April 2020 - Highlights and Hot Topics
Letter from the Executive Director
We Are All In This Together
The Coronavirus has changed our lives. We must stay home and away from each other. This is an unprecedented time in which everyone in the whole world has had to stop what we’re doing to protect themselves and each other.
This crisis shows that we are interdependent. And, it takes all of us to keep each other safe.
Many lessons will be learned from this crisis. One I hope we learn is how much we rely on each other. When we get back to “normal,” we need to continue to remember and advocate for our fellow North Carolina citizens with disabilities. Many of these individuals will continue to be confined in their homes or institutions after the Coronavirus for the simple reason that they have always been socially isolated. This needs to change. Their physical, mental, and social health should matter to us, not just during a crisis, but always.
I am very proud of the way in which the North Carolina Council on Developmental Disabilities (NCCDD) has responded to this crisis. Our team is updating COVID-19 resources on our website and social media daily. We are working to ensure North Carolina citizens with disabilities, their families and direct support professionals have critical information related to the coronavirus.
We created a short video of Ten Things Every North Carolina Citizen Needs to Know About COVID-19. And, we were able to provide $75,000 in small grants between $500 and $3,500 available to organizations serving people with intellectual or other developmental disabilities (I/DD) during this crisis. We were able to provide the funding to over 30 organizations serving our fellow citizens across the state.
I am also proud of our state – North Carolina took the virus seriously early on. It began taking action before anyone in the state was diagnosed. These early steps have meant that fewer people on average have had the virus than our surrounding states.
This crisis will last longer than any of us want. But the more we work together to end it, the sooner we can come back together in person, and the sooner we can continue to work together to ensure all North Carolina citizens with disabilities have what they need to live full and meaningful lives in the community.
I hope you will read all of our updates in this newsletter. There are critical changes to the Innovations Waiver to ensure people with intellectual or other developmental disabilities can continue to receive the supports they need, including allowing families to provide services. Also, read about our important new “It’s My Home” supported living guidebook. Make sure to watch all of the supported living videos, they will make you smile, and feed your passion to advocate.
Talley Wells, Executive Director
Public Policy Update as of April 17
FEDERAL
Coronavirus (Covid-19) Legislation
In response to COVID-19, US Congress has passed three major pieces of legislation. Some highlights of these acts that are most relevant to people with disabilities are described below.
March 8 – Coronavirus Preparedness and Response Supplemental Appropriations Act, $8.3 billion emergency funding bill, which included loans for small businesses, funds for testing and production of vaccines and treatments and funds for training on prevention/reduction of exposure for workers at risk. This bill also contained the first efforts at allowing services to be delivered in a different way by waiving certain Medicare requirements related to telehealth services.
March 18 – Families First Coronavirus Response Act included expansion of Supplemental Nutrition Assistance Program (SNAP) to cover children home from school who were receiving free or reduced lunch. It also included an expansion of the Family Medical Leave Act to include caring for children affected by COVID-19.
March 27 – The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed which included a variety of funding allocations to address COVID-19. It included Small Business Paycheck Protection in the form of funds for small businesses to pay up to eight weeks of payroll. This Act also included the Economic Income Payments of up to $1,200 per adult and $500 per child and the extension of unemployment benefits by 13 weeks with an additional $600 per week. There have been some questions about how these payments might affect benefits for people with disabilities. The Economic Income Payments will not count as income to Social Security beneficiaries receiving Social Security Income (SSI) and/or Social Security Disability Income (SSDI). These cash payments will also not count as resources for a period of 12 months for individuals to maintain their Social Security benefits under means-tested federal benefits programs (Medicaid, SSI, SNAP, housing assistance).
The additional $600 unemployment benefit counts as income when determining eligibility for means-tested programs, except for Medicaid and the Children’s Health Insurance Program, known as CHIP.
The CARES Act also includes many measures to increase the use of telehealth and waives some face-to-face requirements.
STATE
The Department of Health and Human Services (NC DHHS) responded quickly to COVID-19 with efforts to ensure the safe continuity of care for people with intellectual or other developmental disabilities (I/DD). Some of the first steps involved asking the federal government for permission to make changes to some of our standard ways of providing services and supports. This was done through two different requests – the 1135 Federal Waiver and the Appendix K – Emergency Preparedness and Response.
Important Temporary Changes to the Innovations Waiver During COVID-19
Appendix K: Emergency Preparedness and Response is used by the state during an emergency to make changes to its 1915(c) Home and Community-Based Services Waiver. NC asked for permission to make the following changes for the Innovations Waiver:
- People who do not use their services are not at risk of being discharged from services. Care Coordinators will provide monthly contact.
- Current service limitations can be exceeded based on need. Recipients and families can reach out to their provider or care coordinator to request.
- Services can be provided in different locations. Day Support, Supported Employment, Community Living and Supports, and Community Networking can be provided in a person’s home, the DSP home, or in a residential setting.
- Respite can exceed 30 days and can be provided if family is out of state.
- Allows payments for services provided by family caregivers or legally responsible adults. Extra time is allowed to complete background checks and training. The LME/MCO will provide monthly monitoring.
- Allow current staff extra time (up to 90 days) to complete required training such as CPR and Crisis Prevention.
- Additional 3 months for annual re-assessments to be completed by Care Coordinator and services can continue.
- Services can be provided in an acute care hospital or short-term institutional stay.
- Provide payments to staff when staff are unable to provide services because the waiver recipient is sick or quarantined due to COVID-19. These are provided in 30-day increments.
- Care Coordination monitoring can occur telephonically
- SIS Assessments can be conducted remotely, or family can request to delay due to COVID-19.
A second submission of Appendix K to the federal government is planned to add some additional flexibilities including allowing Alternative Family Living (AFL) providers to provide day supports.
Other Changes During COVID-19
The 1135 Federal Waiver allows states in an emergency to temporarily put aside some of its standard requirements for providing physical and behavioral health care. Some of the changes or flexibilities under the 1135 waiver include:
- Enable North Carolina to temporarily enroll and pay providers who are out-of-state in order to meet the needs of people who may have been displaced due to COVID-19.
- Allow services to allow facilities, including intermediate care facilities for individuals with intellectual and other developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs), to be fully reimbursed for services provided in an unlicensed facility (during an emergency evacuation or due to other need to relocate residents).
Weekly Phone Calls for Families, People with Disabilities and Other Consumers
DHHS continues to work with consumers, families, providers and agencies including the Council to address barriers, answer questions, and provide guidance as we navigate through this unusual time. There is a weekly call for consumers, families, and stakeholders to provide updates and answer questions from callers. There is also an email address where questions can be submitted: [email protected]
Help NCCDD With Its Upcoming Five-Year Plan
The North Carolina Council on Developmental Disabilities (NCCDD) is working to create a North Carolina for individuals with intellectual or other developmental disabilities (I/DD) and we need your input!
We are working on developing our 2022-2026 Five-Year State Plan (5YSP) and your feedback will help in determining what NCCDD will focus on through 2026.
The Council will be posting its Conversations with the Council – Virtual Road Tour schedule on our website soon, and we hope you will join us.
Save the dates for the Virtual Road Tour:
- Mountain Region: Monday, May 11
- 12:30 pm - 2 pm
- 6:30 pm - 8 pm
- Piedmont Region: Monday, May 18
- 12:30 pm - 2 pm
- 6:30 pm - 8 pm
- Coastal Region - Monday, June 1
- 6:30 pm - 8 pm
- Coastal Region - Saturday, June 6*
- 1 pm
June 6 is also open to individuals who were not able to attend the listening sessions scheduled in May.
In addition to the virtual listening sessions, the Council will seek in-depth information through Individual, Family, and Community Stakeholder online surveys, beginning in May.
Supported Living: The Most Person-centered Service
The most person-centered service option is supports in one’s own home. This is the focus of the Supported Living: Making the Difference initiative. This initiative included the North Carolina Council on Developmental Disabilities (NCCDD) and North Carolina Money Follows the Person demonstration project (NC MFP). Its impact included:
- A statewide kickoff promoting the Supported Living Waiver service and an invitation for stakeholders to engage in work in shaping the future direction of this service.
- A partnership with four agencies serving at least 24 individuals to learn and evaluate the Supported Living service.
- A variety of webinars and workshops on the Supported Living service.
- The development of It’s My Home, a Supported Living guidebook.
The new It’s My Home: Supported Living Guidebook/Resource Manual is posted on NCCDD’s website. The guidebook is a result of Vaya Health’s work with four provider agencies in assisting 45 individuals with intellectual or other developmental disabilities (I/DD) in transitioning to homes of their choice. In making successful moves to their homes, these individuals encountered a variety of challenges. These challenges and learning experiences, along with solutions, are documented in It’s My Home.
In addition, successful transition stories of people moving into their own homes were recorded and are shared on NCCDD’s website here. People with I/DD who are featured in the guidebook and videos talk about how their lives are progressing with their jobs and how they are succeeding in living on their own.
It is the Council’s hope that the information provided through the guidebook and videos enables individuals with I/DD, their families, their support professionals, the agencies they work with, and other community partners in setting up Supported Living successfully to make community living a reality for all.
Watch our new Supported Living Success Story Videos below:
Audio - Highlights and Hot Topics