Hurricane Helene Recovery Resources

If you need to transfer a patient from Western NC hospitals impacted by Helene you can enter the patient here: https://nc.readyop.com/fs/4dDL/830f or contact the team at 919-937-7112. 

Important Update from SERT/SMAT on Staffing Support and Accessing Life-Safety Items
The North Carolina State Emergency Response Team (SERT) wants to ensure that healthcare entities across North Carolina know how to get access to life-safety related items (water, fuel, food, oxygen, staffing, etc.).

NC Office of Emergency Medical Services has rostered clinical staff and is working to continue to source commodities to support healthcare facilities. The rostered clinical staff will be vetted through the State Medical Assistance Teams (SMAT), Medical Reserve Corps (MRC), or are employed as part of the health systems across North Carolina.

For support, facilities should reach out to their local emergency managers to place requests for help.

Staffing Support
Supply Requests

Should you have questions please contact OEMSSupportCell@dhhs.nc.gov

State Medical Assistant Team and Medical Reserve Corps
Many clinicians want to use their unique skill sets to help with recovery efforts. Please do NOT self-deploy. Use this link for State Medical Assistant Team (SMAT) and Medical Reserve Corps (MRC) personnel to indicate any availability to provide staffing assistance for potential medical sheltering operations in Western North Carolina. Signing up will not necessarily result in deployment. Requests will be sorted at the State Emergency Operations Center and through the Healthcare Preparedness Coalitions.

Emergency Licensure for Disaster Relief
The North Carolina Medical Board has activated the Limited Emergency License to help facilitate medical professionals volunteering their time and skills to help communities in need. Read more here.

Nursing Licensure Verification 
The North Carolina Board of Nursing allows out-of-state nurses to practice during a disaster in an established healthcare system or facility, provided the nurse has a valid, unencumbered license in another state. Licensure information can be verified easily through “Nursys QuickConfirm License Verification.” Contact general@ncbon.com for additional information if you’re a licensed out-of-state nurse interested in helping or an employer that needs help. 

Steps to register to volunteer for medical staffing:

1. Register in TERMS- Training, Exercise & Response Management System – First Time Registration (ncem.gov) this will prompt the appropriate state vetting process as well as give you access to the orientation training.
2. Create profile in TERMS – Be sure to enter required information, especially any licenses, contact information, and your work organization as applicable.
3. Once registered with TERMS, go to Response Participation on the left side of the screen.
4. Under Request for TEAM membership, select ESF8
5. Complete SMRS Responder Orientation online (takes about 90 minutes) – Training, Exercise & Response Management System – Online Course Description (ncem.gov)
6. Next, if they have not already, please fill out the ready op form
7. Once these steps have been completed, a deployment availability link will be sent for personnel to indicate when they could deploy.  NC OEMS will review and contact those that are needed.  No one should self-deploy.

NC Office of Emergency Medical Services has opened State Medical Support Shelters (SMSS) to manage individuals requiring non-acute medical care by physicians, nurses, etc. All patients MUST be triaged prior to acceptance to ensure they meet the criteria for placement.

• State Medical Support Shelter Patient Movement Support Guide
• State Medical Support Shelter Placement Guidance
• SMSS Individual Patient Placement Request Form
• SMSS Resources

Contact the OEMSSupportCell@dhhs.nc.gov or the State Emergency Operations Center at 919-825-2427.

Section 1135 Wavier
The public health emergency caused by Hurricane Helene allows for 1135 waivers that give impacted hospitals operational flexibilities. See this document for details. The waivers and modifications will take effect on Oct. 1, 2024, with retroactive coverage starting from Sept. 25, 2024, and will last for the duration specified in section 1135(e) of the Social Security Act. Read more here.

New Executive Order 318  from Governor Cooper with flexibilities, including expanding flexibilities of licensing boards and authority for standing orders.

CMS Blanket Waivers and Other Flexibilities Now Include All North Carolina Counties
10-4-2024 —The North Carolina Department of Health and Human Service (NCDHHS) released this Medicaid bulletin noting that the Centers for Medicare and Medicaid Services’ blanket waivers now apply to all counties in North Carolina. Because the publicly available version of the President’s declaration currently only includes 25 counties and Eastern Band of Cherokee Indians, NCHA sought a revised declaration, which is attached. It confirms all 100 counties in North Carolina and EBCI, allowing that the blanket waivers apply statewide.

Medicaid flexibilities
10-3-2024, NC Medicaid Flexibilities Update

Board of Nursing Waivers
10-3-2024,  North Carolina Board of Nursing Temporary Waivers

Board of Pharmacy
NC Board of Pharmacy emergency waiver

Bed Capacity flexibility
NC Division of Health Service Regulation flexibility memo on exceeding licensed beds. This does not apply to an eastern NC hospital not treating/responding to an influx of patients from the western disaster counties.

The NCHA Mutual Aid Agreement (MAA) is a voluntary written arrangement among signatory hospitals to promote effective utilization of hospital resources in the event of disaster. See a copy of the MAA here. Members can login at the top of the page for access to additional resources on this page, including a list of signed MAAs.

If you want to activate your Mutual Aid Agreement, contact Tatyana Kelly tkelly@ncha.org 404-285-7050 

FDA action on Baxter
On October 11, 2024, the FDA issued an immediately-in-effect guidance, Temporary Policies for Compounding Certain Parenteral Drug Products, for compounders to help fill the gaps from the impact of Hurricane Helene on Baxter International’s North Cove facility.

The FDA also added three new drug products to the Drug Shortages Database as a result of Hurricane Helene. The agency now considers Dextrose 70% IV solution, Lactated Ringers IV Solution, and Peritoneal Dialysis Solution to not be commercially available in adequate supply to meet national demand.

The FDA is working continuously to address the shortages and supply disruptions to ensure patients have access to certain parenteral drugs, including IV solutions. For the most recent information on drug and biologic products that were impacted by Hurricane Helene, please see FDA’s Baxter Recovery webpage.

Baxter launches webpage with clinical resources to support IV solution conservation
As part of its regular updates on the IV solution supply disruption as a result of the temporary closure of a manufacturing plant in North Carolina, Baxter today launched a new webpage with resources that hospitals can use for product management and conservation strategies. The webpage contains resources from Baxter, the federal government and other groups. In addition, Baxter said shipments to the U.S. from two Baxter sites abroad that were already able to export products “started last week and more are on the way.”

Administration, Baxter Officials Provide Updates on IV Solution Supplies
10-10-2024 – On a call hosted by US Department of Health and Human Services Secretary Xavier Becerra, officials from the federal government and Baxter provided updates on the ongoing efforts to address the IV solution supply disruptions caused by the temporary closure of a Baxter manufacturing plant in North Carolina. Read more here.

Strategic National Stockpile (SNS)
SNS does not currently maintain an inventory of IV solutions available for distribution nationwide.

Letter to Health Care Leaders and Stakeholders from HHS Secretary, Xavier Becerra
On October 9, 2024, Secretary Becerra wrote a letter to inform health care leaders that the Department of Health and Human Services (HHS) is working tirelessly to mitigate the sterile solutions supply chain disruptions you may already be experiencing as a result of the storm. The letter details the status of the current supply chain disruption, what to expect in the coming months, and what to consider in light of the challenges

Hurricane Helene: Baxter’s Manufacturing Recovery in North Carolina
Check here for the latest Information and updates on CDER-regulated drug and biologic products.

ASPR Technical Resources, Assistance Center & Information Exchange (TRACIE)
ASPR TRACIE has developed a new tipsheet- Intravenous Fluid Shortage Strategies. The tipsheet can be found on the Medical Product Shortages and Scarce Resources Page and it contains information that can help healthcare providers modify traditional practices and conserve IV fluids.

Food and Drug Administration (FDA)
FDA has a dedicated page displaying the current information and updates on their Center for Drug Evaluation and Research (CDER) regulated drug and biologic products. They have determined which products manufactured at the North Cove facility are currently in shortages, provided information on compounding, and provided temporary importation sources to help mitigate shortages.

UPDATE: Product Allocations – Hurricane Impact on Baxter’s North Cove, NC Facility
10-9-2024 — In follow-up to Baxter’s October 1 implementation of product code allocations in response to Hurricane Helene’s impact on our North Cove, NC facility, we are pleased to share an increase in allocation levels across several product categories. Updated allocation levels are listed in this letter and will be consistent across Baxter’s direct customers and distribution partners, effective Wednesday, October 9. Due to the vulnerable patient population they serve, effective today, all allocations for designated children’s hospitals were increased to 100%. Health systems that are not designated as a children’s hospital but have key pediatric services, including pediatric emergency departments, NICUs or PICUs, should contact their Baxter representative with any questions about allocation levels. Information on Peritoneal Dialysis products will continue to be communicated separately to home patients and customers. Read more here.

Small- and Large-Volume Fluid Shortages – Suggestions for Management and Conservation
This fact sheet from ASHP provides potential actions for organizations to consider in managing fluid shortages. Healthcare practitioners should use their professional judgment in deciding how to use the information in this document, considering the needs and resources of their individual organizations.

Baxter Plant Update
10-9-2024 Hurricane Helene Update

US HHS current supply chain disruption
10-9-2024 — Letter to Health Care Leaders and Stakeholders on Impacts of Hurricane Helene from Secretary Becerra, including status of the current supply chain disruption, compounding when drugs are on FDA’s Drug Shortages List

AHA Letter to Biden Administration on IV Solution Shortage
10-7-2024 — The American Hospital Association sent this letter to President Biden urging the Administration to take immediate actions to increase the supply of IV solutions for hospitals and other health care providers that are struggling with shortages following the closure of a Baxter manufacturing plant as a result of Hurricane Helene.

AHA Special Bulletin on Baxter Plant
10-4-2024 — The American Hospital Association (AHA) is continuing efforts on multiple fronts to provide updates on the supply chain issues resulting from the closure of a Baxter manufacturing plant in North Carolina because of damage from Hurricane Helene. The plant manufactures 60% of the country’s supply of IV solutions and produces 1.5 million bags per day.  The AHA is in frequent discussions with officials from Baxter, the Department of Health and Human Services (HHS), the Food and Drug Administration (FDA), and other federal agencies about the supply disruptions and what steps can be taken to assist hospitals and health systems as they care for patients. We have developed a webpage that contains information that we are sharing with members to keep them informed, as well as resources that hospitals can use. For more details, see this Special Bulletin.

Temporary Closure of Baxter’s Plant in North Carolina Due to Hurricane Helene
Baxter International Inc. announced Sept. 29 that its North Cove manufacturing plant in Marion, N.C., was temporarily closed as a result of damage from Hurricane Helene. The plant manufactures 60% of the country’s supply of IV solutions and produces 1.5 million bags per day. In a letter to customers, Baxter shared that it is implementing allocations on certain products effective immediately. It also said that additional information on peritoneal dialysis products will be coming soon.

Patient safety nonprofit releases guidance for navigating medical supply chain disruptions caused by Hurricane Helene
Review the report from ECRI designed to help health care providers navigate shortages caused by the Baxter facility shutdown. The report identifies up to the top three alternatives from other manufacturers to the IV and irrigation solutions affected by the plant closure.

With so many people in Western North Carolina displaced and in need of food, water, shelter and medical care, the North Carolina Medical Board (NCMB) knows medical practices in the region are doing everything they can to care for their patients and communities. At the same time, many medical practices have been destroyed or damaged and are not in a position to see patients.

NCMB needs help in building two resources that are being developed in partnership with NC DHHS and dozens of stakeholders working to support medical practices.

1.     To help patients in the counties hardest hit by Hurricane Helene access medical care, we are asking licensees to notify NCMB of the current status of their medical practices. This information will be used to create an online database that patients can use to find open medical clinics, and also help NC DHHS identify areas that do not have any medical services and may need assistance. Click here to let us know if you are seeing patients, either in person or via telemedicine, or if you are currently closed. If your status changes after you complete the form, email communications@ncmedboard.org and NCMB staff will update your information.

2.     Additionally, the NC Medical Society (NCMS) is compiling information about how practices have been impacted by Helene (financial, infrastructure, patients, supplies, etc.). They are collecting this information from practices across Western NC in order to share the needs with NC DHHS to support the State in allocating resources. Please take a few minutes to complete the NCMS survey.

For more information and resources related to Hurricane Helene, visit www.ncmedboard.org/disaster.

Flexibilities for HIE Access
The NC HealthConnex team is committed to supporting those most in need in western North Carolina impacted by Hurricane Helene. The NC HealthConnex Clinical Portal is a web-based application that allows providers to access critical clinical information such as medical history, medications and treatment plans for displaced patients. See the NC Health Information Exchange website for more details. This includes some guidance for providers without internet access.

CMS will permit people with Medicare who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the hurricane to receive replacements of such items and services. This will help to ensure beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. People with Medicare can contact 1-800-MEDICARE (1-800-633-4227) for assistance. 

• Open Pharmacy – Locate a pharmacy near you: EmergencyOperatingPharmaciesHelene (ncbop.org)
  • Statewide standing orders for epi-pens – https://www.dph.ncdhhs.gov/about-us/nc-state-health-director-standing-ordersfor
  • For epi-pens for pharmacists  https://www.dph.ncdhhs.gov/north-carolina-state-health-directors-epinephrine-auto-injector-standing-order/download?attachment
  • New Nursing Orders:
    SWSO for Nursing Administration of Epinephrine 16.5 to 33 lbsSWSO for Nursing Administration of Epinephrine 33 to 66 lbsSWSO for Nursing Administration of Epinephrine 66 lbs or more

The Centers for Medicare and Medicaid Services is helping people obtain and maintain access to critical life-saving services by activating the Kidney Community Emergency Response (KCER) program and working with End-Stage Renal Disease (ESRD) Network 6 (Georgia, North Carolina) and Network 7 (Florida), which is responsible under a contract with CMS for assessing the status of dialysis facilities in potentially impacted areas of the impacted states. 

The ESRD Network 6 (Georgia, North Carolina) toll-free hotline is 1-800- 524-7139 and ESRD Network 7 (Florida) toll-free hotline is 1-800-826-3773. 

Additional information is available on the KCER website at: kcercoalition.com/ 

Hurricane Helene and NBS Specimen Storage and Transport
The NC Department of Health and Humans Services has released a memo for those impacted by Hurricane Helene advising on storing and transporting newborn screening (NBS) specimens. Read more here.

Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Impacted by Hurricane Helene
Families participating in WIC who may have relocated to a new area can go to any NC WIC agency to have a new eWIC card issued, or to request replacement of breastfeeding supplies, breast pumps, and food purchased with current WIC benefits and lost due to Hurricane Helene.  A list of WIC agency closures related to Hurricane Helene can be found on the NC WIC landing page under Special Weather Announcement.

North Carolinians Enrolled in Food and Nutrition Services Can Use Benefits to Buy Hot Food Following Hurricane Helene
People and families in North Carolina who are enrolled in the Food and Nutrition Services (FNS) program can use their benefits to purchase hot food. This temporary flexibility applies to all 100 counties in North Carolina and the nearly 700,000 households enrolled in the FNS program. The North Carolina Department of Health and Human Services is working closely with the U.S. Department of Agriculture to ensure people impacted by Hurricane Helene receive assistance as soon as possible. Click here for more.

Replacement Benefits Available for Food and Nutrition Services Recipients Impacted by Hurricane Helene
People in 23 Western North Carolina counties impacted by Hurricane Helene who are enrolled in Food and Nutrition Services now have access to replacement benefits on their Electronic Benefit Transfer (EBT) cards. The United States Department of Agriculture approved North Carolina to allow current FNS participants in the 23 counties to receive 70% of their total monthly September benefit back on their EBT card. The benefit replacement is automatic and does not require action from the FNS participant. This impacts more than 200,000 people in North Carolina and more than $24 million in replacement benefits. Read more here.

The North Carolina Department of Health and Human Services is sharing guidance on actions people can take to ensure water is safe and to prevent waterborne disease or illness after the storm.

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NCDHHS Urges Well and Septic Safety Following Hurricane Helene
10-10-2024– The North Carolina Department of Health and Human Services is urging western North Carolinians who rely on a private well for their drinking water and were impacted by Hurricane Helene to continue to use bottled, boiled or treated water until private wells can be disinfected and tested for dangerous bacteria. Safety measures and precautions are also needed for septic systems that have been impacted by the storm before returning to use. Read more here.

Hand sanitizer is acceptable and the preferred method of hand hygiene for most healthcare situations. A handwashing station would be preferred for when staff/patients need to wash their hands when visibly soiled. Link for building a portable handwash station.  https://dec.alaska.gov/eh/fss/resources/handwashing-station/.  For further for health care infection prevention, you can contact infectionprevention@dhhs.nc.gov

Behavioral Health Resources Available for People Impacted by Hurricane Helene
10-10-2024 – NC Department Health and Human Services has resources listed to get mental health support if you believe you or a loved one may need help. Read the press release here.

• 988 Lifeline: 988 Lifeline – If you need emotional support, reach out to the national mental health hotline: 988.
• Peer Warmline: Get Support – You’re never alone. | Promise Resource Network
• Disaster Distress Helpline: Hurricane Helene – Partners Health Management (partnersbhm.org)
• Help for Helpers Hope4NC website: Hope4NC Helpline | NCDHHS or by phone 1-855-587-3463 to provide mental health support for first responders and volunteers working on our Hurricane Helene disaster response
• Disaster Distress Hotline: For everyone, we have the Substance Abuse and Mental Health Services Administration (SAMHSA) disaster distress hotline: 1-800-985-5990. This service provides support, listening, and resources specializing in post-disaster trauma.
• Support for First Responders: We are deploying mental health clinicians for all first responders and have launched the Hope4NC hotline for them at 1-855-587-3463.
• Counselors at Shelters: Mental health counselors are available at shelters, stocked with naloxone, and have access to methadone. You can find shelters here: Shelters.
• Opioid Treatment Programs: All opioid treatment programs in the region are open, and individuals can receive their treatment doses at any location, not just their usual one. Treatment options can be found here: Treatment Locations.
• Vaya Health Resources:  Vaya Health has compiled a comprehensive list of providers addressing urgent needs. Vaya’s 24/7 line is 1-800-849-6127, and the resource list is available here: Vaya Resources. Please note that lists walk-in clinics in each community that are open and available to provide services to members in distress.

Visit the NC Medicaid Hurricane Helene Virtual Bulletin Board for information and resources for NC Medicaid beneficiaries and families impacted by Hurricane Helene. Updates are added as the recovery continues.

Information on the flexibilities in place for Hurricane Helene can be found on the NC Medicaid Bulletins webpage.

NC Medicaid and the health plans are committed to supporting providers impacted by the devastating effects of Hurricane Helene. The following financial supports may be available to providers, even if they are unable to submit claims or perform services.

• Hardship Advances: All health plans and NC Medicaid Direct have processes to make hardship advances for providers unable to meet financial obligations.
• Stabilization Payments: The health plans have the flexibility to make stabilization payments to support provider sustainability and beneficiary access.
• Retainer Payments for Home and Community-Based Services (HCBS): NC Medicaid is seeking authority to make retainer payments for 1915(c) waiver services to support certain HCBS providers with maintaining staff and capacity, even if service delivery is temporarily interrupted.

Providers in need of financial supports should work directly with the health plans to learn what supports each plan is offering and their associated process(es).

Contact Information

• Alliance Health alliancehealthplan.org/provider-updates/hardship-payment-requests-2
  Provider support: 855-759-9700
• AmeriHealth Caritas North Carolina amerihealthcaritasnc.com
  Provider support: 888-738-0004
• Carolina Complete Health carolinacompletehealth.com
  Provider support: 833-552-3876
• Healthy Blue healthybluenc.com/north-carolina/home.html
  Provider support: 844-594-5072
• Partners partnersbhm.org/tailoredplan/providers/providerconnect
  Provider support: 877-398-4145
• Trillium ncinno.org
  Provider support: 855-250-1539
• United Healthcare Community Plans of North Carolina  uhccommunityplan.com/nc/medicaid/medicaid-uhc-community-plan
  Provider support 800-638-3302
• Vaya Health https://providers.vayahealth.com/helene-recovery/
  Provider Support Line: 866-990-9712
• WellCare of North Carolina wellcare.com/nc
  Provider support 866-799-5318
• NC Medicaid Direct To request a hardship advance, contact the Medicaid Provider Ombudsman Medicaid.ProviderOmbudsman@dhhs.nc.gov or 866-304-7062

Hurricane Helene: Fact vs. Rumor

There are many false reports and misinformation being shared on social media about the response to Hurricane Helene.  Click here for details. Additional reliable information regarding Helene can be found at www.ncdps.gov/helene.

The public should get information about storm response and impacts from trusted sources like the State Emergency Response Team, National Weather Service, and other federal, state, county and local government sites. Be aware that Artificial Intelligence or AI-generated images are being circulated on social media that do not depict conditions on the ground.

Do your part to the stop the spread of rumors by doing three easy things:

• Find trusted sources of information.
• Share information from trusted sources.
• Discourage others from sharing information from unverified sources and question where information is coming from.