May 2020 - Highlights and Hot Topics
Letter from the Executive Director
While we are still being mindful of the impact COVID-19 has had on our state, it is important we take this time to find ways to better our communities for everyone.
Thus, it was good to get back to the normal, important work of the North Carolina Council on Developmental Disabilities (NCCDD) this month. We kicked off our virtual Conversations with the Council for each region of North Carolina, starting with the Mountain Region on May 11 and then the Piedmont region on May 18. We had over 200 people register and provide their ideas and suggestions for what the Council should focus on over the next five years. We heard fantastic suggestions for what our focus should be in the areas of community living, financial and asset development, transition planning, advocacy and communications.
This is a critical time for people with intellectual or other developmental disabilities (I/DD) in North Carolina with many changes to the Medicaid waivers; the hold on Medicaid Transformation; and the discussions for the Registry of Unmet Needs is being discussed across the state.
Therefore, we need to hear from you! If you haven’t done so, please fill out our ten-minute survey so the Council can hear your voice on what we should focus on. Also, check the NCCDD.org website for when our next Conversations with the Council will be and sign up to join us!
Talley Wells, Executive Director
Public Policy Update as of May 14
FEDERAL
Coronavirus (Covid-19) Legislation
In response to COVID-19, Congress has passed four major pieces of legislation:
- March 8 – Coronavirus Preparedness and Response Supplemental Appropriations Act, $8.3 billion emergency funding bill (Small business loans, testing, vaccine and treatment development, waiving certain Medicare requirements)
- March 18 – Families First Coronavirus Response Act (Supplemental Nutrition Assistance Program SNAP, extension of Family Medical Leave Act FMLA)
- March 27 – The Coronavirus Aid, Relief, and Economic Security (CARES) Act (Paycheck Protection Program, Economic Income Payments, extension of unemployment benefits)
- April 24 -Paycheck Protection Program and Health Care Enhancement Act (Paycheck Protection Program, disaster loans, hospitals, testing)
Congress continues to work on a larger package to meet the growing needs of Americans. The House introduced a more than $3 trillion Coronavirus relief bill which provides funding for state and local governments, Coronavirus testing and a new round of direct payments to Americans.
It is expected to be brought to the House floor for a Friday vote. There is little support for this bill in the Senate. While there was bi-partisan support for the first packages, it is expected that the next package will take longer to negotiate. Some priorities in future legislation for people with I/DD include:
- Support for the direct support professional (DSP) workforce
- Protective equipment for DSPs
- Personal and sick days for family caregivers of adults with disabilities
- Economic impact payments for all people with disabilities, including adult dependents
Federal Bills to Follow
SNAP Online Purchasing Flexibility Act of 2020, H.R. 6510 - This bill directs the Department of Agriculture to authorize all states to participate in the Supplemental Nutrition Assistance Program (SNAP, formerly known as the food stamp program) online purchasing program during the COVID-19 (i.e., Coronavirus disease 2019) public health emergency. The program allows approved retail food stores to accept SNAP benefits through online transactions.
Food Assistance for Kids and Families During COVID-19 Act of 2020, S. 3563 - This bill would provide authorization and funding for grocery delivery services via SNAP.
Both of the above bills would allow people with disabilities to utilize their SNAP benefits while protecting themselves and their families in this time of crisis.
Strengthening UI for Coronavirus Impacted Workers and Students Act, H.R.6680 - This bill would make several improvements to unemployment insurance (UI) benefits, including exempting them from income for all means-tested programs. This would allow people with disabilities to receive UI benefits without complicating eligibility for Supplemental Security Income (SSI) or the Supplemental Nutrition Insurance Program (SNAP).
STATE
First COVID-19 bills were passed by the General Assembly. One addressed funding related to COVID-19 and the other addressed policy issues related to COVID-19.
SB 704 - COVID-19 Recovery Act (Funding)
- $20 million to the seven LME/MCOs for MH/DD/SAS services:
- $12.6 million would address funding for Intermediate Care Facilities
- The remainder to be used in part to address the needs of those with behavioral issues and help keep them out of emergency rooms.
- Increases the rates paid to fee-for-service Medicaid providers by 5%. This change does not increase rates to MH/DD/SAS providers paid for services that are part of LME/MCOs Medicaid managed care funds, including Innovations waiver, TBI waiver, or other behavioral care services.
- $40 million for Medicaid (which will draw down an additional $120 million or more in federal funding) to address COVID-19 related shortfalls.
- $12.6 million would address funding for Intermediate Care Facilities
HB 1043 - COVID-19 Time Sensitive Matters (Policy)
- Adjusts healthcare liability for COVID-19 services delivered during the emergency and suspends inspections and monitoring of health care facilities
- DHHS is required to develop a plan for the state’s personal protective equipment stockpile including access, increasing procurement, and finding ways to increase production.
- The state will do a pandemic healthcare workforce study including a health disparities impact and other issues including the delivery of behavioral health.
- A portion of the bill addressing public education includes language that helps to ensure students with disabilities have equal access to the remote instruction provided by their public school units and that remote instruction is provided in a manner consistent with each student’s individualized education program (IEP) or 504 plan.
The General Assembly restarted the short session on May 18. They will address COVID-19 related legislation not covered in the first bill and may also address budgetary and policy changes. The current pandemic has served to highlight existing gaps and needs in the system for people with I/DD. There were items in the budget last session (that was not passed) that continue to be of critical importance. These include:
- Expanding Innovations Waiver: 500 slots in January 2020 and 500 slots in January 2021.
- Traumatic Brain Injury Funding.
- Supplemental Short-Term Assistance for Group Homes: This funding fills a gap created when some people with I/DD lost funding due to eligibility changes to Personal Care Services.
- Increase in ICF Group Home Wages: to align with wages paid in the DD Centers.
- Innovations Wages: Study to align wages.
- Addressing Unmet Needs in Innovations Waiver: a ten-year plan to address waiting list.
- Evidence Based Supported Employment: Provides funds to APSE to develop training to implement supported employment.
As mentioned above, federal funds that came to NC were used to raise Medicaid rates by 5% but did not affect rates for the Innovations Waiver or the TBI since they are under Medicaid Managed Care through the LME/MCOs. And as we know, the LME/MCOs have experienced significant cuts to their state dollars over the past few years. The pandemic is creating strain on an already strained system.
POLICY
The NC Department of Health and Human Services (DHHS) requested, and were granted waivers through the Center for Medicare and Medicaid Services (CMS) to create flexibilities in many of its services. These are described within the bulletins on the DHHS website. Some that most directly impact people with I/DD include:
SPECIAL BULLETIN COVID-19 #55: Flexibilities for Home and Community Based Services (HCBS) – Allows for flexibilities for Innovations Waiver, TB Waiver, CAP-C, and CAP-DA around timelines and process for Plan of Care, location of service, guardian/caregiver as provider, and waives some assessment requirements.
SPECIAL BULLETIN COVID-19 #75: Flexibilities for Innovations and TBI Waiver - Allows “telehealth” or two-way, real-time interactive audio and video for provision of services for Innovations and TBI waivers.
SPECIAL BULLETIN COVID-19 #76: Flexibilities for B3 Services - Allows “telehealth” or two-way, real-time interactive audio and video for provision of services for B3 services.
SPECIAL BULLETIN COVID-19 #83: Title II Americans with Disabilities Act (ADA) and Section 504 Rehabilitation Act (RA) Protections during the COVID-19 Pandemic – This bulletin reiterates that Federal law requires all Medicaid providers in North Carolina to comply with the Americans with Disabilities Act (ADA) and Rehabilitation Act, which includes providing reasonable accommodations for people living with disabilities. It also cites the U.S. Department of Health and Human Services Office of Civil Rights (OCR) issued Bulletin "Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19)” which provides guidance for people, or allowing people with I/DD, to have caregivers with them in healthcare settings. It includes the following statement: For individuals with a cognitive impairment or intellectual disability, it is important to ensure the individual has adequate support for decision making and treatment. These individuals may need to have a caregiver accompany them in either the ambulance or in the hospital. Accompaniment should be allowed in accordance with the guidance above.
*The Council, as well as several other I/DD organizations, has requested a plain language document explaining the intent of this bulletin from DHHS for use by individuals with I/DD and their caregivers.
The state continues to provide updates and opportunity for questions/input through a weekly call. The Joint DMH/DD/SAS and DHB (NC Medicaid) COVID-19 Update Call For BH/I/DD Consumers, Family Members and Community Stakeholders is held every Monday at 2:00 pm. Toll-Free 844-291-5495; Access Code 1279313
NCCDD and NC ADA Network Support Arts Access Accessibility Online Training
On May 6, North Carolina Council on Developmental Disabilities (NCCDD) Systems Change Manager Philip Woodward participated in the Accessibility Online training webinar hosted by Arts Access with the support of the NC ADA Network initiative. Woodward and Relay NC Customer Relations Manager Bola Desalu spoke along with Arts Access Executive Director Betsy Ludwig and Programs Manager Megan Bostic about how to make online meetings and events accessible to deaf and hard of hearing people.
This topic is especially relevant during the COVID-19 pandemic, which has forced people all over the world to telework and conduct meetings virtually.
More than 50 people participated and learned why it is important to make online meetings and events accessible as well as gaining resources for captioning meetings, events and videos and providing American Sign Language (ASL) interpreters for meetings. Woodward discussed how the captioning that benefits him can also benefit people who speak foreign languages, people learning to read and people who watch videos on their smartphones with the volume turned off.
Meanwhile, Desalu shared all of the ins and outs of Relay Conference Captioning, a free service available to deaf and hard of hearing people to participate in conference calls and webinars.
The webinar will be posted on the Arts Access website, and the PowerPoint presentation is available on DropBox.
Disability Council Provides Funding for Adjustments to Services During COVID-19
Thirty-one mini-grants were awarded by NCCDD to agencies and organizations serving people with intellectual or other developmental disabilities (I/DD) throughout North Carolina to help with adjusting needed services and activities during this time of COVID-19 and social distancing.
NCCDD provided $75,000 for time-limited projects to fill the gaps in activities and services many people with I/DD may be experiencing due to the Coronavirus pandemic and the resulting stay-at-home order.
To read more about the mini-grants, click here: https://nccdd.org/covid-19-resources/covid-19-alerts-2/981-nccdd-mini-grant-stories.html
Take the NCCDD Survey to Share What’s Important to You in our Five-Year Planning Process
Every five years, the NCCDD develops a State Plan that reflects a comprehensive review of major service systems and issues in North Carolina. It outlines goals, objectives and specific activities that will be implemented to bring about change.
And the Council wants to hear from you! We want to learn about how individuals with intellectual or other developmental disabilities (I/DD) are doing. Your ideas will make a difference as we plan for the next five years. Thank you for helping us by filling out this survey. The survey is available in both English and Spanish.
Audio - Highlights and Hot Topics