• Several North Carolina Counties issue stay at home orders - In addition to Charlotte-Mecklenburg, which issued a stay at home order earlier this week, a number of other counties and cities in our state have issued similar orders. The cities of Winston-Salem, Greensboro and High Point, and Durham and counties of Orange and Wake, have issued or are in the process of issuing stay-at-home orders or ordinances this week, which means most individuals are encouraged to stay at home except for certain circumstances. Health care workers, including staff in adult and family care homes are not subject to the orders as they are considered essential health care personnel.

• Medicaid PCS rate increase - As noted in yesterday's NCSLA Update, the NCDHHS plans to increase the Medicaid PCS rate by 5% retroactive to 3/10/2020. A Press Release was issued late yesterday, which goes into more detail regarding the increase as well as other programs that will also be affected, i.e. skilled nursing facilities, CAP/C, CAP/DA, etc.

• 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.

• North Carolina DHHS recommendations for prevention of COVID-19 related deaths (repeat of previous article) - The North Carolina Department of Health and Human Services recommends that people at high risk of severe illness from COVID-19 stay at home to the extent possible to decrease the chance of infection. On March 22, the Centers for Disease Control and Prevention (CDC) updated who is at high risk for severe illness. People at high risk include anyone who: 
• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
• People with chronic lung disease or moderate to severe asthma
• People who have serious heart conditions
• People who are immunocompromised including cancer treatment
• People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

• Personal protective equipment (PPE) (repeat of previous article) - We have heard from numerous 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. 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 a webinar hosted by the Coalition and that NCSLA participated today, it appears that long term care facilities that have a resident with COVID-19 and are at risk of exhausting their supplies of PPE, will only be given priority. However, in the event this occurs in your facility, when you 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.

• Number of COVID-19 cases - According to the most recent case count as of today, North Carolina has 636 (504 cases yesterday - 3/25) cases of COVID-19 and is now found in over half of North Carolina's 100 counties. 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.

• 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. 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)