By Rose Hoban
After a month of intense work behind the scenes, rare bipartisan cooperation, six at times emotional meetings, and technical glitches throughout, a House committee moved forward bills on Thursday that will help health care providers in North Carolina address lost revenues and the need to change the ways they deliver care as a result of the COVID-19 pandemic.
“It’s unfortunate that it’s taken a crisis like this to see the type of collaboration and unity that we’ve seen throughout this committee,” said Rep. Josh Dobson (R-Nebo). “I think we all could say that we need more of that.”
In one bill lawmakers voted to approve about $480 million dollars in funding for all types of health care priorities, including assistance to hospitals, funds for testing and contact tracing for people stricken by the virus, buying personal protective gear and increased funds for mental health care.
In the other, the legislators made numerous policy tweaks that will allow more telehealth, delays some policies that were slated to take effect this summer and created a plan for the state to establish its own strategic stockpile of personal protective equipment and testing supplies.
“It has been historical, it’s been stressful, it’s scary dangerous to an extreme,” said Rep. Donny Lambeth (R-Winson-Salem), one of the co-chairs of the House Select Committee on COVID-19 Health Care Working Group. “This is a package that I would consider to be phase one, we will continue to monitor the situation and we’ll address the next phase at some point in our future.”
Show me the money
North Carolina’s hospitals have been asking for relief for the losses they’ve incurred by ceasing elective surgical procedures and by all of the moves they’ve had to make to prepare for surges of critically sick patients.
Rural hospitals in North Carolina are losing about $145 million each month due to the coronavirus pandemic, Roxie Wells, CEO of the Cape Fear Valley Health in Hoke County, told lawmakers several weeks ago during one of the group’s meetings. She detailed that $118 million alone came from stopping the elective procedures.
“Another $13 million is due to the need to purchase excess supplies and labor costs,” Wells said. “And the final $14 million is associated with expenses incurred to protect health care workers and patients.”
Lawmakers are suggesting a $75 million appropriation for the North Carolina Healthcare Foundation’s Coronavirus Relief Fund to be distributed among rural hospitals alone.
The bill calls for an additional $25 million to teaching hospitals, with up to 60 percent of that amount to make up for lost revenues from foregone elective procedures, and an additional $25 million to other hospitals.
The appropriations bill also has $110 million to go to members of the NC Policy Collaboratory, a research group formed several years ago by the General Assembly. That money will be divided up between Duke’s Human Vaccine Institute, the Gillings School of Global Public Health at UNC Chapel Hill and the medical schools at Wake Forest University and East Carolina Universities. Lawmakers called for the schools to use the money to come up with antibody treatments for COVID-19, community testing initiatives, getting a coronavirus vaccine to North Carolinians and “other research.”
Other appropriations would include:
- $50 million to match federal funding in order to purchase supplies to become part of a North Carolina stockpile for personal protective equipment and other supplies,
- $25 million to expand diagnostic testing for COVID-19, and expanding the contact tracing workforce and infrastructure.
- $25 million for adult and child protection activities, including support for homeless and domestic violence shelters,
- $1.5 million for NC MedAssist, which helps low-income people gain access to medications
All of this money does not include increases in Medicaid coverage for any testing or treatment for people earning up to 200 percent of the federal poverty level and a bump up in provider reimbursement. DHHS Sec. Mandy Cohen has asked federal regulators to approve an emergency measure to allow the state to reimburse for testing and treatment for COVID-19 for this group of people. The price tag for that could run into the hundreds of millions of dollars which would be borne jointly by the state and the federal government.
Easing treatment and changes to practice
Telehealth has become one of the hallmark methods of delivering health care in the past two months as coronavirus has kept patients and providers in their homes. The policy bill expands the state’s use of telehealth, to include its use for evaluating patients waiting in emergency departments for mental health commitment exams, physical, occupational and speech therapy visits, and reimbursement of audio-only visits for seniors who may not be conversant with computer telehealth technology.
The policy bill also expands what some providers can do to combat the spread of the coronavirus, such as allowing for dentists to administer COVID-19 tests and for pharmacists to give coronavirus vaccines once they become available. The bill also calls for a study on the supply of workforce needed to respond to the ongoing pandemic, both as direct care providers and for public health contact tracing that will be needed to track down people who may be exposed to the virus in coming months.
Many of the measures are meant to smooth out possible speed bumps in getting health care and child care workers into the labor pool. Measures such as a temporary waiver on fingerprint-based criminal background checks for new child care workers could facilitate people laid off in other industries to getting jobs caring for children of essential workers.
The bill also affirms a request to federal regulators made by DHHS Sec. Mandy Cohen for waivers to provide enhanced funding for providers and one that would expand coverage for COVID-related expenses to people earning up to 200 percent of the federal poverty level ($43,440 for a family of three).
Other policy initiatives included in the bill:
- Creating a study of the workforce needs created by the pandemic,
- Extending the time, by a year, for all hospitals to connect to the state’s electronic health information exchange,
- Suspending annual inspections for adult care and group homes and replacing them with compliance reviews on infection control violations and procedures.
- Requiring staff in these homes to undergo “immediate” training on infection control procedures.
As the meeting wrapped up, the bipartisan group of co-chairs expressed their amazement at the quantity of work they had been able to accomplish in six weeks, working remotely.
“I’ve been in serving for 18 years and, of course, I can tell you we have never experienced trying to govern virtually like we have,” said Rep. Becky Carney (D-Charlotte) “I think it has been successful, and you’ve been a part of history.
“These needs are real, we have to get this money out, we’ve got these policies and these waivers in place,” she continued. “Thank you all for being a part of that, and getting us, our state, moving and we’re going to make it.”