• Number of COVID-19 cases - According to the most recent case count as of today, North Carolina has 1307 cases, which is a 71% increase in cases from this past Friday (3/27), which was 763 cases.. In addition, to date there have been 6 deaths related to the virus and 137 currently hospitalized. You can view the number of cases and map of the state Here. To determine how many cases are within a county, click on the county in question and the name of the county and number of cases will be displayed.

• Governor Cooper Issues Stay at Home Order Effective Today, 3/30/20, at 5 PM - As noted previously, Governor Cooper issued a stay at home order, Executive Order 121, that goes into effect today, 3/30/20, at 5 PM. In addition to a number of other health care workers, staff in adult and family care homes are not subject to the order as they are considered essential health care personnel. The order will remain in place for 30 days unless repealed, replaced or rescinded by another applicable Executive Order.

• Families First Coronavirus Response Act (P.L. 116-127, 2020 H.R. 6021) - Last week we reported that NCSLA received information from Jim Wrenn (Hicks & Wrenn, PLLC) our legal counsel, a summary (Click Here) of the Families First Coronavirus Response Act that was recently passed by Congress and signed into law. The Act has two principal parts:
• Emergency Paid Sick Leave Act ("Emergency PSL Act") which covers private employers with fewer than 500 employees and all government employers. However, the Secretary of Labor is authorized to issue regulations for good cause that:
• Exempt businesses with fewer than 50 employees from the paid sick leave requirements under the Emergency PSL Act if providing leave would jeopardize the viability of the business as a going concern.
• Exclude certain health care providers (as defined in the FMLA) and emergency responders from the definition of covered employee or allow their employers to opt out of the paid sick leave requirements.
• Previously, the definition of “health care provider” was not broad enough to cover any of the direct care or support staff typically employed by adult care homes. However, the definition of health care provider was recently updated and emergency responder has been defined under the Families First Act. The full Q&A provided by the US Department of Labor (DOL) can be found at https://www.dol.gov/agencies/whd/pandemic/ffcra-questions.

• Please see the definitions below. For the most part, the descriptions below are self-explanatory, however, if you have questions, please refer to the above website or contact NCSLA. but we do expect some questions .
• 1. Who is a “health care provider” who may be excluded by their employer from paid sick leave and/or expanded family and medical leave? For the purposes of employees who may be exempted from paid sick leave or expanded family and medical leave by their employer under the FFCRA, a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions. 

• 2. This definition includes any individual employed by an entity that contracts with any of the above institutions, employers, or entities institutions to provide services or to maintain the operation of the facility. This also includes anyone employed by any entity that provides medical services, produces medical products, or is otherwise involved in the making of COVID-19 related medical equipment, tests, drugs, vaccines, diagnostic vehicles, or treatments. This also includes any individual that the highest official of a state or territory, including the District of Columbia, determines is a health care provider necessary for that state’s or territory’s or the District of Columbia’s response to COVID-19. To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA.

• 3. Who is an emergency responder? For the purposes of employees who may be excluded from paid sick leave or expanded family and medical leave by their employer under the FFCRA, an emergency responder is an employee who is necessary for the provision of transport, care, health care, comfort, and nutrition of such patients, or whose services are otherwise needed to limit the spread of COVID-19. This includes but is not limited to military or national guard, law enforcement officers, correctional institution personnel, fire fighters, emergency medical services personnel, physicians, nurses, public health personnel, emergency medical technicians, paramedics, emergency management personnel, 911 operators, public works personnel, and persons with skills or training in operating specialized equipment or other skills needed to provide aid in a declared emergency as well as individuals who work for such facilities employing these individuals and whose work is necessary to maintain the operation of the facility. This also includes any individual that the highest official of a state or territory, including the District of Columbia, determines is an emergency responder necessary for that state’s or territory’s or the District of Columbia’s response to COVID-19. To minimize the spread of the virus associated with COVID-19, the DOL encourages employers to be judicious when using this definition to exempt emergency responders from the provisions of the FFCRA.

• Medicaid PCS rate increase update - As noted in the previous NCSLA Update, the NCDHHS increased the Medicaid PCS rate by 5% retroactive to 3/10/2020. It is our understanding that providers can now rebill claims retroactive to 3/10/20 and receive the higher rate and also bill the higher rate going forward.

• NCSLA Upcoming COVID-19 Webinars - NCSLA offering three (3) free webinars related to COVID-19 on the following dates and times
• Monday, March 30, 2 - 2:45 pm: COVID-19 Pandemic Preparedness for Your Front-Line Staff

• Tuesday, April 7, 2 - 3:30 pm: Actions Home Health Clinicians Can Take To Prevent The Spread of COVID-19

• Thurs., April 9, 2 - 3 pm: COVID-19 and Long-Term Care Providers: Where Are We Now?

• For additional information on the free webinars Click Here

• NCDHHS issues new "Interim Long-Term Care Setting Guidance for Residents with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) and Their Caregivers" - The new interim guidance (Click Here) addresses a number of areas as noted below. We strongly recommend all providers read the new guidance carefully and make certain it is followed in your adult care or family care homes.
• 1. Minimize Opportunity for Introduction and Exposures 
• 2. Adhere to Infection Prevention Precautions
• 3, Management of Residents and Environment including
• Manage Residents with Respiratory Illness, Suspected or Confirmed COVID-19
• Management of Incoming Residents
• Environmental Infection Control
• 4. Management of Staff

• Re-verification Due Dates Extended for NC Medicaid Providers - As a result of hardships caused by COVID-19, the NCDHHS Division of Health Benefits (NC Medicaid) issued a Medicaid Bulletin on 3/26/20 (Click Here) that extends the due dates for NC Medicaid providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020. As a result, NCTracks has reset re-verification due date to Sept. 13, 2020.

• Medicaid PCS assessments by phone are resuming - A NCSLA member spoke with Liberty Healthcare this morning and learned that Medicaid PCS assessments by phone are resuming for New Admissions or Change of Status requests only. Annual assessments are postponed for now and authorizations have been extended for those residents who are due for annuals.
• For a New Request that has been submitted, a Liberty nurse will be reaching out to the facility to discuss the needs of the residents. The nurse will be going through the ADLs and asking questions to get an overall understanding of the care the adult or family care home provides the resident each day. Liberty will also ask questions pertaining to exacerbating conditions (for example: incontinence, cognitive impairment, lack of balance, impaired endurance, shortness of breath, etc.). 
• Providers are unlikely to receive a call beforehand from the Liberty scheduling department, but the Liberty nurse will be contacting the facility directly and may be asking for the resident themselves. 
• NCSLA recommends that if your facility receives a call from Liberty, please make sure the Resident Care Coordinator (RCC) and/or Director is the one taking the call and answers the questions asked by the Liberty nurse. If the nurse wants to speak with the resident, they have a right to do so, but they do want feed back from the provider as they normally do during face-to-face assessments.
• For a Change of Status request that has been submitted, the Liberty scheduling department will be reaching out to the facility to schedule a time for the phone assessment to occur. The Liberty nurse will be going through the entire 15-page assessment for anyone who has had a change of status (normally this is for someone with a dementia diagnosis); therefore, it is imperative that the RCC and/or Director is involved with this call. Liberty will be going through each ADL section as well as the exacerbating conditions similar to new requests.
• For a resident with a cognitive impairment such as an intellectual or developmental disability (IDD) diagnosis or Alzheimer's or other dementia, Liberty requests for the facility to be involved with the call so they can get the information first hand from the provider since they are the one providing the care and the resident may not be cognitively able to answer some of the questions Liberty asks

• This is a new process for providers as well as Liberty. If there are questions, please contact Liberty Healthcare directly.

• Personal protective equipment (PPE) - 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 and cannot provide PPE to adult or family care homes at this time.

• **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.

• Process for applying for State/County Special Assistance (SA) and other public benefits changing in some county Departments of Social Services (DSS) - NCSLA has heard from a number of providers this week that as a result of COVID-19, local DSS offices are not open to the public and the process for applying for SA and other public benefits is by completing a paper application and placing it in a drop box at the DSS or mailing it. NCSLA contacted the NC Division of Aging and Adult Services, which oversees the SA program and county adult services, and was told that "the application date will be honored" regarding the effective date of SA.

• Medicaid Bulletins on Telehealth - We continue to hear from providers that are having problems getting physicians to sign forms for PCS and other services. We recommend providers emphasize to physicians of the new Medicaid Telehealth Policy which physicians can use to bill for services that do not require a face-to-face visit. In addition, today an amendment to the Medicaid Telehealth Policy that also covers enhanced behavioral health services. There are three telehealth modalities referenced within the policy, defined as: 
• Telemedicine: Telemedicine is the use of two-way real-time interactive audio and video to provide and support health care when participants are in different physical locations. 
• Telepsychiatry: Telepsychiatry is the use of two-way real–time interactive audio and video to provide and support psychiatric care when participants are in different physical locations. 
• Virtual Patient Communication: Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g., secure messaging); and store and forward (e.g., transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

• The NCDHHS, the CDC and others continue to provide excellent materials and timely guidance related to COVID-19. In addition, the NC Division of Public Health (DPH) and NC Area Health Education Centers (AHEC) will be holding weekly forums for health care facilities, home-based providers and others on Tuesdays from 11:00 AM - 12:00 PM. Forums will be held every Tuesday, and will continue until they are no longer needed. Forums will be recorded and available to the public.
• During the forums, Subject Matter Experts from DPH will provide a quick update on any new developments and will then respond to questions received before or during the forum.
• Send any questions you would like for DPH Subject Matter Experts to be prepared to answer during the forum to questionsCOVID19forum@gmail.com - questions must be received no later than 5:00 on the Sunday prior to the call (3/22 this week).
• The forums will be structured to allow either webinar access through your computer OR traditional audio dial-in. PLEASE NOTE - Questions during the forum can only be submitted using the Q&A function using the webinar access through your computer.
• Click the following link to join the webinar: https://zoom.us/j/988453520
• (NOTE: Use the Q&A function to submit questions during the live webinar. For audio-only access (mobile)