Benchmarks Membership Webinar  September 18, 2020

 

Dave Richard, DHHS Deputy Secretary for NC Medicaid, joined Benchmarks on their Friday member webinar to discuss the progress of Medicaid Transformation. He outlined the following timelines:

HHS is still working out timelines and expectations for providers to connect to the HIE before the 2022 deadline. Legislation allows for exemptions of providers and DHHS does not want to push out behavioral health providers who cannot connect to an HIE, while standing up Tailored Plans.

 

Tailored Plans will likely be contracting with both the NC Division of Medicaid and the Division of MH/DD/SAS, similar to what they currently do as LME/MCOs. DHHS has been working to make the two divisions oversight of the LME/MCOs more seamless. Under Tailored Plans, the contract management process will be integrated which they believe will reduce any silos in the oversight.

 

DHHS is putting a lot of time and energy into addressing racial health disparities that have become even more prominent under COVID. Dave said to expect to see their effort to break down disparities and provide equity in services woven through their Medicaid Transformation work.

 

NC Medicaid plans to continue the increase in Medicaid reimbursement through December 2020. All of the increased rates they have implemented (through state plan amendments-SPAs) have been tied to the federal COVID emergency order that is set to expire Dec 30,2020. Once the order expires, the increased FMAP rates will sunset. The federal government has until Oct 22, 2020 to extend the state of emergency past December. If they chose to extend the date, the increased FMAP will continue through the remainder of the new order. However, the legislature will need to determine and approve how the additional FMAP funds will be utilized, which may or may not include the continuation of enhanced rates. Many states are currently using the enhanced FMAP rate to fill gaping budget holes and North Carolina may soon find themselves grappling with similar budget deficits.

 

Children in kindergarten through fifth grade could return to in-person learning in early October, if their school system agrees to it, under a plan Gov. Roy Cooper announced Thursday.

The move is an option for public school systems across North Carolina, not a mandate, and would be available starting Oct. 5, Cooper said. Middle- and high-school students cannot yet return to class, he said.

"Plan A [in-person classes] may not be right at this time for many school districts and for every family. Opportunities for remote learning need to be available for families who choose it, and districts will have the flexibility to select a plan based on their unique situation," he said.

All elementary school students and staff will be required to wear masks, and schools will have to follow social distancing, health screening and sanitation regulations, but there will be no restriction on the number of students in classrooms.

"We're able to open this option because most North Carolinians have doubled down on our safety and prevention efforts and stabilized our [coronavirus case] numbers. The science of lower viral spread among younger children also backs up our decision," Cooper said.

Ten coronavirus clusters have been reported in schools across North Carolina during the past month, involving 16 students and 46 staffers, said Dr. Mandy Cohen, secretary of the state Department of Health and Human Services. The number of school-age children infected with the virus has declined over the last two weeks, she said, and the trend is "particularly strong among our younger, elementary school children."

Many school districts statewide have been conducting all classes online since the new school year started last month, while others use a mix of in-person instruction at reduced capacities and remote learning.

Cohen said there are no clear differences in community spread of the virus between districts that are using a hybrid system and those that are completely online.

The decision to prohibit schools from opening at the start of the school year sparked criticism from Republican leaders, including Cooper's opponent in the upcoming election, Lt. Gov. Dan Forest, who said parents need to have the option of sending their children to school.

"It's great news today that we are a step closer to providing the option of in-person learning to families who want their children to return to school," Republican Superintendent of Public Instruction Mark Johnson said in a statement. "The option for remote learning remains in place for families who may not yet feel comfortable returning to schools. But we need to open our schools for students, teachers and parents who are ready to return."

"This announcement from Gov. Cooper is a step in the right direction, but he needs to provide all parents with the option of full-time, in-person instruction," agreed Senate President Pro Tem Phill Berger. "We continue to hear that these decisions are being made based on science. What is the science that says it's safe for fifth-graders to be in school full time, but it's not safe for sixth-graders?"

Cooper said he wants to reopen all schools as soon as possible, but safety comes first. In the meantime, he said, he wants districts to have options.

The North Carolina Association of Educators was skeptical of the move to reopen elementary schools, however, expressing fears for the health of teachers.

"Local school districts already have significant flexibility to open for in-person instruction, and loosening guidelines further is flirting with danger," NCAE President Tamika Walker Kelly said in a statement. "Maintaining a minimum 6-foot social distance at all times is a critical safety measure for both educators and students, and we will not recommend for any educator to enter a non-distancing classroom without a properly fitted N-95 mask to protect their health and the health of everyone around them."

Some districts, including those in Wake and Johnston counties, are looking to start bringing students into school, while Cumberland County officials decided Thursday to remain online-only for the rest of the semester.

 

Most North Carolina parents will receive checks for $335 from the state this fall, meant to help offset costs from their children's virtual learning during the coronavirus pandemic. Each check will come with an insert from the state controller, explaining that the grant "is intended to assist with the additional virtual schooling or child care expenses incurred due to COVID-19," according to the law. No elected officials' names will be on the insert.

The two conditions are that the taxpayer (or spouse for joint filing) reported on their state tax Form D-400 that they were a resident of North Carolina for the entire 2019 calendar year; and that they reported at least one qualifying child on that same form, according to the law. North Carolina allows a tax deduction if you also claimed the federal child tax credit, which begins to be phased out for an individual above a $200,000 modified adjusted gross income, or $400,000 for joint filing, according to the IRS. The checks will be sent automatically by Dec. 15. 

 

A bipartisan group of 50 centrist lawmakers planned Tuesday to present a $1.5 trillion proposal to prop up the coronavirus-ravaged economy, making a last-ditch attempt to broach a compromise in hopes of breaking a stalemate in stimulus talks before November's elections.

The proposal faces long odds amid partisan divisions over what should be included in such a package, and members of the group - which calls itself the House Problem Solvers Caucus - concede privately that their framework stands little chance of becoming law. But the decision to offer it up publicly reflects frustration among rank-and-file lawmakers in both parties at the failure by their leaders to agree to another round of pandemic aid and a reluctance to return home weeks before Election Day without cementing such help.

Aiming for middle ground between Republican and Democratic positions, the proposal includes measures that enjoy bipartisan support, such as reviving the popular Paycheck Protection Program for small businesses and direct checks of $1,200 or more for American taxpayers, as well as more contentious ones like new legal rights and protections for workers and their employers.

The measure would reinstate lapsed federal jobless aid at $450 per week for eight weeks, then replace up to $600 weekly in lost wages for an additional five weeks. That is more than Republicans wanted but less than the flat, $600-a-week benefit that lapsed at the end of July, which Democrats have insisted must be extended in full. And the proposal would send $500 billion to strapped state and local governments, less than the nearly $1 trillion Democrats included in their $3.4 trillion stimulus plan that passed the House in May but roughly double what the White House has signaled it could support.

In addition to money for state and local governments and for schools, lawmakers included $100 billion for testing, contact tracing and other health initiatives to try to increase the nation's testing capacity to 3 million tests a day. There is money for expanding rural and urban broadband, supporting agricultural workers and extending the 2020 census to ensure an accurate count.

The bill would allocate $25 billion for mortgage and rental assistance, $130 billion for schools and $15 billion for the Postal Service, as well as separate funds to administer the 2020 elections during a health crisis and for food assistance programs.

Forty minutes to the east of uptown Charlotte, in rural Stanly County, you might think that COVID-19 poses relatively little threat. In fact, the death rate from the coronavirus is almost three times higher in Stanly than in the much more densely populated county of Mecklenburg. What's happening in Stanly County illustrates a broader problem: In North Carolina's rural counties, people are dying from COVID-19 in greater overall numbers - and at higher rates - than in the state's urban and suburban counties.

A recent study by the UNC Highway Safety Research Center came to that conclusion. So did a Charlotte Observer analysis, which looked at more up-to-date COVID-19 data. In the state's 80 rural counties - as those are defined by the N.C. Rural Center - about 33 of every 100,000 residents had died from COVID-19 as of Sept. 9, the Observer found. In suburban and urban counties, the rates per 100,000 are 26 and 24 respectively. "I hope people don't assume this is just an urban problem," state epidemiologist Zack Moore told the Observer. " ... This is something affecting all parts of the state. And rural areas are in no way immune to this problem."

Many in those areas work in food processing plants, where crowded working conditions have contributed to the virus's spread. Others live or work in cramped prisons that suffered outbreaks. Still, others reside in nursing homes where the virus jumped from bed to bed. But researchers and infectious disease experts also point to more systemic problems: Those who live in rural counties tend to be older, poorer and sicker than those in the suburbs and cities. They tend to have less access to health care. And they are less likely to have the sorts of office jobs - and internet connectivity - that allow them to work from home.

In North Carolina, as in many other states, COVID-19 got its first foothold in cities, where the population density helped the virus spread. Few wore masks in rural areas in the pandemic's early days, said Patrick Woodie, president of the N.C. Rural Center. "I think they felt safer," Woodie said. "I think they felt this was going to be a big-city problem." While COVID-19 was slow to strike rural counties, it later "showed up with a vengeance," Woodie said.

The virus gradually began to take hold In places like Columbus County, on the state's southeastern border, where many residents live in poverty and suffer from chronic health problems.

Nonetheless, county health director Kim Smith said large groups - particularly extended families - continued to gather without wearing masks. In May, 29 people in the county gathered for a birthday party, she said. Later, she said, 25 of them caught COVID-19. Two of them died. They are among the more than 50 people in Columbus County who have died from the coronavirus so far. Today, the death rate from COVID-19 is more than four times higher in Columbus County than in Wake County, the large urban county to the north where about 20 of every 100,000 residents have died from the virus.

 

North Carolina is getting a big boost to help its fight against the opioid epidemic. The state has been awarded a multimillion-dollar federal grant to provide treatment and recovery services. The North Carolina Department of Health and Human Services has been awarded a $35 million State Opioid Response (SOR) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). State officials say these funds are especially vital as the COVID-19 pandemic has made it more difficult for some individuals to access treatment for substance use disorder, prompting a spike in opioid overdoses.

In North Carolina, there's been a 21 percent increase in emergency department visits relating to opioid overdoses from the prior year, even as overall emergency department visits have declined. NCDHHS says it will provide treatment, recovery, and prevention services to at least 3,300 additional individuals in the first year. It will also go toward funding continuing care for those who have been receiving services under existing opioid response grants.

Secretary Mandy Cohen says the federal funding will help save lives, but she's calling on lawmakers to meet the need by expanding Medicaid.

 

The N.C. Coastal Resources Commission is looking to tweak its rules for wheelchair-accessible beach mats after outcry over orders to remove one at Carolina Beach. The commission voted last week to move forward with amendments to beach mat rules, which will require a public hearing process before a final decision. They would allow only local, state or federal government agencies to install the mats, which would need to be six feet wide and end at a point described as "no more than six feet seaward of the waterward toe of the frontal or primary dune."

"The state recognizes that this is a challenging situation at Carolina Beach given the parallel and important goals of enhancing handicap access, managing development on a public beach, and protecting threatened and endangered species," commission spokeswoman Christy Simmons said in an email. According to the Port City Daily, the Division of Coastal Management ordered Carolina Beach's mat to be removed by Sept. 8. The nonprofit Ocean Cure owns the mat, which likely doesn't meet the six-foot width requirement. For several years, it has allowed wheelchair users to have easy access to the beach, and the town estimates it's boosted tourism by about $1 million.

The state's coastal regulations aren't the only hurdle the beach mat faces. According to Simmons, "division staff also advised Ocean Cure and the town to work directly with the U.S. Fish and Wildlife Service to address concerns related to sea turtles, as interactions with sea turtles are regulated under the federal Endangered Species Act and do not directly lie within the state's jurisdiction."

 

David Ford, WFDD RADIO, 9/14/20

With just over two weeks left to go for the 2020 Census, the Census Bureau is intensifying its efforts as North Carolina's response rate continues to lag behind. For now, people can still fill out the form online, but with just 83% of North Carolina households counted - roughly 10% behind the national average - new methods are being employed. 

For the first time ever, the U.S. Census Bureau is calling households by phone in hard-to-reach areas due to the pandemic. Spokesperson Virginia Hyer says there's an easy way to assess if the call is legitimate. "We will never ask financial information," says Hyer. "We will never ask your full social security number. And we will never ask anything related to a political party. So, you can confirm that a census taker is calling you because they're only going to be asking you very basic demographic questions." 

 

When the U.S. Centers for Disease Control and Prevention issued a nationwide order halting residential evictions for millions of renters, Pisgah Legal Services called the news "a welcome step forward" but cautioned that it will not completely solve the eviction crisis. Jim Barrett, executive director for the nonprofit - which provides free, civil legal aid in Western North Carolina - told the Citizen-Times renters still can be evicted for reasons other than lack of payment and that the CDC's measure could lead to confusion and more problems down the road. "I hope this so-called moratorium buys some time, but if you think about it, it expires the end of December," he said. "When would you rather not be evicted?"

The moratorium went into effect Sept. 4 and will run through Dec. 31. It applies to individuals earning less than $99,000 a year and couples making less than $198,000 who are unable to make rent or housing payments due to the coronavirus pandemic. Tenants also must be unable to get rental assistance and show that they would experience homelessness if they were evicted.

Barrett said there are some positive aspects to the eviction moratorium put in place by the CDC. For one thing, the measure could provide a stopgap to families who will receive relief funds in the future and just need a few more months of leniency to get by. "It's good because it calls attention to the eviction crisis that's upon us," Barrett added, "and it's good because it points out that millions of renters need rental assistance and they don't have it yet because the relief bill money is so slow getting disbursed out through the states and through local communities." But Barrett stressed that the moratorium doesn't make the cost of rent go away. It simply pushes it back to the end of the year, when tenants will be expected to pay up on the sums they've missed. 

 

PHILADELPHIA - The behaviors started a few days after COVID-19 closed schools indefinitely in March: Eleven-year-old Ronan Strouse would bite one arm, issue frequent short, high-pitched yells, bang his leg hard.

Ronan, who has intellectual disability, autism and other complicated conditions, can't carry on a conversation, but he had words enough to ask his mother: "School sick?" "Yes," Celine Nace would tell her son. "School is sick."

As a fifth grader in the Upper Perkiomen School District, Ronan was supposed to have virtual lessons with his teacher, and a host of services such as occupational and speech therapy on the computer, too. But that didn't work for more than perhaps 10 minutes a week; Ronan would refuse to sit, walk away, unable to grasp or tolerate what he was supposed to do. The problems continued this summer, when he had online-only services as mandated by his special education plan.

"He got nothing out of it," Nace said. "He's not being educated."

Come next week, school starts again, and Ronan will have three hours of in-person instruction at Upper Perkiomen Middle School four days a week. He's supposed to spend every afternoon online. That's untenable, his mother said - and she's worried he'll never catch up.

For nearly seven million children nationwide with significant special needs, COVID-19 has been particularly disruptive; the patchwork of all-virtual or hybrid learning plans now offered by schools and districts is inadequate to meet their needs and could bring negative long-term consequences, parents and advocates say. Lawsuits - including a class-action claim that Ronan's family has joined - allege schools that are not operating in person or offering compensatory services are illegally denying children the services spelled out in their federally mandated, individualized special education plans.

 

Schools very much want to meet students' needs, even ones that are complex and costly, said Francisco Negrón, chief legal officer for the National School Boards Association. But the pandemic "has presented quite a challenge for school districts, in particular because depending on the severity of a particular disability, there may be interventions that are difficult to address in a socially distant environment," he said.

 

If a student must work toward learning how to hold a pencil, for instance, there's no way to do that other than having a staffer put their hand on the child's hand. Educators and therapists are finding alternative ways to help students, but there are challenges, said Negrón. And, frankly, districts are quite concerned about "a potential rise in demands from parents who don't understand the challenges."

 

At the federal level, the School Boards Association and others are asking Education Secretary Betsy DeVos and Congress for some flexibility in special education requirements during the pandemic, relief that so far has not come. Many districts say they hope to bring special education students back to school or increase their hours in school as soon as health conditions and other considerations allow, but families like Ronan's say needy students like him cannot wait.

 

Nace works full time and won't be able to manage his schoolwork and the constant redirection Ronan will need during the day. Her family is "white-knuckling it" now to get through the days; she's not sure how they'll manage when school begins. "I don't want my son to get sick or his teachers to get sick, but this is our societal agreement," said Nace. "I'm not asking for the sun, the moon and the stars. I'm just asking for what my kid needs."

 

Ronan's is one of 500 families across the country who have signed onto a federal class-action lawsuit filed in New York in July; the number grows daily, said Patrick Donahue, the lawyer who filed the action, which seeks to either force schools to reopen or offer parents vouchers to obtain the services their children need, plus compensatory education and punitive damages for missed months of education.

 

"There's no pandemic pass," said Donahue, who also runs a private school for students with special needs. His school sent workers to offer in-person services in students' homes when the coronavirus first shut schools; it fully reopened in May. "These are the most vulnerable of our population, and most schools have abandoned these families."

 

The N.C. Department of Health and Human Services on Tuesday announced its selection of an additional vendor, Optum Serve, to continue surging COVID-19 testing capacity in the state. These new community testing sites build on North Carolina's ongoing work to increase access to testing and slow viral spread in key locations, including the previously-announced surge of additional testing capacity in seven counties. 

Optum Serve will join two previously selected vendors, the North Carolina Community Health Center Association and StarMed Urgent and Family Care P.A., in standing up turnkey testing sites - including clinical and administrative staff, tents, marketing materials, specimen collection supplies, registration and interpreter or translation services - and will leverage commercial-laboratory capacity to provide testing results. As with all NCDHHS-supported testing sites, there will be no co-pays or cost-sharing for anyone seeking testing, including North Carolinians who are uninsured.

In total, the three testing vendors currently have 230 sites planned across 80 counties during September and October. Optum Serve will initially support testing sites located in 28 counties: Alamance, Beaufort, Bertie, Bladen, Burke, Chowan, Clay, Cumberland, Davie, Durham, Edgecombe, Gaston, Greene, Halifax, Hertford, Hoke, Johnston, Jones, Martin, McDowell, Montgomery, Orange, Pamlico, Robeson, Scotland, Stanly, Surry and Yadkin counties.

 

Health officials with the North Carolina Department of Health and Human Services are urging North Carolina residents to protect themselves, their families and those around them by getting vaccinated against Influenza as the state enters flu season amid the COVID-19 pandemic. "This year, with COVID-19 still spreading in our communities, it's critically important to get your flu vaccine," said NCDHHS Secretary Dr. Mandy Cohen. "Flu can be a serious, sometimes deadly, disease. It is important to get vaccinated against the flu to keep you and your family healthy."

The Centers for Disease Control and Prevention recommends vaccination against the flu for everyone six months and older with any licensed, age-appropriate flu vaccine. Vaccination against the flu can make illness milder and reduce the risk of more serious outcomes, making it especially important for those at higher risk of complications, such as people over 65, children younger than 5, pregnant women and those with certain medical conditions such as asthma, diabetes, heart disease or obesity. Some of those same groups are also at high risk of complications from COVID-19.