CHAD Connection COVID-19 Edition

Thank you for reading this special edition of the CHAD Connection. CHAD plans to release weekly editions of the COVID-19 Digest over the next few months to cover COVID-19-related news and updates for our members adequately. We also encourage you to visit our COVID-19 webpage for up-to-date resources and links.

In this newsletter, you will find updates from the Bureau of Primary Health Care (BPHC), the National Association of Community Health Centers (NACHC), and both North Dakota and South Dakota. You will also find information we thought would be useful, including telehealth guidance and funding, legislative updates, and marketing resources.

The Health Resources and Service Administration (HRSA) uses the information collected from the weekly surveys to help track health center capacity and the impact of COVID-19 on health center operations, patients, and staff. It is also a way to better understand training and technical assistance, funding, and other health center resource needs. To view the COVID-19 survey data being collected by health centers, visit the health center COVID-19 survey page to see the national report and state reports.

The North Dakota Department of Commerce has released a survey to help them understand how the coronavirus pandemic is impacting communities and individuals across North Dakota. Tracking this information will be helpful to their agencies and partner organizations in identifying additional resources to leverage to support North Dakotans during this challenging time.

This survey will ask about experiences since March 13, when Governor Burgum declared a State of Emergency in response to the pandemic, and within the next 30 days. They plan to reissue the survey in the future to identify trends in community impact over time.

As part of the CARES Act, an initial disbursement of $30B has been made by the Centers for Medicare and Medicaid Services (CMS) to health care providers via direct deposit. All facilities and providers that received Medicare fee-for-service reimbursements in 2019 are eligible and payments are proportionate to last year’s Medicare payment amounts. Health centers in North Dakota and South Dakota should have received those payments on Friday, April 10. These payments are grants to health care providers and will not need to be repaid. Providers must sign attestation confirming receipt of the funds within 30 days of receiving the payment. For more information, click here.

Both the U.S. House and Senate have extended their recesses until May because of social distancing and travel concerns surrounding COVID-19. Both chambers are working on additional legislation that would add to the $2.2T stimulus package that was passed in March. Senate Republicans have put forth a smaller bill that would add $250B to the Paycheck Protection Act that is quickly diminishing. The House agreed to fund the additional appropriation for small businesses but want and additional $250B for hospitals and state and local governments. Since no agreement was reached, any further bills will have to wait until the House returns to Washington on May 4.

Although there is no formal legislation pending, the National Association of Community Health Centers (NACHC) has prepared several funding requests for Congress for when they begin writing the next piece of legislation. NACHC’s requests include:

$7.6B over six months to respond to the COVID-19 emergency and enable health centers to retain staff and capacity through the next six months;
A five-year funding extension including expansion dollars to care for an additional 10 million patients over five years;
A five-year extension of mandatory funding for workforce programs such as the National Health Service Corps (NHSC);
$20B over the next five years or until expended for critical infrastructure for health centers; and
Permanent changes to FQHC/RHC Medicare telehealth billing, so the rates are consistent with the prospective payment system (PPS) rate.

For more information on the funding requests from NACHC, click here.

Governor Doug Burgum extended the closure of non-essential businesses through April 30. In addition, the Governor released an initial step by step plan, that includes information on what will be needed to re-open businesses across the state. The list of needs includes:

Widespread rapid testing;
Robust contact tracing;
Targeted, effective tracing;
Protections for most vulnerable;
Sufficient health care capacity;
Ample PPE availability;
New standard operating procedures for businesses; and
Prepared for the second surge.

For more information on the state’s plan for a graduated re-opening process past April 30, click here.

Announced earlier this week was the state’s hospital surge plan, which includes a plan for the highest level of need for hospital beds called tier three. For more information on the state’s hospital surge plan, visit here.

A COVID-19 crisis or "hot spot" has emerged in the Sioux Falls area tied to an outbreak in a Smithfield Food meat-packing plant with around 3700 employees. While the state of South Dakota sits at just over 1,311 cases, the majority of those -- 733 -- are tied to employees at Smithfield Foods, making it the nation’s top "hot spot," according to tracking by The New York Times. Both Governor Kristi Noem and Sioux Falls Mayor Paul TenHaken have been addressing community concerns day by day. Eventually, the company chose to close indefinitely this week with two weeks of paid time off for their employees. Health Secretary Kim Malsam-Rysdon requested that the Centers for Disease Control and Prevention (CDC) help the state understand the Smithfield coronavirus situation. The CDC team toured the Smithfield plant on Thursday to create a checklist of what the company needs to safely re-open. One Smithfield employee has died of COVID-19 according to local reports.

Governor Noem denied Mayor TenHaken’s requests for a Stay-at-Home (SAH) order for Minnehaha and Lincoln Counties as well as creating an isolation center in Sioux Falls for COVID-19 patients. The mayor is now moving forward to pass his plans on the municipal level. The Sioux Falls City Council voted 8-0 on Wednesday to have a second reading next week on the SAH ordinance. The full proposed SAH ordinance can be found here.

The federal government classified several industries as essential critical infrastructure workers. The City of Sioux Falls also defined several other specific groups as essential workers including:

Construction workers and those in services which support construction operations;
Professional services, such as legal or accounting services, insurance services, real estate services, and veterinary services; and
Employees of biotech companies and financial institutions.

The Federal Communications Commission (FCC) established the COVID-19 Telehealth Program in response to the public health emergency caused by the COVID-19 pandemic. This program will provide $200 million in funding to assist health care providers and health systems in establishing a telehealth solution to care for patients in a remote location such as their homes. The funding is provided through the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed by Congress earlier this year. The purpose is to fully fund the health systems’ telecommunication services, information services, and connected devices necessary to provide a telemedicine solution that will have an immediate impact on patients. The Great Plains Health Data Network (GPHDN) submitted an application on Tuesday, April 14, on behalf of 10 health centers across North Dakota, South Dakota, and Wyoming.

Examples of eligible services and devices include voice-only services, internet connectivity, tablets, smartphones, and pulse oximetry monitors. Health systems that are responding to the COVID-19 pandemic will be provided immediate funding support up to $1 million to any single applicant. The funds will target areas that have been hardest hit by COVID-19, and the Commission encourages applicants to provide telehealth to high-risk and vulnerable patients. The FCC started accepting applications on Monday, April 13 and will run until the funds are exhausted. If you have questions, please contact Kyle Mertens and Becky Wahl.

When providing telehealth services to patients in another state, a provider must comply with the patient’s state’s laws and licensure regulations. If providing services in another state is considered unlawful under applicable state law, Federal Tort Claims Act (FTCA) coverage may be jeopardized. Some states may have temporarily amended their requirements for providing health care through telehealth to address the needs of the COVID-19 public health emergency. It is important to check state laws when providing care in another state, and if uncertain of legal requirements, it is advised to consult with private counsel. PAL 2020-01: telehealth and health center scope of project highlights this and other relevant considerations for health centers providing services through telehealth. For considerations relating to FTCA coverage, detailed information can be found in the FTCA health center policy manual.

Last week, CHAD and the Health Center Association of Nebraska (HCAN) hosted a call with Jonathan Chapman, chief project officer with Capital Link, to review the main cashflow and payroll opportunities available in response to the COVID-19 public health emergency. Jonathan shared the main terms of each of the financial relief opportunities outlined in the National Association of Community Health Centers (NACHC) cashflow and payroll options for health centers. The recording of the call and all resources provided are available on the past event resources page of the CHAD website.

HRSA has extended the deadlines for health centers for various submissions.

Calendar Year 2021 FTCA deeming applications will open on Monday, April 13, in HRSA’s electronic handbooks (EHBs), and the deadline is extended to Monday, July 13.
Service area competition (SAC) notice of funding opportunity (NOFO) HRSA-20-100 applications has an extended deadline of Wednesday, April 22.
Budget period progress reports (BPR) non-competing continuations for the September budget period start dates are now due on Friday, May 1.

COVID-19 Supplemental Funding (also referred to as H8C in the payment management system) may be used for hazard and premium pay if there are policies and procedures in place that cover this type of compensation. Personnel who will be paid with COVID-19 Supplemental Funding (H8C) must receive salary and benefits consistent with a health centers’ policies of paying salaries under unexpected or extraordinary circumstances from all funding sources, federal and non-federal. If health centers do not have hazard pay policies currently in place, they should be developed immediately. To be eligible, there must be documentation following organizational policies for changing salaries during unexpected and extraordinary circumstances and following HRSA guidance as adopted and permitted by the OMB memoranda M-20-11 and M-20-17.

COVID-19 (H8C) supplemental funding may only be used for in-scope activities. A request for scope adjustment or change in scope must be submitted to the assigned project officer for prior approval if H8C funding is to be used to support new services.

The Bureau of Primary Health Care (BPHC) continues to update the Health Center Program COVID-19 frequently asked questions (FAQs). On Wednesday, April 8, the Health Resources and Services Administration (HRSA) announced the release of more than $1.3 billion provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. HRSA used the following distribution formula:

Base value of $503,000;
$15 per patient reported in the 2018 Uniform Data System (UDS); plus
$30 per uninsured patient reported in the 2018 UDS. The average award is approximately $950,000.

As with the COVID-19 supplemental funding, HRSA made funds immediately available and will collect budget and activities to be supported by the funding through EHBs by 10:59 pm CT on May 8. See the CARES technical assistance webpage for information regarding the reporting requirement submission.

There will be a new grant number starting with activity code H8D to track CARES awards. This is separate from the funding (H80) and the COVID-19 supplemental funding (H8C). This allows for tracking of CARES Act spending across all parts of the government. It also helps ensure that each set of funds is used for its intended purpose, including:

Detection of COVID-19;
Prevention, diagnosis, and treatment of COVID-19;
Maintaining or increasing health center capacity and staffing levels during this public health emergency; and
Flexibility to use CARES funds as circumstances and needs evolve.

See the CARES technical assistance webpage for examples of allowable uses of funding.

The performance period for this one-time funding is 12 months. Pre-award costs are permitted to support expenses related to the coronavirus public health emergency dating back to January 20.
The same PIN is used to access CARES supplemental funding in the payment management system (PMS) as for the base grant funding (H80). If you have issues accessing the H8D funding, contact your PMS accountant or grants management specialist identified on your H8D grant notice of award. The assigned PMS accountant can be identified though find your PMS liaison accountant.

The latest episode of Today with Macrae was on Wednesday, April 15. When available, the call recording can be found here. Some of the highlights from the call are:

Review of COVID-19 and CARES supplemental funding amounts and the average amounts received by each health center:

COVID-19 (H8C) supplemental funding was released on March 24. It was a total of $100 million, with an average of $70,000 per health center. The reporting deadline is April 23.
CARES Act (H8D) supplemental funding was released on April 9. It was a total of $1.32 billion, with an average of $950,000 per health center. The reporting deadline is May 8.
Increased the flexibility of costs will be allowed with the COVID-19 (H8C) funding to include maintaining and increasing health center capacity.
CARES Act (H8D) funding may be used for minor alterations and renovation or the purchase of mobile units.
Separate accounting is required for base grant (H80), COVID-19 (H8C), and CARES Act (H8D) usage.
Both funding sources can be used to cover costs starting on January 20.

Remaining three months of mandatory funding will go out in mid- to late-May.
HRSA base grant (H80) funding may be re-budgeted for more effective use. Prior approval is only needed for the following two circumstances:

More than 25% of the total grant award, or
Moving funds to line items that previously had no federal funds in it.

Health center survey results from last week (April 10 survey)

1,154 surveys returned (83% of health centers)
82% have COVID-19 testing capacity
Health centers completed 56,000 tests with 9,300 positives
44% of health centers have drive-up or walk-up ability
Weekly visits compared to baseline is 47%
Almost 2,100 sites have closed
51% of visits involved telehealth
PPE and supply availability is improving

PCAs reported the top issues in their states. The top three concerns reported were:

Lack of PPE;
Impact of decreased patient visits; and
Transitioning to telehealth operationally, technologically, and the ability to bill.

CHAD designed a marketing campaign toolkit to assist health centers in communicating with patients via social media. The campaign’s focus includes "call first" directions and highlighting the availability, ease, and importance of telemedicine for primary care and behavioral health visits. We have adapted these messages from the National Public Health Week campaign, which received high engagement numbers on CHAD’s social media channels, including a Facebook reach of over 1000 and over 2000 Twitter impressions. Marketers can find the toolkit here.

Health center leaders have shared with CHAD some of the questions, concerns, and fears that have been raised by staff as they have moved into a pandemic response. There are so many reasons health center staff could be feeling increased stress and anxiety, including concerns about safety, the health of one’s family, and all of the other life issues that are amplified due to the impact of COVID-19 on our families and communities.

In an effort to respond to the potential needs of health center staff, CHAD’s behavioral health and substance use disorder program manager, Dr. Robin Landwehr, is available to offer health center providers and staff free telephone or video-based informal conversations as an additional support resource. Discussions can be about anything that would be helpful during this difficult time, such as work, health, family, and relationships. While not considered therapy, these conversations will be kept confidential. Health centers can make this informational flyer available to employees.

Robin has both day and evening times available. You may reach Robin through her email or by leaving a confidential voicemail at (407) 252-0898. Read more about Robin and her work at CHAD here.

Flattening the COVID-19 Curve: Managing Financial Insecurity During a Crisis

The National Association of Community Health Centers (NACHC) will hold webinars for the next few Thursdays. Leaders from NACHC, the Center for Disease Control, and the Bureau of Primary Health Care will provide critical updates for health centers. Health center leaders from the field will also present on making it through this pandemic, continuing to provide excellent clinical care, and staying financially solvent amidst our COVID-19 response. These webinars are a part of NACHC’s on-going COVID-19 webinar series designed to address health centers’ most pressing questions.

Thursdays in April
11:00am MT/ 12:00pm CT
Visit NACHC’s website to register or view past recordings.

Billing and Coding Office Hours with Shellie Sulzberger

CHAD has contracted with Coding and Compliance Initiatives to offer at least one office hours session to share updates, and to provide the opportunity for Q & A. CHAD will schedule additional office hours sessions as needed. For questions or clarification on something specific, please send questions to Mary Hoffman in advance in case there’s a need for research.

Friday, April 17
11:00 am MT/ 12:00 pm CT
Click here to register

Technical Assistance for COVID-19 Supplemental Funding for Health Centers

HRSA recently awarded $100 million through the FY 2020 as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act. The funding supports prevention, preparation for, and responding to coronavirus disease. Visit the COVID-19 supplemental funding for health centers technical assistance (TA) webpage for resources.

HRSA will host another question and answer sessions to help award recipients develop their responses to the COVID-19 response reporting requirement due in EHBs on Thursday, April 23.
 

COVID-19 Supplemental Funding for Health Centers Q&A Session
Friday, April 17
12:00 pm MT/ 1:00 pm CT
Join the webcast the day of the session
Call-in: 888-469-2076
Passcode: 6250835

COVID-19/CARES Supplemental Funding for Health Centers Q&A Session
Wednesday, April 22
12:00 pm MT/ 1:00 pm CT
Join the webcast the day of the session
Call-in: 888-790-3515
Passcode: 5509950

CARES Supplemental Funding for Health Centers Q&A Session
Monday, April 27
12:00 pm MT/ 1:00 pm CT
Join the webcast the day of the session
Call-in: 888-469-2076
Passcode: 6250835

Financial Preparedness in the Midst of a Crisis
Finance Office Hours for Health Centers: Strategies to Manage Operations during COVID-19

The National Association for Community Health Centers (NACHC) is offering financial preparedness office hours every other week on Fridays. The next session is Friday, April 17. Topics will change to address real-time challenges based on health center input and feedback.

Friday, April 17 (reoccurring bi-weekly)
12:00 pm MT/ 1:00 pm CT
Register here

NCFH COVID-19 Webinar Series: Resource-Sharing and Discussions with the Frontline

Join the National Center for Farmworker Health (NCFH) for this 4-part webinar series titled "COVID 19: Resource Sharing and Discussions with the Frontline." As health centers across the country are being impacted by this current crisis, there is a need amongst health center staff to share how service delivery, such as outreach strategies and enabling services, are being adjusted to maintain patient care. This series that began on April 8 will provide health centers with the resources and strategies to continue enabling access to care for their patient populations. Each webinar will focus on a specific theme related to service delivery modalities. Register for the series here.

Wednesday, April 22 – 12:30 pm MT/ 1:30 pm CT
Wednesday, April 29 – 12:30 pm MT/ 1:30 pm CT