|
|
| Benchmarks' Member Webinar: July 10, 2020 |
NC Cases: 79,349
NC Cases Hospitalized: 1,034
NC Deaths: 1,461
COVID-19 Hospitalizations
COVID-19 hospitalizations in North Carolina set a new record, rising to 1,034. Coronavirus hospitalizations have not dipped below 900 patients since June 29. Although some states where coronavirus cases are surging are facing shortages of hospital beds, North Carolina hospitals still have space available. Seventy-nine percent of North Carolina's inpatient hospital beds are being used, as are 80% of ICU beds.
DHHS said that 10% of tests completed Monday were positive. Positive percentages have remained in the 8% to 10% range. Cohen has said that number needs should be closer to 5%. Since the first case was reported in March, the state has counted 79,349 coronavirus cases.
Gov. Roy Cooper on Thursday said he will announce a plan next week for reopening North Carolina schools and details about Phase Three of the state's reopening plan. Options for reopening schools include returning full time, remote instruction only or a mix of in-person and online. The governor was set to announce the statewide plan last week but said July 1 he was not ready to do so.
Cooper said when the state makes an announcement about schools next week, that announcement will include information on face coverings in schools. Cooper also emphasized the plan announced could be a combination of in-person and remote learning.
"We're going to have a culmination of all this work that has gone on among teachers, superintendents and health officials," Cooper said. "It's going to be something that follows the law, and it's going to be something that gets our kids back into school safely."
Phase Three of the state's reopening plan is tentatively set to start July 17. However, Cooper has not decided if that will happen. The coronavirus continues to spread in North Carolina and though it isn't a "surging hot spot" like other areas, Cooper said, it could become one.
North Carolina has been in Phase Two of reopening since May 22. It was originally set to move into Phase Three on June 26 but on June 24 Cooper
extended the second phase
for at least three more weeks, keeping some businesses in the state closed and continuing to limit gatherings to 10 people indoors and 25 outdoors.
NC COVID-19 Testing Authorized Without Physician Referral
Who Should Get Tested?
North Carolina is focused on rapidly
increasing testing
of people who may not currently have symptoms, but may have been exposed to COVID-19. NCDHHS released
updated guidance
for doctors and clinicians on who should be tested for COVID-19.
This includes:
- Anyone with symptoms suggestive of COVID-19.
- Close contacts of known positive cases, regardless of symptoms.
- Groups of some of the populations with higher risk of exposure or a higher risk of severe disease if they become infected. People in these groups should get tested if they believe they may have been exposed to COVID-19, whether or not they have symptoms.
- People who live in or have regular contact with high-risk settings (e.g., long-term care facility, homeless shelter, correctional facility, migrant farmworker camp).
- People from historically marginalized populations who have been disproportionately impacted by COVID-19. This fact sheet provides best practices for community testing in historically marginalized populations.
- Frontline and essential workers (grocery store clerks, gas station attendants, child care workers, construction sites, processing plants, etc.)
- Health care workers or first responders.
- People who are at higher risk of severe illness.
- People who have attended protests, rallies, or other mass gatherings could have been exposed to someone with COVID-19 or could have exposed others.
Most people who get COVID-19 recover without needing medical care. If you are experiencing severe, life threating symptoms (for example, severe difficulty breathing, altered thinking, blue lips), seek immediate medical care or call 9-1-1.
Two kinds of tests are available for COVID-19: viral tests and antibody tests. A viral test tells someone if they currently have COVID-19. It is also called a diagnostic test. An antibody test tells someone if they had the virus before.
Free Testing Sites Across NC
The NC Department of Health and Human Services
announced a new effort
to deploy up to 300 free testing sites in underserved communities. This targeted testing initiative seeks to confront historical health disparities by increasing access to no-cost COVID-19 testing for African American, Latinx/Hispanic and American Indian communities across the state.
A disproportionately high percentage of North Carolina's confirmed cases of COVID-19 have occurred among historically marginalized populations. Mounting evidence shows the members of these populations experience higher rates of COVID-19 mortality and serious complications.
As many as 300 temporary testing sites will be deployed throughout the month of July, including drive-thru and walk-up sites. The initiative will increase testing capacity in more than 100 ZIP codes, providing testing access for 2.2 million African American, Latinx/Hispanic and American Indian individuals. Two vendors have been identified to begin this work, Vidant Health and Orig3n, Inc.
The initiative emphasizes a community testing approach. The awarded vendors are required to connect individuals with medical homes and provide services with culturally and linguistically appropriate standards, working within existing trusted community partnerships; additionally, no payment from the individual will be needed for the testing. Insurance, if available, will be billed but no co-pays or cost-sharing will be asked of anyone seeking testing. Those who are uninsured will have full access to free testing at these sites.
Communities were selected based on low testing capacity and high African American, Latinx/Hispanic and/or American Indian populations. Higher concentration of elderly populations with multiple chronic conditions and higher rates of construction and seasonal farm work were also factors.
Mask Law
Colin Campbell, THE INSIDER, 7/09/20
Masks would remain legal for public health purposes indefinitely under legislation headed to Gov. Roy Cooper's desk. An exception to a 1950s, Ku Klux Klan-related mask law is set to expire in August, and if the state reverted to the earlier law, mask wearers might need to claim another exception to the ban on face masks in law, such as participation in a masquerade ball or theatrical production.
"We all don't know how long the virus will last, but we don't want our citizens to worry about getting ticketed for wearing a face covering," said Sen. Rick Gunn, R-Alamance. "If someone was wearing a mask to conceal their identity, it would still be illegal." The Senate had rejected a previous House proposal to extend the mask exception through February, but this time the chamber passed it in a 43-4 vote. The opposing votes came from Sens. Carl Ford, R-Rowan, Ralph Hise, R-Mitchell, Rick Horner, R-Nash, and Todd Johnson, R-Union.
Senate Bill 232 also includes a provision to repeal a controversial public records secrecy provision in the vetoed Senate Bill 168. "We have not put the veto of Senate Bill 168 on the calendar for reconsideration at this time, but this would ensure that if we do, the death record provision would not become law," Gunn explained. Also Wednesday, the Senate approved a Gunn-sponsored measure to give shuttered bars an extension on paying their ABC permit renewal fees.
HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers (Includes Behavioral Health Providers!)
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced additional distributions from the Provider Relief Fund to eligible Medicaid and Children's Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.
HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.
ENHANCED PROVIDER RELIEF FUND PORTAL
On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.
The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today's announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.
Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers, serving Medicaid/CHIP beneficiaries, possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and
behavioral health providers
, assisted living facilities and other home and community-based services providers.
To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.
Frequently Asked Questions (FAQs)
In order to better address your most important concerns, we have
updated our FAQs
to address the questions you submitted for the webcast. The FAQs include expanded information on eligibility, application, payment process, and more.
Additional Information
For additional information, please call the Provider Support Line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.
Legislative Update
The General Assembly reconvened July 6-8 to take up vetoed bills from the Governor.
Override votes on bills to reopen gyms and skating rinks in North Carolina both failed Wednesday, one in the House and one in the Senate. The businesses, and others, have been required to remain closed under Phase Two of the state's reopening plan.
Additionally, the legislature failed to override the governor's veto of a bill that would have required the governor to obtain agreement from the Council of State, which is majority Republican, to declare a state of emergency.
Bills of importance to our industry that were vetoed but the GA did NOT attempt to override included:
- House Bill 918 - which attempted to move children, born to mothers addicted to illegal substances, into permanency more quickly by increasing the ability to penalize the mother for using substances in-vitro, take away their parental rights more quickly, and give foster parents the same legal rights as the birth family after 12 months.
- House Bill 612 - which required DSS to review every "directive", usually sent out in Dear County DSS letters, that held the same authority as a rule, but had not gone through the rule making process. Any directive that equated to a "rule" required DSS to move it through the Rules Commission.
DHHS was opposed to both of these bills. Below are news stories on each.
The legislature is planning on returning to Raleigh in September to address any new COVID-19 federal funding that NC may receive and take up any lingering budgetary legislation that is needed.
House Bill 918
Gov. Roy Cooper vetoed a bill Thursday that he said would disproportionately impact low-income and minority women. House Bill 918 became controversial in its final days in the House and Senate. The bill would require women with substance abuse addictions while pregnant to get treatment, and it would place her child into someone else's custody and speed up the foster care and adoption placement processes.
The bill drew ire from 14 advocacy and judicial groups and many members of the House and Senate. The bill barely passed through either chambers before making its way to Cooper's desk. Before it passed the Senate there was a call for decorum between Sens. Gladys Robinson, D-Guilford, and Joyce Krawiec, R-Forsyth, as Robinson reprimanded Krawiec for not caring enough about the minority women the bill affects.
"House Bill 918 discourages pregnant women with substance use disorders from seeking treatment and prenatal care, risking their health and the health of newborns," Cooper wrote. "And while it penalizes pregnant women with substance use disorders, it does nothing to expand access to treatment." Cooper said that women of color and low-income women are already less likely to have access to substance use treatment and quality healthcare.
House Bill 612
Gov. Roy Cooper has vetoed a bill that would change the process for administrative rules and policies at the Department of Health and Human Services, calling it "an overreach of legislative authority." House Bill 612 would mandate DHHS and its Division of Social Services to identify any policies and procedures that should actually be considered rules under state law - meaning they'd need approval from the Rules Review Commission. Legislators say the policies should be cleaned up after a change they say resulted in more child custody court cases.
Part of the bill would also set out a new process that allows for objections to new administrative rules to be reviewed by the legislature. Such an objection could make the rule temporary, and a bill could be introduced to overturn the rule.
Cooper indicated in his veto message that he thinks that process could handcuff cabinet agencies' policy-making authority. "House Bill 612 limits the ability of the Department of Health and Human Services to implement, adapt to and oversee programs of public assistance and child welfare which are regulated and driven by federal law, thereby jeopardizing the health, safety and well-being of our most vulnerable populations," he wrote. "Additionally, this is an overreach of legislative authority to effectively nullify executive branch policy and rulemaking, which is unconstitutional."
Medicaid Transformation Legislation
WILL DORAN, THE NEWS & OBSERVER, 7/02/20
North Carolina is set to overhaul a large part of the health care industry. The changes will give doctors incentives to focus more on preventive care or outside-the-box solutions for their low-income patients, and they could also be lucrative for health care companies. It's not Medicaid expansion - a divisive topic in state politics - but politicians in both parties told The News & Observer that these changes could kick start that separate debate over expansion. The changes are called Medicaid transformation, and they were supposed to have started already.
But after false starts and delays, including vetoing it last year, Democratic Gov. Roy Cooper signed the transformation into law on Thursday. It now will begin no later than July 2021. "Hallelujah, we're finally there" said Ralph Hise, R-Mitchell, just before midnight June 25. The bill was just about to pass, in a late-night session that wrapped up lawmakers' work for the near future.
NC Medicaid serves more than 2 million North Carolinians, many of them children and people who are either low-income or have a disability. Transformation would change how all of them interact with hospitals and doctors in the future.
"This is a critically important topic," WakeMed President and CEO Donald Gintzig said in a statement to The News & Observer, adding that it has been highlighted even more by COVID-19.
Transformation will give health care providers more of an incentive - and, in some cases, brand-new abilities - to focus more on long-term, personalized or creative solutions for their patients. "By implementing thoughtful and thorough policy changes, this is an opportunity for our state leadership to create a healthier North Carolina for generations to come," Gintzig said.
Right now, whenever someone on Medicaid goes in for health care, the state is billed for each procedure or test they get. But under Medicaid transformation, the state will divvy up its Medicaid budget into lump sums that will then get sent to private health plans, which Medicaid patients will soon be asked to sign up with. Those companies, called managed care organizations or MCOs, will get to keep any Medicaid money they have left over at the end of the year. In theory that will create an extra incentive not only to treat patients but to work on preventative care and more personalized approaches. "What we're really trying to cut down on is unnecessary care," Hise said in an interview.
Most of the 2.1 million people on Medicaid will start hearing from the state within the next few months about what the changes will mean for them, said Dave Richard, the deputy secretary for NC Medicaid. The first wave of changes will include everyone except those in more specialized situations, like disabled adults, children with severe health issues and elderly people who qualify for both Medicaid and Medicare. Richard said the new system is intended to improve people's long-term outlook by focusing more on their personal situation, as well as broader issues like how race, gender and poverty relate to health.
Centene Hub in NC
GARY D. ROBERTSON, THE ASSOCIATED PRESS, 7/01/20
Government health insurance provider Centene Corp. said on Wednesday it will build an East Coast campus in Charlotte, North Carolina, developing a $1 billion construction project that's expected to create more than 3,200 new jobs by 2032. Gov. Roy Cooper described the expansion as the state's largest single jobs announcement by number in nearly two decades.
The St. Louis-based managed care company will benefit from a recently sweetened state economic recruitment law, which along with local incentives could provide Centene with $465 million in cash and other benefits over time, according to state officials. The average pay for the new jobs will be $100,000, Cooper's office said, $32,000 above the local average. "This is a transformative initiative," Cooper said in an online announcement, minutes after a state panel agreed to most of the incentives. "When you look at Centene's monumental decision here, you see what a significant impact this is going to have on North Carolina's economy."
The rapidly growing company already has 70,000 employees and expects to generate $112 billion in revenues this year. Centene offers government-sponsored healthcare programs nationwide. They include Medicaid and Medicare coverage in more than 20 states as well as products for TRICARE, and through the marketplace created through the 2010 federal health care law.
Centene chose Mecklenburg County, which includes Charlotte, over potential sites in Tampa, Florida and York County, South Carolina for the project, a Commerce Department document says. York County is considered a bedroom community of Charlotte, so South Carolina residents also should benefit. Tampa was the headquarters for WellCare Health Plans, which Centene recently purchased for $17 billion, bringing their customer base over 23 million.
Clinical Coverage Policy 1H - Public Comment Posting-Re: Telehealth/Telepsychiatry
DHHS has released a draft of revised clinical coverage Policy 1Hprovides telehealth and telepsychiatry services to submit feedback directly to DHHS and participate in the public comment process to ensure that DHHS understands clearly:
- what changes, included thru the links below, work well for your agency; and
- the items that you believe need to be changed or create unnecessary barriers to service delivery.
Benchmarks Members - PLEASE take time to provide DHHS feedback on what you believe is important to maintain in the telehealth/telepsychiatry changes you have experienced during COVID-19. They need to hear from your direct experience to help guide them in what to keep in place after the pandemic ends.
**Clinical Coverage Policy 1H Telehealth, Virtual Patient Communications and Remote Patient Monitoring has been posted for public comment at the following link:
The public comment period ends on 8/15/20. Please share with your staff and network.
DMA Extends Enhanced Medicaid Rates
NC Medicaid is committed to ensuring beneficiaries continue to receive Medicaid and NC Health Choice services with no interruptions or delays due to the novel coronavirus (COVID-19) outbreak.
NC Medicaid has temporarily enhanced many reimbursement rates, including medical home per member per month payments, to support health care providers in delivering Medicaid services. NC Medicaid also committed to evaluating the need for and possibility of extending these temporary enhanced Medicaid rates past June 30, 2020. NC Medicaid has determined that is both necessary and feasible to continue all of these enhanced rates into the new State Fiscal Year.
NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community Services - NC Innovations and NC TBI Waivers
NC Medicaid submitted a second set of Appendix Ks for the NC Innovations and NC Traumatic Brain Injury (TBI) waivers (for additional flexibilities during the COVID-19 pandemic) to CMS following modifications in scope and coverage during the COVID-19 pandemic. They were approved effective April 30, 2020, to March 13, 2021.
- The addition of home delivered meals. Home delivered meals consists of two home delivered meals per day. Home delivered meals are not an option on the same day that an Innovations or TBI waiver member receives Residential Supports. Oral nutritional supplements are excluded from home delivered meals and members who are solely dependent on oral nutritional supplements may not receive home delivered meals.
- The waiver of the requirement for a letter of medical necessity or prescription from the physicians, nurse practitioner or physician's assistant for ongoing supplies or replacement equipment for which member has an already established authorization. This applies to assistive technology, equipment and supplies.
- Allow for additional 90-day periods for existing staff to continue providing services when staff are unable to complete the hands-on portion of the Crisis Prevention/De-Escalation training or the hands-on portion of the Cardiopulmonary Resuscitation (CPR) training. Where the extension of the waiver of provider determinations falls outside of the expiration date of the Appendix K, the State will submit either an amended Appendix K or a simple waiver amendment.
- Allow primary Alternative Family Living (AFL) providers to provide Supported Employment, Day Supports or Community Networking to the participant living in the AFL during times that Supported Employment, Day Supports or Community Networking would be regularly provided.
- Allow legally responsible persons and other relatives of minor waiver beneficiaries who reside in the home and out of the home to provide the following services when other providers are not available: Day Supports, Supported Employment, Community Living and Supports, and Community Networking. (Innovations Only)
- Allow for additional services to be provided by relatives who live in the home of the adult waiver beneficiary (current waiver only allows for Community Living and Supports) to include Community Networking, Day Supports and Supported Employment for 90 days. There may be more than one 90-day period. (Innovations Only)
Olmstead Planning Meeting - 1st Quarterly Kick- Off
