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NCARF

Legislative and Advocacy Update

August 24, 2021



The NC General Assembly spent last week prepping for the budget conference process that will start in earnest this week. Leaders in both chambers appointed the conference committee members. You can view the budget conferee list online.
We have so much to share with you as we prepare for the week ahead. Let’s get started!
 
In This Issue:

      Governor Cooper News: COVID 19 Update and Vaccinations
      NC Legislative Update: A Comparison of the Budgets
      Federal Update: President Biden’s Vaccine Announcement
      FDA Approves Pfizer Vaccine Breaking News!
      NC COVID-19 Update: Recent News
      NC Medicaid Managed Care Update
      NC Medicaid Bulletins
      NC Health Opportunities: Webinar
      NC News You Can Use
      Federal News You Can Use 

Governor’s Office:
Governor Cooper Provides Update on State’s Pandemic Trends,


Encourages Vaccination
WEDNESDAY, AUGUST 18, 2021 AT 12:00 PM
Governor Roy Cooper and North Carolina Department of Health and Human Services Secretary Mandy K. Cohen, M.D. provided an update on the state’s COVID-19 key metrics and trends.

NC General Assembly:
Budget
Last week the NC House and Senate leadership appointed conferees to the budget conference committee. We expect the budget conference process to begin during the next few weeks. We want to provide the following comparisons between the House and Senate Health and Human Services budget.
 
Senate:
•       Direct Care Worker Bonuses: The budget appropriates $100,000,000 from the State Fiscal Recovery Fund in FY2021-2022 to provide a $1,500 bonus for eligible direct care workers employed by eligible providers enrolled in the Medicaid or NC Health Choice program.
•       Innovation waiver slots-Appropriates $7.1 million in recurring funding for the first year of the biennial and $25 million in recurring funding for the second year of the biennial to open 1000 new slots to be funded through general fund appropriations.
•       CAP/DA slots-Appropriates $650,000 in recurring funding to open 114 new slots new slots to funded through general fund appropriations. Slots would open on October 1, 2021. This funding is recurring.
•       ICF Temporary Funding: Appropriates $12.6 million in one-time funding for FY2020-2021.
•       ICF Rate Increases: ICF Funding Increase: Wage Increase for Direct Support Personnel
The budget appropriates $17, 500,000 in recurring funding in FY2022-2023 to raise wages for direct support personnel in ICF/IDD facilities. The intent of this funding is to raise wages to $15 dollars per hour. The would adjust the LME/MCO per-member per month for the ICFs.
•       Certificate of Need Special Provision: Senate did include a Certificate of Need Special Provision that mirrors the language in Senate Bill 462.
•       EVV Fund: Appropriates $314K in recurring funding for operations and maintenance of the EVV system.
 
House:
•       HCBS Direct Care Worker Wages Fund: Provides funding to increase Medicaid reimbursement rates for the purpose of increasing direct care worker wages among HCBS providers. The State share of funding, $33.9 million in FY 2021-22 and $68.1 million in FY 2022-23, will be transferred from the HCBS Fund.
•       Medicaid Rate for Private Duty Nursing Fund: Increases the Medicaid reimbursement rate for private duty nursing to $10.75 per 15 minutes ($43/hour). The State share of funding, $2.1 million in FY 2021-22 and $5.6 million in FY 2022-23, is provided through the HCBS Fund.
•       Home Health Enhancements:
Provides funding to extend home health services to Medicaid recipients who have 3 or more chronic conditions and are transitioning from institutions to the community. Enhancements will include the provision of expanded specialized therapies for the population. The State share of funding, $5.2 million in FY 2021-22 and $10.4 million in FY 2022-23, will be provided from the HCBS Fund.
•       Direct Care Worker Bonuses: One-time bonuses for direct care workers funded by the HCBS Fund. These bonuses would be $2,000 per direct care worker.
•       CAP/DA Slots: Appropriates $500K in recurring funding to open 114 new slots funded through ARPA/HCBS Fund. The slots would be available on October 1, 2021.
•       Innovation Waivers: Appropriates $7.8 million in FY2021-2022 and $25.9 million in FY 2022-2023 to fund 1000 new slots funded through ARPA/HCBS Fund. These slots would open in January 1, 2022 and October 1, 2022.
•       Certificate of Need Special Provisions: The House did not include Senate Bill 462 CON language but did include multiple special provisions on behavioral health beds.

      Wage Increase for Direct Care Workers in Intermediate Care Facilities:

Provides funding for a wage increase for direct care workers employed by intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs). Capitation rates for local management entities/managed care organizations will be increased to enable higher reimbursement rates for ICF/IIDs, and 80% of the rate increases must be used to enhance the rate of pay for direct care workers at the facilities. $17,500,000 for fiscal year 2021-2022 and $21,800,000 for fiscal year 2022-2023. This funding is from the general fund and is recurring.

      ICF Temporary Funding: Appropriates $12.6 million in one-time funding for the first fiscal year of the biennial to provide stabilization funding.
      Establishment of an HCBS Fund Based on General Funds Saved Due to FMAP Increases/ARPA:$274,800,000 will be transferred to a newly established HCBS Special Fund. This transfer represents the savings from the additional federal match for HCBS services through the American Rescue Plan Act. The amount transferred represents projected savings from the enhanced match for services provided between April 1, 2021, and March 31, 2022, and must be used to strengthen, enhance, and expand Medicaid HCBS programs.
 
NC Health News has a full side by side comparison of all the budget items for the health and human services budget. You can find the article at this link.
 
 
Federal UPDATE:
With Congress on recess, the big news coming out of DC was President Biden’s announcement regarding mandatory testing for nursing home staff and residents. CMS is developing emergency regulations to require staff in nursing facilities to be vaccinated and are linking this regulation to condition of participations with Medicare/Medicaid. We do not expect to see this emergency regulation until early to middle September.  We will continue to monitor all CDC and CMS communication regarding mandatory vaccine requirements for healthcare providers.
 
Biden-Harris Administration Takes Additional Action to Protect America’s Nursing Home Residents from COVID-19 (Press Release)
Aug 18, 2021
The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), is developing an emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes.
 
This new requirement is a key component of protecting the health and safety of nursing home residents and staff by ensuring that all nursing home staff receive COVID-19 vaccinations. Over the past several months, millions of vaccinations have been administered to nursing home residents and staff, and these vaccines have shown to help prevent COVID-19 and have proven to be effective against the Delta variant. (SOURCE)
 
FDA Update: Pfizer Vaccine: Breaking News
August 23, 2021
Today, the U.S. Food and Drug Administration approved the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will now be marketed as Comirnaty (koe-mir’-na-tee), for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals.
“The FDA’s approval of this vaccine is a milestone as we continue to battle the COVID-19 pandemic. While this and other vaccines have met the FDA’s rigorous, scientific standards for emergency use authorization, as the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product,” said Acting FDA Commissioner Janet Woodcock, M.D. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated. Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.” (SOURCE)
 
NC COVID-19 Updates:
Aug. 16
North Carolinians who are moderately to severely immunocompromised and received the Moderna or Pfizer vaccines can now begin receiving an additional dose to better protect themselves from COVID-19.
 
The U.S. Food and Drug Administration has amended the Emergency Use Authorizations for both vaccines to allow for the use of an additional dose in some immunocompromised individuals, which was then recommended by the CDC's Advisory Committee on Immunization Practices (ACIP). A full list of conditions can be found on the CDC's website
 
Medicaid Managed Care Update:
Expedited Hardship Advances for Managed Care Providers
The North Carolina Department of Health and Human Services (DHHS) and prepaid health plans (PHPs) are committed to supporting providers during the transition to managed care. We stand by the Day One goal to ensure providers are paid for services they provide. DHHS and PHPs are aware of potentially delayed payments and increased claim denials during the transition period. 
Providers experiencing claim payment issues should initially work with the PHPs to address claim issues and avoid the need for a hardship advance. Refer to the Guidance for Providers Experiencing Payment Issues bulletin for contact information. 
As DHHS, PHPs and providers address the various claim processing problems, providers who are at risk of not meeting financial obligations this month as a result of claim processing issues may request a hardship advance to offset the business cost due to pended or denied claims. 
Thank you for your patience and cooperation as we work to resolve managed care transition claim issues. For more information, please see the Medicaid bulletin Expedited Hardship Advances for Managed Care Providers.
 
Non-Emergency Transportation:
NC Medicaid is committed to ensuring that beneficiaries are able to get rides to their medical appointments through Non-Emergency Medical Transportation (NEMT) providers.  Therefore, we are sharing updated recommendations for NEMT vendors and drivers related to COVID-19.
 
The best protection against COVID-19 is a vaccine.  NC Medicaid strongly recommends that all employers direct employees to information and encourage them to get vaccinated.  It is strongly recommended that businesses:
 

Require employees to report vaccination status
Require employees who are unvaccinated, or do not disclose vaccine status, participate in screening/testing programs 
For the full list of recommendations, please see Medicaid SPECIAL BULLETIN COVID-19 #175.
 
Extension of Out of Network Provisions
Update provided by DHB:
In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021. 
Under this policy, the PHPs have agreed to:

permit uncontracted, out of network providers enrolled in NC Medicaid to follow in
network provider prior authorization rules and may continue to get a prior authorization retroactively (This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period);
reimburse out of network providers at the in-network rate of 100% of the Medicaid fee schedule;
delay implementation of the 90% rate reduction following good faith contracting provision;
allow beneficiaries to change their Primary Care Provider for any reason; and
extend flexibility for Non-Emergency Medical and Non-Emergency Ambulance Transportation providers through November 2021. For more information, please see Medicaid bulletin Extension of Out of Network Provisions.
 
 
Medicaid Bulletin:
SPECIAL BULLETIN COVID-19 #176: Third COVID-19 Vaccine Available
Thursday, August 19, 2021
The FDA has modified the Emergency Use Authorizations (EUAs) for Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine to allow for administration of a third dose of an mRNA COVID-19 vaccine after an initial two-dose primary mRNA COVID-19 vaccine series for certain immunocompromised people.
 
SPECIAL BULLETIN COVID-19 #175: Updated Guidance for Non-Emergency Medical Transportation
Thursday, August 19, 2021
Recommendations for Non-Emergency Medical Transportation (NEMT) Vendors and Drivers
 
Expedited Hardship Advances for Managed Care Providers
Wednesday, August 18, 2021
May be available for those at risk of not meeting financial obligations
 
 
NC Healthy Opportunities Update:
Webinar
Join us on Tuesday, Aug. 31, 2021, from 9:30-11:00 a.m. ET for a webinar on North Carolina’s Healthy Opportunities
Pilots.
 
This webinar will provide an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar will also highlight important upcoming implementation milestones and next steps. The session will be geared towards human services organizations that are interested in providing Pilot services, but is open to the public. There will be time reserved at the end for Q&A.
 
The Pilots offer the unprecedented opportunity to evaluate the impact of providing evidence-based, non-medical interventions to a subset of high-risk eligible Medicaid members in select regions of the state. The federal government has authorized up to $650 million in state and federal Medicaid funding to cover the cost of providing select Pilot services related to housing, food, transportation and interpersonal safety that directly impact the health outcomes and health care costs of Medicaid members.
 
Register to attend the webinar here. More information about the Healthy Opportunities Pilots is available at: https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots
 
 
NC News You Can Use:
Vaccine Boosters
BEN SESSOMS, THE NEWS & OBSERVER, 8/18/21
The Biden administration on Wednesday announced plans for COVID-19 vaccine boosters to combat waning immunity, as the delta variant causes cases to surge in North Carolina and the rest of the nation. Meanwhile, North Carolina reported the most hospitalizations in the state due to the virus since Jan. 29.
 
U.S. Surgeon General Dr. Vivek Murthy said during a live-streamed White House press briefing Wednesday that the current plan is to make a third dose of the vaccines from Pfizer and Moderna available starting Sept. 20, pending approval from the Food and Drug Administration and a recommendation from the Centers for Disease Control and Prevention. The rollout would start with those groups who received their initial doses before the general public months ago, including health care workers, long-term care residents and older people, Murthy said. Others would begin getting boosters eight months after they received their second dose.
 
Dr. David Wohl, infectious disease specialist at UNC-Chapel Hill, told The News & Observer that the vaccine protects against the delta variant and that the booster shots are there to maintain caution. “It’s not reacting. It’s being very proactive, which I applaud,” Wohl said.
 
North Carolina reported 2,930 hospitalizations statewide on Wednesday due to COVID-19, the most since Jan. 29. Health officials say the increase is due to the delta variant, which makes up over 86% of sequenced virus in North Carolina, according to the latest CDC data. A week ago, state health officials said that over 90% of people hospitalized statewide due to the virus were unvaccinated. And the average patient age was 44, down from 61 in January. [Source]
 
 
Patient Visitation 
RICHARD CRAVER, WINSTON-SALEM JOURNAL, 8/18/21 
The state House fulfilled Wednesday its part of a legislative deal addressing patient visitation bills. The House voted 88-14 to approve Senate Bill 191, titled “The No Patient Left Alone Act,” which sends it to the House Rules and Operations committee. The bill was rushed to the House floor after clearing the House Rules and Operations committee earlier Wednesday. Because of an amendment added to the bill on the House floor, SB191 goes back to the Senate to approve or reject the change. SB191 cleared the Senate by a 40-9 vote on May 6. [Source]
 
Mask Request 
COLIN CAMPBELL, THE INSIDER, 8/18/21 
N.C. House Democrats are calling for masks to be required at the legislature and for legislative employees to face a vaccination or testing requirement. House Democratic Leader Robert Reives, D-Chatham, and Deputy Democratic Leader Gale Adcock, D-Wake, wrote a letter this week to Legislative Services Officer Paul Coble, who sets the rules for the legislative complex and its staff. The letter was first reported on Twitter by Michael Hyland of WNCN News.
The Democrats want Coble to institute a policy for staff that mirrors Gov. Roy Cooper’s recent executive order for Cabinet agency state employees, which requires employees to be fully vaccinated against COVID-19 or get a negative COVID test weekly. They also want a mandatory indoor masking policy and notifications about any COVID cases involving lawmakers in staff. “Mask wearing is a simple step to protect everyone,” the letter says. “These three decisions will make the NCGA a safer environment for everyone.”
The letter comes after Democratic legislators raised concerns about possible COVID cases that weren’t disclosed. WRAL later reported that the only two confirmed cases were Rep. Keith Kidwell, R-Beaufort, and a vaccinated staffer in Senate leader Phil Berger’s office. Relatively common among both parties at the height of the pandemic, masks have become a partisan affair at the legislature lately. Nearly all Democrats wear them, virtually no Republicans wear them, and small percentage of lobbyists and nonpartisan staffers wear them.
 
Budget Timeline 
COLIN CAMPBELL, THE INSIDER, 8/18/21 
Budget negotiations between the House and Senate are beginning this week, but don’t look for Gov. Roy Cooper to have a seat at the table immediately. Senate leader Phil Berger outlined the process on Tuesday, and he said budget writers from the two chambers want to reach a tentative compromise first. Then they want the governor to weigh in before the legislature takes a final vote on the spending plan. 
“This is a little different from the way we’ve done it in the past,” when lawmakers tried to negotiate a deal with Cooper after he vetoed the budget, Berger said. “Hopefully we can give him an idea of what we’re going to agree to and let him voice his thoughts on those things, and see if there’s some accommodation that can be made to address the concerns.” Berger said he’s hopeful that the two chambers can resolve most of their differences by the end of the month. If an agreement can be reached with Cooper in the following weeks, the goal is to have final floor votes on the budget around Sept. 9. The Senate appointed its conference committee on Tuesday, including numerous Republicans and the four Democrats who voted in favor of the Senate budget; the House is expected to name its conference committee members this week.
Berger says one of the key points of contention involves how certain budget items should be funded. He pointed out that the House budget opted to use the State Capital and Infrastructure Fund, or SCIF, to pay for programs that the Senate budget funded from other sources. Because SCIF projects weren’t included in the total spending cap that the House and Senate previously agreed to, the House budget ultimately spends a bit more than the Senate wants. 
The budget timeline will dictate when this year’s long session will finally wrap up. Berger said that if a compromise budget can be enacted by mid-September, lawmakers would likely adjourn while redistricting committees conduct public hearings on proposed congressional and legislative maps. Then the full chamber could vote on maps in October. But if the budget process drags on longer, there might not be a break before the redistricting session.
 
 
Federal News You Can Use:
 
Biden Administration Invests About $19 Million In Telehealth Grants
Inside Health Policy
https://insidehealthpolicy.com/daily-news/biden-administration-invests-about-19-million-telehealth-grants
 
By Dorothy Mills-Gregg / August 18, 2021 at 8:00 AM
 
Thirty-six academic medical centers and telehealth resource centers, among other virtual health care support organizations, will receive $19.18 million to strengthen, improve and innovate telehealth in rural and underserved areas, the Biden administration announced Wednesday (Aug. 18).
 
The announcement comes as House lawmakers review the nearly $1 trillion infrastructure package senators passed last week. If passed, it would make about $42.5 billion available for states to invest in broadband, a key component for telehealth. Meanwhile, counties are using COVID-19 relief to address the social determinants of health, which include improving broadband availability and affordability.
 
CMS is also moving forward with telehealth policies, proposing on July 13 to continue covering certain Medicare telehealth services through the end of 2023 as part of the 2022 physician fee schedule. The proposed rule also lays out plans for expanded coverage of telehealth for mental health care.
 
“Telehealth expands access to care and is a vital tool for improving health equity by providing timely clinical assessment and treatment for our most vulnerable populations,” acting Health Resources and Services Administration Administrator Diana Espinosa said in a statement. “This funding will help drive the innovation necessary to build clinical networks, educational opportunities, and trusted resources to further advance telehealth.”
 
The $19 million telehealth investment will be funneled through four programs.
 
Two organizations will receive $6.5 million -- the largest grant announced -- to improve health care in rural, medically underserved areas with high rates of chronic diseases and poverty. Called telehealth centers of excellence, they will operate in academic medical centers and pilot new telehealth services, track outcomes and publish their research. These centers will also establish an evidence-base for telehealth programs and a framework for future programs.
 
HRSA will also send $4.55 million to 14 national and regional telehealth resource centers that provide their communities with expert advice on telehealth reimbursement, licensing and privacy, as well as the technology itself.
 
The third program will invest $4.28 million in nine academic medical centers to build sustainable tele-mentoring programs that train and support primary care providers in rural and underserved communities. The goal is to give these providers tools so they can treat patients with complex medical conditions, like so-called long COVID and substance use disorders.
The smallest award, $3.85 million, goes to the Evidence-Based Direct to Consumer Telehealth Network program. Its 11 award recipients will help health networks increase access to telehealth services while assessing the virtual care’s impact on patients, providers and payers. -- Dorothy Mills-Gregg (dmillsgregg@iwpnews.com)
 





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NCARF

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Boone, NC 28607

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