Serious illness care recommendations during COVID-19

RALEIGH -- The North Carolina Institute of Medicine Task Force on Serious Illness Care, recommends actions to improve quality of living for individuals with serious illness and their caregivers. The full report of the Task Force will be released this summer, but with COVID-19, serious illness care is touching a record number of North Carolinians and there are some recommendations that can’t wait.

Task Force recommendations concerning access to telehealth services and improving advance care planning, are of dire importance in this pandemic.

NCIOM president and CEO, Dr. Adam Zolotor, talks about the recent legislation and action required on Task Force recommendations:

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:

Hospital & local health system support, telehealth and broadband infrastructure: In addition to supporting hospitals and rural health services, 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 acted on 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 under-served 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).

The Centers for Medicare and Medicaid Services (CMS) has also expanded coverage for telehealth clinical visits, which will now be paid for at the same amount as in-person services.

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 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.

The NC COVID-19 Recovery Bill 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. The Bill 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.

Dr. Zolotor concludes, "Task Force recommendations are consensus- based and involve all stakeholders when it comes to the care of the seriously ill. Further action on these recommendations will go a long way to minimize the impact of pandemics and other dangerously contagious diseases."

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, convened the Task Force ten times through 2019 and will issue a final report in July 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.