• Number of COVID-19 cases - According to the most recent case count as of today, North Carolina has 1857 cases, which is a 17.2% increase in cases from yesterday (4/1 had 1584 cases). In addition, to date there have been 16 deaths related to the virus and 184 currently hospitalized (down from 204 hospitalized yesterday). To put things into perspective, the 1st COVID-19 case in North Carolina was identified on March 3rd; therefore, the state has added 1856 cases in 30 days. You can view the number of cases and other date Here.

• Division of Health Service Regulation (DHSR) Contacting Facilities About COVID-19 Preparedness - After hearing from members, NCSLA confirmed with DHSR today that they are contacting adult care homes and asking a series of questions regarding their preparedness and practices during the COVID-19 Pandemic. The calls are to gather information and to make certain facilities are aware of and following recommendations from the NC DHHS and to give them information on where to submit questions. 

• NCSLA is Working for You! - In the past month, NCSLA has sent two separate letters to Dr. Mandy Cohen, Secretary of NCDHHS containing recommendations for that the Department can do to assist adult and family care homes during the COVID-19 crisis. Our goal is to communicate to the Department concerns and areas our members are struggling with so the Department can be in a better position to assist our industry as the COVID-19 crisis intensifies, which will likely occur over the next month. As always, our goal is the help our industry in order to help protect and provide care for our residents. Without you and your staff, many many vulnerable North Carolina citizens will be at risk during this critical time. If you have questions or comments regarding the letters, please do not hesitate to contact the NCSLA office.
• The first letter was sent on 3/13/20 and can be read/downloaded Here
• The second letter was sent today and can be read/downloaded Here

• NCSLA Upcoming COVID-19 Webinars - NCSLA offering three (3) free webinars related to COVID-19 on the following dates and times:
• 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: Dispelling the Myths about COVID-19 which focuses exclusively on assisted living homes.

• For additional information on the free webinars Click Here

• NCDHHS issues new 3/31/20 "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) replaces the guidance issued on 3/25/20 and 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.

• Medicaid Beneficiary Eligibility Recertifications During COVID-19 - NC FAST will be extending cases due to COVID-19, beginning effective March 31, 2020. As part of COVID-19, no Medicaid eligibility benefits will be terminated or reduced for the upcoming certification period, with the following exceptions: 
• Beneficiaries moving out of state.
• Beneficiaries who voluntarily requested the termination of benefits.
• Beneficiaries who are deceased.

• All terminations or reduction in benefits for Medicaid/NCHC that have already been keyed with effective date of March 31, 2020, other than the exceptions listed above, will not occur. Reduction of benefits includes any program change that results in a program that is lower in benefits, other than moving to NCHC. NC FAST will continue the cases at the current benefit.
•  Currently, cases are extended for one month at a time. Beginning at the end of April, DHB will be extending cases for a new 6- or 12-month certification period until the COVID emergency ends.
•  In addition, additional updates related to COVID-19 Medicaid at: https://medicaid.ncdhhs.gov/about-us/coronavirus-disease-2019-covid-19-and-nc-medicaid/covid-19-policy-flexibilities  

• Special Medicaid Bulletin Regarding Personal Care Services (PCS) Assessments (SPECIAL BULLETIN COVID-19 #30) - NC Medicaid issued a Special Bulletin 3/3120 (Click Here) regarding PCS assessments. The Bulletin covers the following areas and more:
• Annual Assessments - Medicaid will extend prior approvals for current beneficiaries approaching their annual due date. Prior approvals will be extended, at minimum, 90 calendar days and face-to-face assessments will be scheduled for a later date. 
• Initial Assessments - Initial requests for services will continue to be received and processed by the Independent Assessment Entity (IAE). The IAE will conduct a telephonic assessment with the beneficiary/legally responsible party or others who are able to speak to the beneficiary’s care needs. The telephonic assessment is the current mini assessment used for expedited requests and asks questions related to the assistance needed with activities of daily living and exacerbating conditions that may be present. 
• Expedited Assessments - Expedited requests will continue to be processed and provisional hours awarded for eligible beneficiaries pursuant to PCS policy section 5.4.4. The provisional PA will be extended to allow for face-to-face assessments to be scheduled for a later date. 
• Change of Status Assessments - Change of Status Assessments will be received and processed by the IAE. The IAE will conduct a telephonic assessment with the beneficiary/legally responsible party or others who are able to speak to the beneficiary’s care needs. Telephone assessments for change of status requests will follow the current full assessment.

• 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 rate increase update - As noted in the previous NCSLA Update, the NCDHHS increased the Medicaid PCS rate by 5% retroactive to 3/10/2020. Providers can now rebill claims retroactive to 3/10/20 and receive the higher rate and also bill the higher rate going forward. With the new rate, PCS was increased from $3.90/15 minute unit to $4.10/15 minute unit or $15.60/hour to $16.40/hour.

• State/County Special Assistance (SA) Recertification - NCSLA inquired with the DHHS Division of Aging and Adult Services yesterday regarding SA recertifications and how they will be handled during the COVID-19 outbreak. SA 3320.II (copied below) indicates all SA recertifications are completed by mail; that will continue through the COVID-19 outbreak. 
• II. REDETERMINATION FORM DAAS-8191 - The redetermination/recertification form DAAS-8191 is sent automatically by NC FAST to all SA beneficiaries, including SSI beneficiaries, to be completed and returned. The DAAS-8191 is sent the first of the month prior to the month in which the certification period ends. The beneficiary is instructed to return the completed DAAS-8191 by the first day of the month in which the certification period ends.
• All SA beneficiaries must complete, sign, and return the Redetermination/recertification form. This has been required since August 1, 2015.
• Note: An interview for SA redetermination/recertification is not required. Because the North Carolina Families Accessing Services Through Technology system (NC FAST) is not currently able to send the DAAS-8191 to the authorized representative, the caseworker must manually send the DAAS-8191 to the authorized representative.

• 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.

• Effect of stimulus checks on SA eligibility - NCSLA has recently received inquiries from members regarding the economic package approved by Congress and signed in to law that will provide stimulus checks to American citizens including individuals that receive State/County Special Assistance (SA) and Medicaid. Inquiries have centered around the issue of the checks potentially affecting eligibility for SA recipients and/or Medicaid recipients. NCSLA inquired with the NC Division of Aging and Adult Services (DAAS), which administers the SA program and their only recommendation was for providers to continue checking the Social Security Administration’s webpage at https://www.ssa.gov/coronavirus/ for guidance. Due to the legislation recently being signed into law they will update the information as it becomes available. DAAS also included additional links below that may be helpful:
• https://www.ssa.gov/payee/
• http://www.ssa.gov/pubs/10076.html
• https://www.ssa.gov/payee/LessonPlan-2005-2.htm?ref=driverlayer.com

• Coronavirus Aid, Relief, and Economic Security Act (CARES) - On March 27th, Congress passed the CARES Act and President Trump signed the Act into law the same day. The Act makes $350 billion in government-guaranteed Payroll Protection Program loans available to small businesses. For businesses that manage to avoid layoffs, these loans can potentially be forgiven. Below we have provided two links to assist providers in understanding and applying for loans. The first link is an article about the program and the second link is the actual website to apply for the loans. If you experience problems getting a loan for your business, we recommend contacting Senator Thom Tillis, Senator Richard Burr and your Congressional Representative.

• Article that explains the Act from Foley & Lardner LLP - Click Here
• Online website where you can apply for a business disaster loan - Click Here

• Governor Cooper's Stay at Home Order in Effect - As noted previously, Governor Cooper issued a stay at home order, Executive Order 121, that went into effect Monday, 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.

• 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.

• Families First Coronavirus Response Act - 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.

• 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)