crisis.
PPP has a host of attractive features, such as forgiveness of up to 8 weeks of payroll based on employee retention and salary levels, no SBA fees, and at least six months of deferral with maximum deferrals of up to a year. Small businesses and other eligible entities will be able to apply if they were harmed by COVID-19 between February 15, 2020 and June 30, 2020. This program would be retroactive to February 15, 2020, in order to help bring workers who may have already been laid off back onto payrolls. Loans are available through June 30, 2020.
Guidance on coronavirus provisions under the Family Medical Leave Act There is a lot going on with the FMLA and the Department of Labor is providing new information on an almost daily basis.
Some highlights: • The new benefits include paid sick leave and expanded FML leave. • They go into effect April 1 and are scheduled to end December 31, 2020. • Many of the new provisions apply to employers with less than 50 employees (even though traditional FMLA did not); though there is a process for requesting an exemption. • In some last minute changes to the bill due to legislative advocacy by the national organization of Benchmark’s counterparts and other, the regulations include a very broad definition of emergency responder that most of our agencies would meet. • Employers whose employees access the benefits can offset the costs with tax credits.
You can find more information on the US DOL website: https://www.dol.gov/agencies/whd/pandemic
Two links of particular note: Fact sheet Questions and Answers
FMLA coronavirus benefit The new benefits, which are in effect April 1 to December 31, 2020, include paid sick leave and expanded FML leave.
A. Two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay where the employee is unable to work because the employee is quarantined (pursuant to Federal, State, or local government order or advice of a health care provider), and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or
B. Two weeks (up to 80 hours) of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a bona fide need to care for an individual subject to quarantine (pursuant to Federal, State, or local government order or advice of a health care provider), or to care for a child (under 18 years of age) whose school or child care provider is closed or unavailable for reasons related to COVID-19, and/or the employee is experiencing a substantially similar condition as specified by the Secretary of Health and Human Services, in consultation with the Secretaries of the Treasury and Labor; and,
C. Up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay where an employee, who has been employed for at least 30 calendar days, is unable to work due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19.
Many of the new provisions apply to employers with less than 50 employees (even though traditional FMLA did not); though there is a process for requesting an exemption.
An employer, including a religious or nonprofit organization, with fewer than 50 employees (small business) is exempt from providing (a) paid sick leave due to school or place of care closures or child care provider unavailability for COVID-19 related reasons and (b) expanded family and medical leave due to school or place of care closures or child care provider unavailability for COVID-19 related reasons when doing so would jeopardize the viability of the small business as a going concern.
Private sector employers that provide paid sick leave and expanded family and medical leave required by the FFCRA are eligible for reimbursement of the costs of that leave through refundable tax credits. If you intend to claim a tax credit under the FFCRA for your payment of the sick leave or expanded family and medical leave wages, you should retain appropriate documentation in your records. You should consult Internal Revenue Service (IRS) applicable forms, instructions, and information for the procedures that must be followed to claim a tax credit, including any needed substantiation to be retained to support the credit. You are not required to provide leave if materials sufficient to support the applicable tax credit have not been provided.
Taxes The Internal Revenue Service extended deadlines for both filing and payments for income taxes from April 15 to July 15. NC lawmakers from both parties and the governor want to go a step further by supporting the passage of a new law to waive interest on late tax payments. The current interest rate on late payments is 5% a year. Waiving interest from tax due dates can’t be changed by the Revenue Department because of state law. The legislature is due to reconvene in Raleigh on April 28 for its short session. The House Special Committee on COVID-19 has already started meeting remotely with multiple working groups to address issues related to COVID-19, including taxes.
Governor’s Executive Orders March 10 – Executive Order 116 – Declaration of a State of Emergency to Coordinate the Response and Protective Actions to Prevent the Spread of COVID-19 March 14 - Executive Order 117 – Prohibiting Mass Gatherings and Directing the Statewide Closure of K-12 Public Schools to Limit the Spread of COVID-19 March 17 – Executive Order 118 – Limiting Operations of Restaurants and Bars and Broadening Unemployment Insurance Benefits in Response to COVID-19 March 23 – Executive Order 120 – Additional Limitations on Mass Gatherings, Restrictions on Venues and Long-Term Care Facilities, and Extension of School Closure Date March 27 – Executive Order 121 – Stay at Home Order and Strategic Directions For North Carolina in Response to Increasing COVID-19 Cases March 30 – Executive Order 122 - Access state surplus property to help bridge gaps during the response to COVID-19. March 31 – Executive Order 123 – Preventing Utility Shut-Offs, Late Fees, and Reconnection Fees for 60 days and Encouraging Telecommunication Providers, Banks and Mortgage Services, to provide assistance and flexibility with their customers.
Stay at Home Orders Concerns raised at the legislature that there needs to be one statewide stay-at-home order and set of rules rather than the piecemeal patchwork of laws that we are seeing throughout North Carolina (100 counties + 552 municipalities) • Local curfews (this is causing issues with staffing essential businesses given different hours in each county). • Local passes being required that are different than the state-issued reentry passes that have been used successfully during hurricanes and in the face of the EO 121 FAQ stating that essential business employees would not need additional documentation when reporting to work. • Businesses deemed essential by the Governor’s Executive Order 121 but not seen as essential by a separate county or municipal ordinance
Because of the individual county interpretations, we STRONGLY encourage all staff to have an agency ID with them at all times while traveling and suggest that the agency provide each employee a letter (on agency letterhead) explaining that the employee is an essential employee. A reminder again that it would be very helpful for you to be registered in your county as an essential service. Reach out to the county manager and/or Emergency Preparedness Department in the counties where your staff will need to travel to inquire what the process will be to have your organization designated as an essential service agency.
Social Services New Electronic Fax system for RILs • Only outward change is a different number but eliminates all the problems with fax transmissions such as busy signals, paper being out, etc as the fax is electronically sent to an electronic inbox
Re-licensure Waivers - Ensuring Continuity of Care • State DSS has been working with DHHS leadership and the Governor’s office to find a solution to the waivers needed to re-license foster families. They believe they will have a solution that will be announced sometime next week. • Black Mountain is tracking all re-license applications that are missing something, and as soon as permitted, will put the license into the system and will back date the license. • The waiver remedy they are seeking does not apply to licensing families, only for re-licensure. Exploring electronic MAPP training or Deciding Together Training • NC DSS reached out to the purveyors of the MAPP training to see if they would allow it to be offered vie videoconference. Because MAPP is specifically designed to be implemented in a group setting, they were unwilling for MAPP to be conducted electronically but they were open to implementing Deciding Together via videoconference.
NC DSS is working with some private provider agencies that have Deciding Together trainers to talk about how we could potentially implement the training.
Potential Locations Identified for Placement of Youth in Custody who have Covid-19 • A number of agencies have self-selected to offer campus services for youth who have tested positive who need a new or a different placement • Looking at the possibility of an enhanced rate to supplement your county contract rate recognizing that you will have significant costs around PPEs, hazard pay, potential quarantine supports, etc • They are working on the details but hope to have the plan in place by next week. Approved waivers to increase access to food and decrease administrative burdens during social distancing and stay at home order: • Waived on-site and congregate meal site requirements to allow delivery or pick up options and enable parents to pick up for children • Increase in Emergency Food and Nutrition Services (FNS) to bring all households up to the maximum benefit • Extension of certification periods to reduce in-person contact • Flexibility in conducting in-person activities (applications, interviews)
Allowing young adults (18-21), participating in extended foster care, flexibility in where they live while still receiving benefits and services
TANF: (pending waiver) DHHS has submitted a request for plan changes including: -Suspending work requirements and sanctions for families who cannot work because of the COVID-19 pandemic -Providing one-time or other emergency payments to eligible program participants at 200% of FPL - Increasing hardship exemptions to prevent a family’s Work First case from terminating
Medicaid Services COVID-19 Triage Plus – A New Resource for Practices and their Patients • Statewide, Inbound Call Center to Provide: -Information on Covid-19 -Clinical Triage by RNs, Using latest CDC/NCDHHS guidance -Care Coordination Services -Open to all NC residents, regardless of payer/insurance
COVID-19 Triage Plus Line: (877) 490-6642 Hours of Operation: 7am to 11pm 7 days a week, including holidays STARTS MONDAY, April 6th
Links for Summary of Covid-19 Medicaid Billing Changes As Medicaid releases frequent changes to clinical policies and billing guidance, CCNC and AHEC will be producing condensed summaries for quick reference on their website. Telehealth Billing Codes Summary Medicaid Special Bulletins
Cares Act The NC General Assembly staff have created a spreadsheet of the CARES Act items coming to NC. They have listed the items where they are aware of how much NC will receive but there are many still blank as they need more guidance to determine the dollar amount.
-Provides a 6.2% FMAP increase. In order to receive the increase, a state has to ensure that all current Medicaid recipients, and any new ones enrolled since March 18th stay within the Medicaid system. -Provides limited Covid19 coverage for testing and full coverage for testing and treatment for 19-64 year-olds under 133% of federal poverty. -Provides $6.1 million to NC for HCBG to help keep individuals in their homes. -Provides $117.3 million to NC for childcare -Provides $25.9 million to NC for Community Services Block Grant to help local agencies that provide a wide range of community services -Provides $1.6 million to child welfare
NC Medicaid Supporting providers and beneficiaries: -Increase of 1.5% in Medicaid rates for LME/MCOs -Released $87 million of one time dollars for use by LME/MCO’s to support provider response to COVID–19
Improve Patient Access and Reduce Administrative Burden: -Expanding Virtual and Telehealth Medicaid Services, including Telepsychiatry and Counseling Services -Modifications to Medicaid Pharmacy, Durable Medical Equipment, Out-patient Therapy, and Home Service Clinical Coverage Policies -Hospital Capacity: − Hospitals may request a 60-day waiver of the rule limiting their number of licensed beds
Waivers in Response to Covid-19 Medicaid 1135- allow to waive: -Critical Access Hospital (CAH) limit of beds and length of stay -Certain provider screening and enrollment requirements -Certain hospital regulatory requirements -Time limit for enrollees to request a state fair hearing (extended to 120 days) -Medicaid prior authorization requirements
Appendix K – (DHHS has received verbal approval for K but not written. They continue to be in a question/answer mode with them that is creating “tweaks” to the guidance.) -Approval to temporarily waive Medicaid program requirements for home and community-based services (Innovations, CAP-DA, CAP-C, and Traumatic Brain Injury Waivers) -Removed certain dollar and stay limits, expanded the type of service delivery locations and eased requirements for reviews of personalized care plans and in-person meetings.
Submitted a Children’s Health Insurance Program (CHIP) Disaster State Plan Amendment: -Request to waive the required annual enrollment fee, copayments, and unpaid enrollment fee balances -extend time period for processing applications and redetermination -waive the prior authorization requirements.
Update on Telehealth Provisions -A new telehealth bulletin will be coming out on Friday or Saturday that outlines the expansion of telehealth services. The new claims should be working by April 7th or 8th and will be retroactive to March 10.
NC Medicaid continues to temporarily modify its Telemedicine, Telepsychiatry, Teletherapy policies to better enable the deliver of remote care to Medicaid beneficiaries. NCTracks has been updated to reflect these changes.
NC Medicaid was made aware that some of the claims for Telehealth services were being paid at a lower rate. Additional guidance on billing will be posted in a bulleting on the DMA website.
NC Medicaid heard our concerns about the low reimbursement rate for Telephonic services despite the lack of available internet or smart device for some clients/locations. They are working on an increased rate change for telephonic that will not equal the telehealth rates but will be significantly better. Implementation date TBD.
A LOT of billing modifiers have come out over the past couple of weeks to support enhanced rates of telehealth services. NC Medicaid has developed a succinct table with all the modifier codes by type of provider with a link to a bulleting that explains each modifier in detail. It should be coming out by 4/3/2020 or 4/6/2020.
NC Medicaid has become aware that some clients are resistant to receiving telehealth/telephonic services. A letter will be going out to all Medicaid recipients promoting these services and explaining their benefits. NC Medicaid will also be writing some Op Eds for newspapers about the importance and benefits of telehealth care.
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