President and CEO of the North Carolina Institute of Medicine (NCIOM) Adam J. Zolotor, MD, DrPH, shares that some of the recommendations from the NCIOM Task Force on Serious Illness Care just can’t wait.
To help the state become better prepared for the health challenges of the seriously ill due to COVID-19 or future pandemics, the North Carolina Institute of Medicine (NCIOM) released a set of recommendations to help the state best respond.
Over the past year, the NCIOM has convened a Task Force on Serious Illness Care, to develop a workable plan to meet the needs of individuals living with serious illness and their caregivers across the state of North Carolina. The full report of the Task Force is being released this summer, but with COVID-19, serious illness care is touching a record number of North Carolinians and there are some recommendations that cannot wait.
“Task Force recommendations concerning access to telehealth services and improving advanced care planning are of dire importance in this pandemic,” said NCIOM President and CEO Adam Zolotor, MD.
“All of the recommendations being made are consensus-based and involved a wide array of stakeholders including the medical community, insurers, the long-term care and hospice industry, long-term care ombudsmen, academics and health care advocates,” Zolotor added. A full report will be released to the public and General Assembly in July.
Action on Task Force on Serious Illness Care Recommendations During COVID-19
Session Law 2020-4 (House Bill 1043) and Session Law 2020-3 (Senate Bill 704) were passed by the North Carolina House and Senate on May 2, and signed into law by Governor Cooper on May 4. These bills appropriate almost $1.6 billion in federal funds from the CARES Act to provide financial relief related to impacts of COVID-19. This legislation addresses several areas related to telehealth, broadband, and advance care planning recommendations from the Task Force on Serious Illness Care:
Telehealth and broadband infrastructure: The Task Force identified improved broadband access as a crucial step toward improving access to health care across the state. NCIOM has written previously about COVID-19 and the “digital divide,” and how lack of access to adequate internet coverage and technology impacts low-income North Carolinians. In bills introduced in May, $9 million was allocated to improve broadband service in rural areas of North Carolina. The bills also included the following to address additional need for telehealth services during the COVID-19 pandemic:
- $50 million to NC Department of Health and Human Services to fund services for rural and underserved communities impacted by the pandemic.
- $20 million to NC Department of Health and Human Services to fund local health departments, rural health providers, the State Laboratory of Public Health, and behavioral health and crisis services.
- $65 million to establish the COVID-19 Rural Hospitals Relief Fund. This funding can be used for planning, training, and implementing expanded telehealth capabilities and services.
- $15 million to establish the COVID-19 Teaching Hospitals Relief Fund. This funding can be used for planning, training, and implementing expanded telehealth capabilities and services.
- $15 million to establish the COVID-19 General Hospitals Relief Fund.
- Expanded use of telehealth technology to make involuntary commitment determinations (due to mental illness or substance use disorder)
Medicare has also expanded coverage for telehealth clinical visits, which will now be paid for at the same amount as in-person services. The NC General Assembly is also requesting that the Medicare pay for services provided by telephone only, in order to increase access for older adults. In North Carolina, Blue Cross and Blue Shield of North Carolina, is covering telehealth services, including phone visits, at the same rate as in-person visits. North Carolina Medicaid is also providing additional telehealth services during the COVID-19 pandemic.
Advance Care Planning
Advance care planning was a key topic for the Task Force, especially the administrative and training challenges to improving the use of advance directives. Advance care planning is a process for people and families to discuss and document their care preferences and ensure that wishes are heard. While the task force focused much of its work on advance care planning for people who are already living with a serious illness, its recommendations also recognize the importance of earlier advance care planning. NCSL 2020-3 enables patients and their caregivers to more easily prepare these important legal documents guiding their desires for “care in advance” while in the current state of emergency. The Task Force on Serious Illness Care acknowledged that North Carolina requirements for advance directives, both two qualified witnesses and a notary signature, may make it hard for many individuals and families to complete advance directives. NCSL 2020-3 includes a temporary waiver of the requirement for two qualified witnesses, allows video witnessing, and also authorizes video notarization of advance directives documents. These changes will be in place through August 1, 2020.
Read the full release here from AARP North Carolina.
About the NCIOM Task Force on Serious Illness Care
The NCIOM, in partnership with agencies and organizations that provide care and advocacy around issues of aging, palliative care, hospice care, and long-term supports and services, will convene the Task Force ten times through 2019 and issue a final report in early 2020. This Task Force is supported by the Duke Endowment, with additional support from AARP NC, the NC Health Care Facilities Association, the Association for Home & Hospice Care of North Carolina, and the Carolinas Center.