NC Cases: 56,393
NC Cases Hospitalized: 878
NC Deaths: 1,317
Phase Two Continuation
Gov. Roy Cooper announced Wednesday the state will remain in Phase Two for another three weeks and made face coverings mandatory in public. The mask requirement takes effect Friday at 5 p.m. Exceptions to the mask requirement apply to children under 11, those with certain medical conditions and people exercising outdoors away from other people. The moves come as the state continues to fail at hitting key benchmarks in its effort to slow the spread and serious cases of COVID-19.
"We're adding this new requirement because we don't want to go backward," Cooper said. "We want to stabilize our numbers so we can continue to safely ease restrictions, and most importantly, get our children back in school."
On Wednesday, the state reached its second-highest reported daily number of patients hospitalized at 906. The single-day high of 915 was established Tuesday. To further relax social restrictions, state health officials want to see either a downward trend, or in some cases a sustained leveling in the daily trends in the number of lab-confirmed cases, hospitalizations, percent of positive tests and people presenting in emergency departments with COVID-like symptoms. Dr. Mandy Cohen, secretary of the state's Department of Health and Human Services, showed data during a Wednesday news conference that shows that is not happening. "These concerning trends tell us that if left unchecked the virus will continue to spread," Cohen said.
In addition to the rising number of hospitalizations, the number of newly reported lab-confirmed cases was 1,721 on Wednesday. That's the second-highest daily total DHHS has reported since the pandemic began. DHHS reported the percent of tests positive was 8% in its latest update on Wednesday. That's down from a high of 10% last Saturday.
Keeping North Carolina in Phase Two for at least three more weeks means the state's bar industry and gyms will remain closed and gatherings limited to 25 people or less.
Bill that Allows Masks to be Legal in Public Beyond Aug 1, 2020 Shut Down
A 2 a.m. vote Friday in the North Carolina Senate has some politicians questioning if it is going to be illegal for people to wear face masks in public, starting in a little more than a month.
Legislation was passed at the beginning of the pandemic to make it legal to wear masks in public through Aug 1, 2020. This legislation was in response to a law that was passed in the 1960's that made masks in public illegal and was apparently tied to curbing KKK activity.
A provision in one of the bills before the legislature would have extended the legality of wearing a mask in public through Feb 2021. However, when the bill came up for a final vote, that passage was no longer included. "We purposefully took out a provision that would have made it legal, and that just seems wrong to me in the middle of a pandemic," Democratic Sen. Natasha Marcus of Mecklenburg County said.
The early-morning vote in the Senate came on the same day that Democratic Gov. Roy Cooper's statewide order making mask-wearing mandatory in public was set to go into effect. Republican Senate leader Phil Berger has strongly criticized that order, which will begin at 5 p.m. Friday.
COVID-19 Surge
NC WATCHDOG REPORTING NETWORK, 6/25/20
Leaders at health systems around the state say a combination of better medical care and larger stockpiles of protective gear means they can handle surges in COVID-19 patients more effectively today than they could three months ago. But those same leaders warn that the additional capacity still has a limit, and they worry for the health of North Carolina residents if current trends continue. "We're in a much better place than we were when we began this," said Dr. West Paul, chief clinical officer at New Hanover Regional Medical Center in Wilmington. "That being said, if you look at our hospitalizations, they continue to go up." A hospital's ability to accommodate growing numbers of patients is about more than how many beds it has, Paul said: It's about "staff, stuff and space."
A survey of hospital systems across the state by a network of reporters shows that while capacity is holding steady now, health care leaders are preparing to handle any influx of patients. However, hospital leaders expect that influx to be more manageable as health care systems have worked together to increase patient capacity and shared access to personal protective equipment, which, three months ago was hard to get. Reporting by the network shows the state doesn't track hospital staffing, but the N.C. Department of Health and Human Services says records show the state has adequate supplies of PPE, including gloves, gowns, respirators, procedure masks and face shields.
North Carolina hospitals didn't see an early surge like those in the northeast, particularly New York. As supply chains snapped back closer to normal, it allowed health systems and the state to beef up stockpiles of PPE, put new policies in place to better triage coronavirus patients and learn from treatment missteps in other areas. As a result, health leaders around the state agree they are much better prepared now than they were three months ago to face an influx of patients. "Yes, (the statewide stay at home order) bought us time. This absolutely helped. We were able to prepare. We were to put plans in place," Paul said.
However, these experts worry that they might see the original scenario become reality. "We are in a markedly different place now than we were in mid to late March," said Dr. Chris DeRienzo, WakeMed Health and Hospitals chief quality and medical staff officer. Still, he added that, "It certainly is concerning to see the slow rise in hospitalizations."
DHHS Congregate Care Guidance
This week, DHHS released two visitation guidance documents,
one for small residential facilities (6 beds or less) and another for
large residential facilities. The guidance allows both small and large agencies to make their own determination around visitation, with appropriate documentation outlining the decision-making process, and safety protocols be put in place for visitation. This places providers in a difficult situation of navigating the different perspectives of family members and clients along with guidance from local health departments and their own agency identified needs. By giving guidance that allows/opens up visitation, it places all the potential risk of the decision making on the provider agency.
This week, the legislature held a committee around the challenges facing long-term care facilities that aligned closely with what the MH/DD/SA residential providers have been facing. The director of their statewide association, Jeff Horton, testified before the committee that while hospitals have been finding it easier to loosen visitation restrictions, managers of senior living facilities still struggle with allowing outsiders to spend time with their residents.
Horton described how balancing the need to keep vulnerable residents safe and the need for family members to see loved ones is challenging. However, he expressed serious concern about maintaining the safety of clients if visitations were to resume.
COVID-19 Policy/Practice/Funding Changes
DHHS is currently reviewing all the policy changes as a result of COVID-19. On a public call this week, they noted that they are planning to keep about half of all the telehealth changes and at a quarter of all the changes put in place in response to the pandemic. Once their draft plan is complete, they will be providing it to providers to gather feedback.
Also, on the call this week, DHHS stated multiple times that none of the COVID-19 changes will be rescinded without at least a 30-day notice to providers. They recognize that providers need time to prepare and respond to the changes and they do not want to disrupt or stress the system any more than has already taken place.
Medicaid COVID-19 Federal Relief Funds
North Carolina providers that participate in Medicaid may be eligible to receive federal relief as a result of lost revenue or new expenses relating to the COVID-19 Public Health Emergency. On June 8, 2020, the United States Department of Health and Human Services (HHS) announced a targeted distribution for Medicaid providers that have not yet received payment from the Provider Relief Fund. Eligible providers will receive at least 2 percent of reported annual gross revenue from patient care. Providers can apply by
July 20, 2020 to receive payments. For more information, please see
SPECIAL BULLETIN COVID-19 #101: Medicaid Providers May Be Eligible for Federal Funding.
Updates have been made to
Key Federal Funding Available for Health Care Providers and Hospitals to include Provider Relief Fund allocations for Medicaid and CHIP providers, safety net hospitals, Indian Health Services, and COVID-19 High Impact Areas, and reflect updates to the COVID-19 Telehealth Program and Small Business Administration Paycheck Protection Program.
FFPSA
Work by NC DSS continues in preparation for implementation of FFPSA in the fall of 2021. Two committees have put forward draft documents needed to move forward with developing NC's state plan.
Candidacy Population Selection Update
The Candidacy Ad Hoc Working Group completed its review of the top contributing factors placing children at risk of foster care entry and made recommendations on candidacy sub-populations previously. Currently, NC DSS is finalizing data collection and collation efforts. This information will inform our undertaking of a fiscal analysis, to determine the impact of the candidacy population considerations and the recommendations related to proposed evidence-based interventions, in order to make informed decisions about inclusion and/or sequencing of the sub-populations in the Prevention Plan.
Evidence-Based Intervention Selection Update
The Evidence-Based Practices (EBP) Ad Hoc working group completed its review of possible interventions for reducing foster care entry for children in North Carolina and made recommendations in June 2020. The draft proposed recommendations were shared during the last LAT meeting. Since that time, NC DSS, at the recommendation of counties, is also exploring the addition of Support Coaching in the Prevention Plan and is considering the Children's Bureau requirement of a systematic review, to determine the evidence level needed and appropriateness of the model, for IV-E funding.
NC DSS has also been working to create new capacity within NC DSS by developing an organizational and project management model to build internal capacity towards support of FFPSA planning and implementation. Over the last six months, new leadership has been added at NC DHHS / DSS, including the addition of a total of four (4) Section Chiefs for Safety and Prevention Services, County Operations, Licensing and Regulatory, and Permanency Planning, allowing for programmatic alignment and coordination. Six Workstreams are now in place, along with identified respective workplans, and a process for progress reporting to a Steering Committee comprised of executive leadership.
Adjournment Plans
Colin Campbell, THE INSIDER, 6/26/20
Despite Senate leader Phil Berger's stated desire for a sine die adjournment this week, the legislature didn't end up dropping the ceremonial handkerchief late Thursday night or early Friday morning. Now the plan is to hold skeletal sessions until July 11 while awaiting Gov. Roy Cooper's action on pending bills, then take a full break from then until Wednesday, Sept. 2. A voting session might be held before July 11 to take care of veto overrides or other pressing matters, Senate leader Phil Berger said. The adjournment resolution limits the activity in the September session to COVID-19 funding issues, appointments and veto overrides.
House Rules Chairman David Lewis, R-Harnett, said he hopes the schedule will make legislating more of a part-time job. "I tried to get the short title (of the adjournment resolution) to be 'let my people go,'" Lewis joked at 2:30 a.m. But House Democratic Leader Darren Jackson, D-Wake, voiced concerns that the resolution would still allow legislative action in the coming weeks. "We came into this session having done such good work on the COVID committees, and I don't know how we lost that," he said.
Legislative Highlights
Bills signed by the Governor
Senate Bill 562 - The Second Chance Act. This bill makes various revision to the expunction laws of the state.
Bill that passed House and Senate and awaiting Governor signature
House Bill 918 - Expedite Permanency/DHHS Report SNAP/TANF. The intent of this bill is to move children, who are born with illegal substances in their system as a result of a mother using illegal substances, to permanency more quickly. The changes this bill seeks to drive permanency is controversial:
- Amends the definition of "non-relative kin" to include a presumption that a foster parent with whom a juvenile under 3 years of age has lived for at least nine months is non-relative kin and adds a definition for "relative" to include an individual directly related to the juvenile.
- Clarifies that the term "abused juvenile" includes minors whose parents expose them to illegal drugs while in-utero.
- Adds to the criteria for non-secure custody a condition providing if a juvenile is an infant who: 1) was born drug-exposed and the drug exposure was not medically based; 2) the parent is unable to discharge parental responsibilities due to a history of chronic drug abuse, and 3) there are reasonable grounds to believe that the parent's substance abuse will continue for a prolonged or indeterminate period based on the opinion of a licensed health care provider with substance abuse disorders experience, then the court will issue an order for non-secure custody.
- Adds the requirement that once a child under age 3 has lived with a foster parent for at least nine months, the foster parent is deemed to be non-relative kin.
Senate Bill 808 - Medicaid Funding Act. This funds the cost for Medicaid Transformation along with money to:
- relocate DHHS from the Dorothea Dix Campus
- pay for the child welfare case management component for NC DSS
- pay for needed funds within the Division of Medicaid for Medicaid rebase
- pay for MH/DD/SA funds
- funding for early childhood services
- funding for contact tracing and testing
The bill requires that Medicaid Transformation begin its rollout July 1, 2021 but the penalties included in the bill of $4 million per PHP, per month for each month of implementation delay was removed from the bill.
House Bill 612 - DSS Review of Procedures/Criminal History/OAH. This bill requires the social services commission of NC DSS to review policies, guidelines and other interpretive statements (usually disseminated through the "Dear County Director Letters") and submit a report to the Office of Administrative Hearings to identify any that meet the requirements of "rule" and must go through the rule making process with the Rules Commission. Any interim rule authorized by this section shall become void July 1, 2022, if the Commission has failed to adopt that interim rule as a permanent rule by that date.
Senate Bill 681 - Agency Policy Directives (Crock Pot Bill - throw in everything left in the fridge that you need to cook)
This bill included language that directed: LME/MCOs shall use an out-of-network agreement in lieu of a comprehensive provider contract when all of the following conditions are met:
(1) The services requested are medically necessary and cannot be provided by a provider in the LME/MCO's closed provider network.
(2) The behavioral health or IDD services provider's site of service delivery is located outside of the geographical catchment area of the LME/MCO, and either
(i) the LME/MCO is not accepting applications for membership into its closed provider network or
(ii) the provider does not wish to apply for membership in the LME/MCO's closed provider network.
(3) The behavioral health or IDD services provider is not excluded from participation in the Medicaid program, the NC Health Choice program, or any other State or federal health care program.
(4) The behavioral health or IDD provider is serving no more than two enrollees of the LME/MCO.
An LME/MCO shall not restrict its number of out-of-network agreements to provide inpatient hospitalization services unless the services could be provided by a provider in the LME/MCO's closed provider network and the out-of-network provider is 4 unwilling to enter into a network agreement with the LME/MCO.
An LME/MCO shall not restrict its number of out-of-network agreements for other behavioral health and IDD services to foster children and "independent foster care adolescents," ages 18, 19, and 20 if the person is already receiving such services from such provider, though the services could be provided by a provider in the LME/MCO's closed provider network.
Any provider enrolled in the North Carolina Medicaid program that provides services pursuant to an out-of-network agreement shall be considered a network provider for purposes of Chapter 108D of the General Statutes only as it relates to enrollee grievances and appeals for those services.
Includes a section that aligns the developmental disability definition with the federal law definition.
Another section allows a co-payment schedule for MH/DD/SA services. Requires DHHS to adopt rules for the implementation of a co-payment graduated schedule MH/DD/SA services based on the Medicaid co-payments for such services, which shall be used by LMEs and by contractual provider agencies. The co-payment graduated schedule shall be developed to adopted under this subdivision shall require a co-payment for services identified by the Secretary. Families whose family income is three hundred percent (300%) or greater of the federal poverty level are eligible for services with the applicable co-payment."
Bills that Didn't Pass
Senate Bill 730 - No Patient Left Alone Act. Provides patient visitation rights that will not be impacted during declared disasters and emergencies.
House Bill 1048/S708 - CPS Intake Screening/PED Recommendations. Requires DHHS to make policy changes as a means to improve the consistency of child protective services intake screening process.
A controversial amendment was added to the bill that allows legislator to request confidential DSS information and records. The amendment passed and is moving forward. Amendment below:
(b2) Except where prohibited by federal law and notwithstanding other applicable State law, a member of the North Carolina General Assembly may request access to confidential social services information and records from the Department or from a local department of social services when necessary for oversight of programs related to child protective services or adult protective services. Upon receiving a request from a member of the North Carolina General Assembly pursuant to this subsection, the Department or a local department of social services shall disclose confidential information and records concerning adult protective services and child protective services cases to the requesting member. A member of the North Carolina General Assembly may not retain copies of any part of the record, and all information shared pursuant to this subsection shall be withheld from public inspection and maintained in a confidential manner.
