• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 6764 cases, which is a 15.4% increase in cases from Friday (4/17 had 5859 cases). In addition, there are 373 currently hospitalized (13% decrease from yesterday) and there have been 179 deaths related to the virus and it is in 93 counties. You can view the number of cases and other data Here

• NEW - Additional Information Regarding Medicaid PCS Rate Increase for Facilities with COVID-19 Outbreaks - As noted previously, NCSLA has been working close with NC Medicaid the past two weeks on an additional rate increase (on top of the 5% PCS increase that went into effect 3/10/20) for those adult care homes with identified COVID-19 outbreaks. NC Medicaid issued a press release last week (Click Here) that addresses the rate increase. In addition, NCSLA has learned if you have a confirmed outbreak of COVID-19 in your facility, you need to do the following:
• Contact and work with your local health department (see list Here) for assistance in containing the outbreak which may involve measures such as isolating infected individuals and other measures;
• Contact your local county emergency management agency (see list Here) especially in the event you need additional personal protective equiment (PPE).
• Contact the NC DHHS Division of Health Benefits (NC Medicaid) to inquire about a hardship payment (will be based on prior two months of Medicaid PCS billing) and how to bill for the new PCS rate going forward. (Note: the hardship payment will have to be paid back at some point as directed by NC Medicaid). The person to contact at NC Medicaid is:
• Joel Mercer - email: joel.mercer@dhhs.nc.gov and phone: 919-855-4156

• As noted previously, if a facility has a COVID-19 outbreak, Medicaid will add 100 monthly PCS hours for each PCS resident in the facility and an additional 40 hours for each PCS special care unit resident in the facility.
• The new PCS rate for COVID-19 identified facilities will be $30/hour/resident.
• Since it may take a period of time to make the necessary changes in NC TRACKS in order that COVID-19 affected providers can bill the new rate and hours, NC Medicaid is willing to provide an up front hardship payment to the facility (to be recouped at a later date) to help them pay for the increased costs associated with providing care to COVID-19 infected residents.

• NC Medicaid realizes the stress that adult care home providers with COVID-19 outbreaks are enduring, and with this new policy, has pursued a path which NCSLA believes will be a great help during this time of increased costs and uncertainty. As more information regarding the new PCS rate and hours becomes available, NCSLA will make certain providers are kept informed.

• NEW - Access to Hydroxychloroquine (HCQ) for Adult Care Homes - HCQ, the drug that has been touted as possibly being beneficial for COVID-19 is now available for adult care homes. The Division of Health Service Regulation (DHSR) has been working with the Division of Public Health and the NC DHHS to enable adult care homes to access the state’s donated supply of HCQ for ACH residents’ use as prescribed by their physician. Directions regarding how adult care homes and residents’ physicians can access this supply if needed can be found Here.

• NEW - Latest Data from the Institute for Health Metrics (IHME) Shows Reduced Mortality Projections for North Carolina - According to data from the Institute for Health Metrics (IHME), last week was likely the peak of the COVID-19 outbreak in terms of utilization of hospital beds and other services in our state. You can view IHME's latest data and graphs Here. According to the data, as long as current measures continue, i.e social distancing, stay at home orders, etc., the outbreak should diminish by mid-May and whereas the projected mortality projections were previously over 400 deaths due to COVID-19, the projection has been revised to approximately 251 total deaths. However, there remains a lot of unknowns regarding COVID-19 and if people get complacent, it is likely there will be upticks in newly identified infections and deaths. Therefore, as always, it is important to remain vigilant and follow recommendations and guidelines set forth by the Centers for Disease Control (CDC) and the NC Department of Health and Human Services

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

• (Re-print from earlier communication) The Trump Administration Releases "Guideline (for) Opening Up American Again" - The Trump administration last week released guidelines (Click Here) for states regarding loosening up restrictions related to the COVID-19 virus. The guidelines reiterate basic information regarding preventing COVID-19 such as hand washing, proper hygiene practices, social distancing, etc. In addition, the guidelines also detail Core State Preparedness Responsibilities which include to "Protect the health and safety of those living and working in high-risk facilities (e.g.,senior care facilities)." The guidelines leave the decision-making regarding loosening up restrictions to governors, counties and local governments.

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

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

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

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

• (Re-print from earlier communication) Personal Protective Equipment (PPE) resources - Below are the PPE resources NCSLA is aware. Many of these suppliers are obtaining their PPE from overseas; therefore, it may take up to 2 - 3 weeks for the PPE to arrive after an order has been placed. In addition, many of the suppliers require payment for the PPE prior to submitting order for fulfillment as opposed to invoicing and getting paid at a later date.

• BSI Medical Supply - Jason King, Customer Service Manager, phone: 704-869-9091, Email: jking@bsimedicalsupply.com, www.bsisupplies.com

• N95 Masks In Stock $3.50 Each No Minimum Order - Roger Quaglian, Zacuto, 401 W. Ontario St. Ste 100, Chicago, IL 60654, Phone: 773-575-8799, Email: roger@zacuto.com

• DYME Institute - Surgical Masks, KN95 Masks, Gowns, Goggles - John Dobson: johnalverdobson@gmail.com https://www.dymeinstitute.com/projects

• Face shields made by Biobubble - Biobubble is currently making cleanable/reusable face shields. Contact Travis Stewart at Travandboo@mac.com or phone at 818-568-3755

• Medical Supply Solutions - Chad Tart, Sales Manager Medical Supply Solution, Email: ctart@medicalss.us

• Intalere - Gross Purchasing Organization has a listing of medical suppliers Click Here

• Go Bright Ideas - According to the supplier, both types of masks are FDA approved. Currently, Production/Delivery time is running 10 to 15 business days and, of course, this can change on a daily basis. Shipping is included in the pricing below to one location. If there is a need to ship to multiple locations, please contact the supplier. Prepayment is required. Supplier contact information is as follows:
• Glenn Rowe, email: glenn@gobrightideas.com
• Phone: 434-260-5250
• Cell 434-906-4179

• NH Med Services - Contact John Quinn at:
• Office: 336-859-0504
• Mobile: 336-859-0504
• Email: john.quinn@nhmedservices.com
• Web: www.nhmedservices.com

• Proforma - Michael S. Prillaman, Proforma Total Print Solutions, 320 Habersham Rd., Ste. 105  •  High Point, NC 27260, office 336.841.5292  •  cell 336.312-0813 michael.prillaman@proforma.com  

• (Re-print from earlier communication) NCDHHS Publication - What to Expect: Response to New COVID-19 Cases or Outbreaks in Long Term Care Settings - NCDHHS release a new publication regarding what to expect when a new COVID-19 cases or outbreaks occur in long term care and can be found Here. The Publication reviews the response steps to a COVID-19 case or outbreak in a long term care facility and include:

1. Notify your local health department
2. Wear appropriate PPE
3. Follow NCDHHS and CDC guidance
4. Site visit by local health department
5. Testing for the virus that causes COVID-19
6. Guidance after testing

• Providers should review and refer to the new NCDHHS Publication in order to be familiar with the steps involved should a COVID-19 outbreak occur in your facility.

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

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

• (Re-print from earlier communication) Social Security and the CARES Act: Social Security and SSI recipients are eligible for the rebate payments - NCSLA has received questions from providers regarding the rebate checks (up to $1200/adult) that Social Security and SSI recipients will receive in the near future and whether that income will affect eligibility for SSI, State/county special assistance, Medicaid or other social programs. A recent document prepared by the US Congress House Committee on Ways and Means (Click Here) states "Like other tax credits, these payments do not count as income or resources for meanstested programs. So receiving a rebate will not interfere with someone’s eligibility for SSI, SNAP, Medicaid, ACA premium credits, TANF, housing assistance, or other income-related federal programs." Therefore, these payments will NOT affect adult care home residents' eligibility for Social Security, SSI, SA, Medicaid or other social program.

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

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

• (Re-print from earlier communication) NCDHHS to offer relief to essential workers for child care, bonuses to child care staff - The NCDHHS is providing financial assistance to help essential workers afford child care and bonuses to child care teachers and staff who provide care during the COVID-19. Information about the program including the COVID-19 Parent Application for Financial Assistance for Emergency Child Care can be found Here. Since adult and family care home staff are considered essential workers, many adult care home staff with children may be eligible to use this service to assist with child care needs during the COVID-19 pandemic.

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

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

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

• (Re-print from earlier communication) Requesting PPE from the Local Emergency Management Agency - We continue to hear from providers that have run out of or running low on supplies of PPE (masks, gowns, gloves, etc.) that they have contacted their County Emergency Management Agency and have been told the PPE supplies are limited.

• **We encourage members that need PPE to keep checking in with your County Emergency Management Agency on at least a weekly basis to re-emphasize the need for PPE to protect your staff and residents. **

• The COVID-19 Healthcare Coalition for Critical Equipment and Supplies recently provided the following forms (Healthcare Guidance for PPE and PPE Request Process) for providers to use when determining their burn rate of PPE and the request process for PPE. According to the state's Healthcare Coalition for COVID-19, if a long term care facility has a resident with COVID-19 and is at risk of exhausting their supplies of PPE, immediately contact your County Emergency Management Agency, it is imperative that you explicitly communicate this information to the Agency so they can work with their Healthcare Coalition to locate PPE and help get it to your facility.

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