FEDERAL (Accurate as of 04/17/2020)

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 and 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]