by Brieanne Lyda-McDonald, MSPH

The North Carolina Department of Health and Human Services (NCDHHS) has established various temporary flexibilities related to long-term services and supports (LTSS) to aid those affected by Hurricane Helene.

LTSS provide care to people with disabilities and older adults who need it in community-based settings or long-term care facilities. These flexibilities are effective from September 26, 2024, through December 31, 2024, and include:

• Community Alternatives Program for Children (CAP/C) and Community Alternatives Program for Disabled Adults (CAP/DA) [1]
  • “NC Medicaid has requested from case management entities, in the impacted counties, an assessment of the health and well-being status of each CAP beneficiary. Case management entities, in impacted counties, are required to complete in the eCAP systems the Disaster Wellness Check Documentation related to the health and well-being status of the CAP beneficiaries they serve. NC Medicaid will seek approval for Appendix K authority, more information will be provided on the flexibilities of service utilization and the effective period of Appendix K when available.”
  • Other CAP/C and CAP/DA flexibilities include: Services may be administered in a different setting if participant has been displaced; annual assessments and new and annual service plans can be postponed; contact with beneficiaries and service providers to monitor the impacted member’s service plan; service needs identified by the emergency and disaster plan assessment can be implemented and retroactively approved; and those who lost access to their regular direct care worker may temporarily select family member or other caregiver.
• Home health [1]
  • Waive home health nursing and home health aide visit limits
  • Waive on-site supervisory visits for home health
  • No prior authorization required for home health skilled nursing visits
• Nursing facilities [1]
  • Expedited admissions for displaced individuals
  • For NC Medicaid Direct, suspended requirement of a Pre-Admission Screening and Annual Resident Review (PASSR) number on prior authorization.
  • “NC Medicaid Direct and NC Medicaid Managed Care will not require Level I and II Preadmission Screening and Resident Reviews (PASRRs).”
  • “Waiving the requirement for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay.”
  • “Coverage for certain beneficiaries who recently exhausted their SNF benefits will be renewed without first having to start a new benefit period.
• Personal care services [1]
  • Telephonic assessment when beneficiaries cannot receive in-person personal care new or annual assessment.
  • Displaced beneficiaries may continue to receive their personal care services in their relocated settings.
  • Other administrative flexibilities

In addition, the preliminary hurricane recovery legislation passed by the North Carolina General Assembly provides for a temporary authorization to extend provisional licenses for adult care homes and family care homes [2].

A notable recommendation from the previous NCIOM Task Force on Serious Illness Care are reflected in the flexibilities being provided by NC DHHS:

Recommendation 3.6: Expand access to coverage for health care services

• Strategy 3.6 (2) – “The North Carolina Department of Health and Human Services should revise processes for determining eligibility for services covered by Medicaid, including long-term care and Special Assistance programs (including Special Assistance for Assisted Living and Special Assistance In-Home programs). Processes should ensure timely and efficient eligibility determination.”

The NCIOM Annual Meeting will be held on November 21 at the McKimmon Center in Raleigh and will focus on LTSS, including discussion of the impacts of Hurricane Helene.

References
1. North Carolina Department of Health and Human Services. Hurricane Helene Policy Flexibilities to Support Providers and Members. October 11, 2024. https://medicaid.ncdhhs.gov/blog/2024/10/11/hurricane-helene-policy-flexibilities-support-providers-and-members-oct-11-2024
2. North Carolina general Assembly. The Disaster Recovery Act of 2024. SL 2024-51. HB 149. https://www.ncleg.gov/Sessions/2023/Bills/House/PDF/H149v5.pdf