• NEW: Current Numbers of COVID-19 cases - According to the most recent case count as of today, North Carolina has 24,140 cases, which is an 11.6% increase in cases from Friday (5/22 had 21,618 cases). In addition, there are 621 currently hospitalized (9.3% inecrease from 5/22), there have been 766 deaths related to the virus and it is now in all 100 counties of our state. As of 5/25, there have been an estimated 14,954 patients presumed recovered from COVID-19. You can view the number of cases and other data Here.

• UPDATE: Governor Roy Cooper's "Safer At Home Phase 2" Now in Effect - This past Friday, May 22nd at 5 p.m., became the effective date/time for Governor Cooper's Executive Order 141 (Click Here) which eased restrictions on travel, business operations and mass gatherings. As a result of the Executive Order, North Carolina moved into Safer At Home Phase 2. Apparently, after two weeks in Phase 1, the state’s overall key indicators remained stable but the continued increases in daily case counts signaled a need to take a more modest step forward in Phase 2 than originally envisioned. Read the FAQs and view the Phase 2 Guidance. Please Note: All restrictions related to long term care facilities, which includes adult care and family care homes, still remain in effect until further notice.

• UPDATE: NEW PPE DROP SITES ANNOUNCED - NCDHHS, North Carolina Emergency Management (NCEM) and the National Guard (NCNG) Continue to Distribute More Packs of Personal Protective Equipment (PPE) to Long-term care Facilities across the State - The NC DHHS announced yesterday additional drop sites for this week. You can view/download the drop sites, including forms to confirm your pickup Here.

• (Re-print from earlier communication) NC DHHS Issues Updated Guidance Regarding Who Should be Tested for COVID-19 - The new guidance (Click Here) recommends that clinicians test any patient in whom COVID-19 is suspected regardless of symptoms.
• The updated guidance for COVID-19 testing includes:
• Anyone with symptoms suggestive of COVID-19
• Close contacts of known positive cases, regardless of symptoms 
• Persons who live in or have regular contact with high-risk settings (e.g., long-term care facility, homeless shelter, correctional facility, migrant farm worker camp)
• Persons who are at high risk of severe illness (e.g., people over 65 years of age, people of any age with underlying health conditions)
• Persons who come from historically marginalized populations
• Health care workers or first responders (e.g. EMS, law enforcement, fire department, military)
• Front-line and essential workers (grocery store clerks, gas station attendants, etc.) in settings where social distancing is difficult to maintain

• (Re-print from earlier communication) Personal Protective Equipment (PPE) resources - In order to save space, NCSLA has now put it's list of PPE resources into a PDF document which can be viewed/downloaded Click Here. The document contains embedded links to emails and websites as were found previously in previous communications.
• Providers can also request PPE (usually only provider to facilities with COVID-19 outbreaks) via the NC DHHS website Click Here
• NCSLA vendor member Intalere currently has a supplier that has a good source for gowns (hard to find at a reasonable price), masks and gloves. Contact information is: Bob Jevin, Future Health Concepts, Inc, Office (407) 547-2010, Mobile (407) 716-4327,Email: bob@fhcusa.com http://www.futurehealthconcepts.com/
• Please note that many of the 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.
• 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.

• (Re-print from earlier communication) Requesting Additional PPE from the Local Emergency Management Agency - For providers that are running low or exhausting their 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) Free Music for Resident Listening Activities - North Carolina composer Dave Combs asked NCSLA to share his music with the adult care home and family care home communities as a way to offer residents music listening activities. Dave's soothing and relaxing instrumental music videos are free to use at no charge and many residents in the Winston-Salem area are already familiar with his music, particularly, Rachel’s Song. Dave is a long-time resident of Winston-Salem and a composer of many albums of instrumental music and considers this offer as one way for him to give back. Below are the YouTube links for Dave's video playlists. Feel free to forward this information to any residents that you think might like to watch the YouTube videos on their own devices. For large video screens in your public areas there are four videos that are long-playing (over 6 hours). These videos can be streamed to have beautiful, relaxing music playing in the background all day long. The videos have beautiful photography accompanied by soothing, relaxing instrumental music composed by Dave Combs and arranged and performed by Gary Prim. When you click on the following link it will take you to the YouTube playlist that looks like the below image. Choose your video, and enjoy - https://www.youtube.com/playlist?list=PLGNq0Ky_ylCTwo-jfcxx9k8QBgR2M22HR

• (Re-print from earlier communication) Governor Signs Executive Order to Provide Regulatory Flexibility for Health Care System During Response to COVID-19 - Yesterday, Governor Cooper Issued Executive Order No. 139 (Click Here), which provides additional regulatory flexibility to help ensure capacity in the state’s health care system and improve its ability to effectively respond to the COVID-19 pandemic. (Please note the Executive Order is in addition to the waiver of DHSR licensure rules as noted in the article below titled "DHSR Waives Certain Licensure Rules As a Result of COVID-19" which is still in effect).
• The Executive Order temporarily gives the Secretary of the Department of Health and Human Services (“DHHS”) the ability to waive or modify regulations for accreditation for asbestos and lead testing professionals, accreditation of local health departments, and regulations impacting child care and high-risk health care facilities, which would include adult care and family care homes. 
• The Executive Order ensures that DHHS can utilize certain authority provided by the federal government to respond to the COVID-19 pandemic. The goal of the temporary flexibility will be to ensure capacity and continuity in services in North Carolina’s health care system while the state continues to respond to COVID-19.
• Executive Order 139 is effective immediately and remains in effect until 5:00 pm on June 26, 2020. If you have questions regarding how to submit a waiver request, please contact Jeff Horton at NCSLA at: jeff@ncseniorliving.org or Richard Rutherford with SembraCare at: Medicaidwiz@gmail.com or by phone at: (919) 264-2398

• (Re-print from earlier communication) NC Medicaid Approves Additional Temporary Rate Increase for Long Term Care Providers - NCSLA has been consistently communicating to NC Medicaid over the past number of months of the need to better compensate providers in order to retain staff and provide care to residents, particularly in light of the COVID-19 pandemic. As a result, NC Medicaid listened to our concerns and issued Special Bulletin COVID-19 #88 yesterday (Click Here) which will provide a 10% rate increase and will be applied retroactively to any claims submitted already with dates of service (DOS) on or after April 1, 2020 (NC Medicaid will systematically reprocess previously submitted claims at a date still to be determined). Providers do have the option to resubmit their claims. NC Medicaid will provide updates and additional details regarding the reprocessing schedule in upcoming Medicaid bulletins.
• All PCS provider base rates, including State Plan PCS, CAP-DA, and CAP-C, are increased 10% in addition to any recently implemented rate increases for all claims submitted with DOS on or after April 1, 2020. This base rate increase will also be applied to recent NPI-specific targeted base rate increases granted to ACH COVID-Outbreak sites. 
• With the new rate increase, PCS rates will be $4.51 per 15 minute unit or $18.04 per hour.
• Strengthening Infection Prevention Activities - NC Medicaid is providing financial support to the above providers to strengthen their infection prevention activities. As part of this work, NC Medicaid expects that any provider receiving this rate increase will assess its current infection prevention and management capacities using the standardized self-assessment tools outlined below. 
• Each provider should, separately for each facility, use the COVID-19 Long-Term Care Infection Control Assessment and Response (ICAR) Self-Assessment Tool (available under the Facility Self-Assessment section on the SPICE webpage) to conduct a self-assessment, and then submit the following by email to Evelyn Cook:

1. The completed ICAR Self-Assessment (if not otherwise submitted through the webpage directly) 
2. An Action Plan (using the template provided at the webpage above) based on the ICAR Self-Assessment
3. The current Infection Control Plan required by licensure for the facility.

• Note: Please ensure that the subject line of your submission email includes only the word “COVID.” 

• (Re-print from earlier communication) COVID-19 Status Reporting Template Now Available - Required Reporting to Maintain Retroactive Targeted Rate PCS Rate and Hours Increases for Adult Care Homes (ACHs) Serving COVID-positive Patients - As reported previously, NC Medicaid is directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID-19 residents in a congregate care setting. This targeted assistance is retroactive to April 1, 2020.
• UPDATE: NCSLA vendor member Richard Rutherford has been working through the process of getting the practical details on the Hardship Advance and the increased Medicaid PCS rate and hours and is willing to provide help, free of charge to NCSLA members, any provider that qualifies due to a COVID-19 outbreak in their facility. Richard's contact information is: Email: Medicaidwiz@gmail.com or Cell: (919) 264-2398
• Templates are now available on the Cost Reports and Assessments web page and contain the following documents:
• NC Medicaid COVID Outbreak Report Template Cover (Click Here) provides guidance on completing the following form which is:
• the NC DHB Outbreak Facility Reporting Date Provider Name Template (Click Here)
• For more information, please see SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients
• As noted in earlier NCSLA communications, NC Medicaid will pay providers an Expedited Hardship Advance (payment) based on the adult care home's PCS billings for January and February 2020 and multiplied by a factor of 1.25, the provider can receive a Hardship Advance to help offset the increased costs of caring for COVID-19 residents.
• ACH COVID-Outbreak Site PCS Reimbursement Increase -

1. An ACH COVID-Outbreak site will be assigned NPI-specific rates that allow them to be reimbursed the increased rates for services provided. The current 15-minute unit rate will be increased to $7.50 per unit ($30/hr) for all Medicaid PCS beneficiaries in an ACH COVID-Outbreak site. Providers should bill their usual and customary charges.
2. An ACH COVID-Outbreak site may bill up to 100 additional service hours per month for each beneficiary with current prior approval up to 80 hours per month. 
3. An ACH Outbreak site may bill up to 40 additional service hours per month for each beneficiary with current prior approval greater than 80 hours per month. 

• (Re-print from earlier communication) NC DHHS Launches Program to Match Health Care Workers to Facilities Seeking Staff - Due to COVID-19, many health care facilities in North Carolina, particularly long-term care facilities, are seeking to hire staff for temporary, part-time or full-time roles. There is an urgent need for Registered Nurses and Certified Nursing Assistants, among other roles to supplement current workers and in some cases fill in for workers affected by COVID-19. Interested health care employees with the ability to pick up extra shifts or who may have been laid off from facilities and are seeking full-time roles can register at https://nc.readyop.com/fs/4cjq/697b. Local Health care Facilities affected by COVID-19 and in need of support can request assistance through their local (county) Emergency Management agencies (Click Here), which have the ability to fulfill the support requested within the county. You can read more about the program Here.

• (Re-print from earlier communication) NC DHHS Releases Flow Chart For Discharge from Hospital to Long Term Care - NC DHHS released a number of updated guidance documents on their website in the past week (Click Here) including a flow chart to follow when discharging someone from a hospital to a long term care facility. You can view/download the flow chart Here. While the guidance allows for transfer of patient with COVID-19 or a patient recovering from COVID-19 to a long term care facility, srtict CDC guidelines (Click Here) must be adhered to as noted below:
• Patients can be discharged from the healthcare facility (hospital) whenever clinically indicated. If discharged to a nursing home or other long-term care facility (e.g., assisted living facility), AND
• Transmission-Based Precautions are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.
• Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.
• Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.

• (Re-print from earlier communication) NCSLA Continues to Work for YOU! - As communicated previously, during the COVID-19 pandemic, NCSLA has continued to work with officials at the NC DHHS and with legislators to communicate our industry's needs during these unprecedented times. As a result, two important bills were passed this past weekend that will positively affect our industry. The two bills are described below and were both signed into law by Governor Cooper yesterday. Once NCSLA has more details regarding the $1,325 SA payments to facilities we will communicate to providers as things progress.
• The first bill is House Bill 1043/Session Law 2020-4 (Click Here) and includes the following, which was based in large part on NCSLA's lobbying and advocacy efforts with members of the General Assembly.
• Section 3.3 (1) of the Bill provides $3.75 million to the NC Senior Living Association for "(i) the purchase of supplies and equipment necessary for life safety, health, and sanitation, such as ventilators, touch-free thermometers, gowns, disinfectant, and sanitizing wipes, and (ii) the purchase of personal protective equipment that meets the federal standards and guidelines from the Centers for Disease Control and Prevention, such as surgical and respiratory masks and gloves". NCSLA will soon begin work of setting up a program that all licensed assisted living facilities in North Carolina may be eligible to receive PPE and equipment to address COVID-19 issues.
• Section 6.3 (30) of the Bill provides for a one time payment of $1325 for each SA resident that is residing in a residential facility that serves SA residents during the period of March 10, 2020 - July 30, 2020. This is the same language that appeared in the Health Committee draft that NCSLA sent out last week and which NCSLA worked very hard on behalf of adult and family care homes serving residents who receive SA.
• The second bill is Senate Bill 704/Session Law 2020-3 (Click Here) which we discussed last week.
• Section 3D.7 of the Bill provides liability protection language that NCSLA had worked on with other health care trade associations. Due to the limitations in PPE, finding sufficient direct care staff to provide care, etc., we believe providers should not be held liable for events related to COVID-19 that are beyond their control.
• Section 3E.3(a) of the Bill requires DHSR to "suspend all annual and biennial inspections and regular monitoring requirements for licensed facilities" except in cases where DHSR "deems necessary to avoid serious injury, harm, impairment, or death to employees, residents, or patients of these facilities."
• Section 3E.3(b) of the Bill requires DHSR to conduct a compliance history of mental health facilities and adult care and family care homes "that were determined to be in violation, assessed penalties, or placed on probation within the six-month period preceding the beginning of the COVID-19 emergency, for noncompliance with rules or statutes or Centers for Disease Control and Prevention guidelines regarding infection control or the proper use of personal protective equipment. DHSR shall require employees of these facilities to undergo immediate training designated by DHSR about infection control and the proper use of personal protective equipment. The training required by this section may be conducted online, by video conference, or in such manner as DHSR determines appropriate under the circumstances."

• (Re-print from earlier communication) Social Security and the CARES Act: Social Security and SSI recipients are eligible for the rebate payments - NCSLA received a number of inquiries this week from providers that are now seeing residents on Social Security or SSI starting to receive rebate checks (up to $1200/adult) as a result of the CARES Act signed into Federal law a few weeks ago. Providers are requesting confirmation that this additional income will NOT 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) Documents for Use by Adult Care and Family Care Homes Related to COVID-19 - Over the past two months, NCSLA has made available documents providers can use to screen residents and visitors, have hospitals complete prior to discharging someone to an adult care home and other forms that are useful with regards to COVID-19. In addition, NCSLA received additional documents from one of our members yesterday that may prove useful to providers as they strive to provide care during this difficult time to their residents and protect their staff. These documents are listed below and can be downloaded and customized for your facility's use free of charge.
• Daily symptom attestation form - COVID-19
• How facility is responding to COVID-19
• COVID-19 Reporting to work procedures
• COVID-19 Temperature control sheet
• COVID-19 Staff and visitor screening form
• COVID-19 Post-acute care transfer form

• (Re-print from earlier communication) DHSR Waives Certain Licensure Rules As a Result of COVID-19 - As the situation surrounding COVID-19 continues to change rapidly, DHSR approved statewide waivers this past Friday (4/24) for certain licensing requirements applicable to Adult Care Homes and Family Care Homes licensed pursuant to N.C.G.S. § 131D, Article 1, and rules 10A NCAC 13F and 10A NCAC 13G. The waivers will remove the need for providers to make individual requests, subject to the Waiver Terms and Conditions included in the attached Notice (Click Here), waivers are granted pursuant to N.C.G.S. § 131D-7 and the Director of Emergency Management’s request for waiver of certain regulations. This statewide waiver will expire at the conclusion of the Governor’s emergency declaration or sooner as determined by the Department and is subject to the terms and conditions set forth in the Notice. The waivers address the following areas:
• Personnel Requirements and Hiring New Staff
• Tuberculosis Testing
• Criminal Background Checks
• Personal Care Training and Competency
• Training on Care of Diabetic Residents
• Family Care Home Administrator Renewal
• Resident Admissions and Other Requirements
• Tuberculosis Testing Upon Admission
• Annual Medical Exam
• Care Plan
• Medication Orders
• Pharmaceutical Care
• Licensed Health Professional Support Quarterly Reviews and Evaluations
• Visitation and Activities
• Visitation
• Group Activities & Outings
• Nutrition and Food Service
• Disposable Place Settings
• Meal Times & Communal Dining
• Menus
• For questions regarding the Waivers, DHSR asks that providres email them at DHSR.AdultCare.Questions@dhhs.nc.gov . 

• (Re-print from earlier communication) DHSR Announces Additional Temporary Testing Sites for Medication Aide and Administrator Exams - In order to assist adult care home and family care home providers in ensuring there is adequate staff to meet the needs of residents during these challenging times due to COVID-19, the Division of Health Service Regulation Healthcare Personnel Education and Credentialing Section (HCPEC), the DHSR Adult Care Licensure Section (ACLS), and several county Departments of Social Services are partnering to offer additional temporary testing site locations for the medication aide and administrator exams. Throughout the remainder of April and through the end of May, DHSR will be offering multiple testing site locations across the state, on Monday, Wednesday and Friday’s at most sites listed below. Site locations, dates and times are being posted on the HCPEC Branch website https://www.ncnar.org/index1.jsp. Testing schedules can be found at https://info.ncdhhs.gov/dhsr/news.html#hcpr . All individuals who wish to take an exam must register and pay the normal required testing fee. In addition, for the safety of all testers and test proctors, we are taking the following safety and infection prevention measures:
• Tests will be limited to no more than 5 people per scheduled exam.
• Testers will be screened prior to entering the testing location. Any person who exhibits signs or symptoms of respiratory illness or has tested positive for COVID-19 will not be permitted to take the exam and will be asked to reschedule.
• All testers are asked to wear a facemask or other face covering upon entering the exam location and wear the face covering for the duration of the exam. 
• Exam proctors will be disinfecting all tables and writing instruments between exams. 
• Testers will need to remain in the testing room and will not be permitted to travel in other areas of the testing site.

• Below are the temporary additional testing sites. All locations will offer the medication aide exam. Select locations will offer the administrator exam.  Again, please refer to the HCPEC website for details and schedules. 
• Buncombe County – DHSR Black Mountain Office - 952 Old US Hwy 70, Building 17, Black Mountain, NC 28711
• Gaston County DSS - 330 Dr. Martin Luther King Way, Gastonia NC 28052
• Davie County Senior Services - 278 Meroney Street, Mocksville, NC 27028
• Mecklenburg County DSS - Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
• Guilford County DSS - 1203 Maple St. Greensboro, NC 27405
• Cumberland County DSS - 1225 Ramsey Street, Fayetteville, NC 28301
• No testing on Fridays.
• Jones County Civic Center - 832 North Carolina Hwy 58, Trenton, NC 28585
• Pitt County Cooperative Extension - 403 Government Circle Suite 2, Greenville, NC 27834
• Wake County – DHSR, Brown Building, Room 104, Dorothea Dix Campus - 801 Biggs Drive, Raleigh

• (Re-print from earlier communication) NC DHHS Publishes COVID-19 Toolkit for Long Term Care Facilities - The NC DHHS has published a COVID-19 toolkit for long term care facilities on their website which can be found Here. The toolkit contains the following items:
• COVID-19 Outbreak Toolkit for Long-Term Care Settings
• Long-Term Care Infection Prevention Assessment Tool
• Infection Prevention Education Resources for Long-Term Care FacilitiesOpen PDF
• Strategies to Optimize Personal Protective Equipment - FacemaskOpen PDF
• Strategies to Optimize Personal Protective Equipment - GownsOpen PDF
• IP Staffing Worksheet for Long-Term Care Facilities During COVID-19Open PDF
• What to Expect: Response to New COVID-19 Cases or Outbreaks in Long-Term Care Settings

• All long term care providers are encouraged to refer to these resources, particularly in the event a COVID-19 outbreak is discovered in a facility.

• COVID-19 Webinars Still Available on the NCSLA Website - Webinars from April 9th and the 14th are still available on the NCSLA Coronavirus Updates webpage. The April 9th webinar focused on "Infection Prevention in Assisted Living Facilities" and the April 14th webinar was on "COVID-19 Pandemic Legislative and Regulatory Changes: An Assisted Living Facility’s Guide." Both webinars are free of charge.

• (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) 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.