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News & Press: Advocacy

LPCANC Legislative and DHHS Update

Tuesday, March 24, 2020  
Posted by: LPCANC Advocacy

The state’s response to the COVID-19 pandemic has continued, with Governor Cooper issuing additional executive orders and NCDHHS refining guidance for providers. As you probably know, NCDHHS also issued a call to providers to volunteer for COVID-19 response efforts.

 

The General Assembly also began formal work on the response to COVID-19. North Carolina House Speaker Tim Moore appointed a House Select Committee on COVID-19 with working groups on health care, economic support, education and continuity of state operations.

 

The health working group is chaired by a bipartisan group of legislators – Reps. Josh Dobson, Donny Lambeth, Perrin Jones, Donna White, Carla Cunningham and Becky Carney; the full list of members is available online.

 

The group held its first meeting on March 26, where it heard from the North Carolina Healthcare Association and the North Carolina Medical Society. The working group is accepting public comments online at https://www.ncleg.gov/RequestForComments/33.

 

At the meeting, NC Healthcare Association (NCHA) Board Chair and WakeMed CEO Donald Gintzig told the working group about the importance of slowing the spread of coronavirus to protect lives. He also noted the importance of personal protective equipment (PPE) in slowing the spread.

 

NCHA Senior Director of Government Relations for NC Healthcare Association Leah Burns discussed actions hospitals are taking to prepare for and respond to COVID-19. She noted that hospital visitation has been significantly restricted, and that hospital systems are moving forward with testing. While there is CDC guidance on testing, states have discretion as to who gets tested. Atrium, UNC and Duke have their own tests, and the time for processing for these tests are 4 to 6 hours. The State Lab’s test right now is 1 to 2 days and with some private labs the wait times are 1 to 2 weeks. 

 

Burns discussed the nationwide and statewide shortage of PPE. If the federal government begins to distribute these resources, North Carolina would likely be behind other hard-hit states like Washington and New York. Dentists and other groups have donated PPE to hospitals. Hospitals and health systems are looking across the country and world to find equipment such as ventilators.

 

According to NCHA, hospitals have been delaying elective surgeries following guidance from the CDC and DHHS. Unfortunately, these changes will create a cash flow problem for hospitals because they have had to cancel hundreds of thousands of “elective” surgeries and surgeries that could be postponed. Hospitals are also offering telehealth visits for patients; insurance, including Medicaid and Medicaid, are allowing virtual visits and visits via telephone.

 

Hospital systems are trying to make sure their employees have everything they need to take care of themselves. Child care is an important issue, and NCDHHS has partnered with the North Carolina Child Care Resource and Referral (CCR&R) network to launch a hotline to provide child care options for children of critical workers who do not have access to typical care because of COVID-19 closures. Workers who need care may call 1-888-600-1685 to receive information about local options for children from infants through age 12. The hotline is open Monday through Friday 8 a.m. to 5 p.m.

Finally, NCHA listed its legislative requests related to COVID-19, including:

·       Legislation allowing Medicaid eligibility expansion for uninsured individual for COVID-19 testing per the emergency period as allowed by Families First Coronavirus Response Act; 

·       Emergency Medicaid rate increases funded via FMAP increase;

·       Creation of a fund at the state level to help financially distressed hospitals during the time of the emergency period; 

·       Relief of regulatory burden, such as inspections in our facilities that are regularly scheduled and not an emergency; and 

·       Work with teaching institutions to ensure students will complete clinical hours outside of hospital. 

Chip Baggett of the North Carolina Medical Society (NCMS) talked to the working group about the strains placed on medical providers. Challenges faced by health care providers may include:

·       Surge in demands – increased volume of patients in need of care with a correlating decrease in workforce, as healthcare personnel may themselves be sick or exposed and unable to work. Family and economic stress - including school closures and child care.

·       Ongoing risk of infection - Increased risk of contracting COVID-19 and passing it along to family, friends, and others.

·       Equipment challenges - Equipment can be uncomfortable, limit mobility and communication, and be of uncertain benefit; shortages occur as a result of increased, and sometimes unnecessary, use.

·       Emotional support - Patient distress can be increasingly difficult for healthcare personnel to manage.

·       Psychological stress in the outbreak settings.

As its primary goals, NCMS has identified:

1. Maintaining access to uncontaminated, community, outpatient practices for the treatment of ongoing illnesses as well as the remote management of mild to moderate COVID-19 symptomatic patients and

2. Maintaining vital healthcare infrastructure (physical and mental health) across North Carolina to prevent overwhelming the healthcare system due to COVID-19 or other urgent illness.

NC Medical Society’s immediate legislative recommendations include:

·       Cash flow assistance for medical practices through deferral of utilities, loan payment principal and taxes for up to six months;

·       Low interest or no interest loans for struggling practices in addition to Medicaid hardship payments;

·       Require alignment across insurer policies for the duration of the State of Emergency to reduce administrative burden and confusion of patient treatment;

·       Presume Medicaid eligibility for those who are without or have lost insurance because of COVID-19;

·       Assure timely access to care by temporarily waiving network status as a condition of reimbursement so that patients may see available healthcare providers; and

·       Expand the scope of emergency medical services to include care delivered during the COVID-19 State of Emergency and specifically include COVID-19 as a part of the God Samaritan Statute.

 

The Health Working Group met again on April 2nd.  At the April 2nd meeting of the Working Group, Deborah Landry, General Assembly staff, provided a summary of COVID-19 federal legislation impacting health and human services.  That summary can be found here.

 

Secretary Cohen also provided this update to the Health Working Group.  Leaders from the North Carolina Local Health Directors Association followed Secretary Cohen with the following update.

 

 

As noted in the summary of the working group, changes at the state and federal levels are making telehealth more available to providers and patients. NCDHHS has put out several bulletins with information for providers:

·       NCDHHS bulletin on Telehealth Provisions for Outpatient Specialized Therapies and Dental Services

·       NCDHHS Bulletin on Telehealth Provisions for Enhanced Behavioral Health Services

·       NCDHHS Bulletin on Telehealth Provisions: Clinical Policy Modifications


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