The House and the Senate agreed to a $1.57 billion compromise budget on Saturday, May 2nd through
Senate bill 704
and
House bill 1043
. The Governor signed the budget bills into law during an unprecedented press conference where he was accompanied by the Speaker of the House and Senate Pro Temp. This is the first of two budgets that will be developed to dole out the $3.5 billion of federal COVID-19 money that NC received. The second COVID-19 budget of $1.93 billion is expected to be out by the end of May or early June.
What you will NOT see in this budget that you saw in the House version is:
- Parity for telehealth under private managed care
- Expansion of Medicaid for COVID-19 testing and treatment for the uninsured who qualify
- An $100 dollar a week increase (from $300 to $400) for unemployment compensation
- No takeout cocktail drinks (limit of 2) to help restaurant sales
An overarching concern in the minds of all the legislators and Department leaders, is the looming budget shortfall because of the coronavirus. Shortfall estimates range from $3.5 to $4 billion dollars. The NC rainy day fund of $1.2 billion is not near enough to cover this deficit and the Governor has already announced there will be significant state budget cuts to reach a balanced budget.
Overview: Policy and Budget for Federal COVID-19 Assistance
(Senate Bill 704 and House Bill 1043)
State Plan for a Strategic State Stockpile of Personal Protective Equipment and Testing Supplies for Public Health Emergencies
Establish definitions for "acute care providers," "first responders," "health care providers," "long-term care providers," and "non-health care entities."
Directs the Division of Public Health (DPH) and the Division of Health Service Regulation (DHSR), in conjunction with the North Carolina Division of Emergency Management to develop a plan for creating and maintaining a strategic state stockpile of personal protective equipment (PPE) and testing supplies. This plan must be submitted to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Oversight Committee on Justice and Public Safety. Section
Pandemic Health Care Workforce Study Section
Charges the North Carolina Area Health Education Center (NC AHEC) with studying the issues that impact health care delivery and the health care workforce during a pandemic, including issues that need to be addressed in the aftermath of this pandemic and plans that should be implemented in the event of a future health crisis. Input must be solicited from all relevant stakeholders.
Funds to Increase the State's Supply of Personal Protective Equipment and other supplies to Respond to COVID-19
$50,000,000 to the entities listed below to be used 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, as follows:
- Fifty percent (50%) to the North Carolina Healthcare Foundation, a nonprofit corporation.
- Fifteen percent (15%) to the North Carolina Senior Living Association, a nonprofit corporation, and the North Carolina Health Care Facilities Association, a nonprofit corporation, in equal amounts.
- Ten percent (10%) to the North Carolina Medical Society to allocate to independent medical practices in this State.
- Twenty-five percent (25%) to the Department of Public Safety, Division of Emergency Management, to be allocated to meet the needs of the State Highway Patrol and North Carolina National Guard, and the remaining balance to be allocated among entities the Division deems essential to the State's response to COVID-19.
Health Care Liability Protection for Emergency or Disaster Treatment
Provides health care facilities and providers immunity from civil or criminal liability for acts and omissions in the course of arranging health care services if all of the following apply:
- The services are provided pursuant to a COVID-19 emergency.
- The health care services are impacted by:
- a provider or facility's decisions in response to the COVID-19 epidemic, or
- by the decisions or activities, in response to or as a result of the COVID 19 epidemic, of a health care facility or entity where a health care provider provides health care services.
- The health care facility or provider is arranging the services in good faith.
Immunity would not apply if the damages were caused by willful or intentional misconduct, gross negligence, reckless misconduct, or intentional infliction of harm on the part of the health care facility or provider. Volunteer organizations would be immune from liability for damages that occur at their facility unless the volunteer organization unless there was willful or intentional misconduct, gross negligence, reckless misconduct, or intentional infliction of harm on the part of the volunteer organization. This section would become effective when it becomes law and would apply to acts or omissions occurring during the time of Executive Order No. 116 and any subsequent time period during which a state of emergency is declared to be in effect during calendar year 2020.
Disabled Adult Child Passalong Eligibility/Medicaid
Eliminates the requirement that an individual must have received a Supplemental Security Income (SSI) payment to qualify for the Disabled Adult Child passalong in the Medicaid program, no later than June 1, 2020.
Modification of Facility Inspections and Training to Address Infection Control Measures for COVID-19
Instructs the Department of Health and Human Services, Division of Health Service Regulation (DHSR), and local departments of social services to suspend all annual inspections, regular monitoring requirements, and adopted rules for licensed facilities for persons with disabilities or substance use disorders, and for adult care homes. Annual inspections, regular monitoring requirements, or adopted rules deemed necessary by DHSR to avoid serious injury or death, or as directed by CMS, would not be suspended.
Requires DHSR to review the compliance history of facilities found 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 CDC guidelines regarding infection control or the proper use of personal protective equipment. Employees of these facilities must undergo immediate training, permissible by video conference, about infection control and the proper use of personal protective equipment.
Becomes effective when it becomes law and expire 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
Authorize State Agencies to Exercise Regulatory Flexibility During COVID-19 Emergency
If a State agency determines that, due to the impacts of the coronavirus, it is in the public interest, including the public health, safety, and welfare and the economic well-being of the citizens and businesses of the State, the agency shall:
- Delay the collection, or modify the method of collection, of any fees, fines, or late payments assessed by the agency under its statutes, including the accrual of interest associated with any fees, fines, or late payments.
- Delay the renewal dates of permits, licenses, and other similar certifications, registrations, and authorizations issued by the agency pursuant to its statutes.
- Delay or modify any educational or examination requirements implemented by the agency pursuant to its statutes.
No later than October 1, 2020, each State agency shall report to the Joint Legislative Administrative Procedure Oversight Committee, the Joint Legislative Commission on Governmental Operations, and the Office of State Budget and Management on its specific efforts to exercise regulatory flexibility under this section.
State agencies shall exercise the authority granted pursuant to this section to the maximum extent practicable in order to protect the economic well-being of the citizens and businesses of the State, while also continuing to protect public health, safety, and welfare.
State agencies may adopt emergency rules for the implementation of this section.
Emergency rule adopted pursuant to this section shall expire August 1, 2020. This section is effective retroactively to March 10, 2020.
Pre-Procedure COVID-19 Test Result Reporting
Requires all health care providers, as defined under G.S. 130A-476(g), to report the results, both positive and negative, of any COVID-19 diagnostic test or COVID-19 antibody test performed on an individual prior to any nonemergency surgery or procedure to the Commission for Public Health (Commission) and to the Division of Public Health. The Department of Health and Human Services shall report pre-procedure test result data on a county-by-county basis and update it daily on its Web site.
This section is effective when it becomes law.
Implement Temporary Provider Enrollment Changes Authorized Under the Medicaid 1135 Waiver Section
Specifies that certain provisions of State law pertaining to provider enrollment shall not apply to the Medicaid and Health Choice programs from March 1, 2020, through the duration of the nationwide coronavirus public health emergency, in order to implement temporary provider enrollment authorized under the recently-approved Medicaid 1135 waiver.
The provisions are as follows:
- G.S. 108C-2.1, which requires a $100 fee for provider enrollment applications and requires recredentialing every five years.
- G.S. 108C-4(a), which imposes a State requirement to conduct criminal history record checks.
- G.S. 108C-9(a) and (c), which requires providers to complete certain trainings prior to initial enrollment as a Medicaid and Health Choice provider.
Extend the NC Child Well-Being Transformational Council
Extends the termination of the Council from June 30,2020 to Aug 1, 2020.
Masks and Hoods for the Protection of Health
Adds language that allows the use of a mask for any person wearing a mask for the purpose of ensuring the physical health or safety of the wearer or others.
A person wearing a mask for the purpose of ensuring the physical health or safety of the wearer or others shall remove the mask, upon request by a law enforcement officer, in any of the following circumstances:
- During a traffic stop, including a checkpoint or roadblock pursuant to G.S. 20-16.3A.
- When a law enforcement officer has reasonable suspicion or probable cause during a criminal investigation."
This section is effective when it becomes law and expires August 1, 2020.
Temporary Waiver of 3-year Fingerprinting Requirement/Child Care Providers /Adoptions / Foster Care
Requires DHHS waive the requirement that current child care providers complete a fingerprint-based criminal history check every three years.
- Allows use of available State and federal name-based criminal background checks for prospective employees seeking employment in licensed child care shall be completed. Prospective employees will be issued a provisional qualification status. In situations where only State and federal name-based checks were completed, fingerprint-based criminal history checks shall be completed within 60 days of Executive Order No. 116 being rescinded, in compliance with State law and rules. If fingerprint-based checks are not completed within 60 days of Executive Order No. 116 being rescinded, the prospective employee will be disqualified until a fingerprint-based check is completed.
- Directs NC Division of Social Services, shall temporarily waive any requirement to complete a fingerprint-based criminal history check pertaining to adoptions, foster care, or child care institutions. However, in accordance with federal guidance, all available name-based criminal background checks for prospective foster parents, adoptive parents, legal guardians, and adults working in child care institutions shall be completed, and, in situations where only name-based checks were completed, fingerprint-based criminal history checks shall be completed within 60 days of Executive Order No. 116 being rescinded, in compliance with State law and rules.
This section is effective when it becomes law and expires 60 days after Executive Order No. 116 is rescinded, or December 31, 2020, whichever is earlier.
Increased Flexibility for DHHS By Extending Required Connectivity Timeline for the State Health Information Exchange
Extends time period for providers of Medicaid and State-funded health care services to begin submitting demographic and clinical data to the Health Information Exchange known as Healthconnex, from June 1, 2020 out to October 1, 2021.
Expanded Use of Telehealth to Conduct First and Second Involuntary Commitment Examinations
During the COVID-19 Emergency Under current law, individuals taken into custody for involuntary commitment must have a first examination conducted by a commitment examiner without unnecessary delay. There is no provision for this examination to be conducted via telehealth, except in cases where geographic distance is an issue. A second examination must be conducted within 24 hours of the first examination.
Allows the first and second examinations, respectively, to be conducted via telehealth, provided that the commitment examiner is reasonably certain that a different result would not have been reached in a face-to-face examination.
Would become effective when it becomes law and expire 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
Enhanced Behavioral Health Capacity Section
Appropriates $20 million in nonrecurring funds received from the Coronavirus Relief Fund to DHHS to support behavioral health and crisis services to respond to COVID-19.
These funds shall be used for at least all of the following purposes:
- To divert individuals experiencing behavioral health emergencies from emergency departments.
- To allocate $12,600,000 to be distributed as a one-time payment to each local management funding assistance for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) services on a per diem basis.
- To allocate $400,000 in nonrecurring funds to the Department of Health and Human Services, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, for the purchase of units of opioid antagonist to be distributed free of charge to opioid treatment programs operating in this State for the purpose of preventing the overburdening of the State's health care system, hospital emergency departments, and intensive care units with patients addicted to opioids or experiencing opioid overdose during the COVID-19 emergency, and to mitigate the loss of life associated with opioid overdose in this State during the COVID-19 emergency.
Rural and Underserved Communities
$50,000,000 to the Department of Health and Human Services to provide funds for rural and underserved communities especially hard hit by the COVID-19 pandemic. The emergency flexible funds allocated in this subdivision shall support health provider grants, targeted Medicaid assistance for rural hardship grants to nonhospital providers, enhanced Telehealth services, transportation for critical services, health care security for the uninsured, the Office of Minority Health, and related items.
DHHS Flexible Funds
Appropriates $20,000,000 to DHHS to provide flexible funds to support local health departments, rural health providers, the State Laboratory of Public Health, and behavioral health and crisis services. Allowable uses of these funds include, but are not limited to, increasing nursing capacity, increasing the number of community health workers, expanding telehealth services, providing infection control support and training in nursing homes and adult care homes, and diverting behavioral health emergencies from emergency departments.
Funding for Various Responses Related to Food, Safety, Shelter, and Child Care Section
Appropriates $19 million
to DHHS to provide funding for food banks, support for residential settings that are incurring additional costs to mitigate spread or isolate positive cases (Special Assistance), adult and child protective services response, support for homeless and domestic violence shelters and housing security (prevention, diversion, and rapid re-housing), child care response, costs to expand NCCARE360, a Statewide coordinated care network that will connect individuals impacted by COVID-19 to local services such as food, housing, child care and other resources, and technology modifications to support COVID-19 emergency relief to beneficiaries.
$2,500,000 of these funds are allocated to Reinvestment Partners, a nonprofit organization, for its Produce Prescription Program, which provides a monthly forty dollar ($40.00) per household benefit for each eligible Food and Nutrition Services recipient enrolled by the recipient's health care provider, to serve individuals impacted by the COVID-19 emergency. Individuals receiving assistance pursuant to this subdivision are limited to three months of food assistance.
Funds for Testing, Contact Tracing, and Trends Tracking Analysis
Appropriates $25 million to DHHS to expand public and private COVID-19 testing, contact tracing, and trends tracking and analysis including
- building capacity for widespread COVID-19 diagnostic testing to enable rapid case-based interventions;
- building capacity for antibody testing to enable rapid deployment when such testing becomes available;
- expanding contact tracing workforce and infrastructure to routinely identify potentially exposed persons and take appropriate public health actions;
- increasing research and data tools and analysis infrastructure to support better predictive models, surveillance and response strategies.
Prescription Assistance
Allocates $1.5M to DHHS to provide a grant to NC MedAssist to offset increased costs for prescription assistance for indigent or uninsured individuals for the COVID-19 emergency.
Prescription Identification Requirements
Allows pharmacists to use the visual inspection of any government-issued photo I.D. to identify patients picking up prescriptions. Pharmacists would also be permitted to identify known customers by examining existing records. They would be required to review a patient's history on the controlled substances reporting system before filling an initial prescription for a Schedule II controlled substance. This expires 60 days after Executive Order 116 is rescinded or December 31, 2020, whichever is earlier.
Provide Medicaid Coverage for Covid-19 Testing to Uninsured Individuals in NC during Nationwide Public Health Emergency
Authorizes DHHS to provide Medicaid coverage of COVID-19 testing for certain uninsured individuals during the period in which there is a declared nationwide public health emergency as a result of the 2019 novel coronavirus, and for which the federal medical assistance percentage is one hundred percent (100%). DHB is authorized to provide this medical assistance retroactively to the earliest date allowable.
Medicaid Provider Rate Increases
Requires DHHS to provide a 5% increase in the Medicaid fee-for-service rates paid to all provider types by the Division of Health Benefits. The rate increase will be effective March 1, 2020, through the duration of the nationwide coronavirus public health emergency.
Supplemental Payments for Foster Care Section
Appropriates $2,250,000 in nonrecurring funds received from the Coronavirus Relief Fund to the Department of Health and Human Services, Division of Social Services, to be used for monthly $100 supplement payments for each child receiving foster care assistance payments for the months of April, May, and June 2020.
Links Program
Appropriates $290,000 to DHHS, Division of Social Services, to provide funds for the LINKS program, a foster care support program for youth ages 13-21 years. These funds shall be used to support youth in the LINKS program who are not receiving foster care assistance payments and need assistance with housing or transitional costs due to COVID-19 and are allocated as follows: a. $250,000 for LINKS Transitional Living Services. b. $40,000 for LINKS Transitional Housing.
One-Time Financial Assistance for Facilities Licensed to Accept State-County Special Assistance
Appropriates $25 million to DHHS, Division of Social Services, for a one-time payment to facilities licensed to accept State-County Special Assistance (SA). Each eligible facility will receive $1,325 per resident of the facility who is a SA recipient between March 10, 2020 through July 30, 2020, to offset the costs of serving these residents during the COVID-19 emergency. If a recipient is transferred to another facility during this time frame, only the first eligible facility will receive payment. Section 6.3(c) would clarify the General Assembly does not have an obligation to appropriate funds, nor is there an entitlement by any facility or resident of a facility to receive financial assistance.
Funds for Underserved Communities and Rural Hospitals Section
Appropriates $65,000,000 to OSBM to establish the COVID-19 Rural Hospitals Relief Fund. OSBM shall allocate the monies in the fund as grants to hospitals designated as critical access hospitals by the Centers for Medicare and Medicaid Services and to hospitals located in
(i) a tier 1 county or (ii) a tier 2 county with a population of less than 150,000.
These funds shall be used to offset expenses incurred for providing patient care in North Carolina to respond to the COVID-19 pandemic. OSBM shall award grants in an amount equal to at least $350,000 for each eligible critical access hospital and in an amount equal to at least $250,000 for each eligible hospital located in a tier 1 or tier 2 county. OSBM shall use any remaining funds to increase the amount of the grants awarded to these hospitals based on a pro rata share of the 2018 hospital operating costs for these hospitals.
Funds for COVID-19 Research
COVID-19 Response Research Fund to establish the COVID-19 Response Research Fund.
Funds would be provided to the following entities to be used for (i) the rapid development of a countermeasure of neutralizing antibodies for COVID-19 that can be used as soon as possible to both prevent infection, and for those infected, treat infection, (ii) for bringing a safe and effective COVID-19 vaccine to the public as soon as possible, (iii) community testing initiatives, (iv) and other research related to COVID-19:
- $15 million to the Duke University Human Vaccine Institute (DHVI) of the Duke University School of Medicine;
- $29 million to UNC Chapel Hill;
- $15 million to the Brody School of Medicine at East Carolina University;
- $20 million to the Wake Forest School of Medicine.
- $5 million would be allocated to the Campbell University School of Osteopathic Medicine for a community and rural-focused primary care workforce response to COVID-19.
Food Banks
Appropriates $6,000,000, distributed equally, to each of the six food banks in the State.
School Nutrition Services
Appropriates $75,000,000 to the Department of Public Instruction for school nutrition services provided in response to COVID-19 by public school units participating in the National School Lunch Program or School Breakfast Program from March 16, 2020, through the end of the 2019-2020 school year. Funds for these services shall be allocated in the same manner as if the participating public school units were reimbursed by school meal receipts or federal funds.
Golden Leaf Foundation
Allocates $125,000,000 to OSBM for Golden LEAF to provide grants to entities for the purpose of making emergency loans to assist small businesses with business needs during periods of economic hardship occasioned by the COVID-19 pandemic. It is the intent of the General Assembly for an equitable portion of funds allocated in this section to be used for the benefit of historically underutilized small businesses.
Limited Business Immunity
The following entities shall have immunity from civil liability: (1) An essential business that provides goods or services in this State with respect to claims from any customer or employee for any injuries or death alleged to have been caused as a result of the customer or employee contracting COVID-19 while doing business with or while employed by the essential business. (2) An emergency response entity with respect to claims from any customer, user, or consumer for any injuries or death alleged to have been caused as a result of the COVID-19 pandemic or while doing business with the emergency response entity.
