• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 178,635 cases, which is a 3.7% increase in cases from Thursday (9/3 had 172,209 cases). In addition, there are 827 currently hospitalized and there have been 2,909 deaths related to the virus. Hospitalizations hit a record high on July 28th with 1,236 hospitalized with COVID-19. As of September 7th, there have been 156,652 Patients Presumed to be Recovered. You can view the number of cases and other data Here.

• UPDATE: Application Deadline for COVID-19 Medicaid Provider AND Private Pay Provider Relief Funds Has Been Extended Again and is Now Sunday, September 13, 2020 - NCSLA learned this past week there is a new federal deadline of September 13, 2020 for Medicaid and Private Pay Providers (Click Here to read about the update regarding Private Pay Providers) to apply for federal Provider Relief Funds. Previously, HHS had also announced an update to payments for providers who had a change in ownership, so we encourage you to read the details closely Here, should this apply to your organization. This funding is aimed at Medicaid and CHIP providers that have not yet received an allocation from the CARES Act. The Centers for Medicare & Medicaid Services has observed that there have been low levels of applications from eligible providers. According to NC DHHS, there has been confusion in accessing different CARES funding streams, challenges in submitting required information amidst the public health emergency, and lack of clarity about this funding deadline. NCSLA encourages providers to apply if they think they might be eligible for the funds. The U.S. Department of Health & Human Services detailed FAQs has helpful information about accessing the funding portal. More information is available in SPECIAL BULLETIN COVID-19 #113: Deadline Extended for Federal Provider Relief Funds for Medicaid Providers.
• The NCSLA Webinar on the COVID-19 Relief Funding Presentation is available at the NCSLA Website. The presentation is from the Free Webinar held on July 9th regarding the US Health and Human Services (HHS) COVID-19 Relief Funding for Medicaid providers is now available on the NCSLA Website. Richard Rutherford with Long Term Care Consulting did an excellent job with putting the presentation together and NCSLA and its members are grateful for Richard's time and expertise! In addition, Richard is still available to provide technical assistance to providers interested in applying for the funds and as a reminder, the application deadline of September 13, 2020 is fast approaching. Richard can be reached via email at: medicaidwiz@gmail.com or via cell phone at: 919-264-2398.
• Also, information on how to apply for the funding is available on the US DHHS COVID-19 webpage, which includes links to the enhanced provider relief portal. HHS is advising Medicaid and CHIP providers to review the materials below before going to the portal to apply:
• Medicaid Provider Distribution Instructions
• Medicaid Provider Distribution Application Form
• Terms and Conditions
• Provider Relief Fund Medicaid CHIP Fact Sheet

1. Must not have received payment from the $50 billion General Distribution (note: earlier payments can be returned to preserve eligibility - to find out if you have received earlier payments, you can call the CARES Provider Relief line at (866) 569-3522); and
2. Must have directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; and
3. Must have either (i) filed a federal income tax return for fiscal years 2017, 2018 or 2019 or (ii) be an entity exempt from the requirement to file a federal income tax return and have no beneficial owner that is required to file a federal income tax return. (e.g. a state-owned hospital or healthcare clinic); and
4. Must have provided patient care after January 31, 2020; and
5. Must not have permanently ceased providing patient care directly, or indirectly through included subsidiaries; and
6. If the applicant is an individual, have gross receipts or sales from providing patient care reported on Form 1040, Schedule C, Line 1, excluding income reported on a W-2 as a (statutory) employee

• 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.

• NEW: Governor Roy Cooper announced a careful step forward moving North Carolina into “Safer At Home Phase 2.5" restrictions, beginning 5 pm Friday, September 4 - Governor Roy Cooper announced on Tuesday, September 1 that after a summer of hard work to slow the spread of COVID-19, North Carolina will take a modest step forward move into Phase 2.5 (for FAQs, click Here) starting Friday, September 4th at 5pm. You can read Executive Order 163 Here. Mask mandates and other prevention methods remain in effect and are even more important to contain the virus, Cooper said. “Safer at Home Phase 2.5 continues our state’s dimmer switch approach to easing some restrictions,” said Governor Cooper. “We can do this safely only if we keep doing what we know works — wearing masks and social distancing. In fact, a new phase is exactly when we need to take this virus even more seriously.” In addition, NC DHHS Secretary Mandy Cohen issued a Secretarial Order (Click Here to read the updated Secretarial Order) allowing for outdoor visitation at nursing homes or skilled nursing facilities. To participate, nursing homes must meet several requirements, including, but not limited, not having a current outbreak, having a testing plan and updated written Infection Control or Preparedness plan for COVID-19, and having adequate personal protective equipment. The Secretarial Order is effective as of September 4 at 5 pm and remains in effect through September 22, 2020.

• NEW: A New, Distinctly North Carolina, Statewide Public Campaign Kicked off on September 3 - The Whatever Your Reason (Cualquiera que sea tu razón) campaign, a new statewide public campaign to encourage every North Carolinian to wear a mask in our collective fight against COVID-19, was launched on September 3 by NC DHHS. This distinctly North Carolina campaign features real North Carolina people and places and focuses on the personal reasons North Carolinians across the state are choosing, every day, to do their part to stop the spread of COVID-19. Materials are available in English and Spanish.

• NEW: Long Term Care Outbreak Response Support - Long-Term Care Facility Outbreak Support is available through the State Emergency Response Team. Please feel free to reach out to your Healthcare Coalition lead (view Coalition Contact list by County Here) or to reach out to their team at OEMSSupportCell@dhhs.nc.gov if you have additional questions. All requests for support should go to local emergency managers for utilization of local resources and then to the State Emergency Response Team if additional support needed. You can read more about the LTC facility outbreak response support Here.

• NEW: NC DHHS Has Created a Free Hotline to Connect Families to Licensed Care for Their School-Age Children - With school now underway, many working parents are facing the added stress of finding a safe place for their children during the day that can also support their remote learning. The good news is that there is ample licensed child care available across the state, and NC DHHS is making it as easy as possible for families to find it. In partnership with Child Care Resources and Referral, the NC Department of Health and Human Services created a free hotline to connect families to licensed care for their school-age children. Families can call the hotline at 1-888-600-1685. Click Here for a flyer containing this information that you can share with your network and employees.

• NEW: Governor Cooper Announces $175 Million to Assist with Rental, Utility Payments for North Carolinians - On Tuesday, August 25th, Governor Roy Cooper announced $175 million to help North Carolinians with rental and utility payment support in the wake of the COVID-19 pandemic. “COVID-19 has strained family finances across North Carolina, and many people are struggling to make ends meet,” said Governor Cooper. “People need a safe, stable place to call home, especially during this pandemic, and we must help keep people in their homes and keep their utilities on while our economy recovers.” This announcement includes three programs designed to work together to help people avoid eviction and pay their bills, per the Governor’s direction. Click Here to read more about these three programs.

• NEW: New Grant Program Accepting Applications to Help Businesses and Nonprofits Hurt by COVID-19 - Governor Cooper announced on Thursday, August 13, that NC Department of Commerce is accepting applications for a program to help businesses and nonprofits that have seen a dip in services due to COVID-19 keep employees on payroll. Governor Cooper stated that “The Job Retention Grant Program offers another way for employers hit hard by COVID-19 to gain some relief. This program aims to help employers keep employees on the payroll.” Read more about Governor Cooper's announcement Here. Applications are due September 1.

• NEW: NC DHHS Sends Additional COVID-19 Testing Capacity to Counties - On August 19th, NC DHHS announced its selection of an additional vendor — StarMed Urgent and Family Care, P.A. — based in North Carolina, to continue surging COVID-19 testing capacity in the state. These new community testing sites build on North Carolina’s ongoing work to increase access to testing and slow viral spread. The selected vendor will provide turnkey testing sites — including clinical and administrative staff, tents, marketing materials, specimen collection supplies, registration and interpreter or translation services — and will leverage in-house laboratory capacity to provide timely testing results. As with all NC DHHS-supported testing sites, there will be no co-pays or cost-sharing for anyone seeking testing, including North Carolinians who are uninsured. NC DHHS selected locations for the additional testing sites based on epidemiological trends and reports from local health departments. Key considerations included the acceleration and overall rate of case growth, the share of new cases among historically marginalized populations and current levels of testing access. The new sites will be located in seven counties: Forsyth, Guilford, Iredell, Mecklenburg, Onslow, Orange and Randolph counties. Click Here to read more.

• UPDATE: NC DHHS Announces Update on August 29 To The State’s Daily And Cumulative Completed COVID-19 Test Counts From Beginning of August - The total new lab-confirmed cases on the NC DHHS COVID-19 Data Dashboard for August 29 reflected an increase caused, in part, by approximately 1,000 positive tests from dates in the first half of the month that were reported to NCDHHS by LabCorp in the past 24 hours. NC DHHS is working with LabCorp to understand the cause of the delayed reporting; however, LabCorp confirmed that individuals were not delayed in receiving their results.

• NEW: Governor Cooper Extends Proof-Of-Immunization & Health Assessment Documentation Deadlines For School And Child-Care Facilities - Governor Cooper issued Executive Order 156 extending, but not waiving, proof-of-immunization and health assessment documentation deadlines for school and child-care facilities. With health care visits limited in some cases due to the ongoing COVID-19 pandemic, the order will give students and families more time to get their required vaccines and health assessments completed. Read the press release Here.

• NEW: Governor Cooper Announces Additional COVID-19 Funds Disbursed to 97 Counties for Public Health and Essential Services - Thursday, July 30, Governor Roy Cooper announced that an additional $150 million in federal funds provided for COVID-19 relief to counties has been disbursed. These funds are from the state-administered Coronavirus Relief Fund (CRF) that was passed by Congress. The funds represent the second half of $300 million appropriated by statute to county governments. Counties are required to offer a minimum of 25% of their total allocation of the funds to municipalities. Though the federal government did not require that the state share any of the $3.56 billion in the CRF to North Carolina local governments, Governor Cooper’s COVID-19 budget proposal recommended $300 million be allocated to counties and municipalities. HB 1023/S.L. 2020-80, Section 3.3(2), appropriated the additional $150 million to county governments. The full distribution of funds is listed Here by county. Counties and municipalities have been given instructions about how the funds may be used. Read more about the additional COVID-19 funds Here.

• NEW: Upcoming NC DHHS COVID-19 Community Testing Events Scheduled; Testing is Free - NC DHHS has 39 upcoming community testing events scheduled in Bladen, Duplin, Johnston, Edgecombe, Henderson, Hertford, Northampton, Randolph, Robeson, Sampson and Warren counties as part of the initiative to increase access to free COVID-19 testing for African American, LatinX/Hispanic and American Indian communities that currently have limited testing sites. So far, nearly 130 testing events have been coordinated through this initiative. There is no cost for testing. For an up-to-date list of events, visit Community Testing Events of the NCDHHS COVID-19 website. NC DHHS testing events are listed under the name of their coordinating vendor: NCCHCA, Orig3n, Inc or Vidant Health. Note - NC DHHS recommends that "Anyone interested in getting tested should contact the test site before they go to confirm testing criteria, availability, hours and registration." You can read more about the upcoming community testing events Here.

• 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.

• NEW: NC DHHS Released An Updated Risk Factors Report for COVID-19 Symptoms - On July 14th, NC DHHS updated the report for Risk Factors of Severe Illness from COVID-19. According to the report, "People who are over the age of 65 and people of any age who have certain underlying health conditions are at higher risk for severe illness from COVID-19. These conditions include chronic lung disease, cardiovascular disease, severe obesity, diabetes, kidney disease, liver disease, and immunosuppressive conditions, including cancer treatment, smoking, and other immune disorders." You can access the updated report Here.

• UPDATE: NC Medicaid Issues Medicaid Bulletin Informing Providers That Enhanced Reimbursement Rates for COVID-19 to Remain in Effect Until At Least September 2020 - On July 8, NC Medicaid Issued Special Bulletin COVID-19 #107 (Click Here) that keeps enhanced Medicaid rates related to COVID-19 in place through September 2020. 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 $30/hour and additional PCS hours (See below article regarding "Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients").

• (Re-print from earlier communication) NC DHHS Division of Health Service Regulation (DHSR) Informs Adult Care and Family Care Homes of Mandatory Training - DHSR Adult Care Licensure Section (ACLS) sent out information to certain adult care and family care homes on Monday, 7/6, of the following mandatory training:
• If the facility had "received a citation/violation in any infection control rule or statute from September 9, 2019 to March 9, 2020, you (the provider) will be receiving notification from the Adult Care Licensure Section today regarding training that all employees of the facility will be required to completed pursuant to section 3E.3.(b) of Session Law 2020-3."
• Providers are asked to "Please pay close attention to the letter, training requirements, and requirements for submitting verification of completed training to ACLS. This training shall be completed no later than August 5, 2020."
• If a provider did not receive notification from ACLS yesterday, then the facility is exempt from this required training. 

• (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) Submitting Documents Regarding One-time Payment of $1325 for Each SA Resident - As communicated previously, NCSLA has worked with officials at the NC DHHS and with legislators to communicate our industry's needs during these unprecedented times. As a result, Session Law 2020-4 (Click Here) that contained a provision for a one-time payment of $1325 to providers for each State/County Special Assistant (SA) resident was passed and signed into law on May 4th by Governor Cooper. The NC DHHS Division of Aging and Adult Services, which administrates the SA program, issued the following notifications.
• PLEASE NOTE: Although the forms embedded in the below "Letter to Owners/Operators" were due June 11th, we have since confirmed with NC DHHS that since the $1325 SA payments are scheduled in five increments with the last one being in October, the final cutoff to submit the W-9 and payment verification form will be Wednesday, September 30, 2020. This allows 10 days for the NCDHHS Controller’s Office to process this information. Everything has to be keyed by the 10^th of each month to process the payment for that month. 
•  Letter to Owners/Operators of Facilities Licensed to Accept Special Assistance Payments (Click Here), which covers when the payments will be issued and provides sample scenarios regarding eligibility and distribution.
• List of Frequently Asked Questions about the payments resulting from House Bill 1043/Session Law 2020-4 (Click Here)

• (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.