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Dear Benchmarks' Members,
Please take a moment to review the information highlighted below, including recordings from Benchmarks' Child Welfare and Friday Membership Webinar.
Take care of each other and stay safe and healthy!
The Benchmarks' Team
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Benchmarks' Child Welfare Webinar:
April 9, 2020
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Benchmarks' Membership Webinar:
April 10, 2020
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NC Cases Hospitalized: 398
NC Deaths: 75
Counties with Cases: 92
COVID-19 Outbreaks
- 21 outbreaks identified
- 18 of those are in Long Term Care Facilities
- Orange County is a hot spot with 64 individuals testing positive in a Nursing Facility
- 7 of them have been hospitalized
- 2 have died
COVID-19 Trends for NC
- North Carolina's peak daily death rate projection dropped again to 27/day, down from 30/day and is still predicted to be on April 15th
- The North Carolina daily death rate will decline after that date and will subside to 9/day on April 28th, slightly later than in the last estimate
Cares Act and Family First Coronavirus Act on Monday, April 13th at 11:00.
- CARES Act
- Payment Protection Program
- Economic Impact Disaster Loans (Including Grant Advances)
- Expansion Of Accelerated And Advance Payment Program
- Public Health And Social Services Emergency Fund
- Employee Retention Tax Credit
- The Families First Coronavirus Response Act
- FMLA Expansion Leave
- Emergency Paid Sick Leave
- The "health care provider" exception
- DOLL guidance on wage payment and leave issues
- CDC guidance for businesses and employers
- Business Interruption Insurance Policies
- North Carolina Medicaid Policy Changes
- Potential North Carolina Licensure Changes
Telehealth Billing Code Resources
As part of our response to COVID-19, NC Medicaid has modified its
Telemedicine and Telepsychiatry Clinical Coverage Policy
to help providers deliver care remotely to Medicaid beneficiaries. As telehealth and virtual patient communications continue to be important ways for health care professionals to care for their patients as safely as possible, NC Medicaid is developing ways to help practices and beneficiaries adjust to using telehealth services.
We want to highlight that the telehealth expansion included 90791 for new clients as a billable code. This code covers initial assessments. This is a recent change that we wanted to be sure all members were aware of. In the past, we had only been able to bill for existing clients which created a major barrier for people and this change opens up access for new clients during this pandemic.
Guides for Congregate Care Facilities on Reducing Transmissions
Legislative House Select Committee on COVID-19
Economic Support Working Group
Met on April 7th - see documents
here
.
Federal CARES Act Funding for Unemployment Program.
The Department of Employment Services noted they are working as quickly as possible to modify its technology systems to allow people to apply for these benefits and receive timely payments. These programs will be paid retroactively.
DES intends to implement the federal programs in this order:
- Federal Pandemic Unemployment Compensation (FPUC). This program provides an additional $600 in weekly unemployment insurance benefits to eligible claimants. DES is currently testing the payment system and anticipates making the first payments by April 17, 2020.
- Pandemic Unemployment Assistance (PUA). This program provides unemployment compensation for individuals not eligible for regular unemployment insurance, such as independent contractors and self-employed workers, and those who have exhausted any extensions to unemployment insurance. DES estimates online filing system will be ready to accept claims for this program around April 25, 2020.
- Pandemic Emergency Unemployment Compensation (PEUC). This program provides up to 13 additional weeks of benefits for those who have exhausted their state unemployment benefits. DES will update the public on when online claims will be accepted when the timeline is confirmed
The legislative staff created a great CARES Act Unemployment
flowchart
to help individuals determine which program they should apply for above.
Health Care Working Group
Met on April 9 - see documents
here.
- Focused discussion on Nursing and Long Term Care Homes / Child Care / First Responders.
- Increased focused and attention on congregate care settings due to the outbreaks in 18 of them. Specific directives in Executive Order for Nursing Homes and recommended for Long Term Care Facilities.
- Still ongoing crisis for facilities (and first responders) to secure PPEs.
The Health Group will be meeting on April 14th to discuss MH/DD/SAS which is been woefully left out of the discussions.
They will meet again on April 16th to focus on committee work around their priorities.
The Health Group plan to have 2 COVID-19 draft bills completed by April 23rd.
- Policy/Regulatory Bill
- Funding bill
***BENCHMARKS MEMBERS
*** - we need your feedback about policy/regulatory and fiscal items that should be included in the Health Group's bill. Note that if it is a Medicaid item in the 1135, we cannot include that in our request as state statute cannot overturn federal regulations.
The bills will be filed on April 28th when session reconvenes. On April 29th they will be sent to the appropriate committee.
Addressing Unstable Housing during COVID-19
Governor Roy Cooper announced that North Carolina has received
approval from FEMA to provide housing alternatives, such as hotels, motels, and dormitories, for North Carolinians with unstable housing who may need to quarantine in response to or are at high-risk for severe illness from COVID-19.
The state will work with local partners to provide more than 16,500 units of individual housing in dormitories, hotels, trailers, or other facilities to:
- People who test positive for COVID-19 and need to be isolated but do not require hospitalization, including those discharged from hospitals.
- People exposed to COVID-19 and identified by a health care professional as needing quarantine but do not hospitalization.
- People needing social distancing as a precautionary measure, as determined by public health officials, particularly for high-risk groups such as people over 65 or with certain underlying health conditions such as respiratory illness, compromised immunities or chronic disease. This may include those whose living situation makes them unable to adhere to social distancing guidance.
The federal government through FEMA will pay 75 percent of the costs associated with operating the non-congregate sheltering program. North Carolina will pay the remaining 25 percent. Funding includes the cost of all supporting infrastructure, such as electricity and waste disposal, as well as other services such as laundry, food, cleaning and security.
2 New Hotlines
- Hope4NC Helpline (1-855-587-3463) connects North Carolinians to additional mental health and resilience supports that help them cope and build resilience during times of crisis. As part of the state's recent hurricane recovery efforts it served over 4,400 people in the most impacted counties, and now it is being made available to everyone in North Carolina's 100 counties during the COVID-19 crisis. This initiative is in partnership with all seven of the state's LME/MCOs and REAL Crisis Intervention Inc. in Greenville. Hope4NC is now available 24 hours per day, seven days a week to speak to a live person.
- Hope4Healers Helpline (919-226-2002) is a new initiative in partnership with the North Carolina Psychological Foundation. It provides mental health and resilience supports for health care professionals, emergency medical specialists, first responders, other staff who work in health care settings and their families throughout the state who are experiencing stress from being on the front lines of the state's COVID-19 response. Hope4Healers is also available 24 hours per day, seven days a week for people to reach out for support; they will be contacted quickly by a licensed mental health professional for follow-up.
Triage Hotline for Covid-19.
It is a statewide call center that will be live effective April 6th at 7 am that you can provide to your clients and staff that will provide:
Information on Covid-19
Clinical Triage by RNs, Using latest CDC/NCDHHS guidance
Care Coordination Services
Open to all NC residents, regardless of payer/insurance
COVID-19 Triage Plus Line:
(877) 490-6642
Hours of Operation: 7am to 11pm
7 days a week, including holidays
STARTS MONDAY, April 6th
Highlights:
- Increases the Pool of Professional Health Care Workers: Waives or modifies legal or regulatory constraints that will allow individuals to practice in ND who are:
- Licensed in other states, but not NC
- Retired or if their licenses are inactive
- Allows skilled, but unlicensed volunteers to provide care
- Allows students at an advanced state of professional study to provide care. Professionals include:
- Medicine
- Nurse
- Social Worker
- Psychologist
- Clinical Mental Health Counselor
- Substance Use Disorder Professionals
- Occupational Therapist
- Defines Emergency Management Worker: Includes auxiliary employee of the state or any agency or organization performing emergency management services at any place in this State
- MH/DD/SAS Regulation Waivers
- Program teaching requirements AND periodic retraining and demonstration of competence requirements for non-restrictive and restrictive interventions
- Requirement that Associate Professional must have individualized supervision plans upon hiring
- Required minimum hours per week for licensed professionals at Residential Treatment Staff Secure Facilities
- Requirements for direct service ratio at Adult Developmental and Vocational Programs (ADVP)
- Maximum limit for an adolescent to receive day treatment services
- Regulations regarding factors and conditions for determining program compliance of take-home eligibility
- Ratios of certified drug abuse or SA counselors to clients
- Regulation of minimum frequency of random testing for alcohol and other drugs for an active opioid treatment client
- Regulations on routine drug screens, staffing, minimum operational hours and days per week, and minimum service hours per week at SACOP
- Regulations limiting cumulative provision of private home respite services
- Regulations establishing specific time frame requirements for the steps of the non-Medicaid appeals process.
- Administrative rule provisions requiring that services, assessments, interviews, consultations, counseling, crisis or emergency responses, or other client contacts be provided in-person or face-to-face in connection with delivery of MH/D/SAS Services
- MH/DD/SAS administrative rule provisions requiring SA treatment programs to operate in a setting separate from the client's residence
- State MH/DD/SAS administrative rule provisions that require adult developmental and vocational programs for individuals with developmental disabilities to provide a majority of services and activities on the program site premises
- Facilities that serve "at-risk" populations will be allowed to temporarily waive fingerprinting requirements for new hires if can receive written verification from a potential new hire's current employer (or most recent employer within 30 days) as a temporary measure in lieu of the national portion of the Criminal History Records Check, so long as the new hire passed both the national background check and state background check portions of a Criminal History Records Check. Must secure fingerprinting within 30 days following the end of the State of Emergency.
- Social Services
- Waives in-person requirement for any visit or supervisory visit - can be conducted through audio or visual means.
- Waives in-person requirement for any assessment, reassessment, or quarterly visit. These can be conducted through audio or visual means.
- Waives enforcement of the direct care service personnel standards for licensure of residential child-care facilities - allows NC DSS to consider waivers of staffing ratios for Children's Homes (we think!)
- Waives requirement of fire and building safety inspections prior to relicensure so long as the foster home has had one completed within the previous 30 months. Any foster home relicensed pursuant to this waive must obtain these inspections within 60 days of the EO termination
***Note these changes are for re-licensure. We know that many of you are very concerned getting your families who have been receiving training licensed. There are currently NO waivers for them. We have pressed this option to NC DSS but they are just not comfortable placing children in homes that haven't had inspections.
***Note - if you are missing a fire inspection - Wake County has started to do virtual inspections. Check and see if your local fire inspector would be willing to consider this option.
Three key areas are addressed in Executive Order 131. The first requires retail stores that are still operating to implement new social distancing policies to make shopping safer for customers and employees. The second makes earlier COVID-19 guidelines mandatory for nursing facilities, and recommends other long-term care facilities to do the same. The third area is unemployment benefits, issuing changes that will speed up certain benefit payments to those who are out of work.
Retail Stores
- Sets limits of how many people can be in a store at one time, 5 people per 1,000 square feet of retail space or 20% of fire marshal posted occupancy limits.
- Requires marking 6 feet of distance for areas where people gather like checkout lines
- Requires specific cleaning measures for retail stores
Nursing Homes
(Encourages Long-term care facilities to follow the same guidance).
- 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
Unemployment
- Simplifies the process for employers to file a batch of claims, called an attached claim, on behalf of their employees.
- The Order will extend 60 days beyond the date the state of emergency is lifted to allow employers to get back on their feet.
Therapeutic Foster Care Rate Increase
In our weekly Child Welfare call held on Thursday, members noted that all LME/MCOs except for VAYA and Partners had increased the TFC rate.
We contacted both VAYA and Partners to see if they were planning to increase rates and received the following:
Public Relations Crisis Management Pocket Card
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At President Trump's direction, the Centers for Medicare & Medicaid Services (CMS) today temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic.
These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.
CMS sets and enforces essential quality and safety standards for the nation's healthcare system that supplement State scope-of-practice and licensure laws for healthcare workers. CMS has continuously examined its regulations to identify areas where Federal requirements may be more stringent than State laws and requirements. The changes CMS is announcing today will ensure that healthcare facilities across the nation can expand their staffs and organize them in the most efficient way possible to handle the incoming surge of COVID-19 patients.
Hospitals and health systems throughout the U.S. are seeing increases in patient volumes, leading to significant challenges in delivering vital services. Allowing clinicians to practice to the full scope of their licenses is critical to address staffing needs during the public health emergency.
As a result of CMS's action:
- Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.
- Nurse practitioners, in addition to physicians, may now perform some medical exams on Medicare patients at skilled nursing facilities so that patient needs, whether COVID-19 related or not, continue to be met in the face of increased care demands.
- Occupational therapists from home health agencies can now perform initial assessments on certain homebound patients, allowing home health services to start sooner and freeing home-health nurses to do more direct patient care.
- Hospice nurses will be relieved of hospice aide in-service training tasks so they can spend more time with patients.
"It's all hands on deck during this crisis," said CMS Administrator Seema Verma. "All frontline medical professionals need to be able to work at the highest level they were trained for. CMS is making sure there are no regulatory obstacles to increasing the medical workforce to handle the patient surge during the COVID pandemic."
CMS's workforce changes apply immediately and address supervision, licensure and certification, and other limitations in healthcare settings including Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and Hospice. These actions are part of the unprecedented array of temporary regulatory waivers and new rules issued recently by CMS and intended to help the American healthcare system respond to COVID-19.
CMS is the nation's largest health insurer, serving more than 140 million Americans through Medicare, Medicaid, the Children's Health Insurance Program, and Federal Exchanges.
On March 30, CMS issued an unprecedented array of temporary regulatory waivers and new rules to allows hospitals and healthcare systems to deliver services at other community-based locations to make room for COVID-19 patients needing acute care in their main facilities. The changes complement and augment the work of FEMA and state and local public health authorities by empowering hospitals and healthcare systems to rapidly expand treatment capacity and separate infected from uninfected patients. CMS's waivers and flexibilities will permit patients to be triaged to a variety of community-based locales, including ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories. Transferring uninfected patients will help hospital staffs to focus on the most critical COVID-19 patients, maintain infection control protocols, and conserve personal protective equipment (PPE).
In recent weeks, CMS also has temporarily:
- Permitted physicians whose privileges will expire to continue practicing at a hospital, and allowed new physicians to begin working prior to full hospital medical staff/governing body review and approval.
- Lifted regulatory requirements regarding hospital personnel qualified to perform specific respiratory care procedures, allowing these professionals to operate to the fullest extent of their licensure;
- Waived federal minimum personnel qualifications for clinical nurse specialists, nurse practitioners, and physician assistants so they can work at rural hospitals as long as they meet state licensure requirements, allowing for maximum staffing flexibility at such facilities
- Allowed physicians and non-physician practitioners to use telehealth technology to care for patients at long-term care facilities, rather than having to treat patients there in person.
- Waived certain training and certification requirements for nurse's aides at long term care facilities, to help address potential staffing shortages during the pandemic;
- Waived paperwork requirements so that hospital doctors can use more verbal, rather than written medical orders;
These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID19, visit
www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the
Current Emergencies Website.
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(We are up to 43 so far!!!)
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Joint DMHDDSAS and DHB (NC Medicaid)
COVID-19 Update Call
For BH/IDD Consumers, Family Members and Community Stakeholders
Monday-April 13, 2020
2:00 p.m.
(Please save every Monday at 2:00 for this regular update call with consumers, family members, and community stakeholders.)
***This call is for consumers, family members, and community stakeholders ONLY. If you are provider who joins the call, please allow consumers, family members, and community stakeholders to ask their questions. Provider questions will be answered during the regularly scheduled NC Providers call.
Dear NC Behavioral Health and IDD Consumers, Family Members and Community Stakeholders,
We hope that you are staying well as we continue to combat the COVID-19 pandemic in North Carolina. The Division of MH/DD/SAS and Division of Health Benefits (NC Medicaid) remain committed to working hard to assess service gaps, create and amend policies, and direct funding into service areas that will be impactful in preventing the interruption and delay of BH/IDD services during this challenging time.
The COVID-19 situation is ever-changing and evolving rapidly; we all must continue work together to meet the needs of individuals, families and communities. As promised, in an effort to help keep consumers, family members and community stakeholders informed and updated on policies and actions impacting service access and health outcomes for BH and IDD consumers, and perhaps more importantly - to hear directly from you about any questions or issues that have emerged since we last communicated- we are hosting another conference on
Monday April 20, at 2:00pm.
We hope that you can join us. The details on how to join is as follows:
Toll-Free:
844-291-5495
Access Code:
1279313
For Closed Captioning see link below:
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Available Training and Resources
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Webinar 4/14: Virtual Wellness
Feeling restless staying at home? Want to learn about how you can participate in Virtual Wellness? The Human Development Institute at the University of Kentucky is hosting a virtual wellness event called "Wellness Edge--Staying Apart Together." This is an opportunity to learn about and try out inclusive wellness practices virtually together!
Wellness Edge is part of the PRC State Pilot program that aims to increase the quality of engagement for individuals with paralysis and their support networks in recreational settings, and thereby improve health outcomes and enhance the capacity of communities to have inclusive recreational spaces for all individuals.
The webinar will include a warm-up activity, yoga, zumba, nutrition, virtual arts, connecting virtually, and group discussion.
Access the webinar:
Or Telephone:
Dial:
+1 646 876 9923 (US Toll)
+1 312 626 6799 (US Toll)
Meeting ID: 860 863 5229
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Here is a book about the virus that is picture based - it is from the UK so instead of 911 it has 111, but other than that, it is a neat resource.
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