FEDERAL (Accurate as of 05/14/2020)

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.

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