Governor Cooper Shares Path Forward for North Carolina
The Governor did a press conference this week with DHHS Sec Mandy Cohen to roll out the next steps for North Carolina in response to COVID-19. There is growing pressure to begin moving out of the shelter in place and to start opening businesses back up. The Governor outlined the focus of the next three steps
Testing: Identifying who has COVID-19
Working with private and public partners to increase testing capacity, expand testing sites and address supply challenges
Tracing: Acting quickly to stop spread - Tracing
Ramping up staffing and technology to determine who has been exposed when someone tests positive.
Trends: Knowing when to dial up or down social distancing
Analyzing new data, including number of new cases, hospitalizations, deaths, protective equipment, supplies, hospital capacity and more.
NC Hospitals Don't Expect to be Overwhelmed
Leaders of two of the Triangle's largest hospitals say they don't think the coronavirus outbreak has crested in the region but they're confident they have the beds, equipment and staffing to handle the peak when it arrives. Janet Hadar, president of UNC Hospitals in Chapel Hill, and Ernie Bovio, president of UNC Rex Healthcare in Raleigh, say they don't know when hospitals will see the full surge of COVID-19 patients.
The oft-cited University of Washington model says North Carolina is experiencing the worst of it now, but other models, including ones done for the state Department of Health and Human Services, suggest the peak won't come until mid to late May. "There's so many different models out there that have peaks at different times in the next few weeks," Bovio said. "We're prepared for it but not sure when it's going to be here."
Hadar said the hospitals have expanded bed capacity, redeployed staff and stockpiled equipment, so they should have plenty of all three when the peak comes. Bovio and Hadar say current trends show the hospitals may be able to begin performing non-urgent surgeries and other procedures in the coming weeks.
General Assembly Leaders Support a Study on COVID-19 with $100,000
Berger announced that $100,000 in discretionary funding from the North Carolina General Assembly is going to start a study tracking symptoms and blood samples from patients at Charlotte's Atrium Health and Winston-Salem's Wake Forest Baptist Health who volunteer to be part of the research.
Berger has been pressing for more random testing but DHHS Secretary Mandy Cohen has pushed back against it for now because of the very limited PPEs available and has prioritized the equipment for health care facilities treating individuals with COVID-19 symptoms or who have tested positive.
This back and forth is symptomatic of a larger political battle over different perspectives of when to lift the strict social distancing measures that have kept North Carolinians sheltered in place for more than a month.
House COVID-19 Health Working Group
The House COVID-19 Healthcare Working Group met on Tuesday April 14th and Thursday April 16th. You can view the documents for April 16th
here
.
The working group has moved from presentations into discussions about developing two C
ovid-19 draft bills 1) Policy/Regulatory 2) Funding by April 23rd when they hold their next meeting. There will be additional "tweeks" after the meeting on the 23rd to finalize the bills so they can filed on April 28th when the legislative short session convenes. The bills will be sent to the appropriate legislative committees and be heard in those committees on April 29th. The policy/regulatory will be heard in the House Health Committee and the fiscal bill will be heard in Appropriations.
Currently, the intent is to merge all the House COVID-19 working group bills (Healthcare, Economic Support, Education and Continuity of State Operations) into one large bill to be voted on April 30th. Our understanding is that legislators will not be at the building until April 30th to vote and all the committee work will be done remotely. Only legislative members and staff will be allowed in the legislative building.
Today's healthcare workgroup reviewed items included on a spreadsheet that had been submitted on the public portal for the legislative committee. The list was by no means a comprehensive list of items being considered but was a tool to use as a starting place for discussions.
The committee noted their support of a limited Medicaid expansion that would pay for the testing and treatment of uninsured COVID-19 patients. "If you have folks who have tested positive for this, it should pay for that treatment and of course pay for the testing as well," Speaker Moore said. "That's something I support."
- Stop the cuts to State Single-Stream Funding to meet the demand for behavioral health services and tremendous burdens for providers that will extend throughout this crisis and beyond
- Increase Innovations Waiver slots to meet the needs of over 12,000 North Carolina citizens on the waiting list for IDD services
- Pursue the new crisis response resources and regulatory flexibilities made available by recent federal legislation
- Grant LME/MCO clinicians access to the NC Controlled Substances Reporting System (CSRS) for real-time prescription data
Benchmarks has been supportive of the LME/MCO requests and is also pressing the legislature to include:
- Fiscal relief for behavioral health agencies with more than 500 employees that were excluded under the CARES Act.
- Increased reimbursement rates for foster families.
- Funding pool for providers to apply for devices and/or data plans for clients that would allow for them to access telehealth services.
Senate Plans
N.C. Senate leadership announced its session plans Thursday for a socially distanced coronavirus session. Senators will be keeping themselves six feet apart, and no lobbyists or members of the public will be allowed inside the Legislative Building.
The Senate hasn't hosted any public meetings or released policy options it's considering, however, leadership in both parties there have been soliciting proposals from their members. Senate Democrats are holding a press conference this morning to announce some of their recommendations. "In the absence of formal efforts by Senate leadership to study and develop legislation that will aid in the recovery of this global pandemic, the Senate Democratic Caucus formed six committees last month to study these issues," according to a news release Thursday from Senate Minority Leader Dan Blue's office.
In Lieu of Lists by LME/MCOs during COVID-19
We have been told that a list of each LME/MCO's notices, sent out in response to COVID-19, will be available next week.
COVID-19 Letters to Beneficiaries
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. These 1.2 million letters will be mailed in batches through April 22, 2020.
You can see the template for the
letters here:
New DHHS COVID-19 Video
|
|
| Why Using Telehealth Is Important During the COVID-19 Pandemic |
DHHS sent out letters last week to consumers explaining the importance of telehealth services and encouraging them to take advantage of these remote services to avoid risk of contracting COVID-19.
This week, DHHS has released a
video
, aimed at consumers and providers, encouraging them to utilize telehealth services. DHHS has been incredibly helpful in quickly transitioning the healthcare industry to a telehealth based system within the span of about 2 weeks. Now, they really want clients to seek and utilize these telehealth services to ensure they continue to access care during the pandemic.
Secretary Cohen Letters to Feds for COVID-19 Support
Secretary Cohen sent out two letters this week in an effort to secure more funds for NC.
The first letter was sent to Secretary Azar and CMS Administrator Verma requesting them to dedicate a portion of the $100 billion CARES Act Provider Relief Fund to providers that serve Medicaid beneficiaries and the uninsured like what was recently done for Medicare providers.
Sec Cohen recommended that they set aside a portion of the COVID Provider Relief Fund (noting that 30% was dedicated to Medicare providers) for essential Medicaid providers and utilize State Medicaid programs to quickly distribute the money in a way that "reflects specific needs in each state.
The second letter sent was to CMS requesting them to approve an emergency demonstration project under Section 1115 of the Social Security Act (the Act) that requested the following:
- Expanding coverage for uninsured individuals related to COVID-19
- Establishing a COVID-19 Disaster Relief Fund
- Covering uncompensated care costs of Medicaid providers preventing, identifying, and treating COVID-19 in uninsured patients.
- Adapting healthcare delivery to reflect the realities of COVID-19. Medicaid providers will need to make significant unanticipated investments in, among other things, telemedicine platforms, bed reconfiguration, off-site screening venues, and quarantine/post-acute care sites, as they adjust to a new reality. Providers will also need to purchase personal protective equipment to treat patients.
- Preserving access to care in light of dramatic shifts in utilization.Providers will vary in their abilities to weather sharp declines in utilization, but many essential Medicaid providers already operate on slim margins and will require financial assistance to remain open. The costs associated with declines in utilization are not eligible for relief under Congress's stimulus package.
- Providing temporary shelter for homeless people with a COVID-19 diagnosis, known COVID-19 exposure, or who live in hotspots to reduce the need for hospital beds.
- Offering nutrition support to allow vulnerable Medicaid beneficiaries to comply with social distancing and home orders.
- Providing more flexibility for beneficiaries receiving home care.
-
Ensuring appropriate behavioral health care. Many behavioral health providers have seen dramatic declines in volume since social distancing began, and certain types of group treatment options are not feasible, threatening to destabilize providers and jeopardize access to services. The State requests flexibility to make directed payments to behavioral health providers through the State's behavioral health managed care plans (known as LME/MCOs), without needing prior approval of a directed payment preprint.
- Streamlining Eligibility and Enrollment
- Expedited enrollment. NC requests the ability to establish an expedited eligibility and to allow providers to bill to a temporary ID number for individuals determined eligible through the streamlined process.
- Other eligibility and enrollment simplifications to mitigate the surge in enrollment. North Carolina is expecting a major surge in enrollment as unemployment spikes while the Medicaid agency and local social service agencies are working to address other urgent issues related to COVID-19. As the pandemic continues, North Carolina will need the ability to identify other eligibility and enrollment flexibilities, such as automatically renewing for 12 months for all individuals whose eligibility is up for renewal during the period of the national emergency.
NC DSS Shares Waiver Process Webinars
NC DSS will be hosting four webinars throughout the day. There will be two calls scheduled
Friday morning, with the first call starting at 9:30 am that will be for county DSS agencies and private agencies that license foster homes. Both morning calls will focus on the same items but will split agencies/attendees into two groups based alphabetically by agency name, to create smaller groups that will allow for more interaction for questions and feedback.
There will be two more calls in the afternoon, one for agencies that provide adoptions and the second for residential Children's Home agencies.
On Thursday, NC DSS sent out the waiver "Dear County Director" and the newly added Dear Executive Directors of Private Licensed Child Placing Agencies letters. We had requested that they begin combining the two and include both counties and private providers on the calls to encourage collaboration and allow each to hear the questions and concerns of the other group. We are incredibly pleased and appreciative that they have moved forward with this format.
They worked hard to create easy to use forms for the waivers to reduce administrative time and cost. We strongly encourage all providers of child welfare services to participate in the meetings and encourage you to let us know any concerns or feedback that would be helpful in the implementation of the waivers. PLEASE don't forget to let State DSS know your appreciation for hosting the webinars and the proactive work they have done around the waivers.
