ATTENTION: NC SENIOR LIVING ASSOCIATION COVID-19 UPDATE 3/27/20
Below are recent developments regarding COVID-19. Providers are encouraged to check the
NCDHHS COVID-19 webpage
for the latest upd
ates regarding the virus and the state's response.
- NCDHHS issues new "Interim Long-Term Care Setting Guidance for Residents with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) and Their Caregivers" - The new interim guidance (Click Here) addresses a number of areas as noted below. We strongly recommend all providers read the new guidance carefully and make certain it is followed in your adult care or family care homes.
- 1. Minimize Opportunity for Introduction and Exposures
- 2. Adhere to Infection Prevention Precautions
- 3, Management of Residents and Environment including
- Manage Residents with Respiratory Illness, Suspected or Confirmed COVID-19
- Management of Incoming Residents
- Environmental Infection Control
- 4. Management of Staff
- Re-verification Due Dates Extended for NC Medicaid Providers - As a result of hardships caused by COVID-19, the NCDHHS Division of Health Benefits (NC Medicaid) issued a Medicaid Bulletin on 3/26/20 (Click Here) that extends the due dates for NC Medicaid providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020. As a result, NCTracks has reset re-verification due date to Sept. 13, 2020.
- Medicaid PCS assessments by phone are resuming today - A NCSLA member spoke with Liberty Healthcare this morning and learned that Medicaid PCS assessments by phone are resuming for New Admissions or Change of Status requests only. Annual assessments are postponed for now and authorizations have been extended for those residents who are due for annuals.
- For a New Request that has been submitted, a Liberty nurse will be reaching out to the facility to discuss the needs of the residents. The nurse will be going through the ADLs and asking questions to get an overall understanding of the care the adult or family care home provides the resident each day. Liberty will also ask questions pertaining to exacerbating conditions (for example: incontinence, cognitive impairment, lack of balance, impaired endurance, shortness of breath, etc.).
- Providers are unlikely to receive a call beforehand from the Liberty scheduling department, but the Liberty nurse will be contacting the facility directly and may be asking for the resident themselves.
- NCSLA recommends that if your facility receives a call from Liberty, please make sure the Resident Care Coordinator (RCC) and/or Director is the one taking the call and answers the questions asked by the Liberty nurse. If the nurse wants to speak with the resident, they have a right to do so, but they do want feed back from the provider as they normally do during face-to-face assessments.
- For a Change of Status request that has been submitted, the Liberty scheduling department will be reaching out to the facility to schedule a time for the phone assessment to occur. The Liberty nurse will be going through the entire 15-page assessment for anyone who has had a change of status (normally this is for someone with a dementia diagnosis); therefore, it is imperative that the RCC and/or Director is involved with this call. Liberty will be going through each ADL section as well as the exacerbating conditions similar to new requests.
- For a resident with a cognitive impairment such as an intellectual or developmental disability (IDD) diagnosis or Alzheimer's or other dementia, Liberty requests for the facility to be involved with the call so they can get the information first hand from the provider since they are the one providing the care and the resident may not be cognitively able to answer some of the questions Liberty asks
- This is a new process for providers as well as Liberty. If there are questions, please contact Liberty Healthcare directly.
- NC Medicaid Issue Special Guidelines for Non-Emergency Medical Transportation (NEMT) - Special guidelines for NEMT related to COVID-19 were issued yesterday (Click Here) to ensure NEMT services are still available to Medicaid beneficiaries and to provide guidelines to NEMT vendors to help decrease the transmission and spread of COVID-19. Adult and family care home providers are still required to contract with local DSS's to provide NEMT to their residents.
- Families First Coronavirus Response Act (P.L. 116-127, 2020 H.R. 6021) - NCSLA today received from Jim Wrenn (Hicks & Wrenn, PLLC) our legal counsel, a summary (Click Here) of the Families First Coronavirus Response Act that was recently passed by Congress and signed into law. The Act has two principal parts:
- Emergency Paid Sick Leave Act ("Emergency PSL Act") which covers private employers with fewer than 500 employees and all government employers. However, the Secretary of Labor is authorized to issue regulations for good cause that:
- Exempt businesses with fewer than 50 employees from the paid sick leave requirements under the Emergency PSL Act if providing leave would jeopardize the viability of the business as a going concern.
- Exclude certain health care providers (as defined in the FMLA) and emergency responders from the definition of covered employee or allow their employers to opt out of the paid sick leave requirements.
- Unfortunately, the definition of “health care provider” is not broad enough to cover any of the direct care or support staff typically employed by adult care homes. We are hopeful that the Secretary of Labor will exercise the authority granted to him in the Act to broaden the definition of “health care provider.” Until then, adult care home providers must comply with the Act.
- The Act also has a portion that expands the Family Medical Leave Act which is also contained in the Summary. Like in the first part of the Act, "health care provider" does not include direct care or support staff of adult care homes and therefore, homes must comply with this portion of the Act also unless the Secretary of Labor exercises the authority granted to him in the Act to broaden the definition of "health care provider."
- Number of COVID-19 cases - According to the most recent case count as of today, North Carolina has 763 cases (636 cases yesterday - 3/26) of COVID-19, 3 deaths, and is now found in almost two thirds of North Carolina's 100 counties. You can view the number of cases and map of the state Here. To determine how many cases are within a county, click on the county in question and the name of the county and number of cases will be displayed.
- Governor Cooper may issue stay at home order effective early next week - In addition to several North Carolina cities and counties that have issued stay at home orders as noted in yesterday's NCSLA COVID-19 Update, Governor Cooper is holding a press conference today at 4 PM (watch live here) and may issue a similar order for the entire State of North Carolina to be effective early next week, possibly by Monday, 3/30/20. Since the orders in the various cities and counties differ from each other, it may make it easier for the public and employers to follow stay at home orders if they apply to the entire state. That said, health care workers, including staff in adult and family care homes are not expected to be subject to the order as they are considered essential health care personnel.
- Personal protective equipment (PPE) - We continue to hear from providers that have run out of or running low on supplies of PPE (masks, gowns, gloves, etc.) that they have contacted their County Emergency Management Agency and have been told the PPE supplies are limited and cannot provide PPE to adult or family care homes at this time. However, we encourage members that need PPE to keep checking in with your County Emergency Management Agency on at least a weekly basis to re-emphasize the need for PPE to protect your staff and residents. The COVID-19 Healthcare Coalition for Critical Equipment and Supplies recently provided the following forms (Healthcare Guidance for PPE and PPE Request Process) for providers to use when determining their burn rate of PPE and the request process for PPE. According to the state's Healthcare Coalition for COVID-19, if a long term care facility has a resident with COVID-19 and is at risk of exhausting their supplies of PPE, immediately contact your County Emergency Management Agency, it is imperative that you explicitly communicate this information to the Agency so they can work with their Healthcare Coalition to locate PPE and help get it to your facility.
- Medicaid PCS rate increase - As noted in yesterday's NCSLA Update, the NCDHHS plans to increase the Medicaid PCS rate by 5% retroactive to 3/10/2020. A Press Release was issued late yesterday, which goes into more detail regarding the increase as well as other programs that will also be affected, i.e. skilled nursing facilities, CAP/C, CAP/DA, etc.
- Process for applying for State/County Special Assistance (SA) and other public benefits changing in some county Departments of Social Services (DSS) - NCSLA has heard from a number of providers this week that as a result of COVID-19, local DSS offices are not open to the public and the process for applying for SA and other public benefits is by completing a paper application and placing it in a drop box at the DSS or mailing it. NCSLA contacted the NC Division of Aging and Adult Services, which oversees the SA program and county adult services, and was told that "the application date will be honored" regarding the effective date of SA.
- North Carolina DHHS recommendations for prevention of COVID-19 related deaths (repeat of previous article) - The North Carolina Department of Health and Human Services recommends that people at high risk of severe illness from COVID-19 stay at home to the extent possible to decrease the chance of infection. On March 22, the Centers for Disease Control and Prevention (CDC) updated who is at high risk for severe illness. People at high risk include anyone who:
- People aged 65 years and older
- People who live in a nursing home or long-term care facility
- Other high-risk conditions could include:
- People with chronic lung disease or moderate to severe asthma
- People who have serious heart conditions
- People who are immunocompromised including cancer treatment
- People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
- People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk
- Medicaid Bulletins on Telehealth - We continue to hear from providers that are having problems getting physicians to sign forms for PCS and other services. We recommend providers emphasize to physicians of the new Medicaid Telehealth Policy which physicians can use to bill for services that do not require a face-to-face visit. In addition, today an amendment to the Medicaid Telehealth Policy that also covers enhanced behavioral health services. There are three telehealth modalities referenced within the policy, defined as:
- Telemedicine: Telemedicine is the use of two-way real-time interactive audio and video to provide and support health care when participants are in different physical locations.
- Telepsychiatry: Telepsychiatry is the use of two-way real–time interactive audio and video to provide and support psychiatric care when participants are in different physical locations.
- Virtual Patient Communication: Virtual Patient Communication is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a patient or a provider and another provider. Covered virtual patient communication services include telephone conversations (audio only); virtual portal communications (e.g., secure messaging); and store and forward (e.g., transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).
- The NCDHHS, the CDC and others continue to provide excellent materials and timely guidance related to COVID-19. In addition, the NC Division of Public Health (DPH) and NC Area Health Education Centers (AHEC) will be holding weekly forums for health care facilities, home-based providers and others on Tuesdays from 11:00 AM - 12:00 PM. Forums will be held every Tuesday, and will continue until they are no longer needed. Forums will be recorded and available to the public.
- During the forums, Subject Matter Experts from DPH will provide a quick update on any new developments and will then respond to questions received before or during the forum.
- Send any questions you would like for DPH Subject Matter Experts to be prepared to answer during the forum to questionsCOVID19forum@gmail.com - questions must be received no later than 5:00 on the Sunday prior to the call (3/22 this week).
- The forums will be structured to allow either webinar access through your computer OR traditional audio dial-in. PLEASE NOTE - Questions during the forum can only be submitted using the Q&A function using the webinar access through your computer.
- Click the following link to join the webinar: https://zoom.us/j/988453520
- (NOTE: Use the Q&A function to submit questions during the live webinar. For audio-only access (mobile)
Dial +1-646-558-8656, ID: 988 453 520#
For audio-only access (office telephone)
Dial (646) 558-8656
Webinar ID: 988 453 520
Reducing resident exposure to individuals who are potentially infected with COVID-19 is of paramount importance since our residents are among the highest risk group for infection and mortality from this virus. Thank you and your staff for all you are doing to provide care to our residents during this difficult time in what we all hope will be a temporary event.
If you have questions concerning any aspect of this document, please do not hesitate to contact me at
Jeff Horton, Executive Director
North Carolina Senior Living Association
4010 Barrett Dr., Ste. 102
Raleigh, NC 27609