CHAD Connection - September 23

As most of you know, CHAD is participating in an effort to bring Medicaid expansion to South Dakota through a ballot initiative. Together we have a once-in-a-lifetime opportunity to provide access to affordable health coverage to over 40,000 South Dakotans. This effort would bring our tax dollars back home to our state and actually save the South Dakota budget money over the first two years of the program. Offering coverage to those who currently can’t afford it will help us retain health care services in rural communities, and it will bring down the cost of health insurance premiums for everyone. It will also reduce health disparities by closing the funding gap that currently exists for Native American residents of our state.

South Dakotans Decide Healthcare, the coalition CHAD is an integral member of, is one of the largest and broadest coalitions ever assembled to fight for an initiated measure in South Dakota. Members come from across the political spectrum and represent health care providers, patient advocates, and good governance groups, along with health care systems and clinic groups. We all bring different perspectives and ideas, but we agree that all South Dakotans need access to high-quality, affordable health care, and that is what we are working towards.

As CHAD members, you understand that access to health care is a critical concern. Medicaid expansion will enable us to continue serving our rural communities by providing critical funding. Without Medicaid expansion, many rural hospitals and clinics will remain at severe risk of closure. In states that have expanded Medicaid, we have also seen an increased ability by health centers to address behavioral health needs. The need for these services is particularly acute in the rural areas of our state and for children.

With all this on the line, it is more important than ever to have all of us working together to win this campaign. You can follow the efforts of the campaign on social media at:
·     Facebook.com/SDDecides;
·     Twitter.com/SDDecides;
·     Sign up for email updates at SouthDakotansDecide.org/Team; and,
·     Learn more about the coalition’s efforts at SouthDakotansDecide.org.

If you would like to set up a time for a campaign volunteer to stop by your organization to collect signatures, please contact Carmen Toft at CHAD to coordinate. We are hoping to wrap up signature collection by mid-October, so act quickly to make your voice heard. I look forward to working will all of you to ensure South Dakotans can access health care, bring our money back home to South Dakota, and protect our rural health care. Thank you to all of you and all you do.

The 2021 CHAD and Great Plains Health Data Network (GPHDN) Conference, The Health Center Journey: Celebrating Successes, Looking to the Future, was held virtually on September 14 & 15. Despite quickly pivoting from an in-person event to a virtual one, the conference went very smoothly, and attendance and participation were excellent!

The conference kicked off with a keynote address from Lathran Johnson Woodard, South Carolina Primary Health Care Association CEO. Ms. Johnson Woodard shared a historical look at the health center movement to provide a vision for the future. Her presentation was immediately followed by a panel that included Ms. Johnson Woodard and four outstanding leaders from the Dakotas and Wyoming who have recently passed their torches to new leaders. Having left a great footprint on health care access and quality in the three great plains states, recent retirees Darrold Bertsch, Jan Cartwright, Jill Franken, and John Mengenhausen shared stories about how they’ve seen and impacted significant growth in health centers in their collective time of over 100 years working in the health center program.

Dr. Billie Jo Kipp, associate director for research and evaluation at the Center for Native American Youth at the Aspen Institute, discussed how we could improve health outcomes and overcome social determinants of health that tribal communities face with an understanding and respect for cultural resources and a focus on community empowerment. Following sessions focused on clinical quality and health equity, behavioral health, health data strategy, workforce engagement, and social determinants of health. With 90 conference registrants, each session was well attended, with immediate positive feedback on content. Thanks to our speakers and attendees for taking advantage of the many tools available to keep the virtual conference interactive and engaging.

Attendees were invited to electronically visit conference sponsors and participate in a fun sponsor scavenger hunt to be entered in a drawing for a $50 gift card. Conference recordings and resources available on the CHAD website.

The South Dakota Foundation for Medical Care (SDFMC) is sharing a collection of "Best Practice Briefs," 20-minute micro-learning sessions highlighting successful system and policy change. The briefs are short, to the point, and showcase people and processes that really work. The Behavioral Health Access Series features several CHAD members, including Kara Roland from the Community Health Center of the Black Hills, Serene Thin Elk and Theresa Henry from South Dakota Urban Indian Health, Kayla Hochstetler from Spectra Health, and CHAD’s own Robin Landwehr.

The unique community-based and integrated care model at Spectra Health in Grand Forks, ND, allows the care team to address behavioral, oral, and medical health as well as assistance with transportation and housing needs. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool allows Spectra Health staff to get to the root of an individual’s need at both the clinic and community level.

Casey Berberich, LMSW, behavioral health consultant at Spectra Health, shared her experience using PRAPARE. "We found that individuals were not discussing issues that impacted their overall well-being in their early appointments. Now, having the answers to these important questions, the team at Spectra Health can connect individuals with community services and resources sooner than we could before."

The PRAPARE tool is a national effort to help health centers and other providers collect and apply the data they need to better understand their patients’ social determinants of health, transform care to meet the needs of their patients, and ultimately improve health and reduce costs. Integrated into the electronic health record or available for print, the PRAPARE form asks questions related to personal characteristics, family and home, money and resources, social and emotional health, as well as other key issues, including domestic safety, violence, and incarceration history.

The Spectra team has had access to the PRAPARE form for nearly a year but made a concerted effort to utilize the tool in mid-June 2021. Staff was offered training, and referrals were put into place. As a result, the quality of responses has improved dramatically, and the turn-around with the deployment of identified services and resources has also improved. "The PRAPARE tool provides a structured way to identify the topics most likely to impact a person’s ability to engage in the care process. We utilize the tool for ‘newly-established individuals who are establishing medical care at our facility. The PRAPARE tool allows us to go through each item in a systemic format and address areas that will hopefully improve the care we offer. It also helps the patients achieve better health outcomes," stated Berberich.

PRAPARE has been a multi-year effort between the National Association of Community Health Centers, the Association of Asian Pacific Community Health Organizations, the Oregon Primary Care Association, and the Institute for Alternative Futures.

Last Friday, the Food and Drug Administration (FDA) external review board met to review the safety and effectiveness of a third Pfizer dose. While the board did not recommend booster doses for the general population, they did recommend a third shot for those 65 and older and those at high risk for serious illness. They also recommended that the Advisory Committee on Immunization Practices (ACIP) include those with occupational exposures. ACIP will meet September 22-23 to discuss third dose recommendations. This booster dose recommendation would only apply to those who received Pfizer at this time.

Pfizer also announced results from their phase 2/3 trial that demonstrated both the safety and effectiveness of the vaccine in children aged five to 11 years. The study included 2,268 participants who received a 10-µg dose in a two-dose regimen. Pfizer announced that it would seek Emergency Use Authorization (EUA) from the FDA as soon as possible. Tentatively, this would allow for vaccination of children ages five to 11 years to begin as early as the end of October. Learn more about the trial data here.

On September 9, President Biden issued a six-pronged comprehensive national strategy to combat COVID-19. The National Action Plan offers the following steps and regulations to increase vaccination rates, continue to protect the vaccinated, keep schools safely open, increase testing, and require masking, protecting our economic recovery, and improving care for those with COVID-19.

The action plan expands COVID-19 vaccine mandates for health care facilities. Health center staff and staff within all Medicare and Medicaid-certified facilities must be fully vaccinated against COVID-19. This rule is expected to be authorized in October as a Centers for Medicare and Medicaid Services (CMS) Interim Final Rule. The National Association of Community Health Centers is working to understand better how this requirement will roll out and how health centers can best comply with the law. Up-to-date information can be found here.

As part of President Biden’s COVID-19 testing initiative, health centers will have the option to participate in two testing supply programs. The first program will provide free BD Veritor point-of-care, diagnostic testing analyzers, and test kits to health centers. This is a rapid antigen test that is performed at the health center or health center testing site. This is an opt-in program, so watch for more information coming soon on how to sign up for this program. The second testing program will provide free at-home, rapid test kits for health centers to distribute to patients, staff, and community members. The at-home test kits will include detailed instructions and guidelines. This is an opt-out program, so if health centers prefer not to participate, they will need to indicate that when given the option.

President Biden’s testing strategy also increases the availability of testing supplies for schools and congregate housing settings for people who are medically underserved. It will ramp up the domestic manufacturing of all testing equipment and supplies. More detailed information on President Biden’s COVID-19 testing strategy can be found here.

The House Committee on Energy and Commerce approved the "Build Back Better" reconciliation bill to provide $10 billion for community health center infrastructure, almost $7 billion for health workforce programs, and closing the Medicaid coverage gaps with affordable health care coverage. These provisions were sent to the Rules Committee, which will compile the bills passed by all 13 committees into a single bill. The Senate committees have yet to publish their draft bills, so these provisions may not be included on the Senate side.

The Medicaid section in the bill includes closing the Medicaid coverage gap and expanding access to Medicaid home and community-based services. The Medicaid coverage gap sets up a two-phase process starting January 2022. Phase one is coverage in the Marketplace, and phase two includes coverage in federal Medicaid plans. In the first three years, there will be premium tax credits for eligible people who pay for coverage in the Marketplace, allowing the Department of Health and Human Services to establish a federal Medicaid program for non-expansion states by 2025.

In addition to closing the coverage gap, the Energy and Commerce bill would:

Ensure that all pregnant people enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) can maintain coverage for 12 months after the end of their pregnancy;
Provide 12 months of continuous coverage to children and youth enrolled in Medicaid and CHIP;
Provide Medicaid coverage of health care services for people within 30 days of leaving jail or prison, which could connect them to the care they need in the community;
Increase access to and quality of Medicaid home- and community-based services (HCBS) and support transitions from institutional settings to the community for seniors and people with disabilities;
Make the successful Money Follows the Person Program and spousal impoverishment protections permanent; and,
Make the Children’s Health Insurance Program (CHIP) permanent.

On September 13, the House Natural Resources Committee passed their portion of the president’s ten-year $3.5 trillion reconciliation infrastructure and social spending package, including $3.5 billion for the Indian Health Service (IHS). The budget reconciliation package prioritizes renovations, construction, and expansion of facilities for urban Indian organizations (UIOs) with $42 million for the Urban Indian Health Program construction, facilities maintenance, and repair. Currently, there is no dedicated funding allocation for UIO facilities, maintenance, sanitation, or medical equipment. UIOs have traditionally been excluded from facilities and construction funds from IHS and cannot receive funding from the IHS Health Care Facilities Construction Priority Program, the maintenance and improvement IHS budget line item, or participate in the agency’s Joint Venture Construction Program. The inclusion of funding for Urban Indian Health for renovations, construction, and expansion of facilities marks historic progress for the 70% of American Indian/Alaska Natives living in urban areas. For further information, see Natural Resources Committee updates here.

The next Marketplace open enrollment period starts on November 1 and runs through January 15, 2022. The American Rescue Plan Act (ARPA) has funded a temporary increase in premium tax credits for 2021 and 2022. This increase has contributed to a surge in Marketplace enrollment, with more than 2.8 million people gaining coverage between mid-February and mid-August.

Under the ARPA, people with incomes below 150 percent of the poverty line pay zero net premium for the "benchmark" silver plan in the Marketplace. People with incomes between 150 and 400 percent of poverty pay a lower share of their incomes toward premiums than they did before. More information on the permanent Marketplace improvements can be found here.

While many individuals will access coverage through the Marketplace during open enrollment, those who still don’t have 2021 coverage can check eligibility at HealthCare.gov. It may be possible to enroll through a special enrollment period that covers individuals who have experienced life-changing events, such as a loss of other coverage, marriage, having a baby, or moving to a new location.

The Northwest Regional Primary Care Association (NWRPCA) and CHAMPS look forward to welcoming everyone to this year’s NWRPCA/CHAMPS Fall Primary Care Conference. The health and safety of attendees, speakers, supporters, and staff is a top priority, and NWRPCA and CHAMPS have made the difficult decision to move this year’s fall conference to virtual-only. All 46 sessions and two plenaries will be held as previously planned, though now on Monday, October 25, through Wednesday, October 27 (previously scheduled for October 24-26). There also will be opportunities to network with peers and colleagues, conference speakers, sponsors, and exhibitors. Visit the CHAMPS Primary Care Conference webpage to download the most recent conference grid and learn more about registration, registration reimbursement opportunities, and more.

The North Dakota Mission of Mercy (NDMOM) is a large-scale, two-day, professional dental clinic that provides donated care to any patient with urgent dental needs. The clinic is intended for those with barriers to care who do not have a dental home. About 30 state dental associations have sponsored Mission of Mercy (MOM) events. In 2018, the North Dakota Dental Association held the first MOM event in North Dakota. Over 900 patients were treated by some 110 dentists, 200 allied dental professionals, and 250 lay volunteers who provided over $550,000 of donated care.

On October 1-2, the Bismarck Event Center will house another NDMOM with clinic hours from 5:50 am-5:00 pm. There will be a 40-chair dental clinic to provide donated care to dental patients who, for whatever reason, have not received urgently needed dental care. Provided services include dental cleanings, fillings, root canals, extractions, oral health education, fluoride treatments, sealants, and X-rays. Volunteers also work to connect patients to a permanent dental health care home.

Volunteers are needed for patient registration, hospitality, patient ambassadors, and providing health care. To sign up or learn more, visit the Mission of Mercy North Dakota website.

2021 Sioux Falls Cybersecurity Conference September 28

The Greater Sioux Falls Chamber of Commerce is hosting the 2021 Sioux Falls Cybersecurity Conference at the Sioux Falls Convention Center on September 28. Jim Edman, cybersecurity advisor for the U.S. Department of Homeland Security, will be the keynote speaker addressing the topic of "Cybersecurity: Are You Giving It Your Best Effort?" Other speakers will touch on trends and best practices in insurance and security, create a culture of cybersecurity, and grow the cybersecurity workforce. Tickets for the event are $75 per person, which includes breakfast and lunch. Additional information and registration can be found here.

Annual CISA National Cybersecurity Summit in October

The Cybersecurity and Infrastructure Agency (CISA) will be hosting the 4th Annual National Cybersecurity Summit in October. The virtual summit will bring together cybersecurity and critical infrastructure stakeholders worldwide and provide a forum for meaningful conversations and collaboration about how we can protect our physical and cyber infrastructure. Each day will feature a different theme that focuses on their mission to "Defend Today, Secure Tomorrow," with presentations from targeted leaders across government, academia, and industry. Four events will make up the summit every Wednesday throughout October. Register for this free summit and read more about the presentations here.

October 6 - Assembly Required: The Pieces of the Vulnerability Management Ecosystem
October 13 - Collaborating for the Collective Defense
October 20 - Team Awesome: The Cyber Workforce
October 27 - The Cyber/Physical Convergence

405(d) Presents: A Case Study of Cancer Care in the Wake of a Cyber Attack

The task group, CSA 405(d), created by the Department of Health and Human Services (HHS) under the Cybersecurity Act of 2015 (CSA), is hosting a webinar to hear from the chief information security officer (CISO) of the University of Vermont Health Network who will discuss the university’s experience with a ransomware attack in 2020, at the height of a pandemic. This case study will be followed by a panel discussion on what the health care and public health sectors can learn from this situation and how to be better prepared for cyber-attacks like this and other cyber threats. Joining the panel will be representatives from across the federal landscape. The event will be moderated by Julie Chua, director of the Governance, Risk Management, and Compliance (GRC) Division within HHS, and Erik Decker, Intermountain assistant vice president and CISO.

Tuesday, October 5
3:00 pm – 4:30 pm CT/ 2:00 pm – 3:30 pm MT
To register for the event, click this link and download the meeting invitation.

The COVID-19 Evolution: A New Breed of Endpoint Security

As health care organizations ramp up technology innovations to improve patient care and patient safety in the "new normal," cybersecurity continues to be one of the top concerns shared by IT decision-makers and c-level executives, especially given limited budgets. But while most organizations invest millions in protecting laptops, servers, and data centers, they often overlook the importance of securing other critical parts of their IT infrastructure.

Join Justine Bone, CEO of MedSec, and Michael Howard, head of security practice and analytics at Hewlett-Packard, for an informative session on the current threat landscape and how health care organizations can prioritize and respond to the ever-evolving cybersecurity threats. In this session, speakers will discuss the importance of best of breed cyber-resilience from all endpoint considerations, including PCs, printers, and medical devices, and provide practical insights on how health care organizations can keep their data safe from security breaches.

Friday, October 8
1:00 pm CT/ 12:00 pm MT
Register here.

Suicidal thoughts can be experienced by anyone regardless of age, gender or background. Suicide is often the result of an untreated mental health condition. Suicidal thoughts, although common, should not be considered normal and often indicate more serious issues.

September is Suicide Prevention Awareness Month — a time to raise awareness on this stigmatized and often taboo topic. In addition to shifting public perception, this month is used to spread hope and vital information to ensure that individuals, friends, and families have access to the resources they need to discuss suicide prevention and seek help.

Throughout September, the National Alliance on Mental Illness (NAMI) is encouraging people to bring their voices together to advocate for better mental health care, including a crisis response system. NAMI wants any person experiencing suicidal thoughts or behaviors to have a system to turn to that would connect them to the treatment and support they need.

During Suicide Prevention Awareness Month, health centers can refer to these images and graphics on websites and social media accounts. You can also use the "It’s Okay to Talk About Suicide" infographics on the NAMI website to encourage discussions with your community through social media or other forms of outreach. Use #Suicide Prevention or #Together4MH.

While suicide prevention is important to address year-round, Suicide Prevention Awareness Month provides a dedicated time to come together with collective passion and strength around a difficult topic. The truth is, we can all benefit from honest conversations about mental health conditions and suicide because just one conversation can change a life.

CCHN/CHAMPS Health Equity Learning Series

The three-part Colorado Community Health Network (CCHN)/CHAMPS 2021 Health Equity Learning Series began on Tuesday, August 31, and continues throughout September, providing participants with a greater understanding of organizational and personal position in health equity as tangible strategies and tools to assist moving forward. The recordings of the first two events in the series, It Starts with Us: The Journey of Dismantling Institutional Racism and Applying the Health Equity Lens: Serving Indigenous People, can be accessed on the CHAMPS Online Archived Distance Learning Events webpage.

Applying the Health Equity Lens: Weight Bias in Health Care
Tuesday, September 28
1:00 pm-2:30 pm CT/ 12:00–1:30 pm MT
Visit the CHAMPS Upcoming Live Distance Learning Events webpage to learn more.

211 University for South Dakota Health Centers

The Helpline Center’s 211 database houses the largest, most comprehensive list of statewide community resources in South Dakota. As health centers continue to respond to patients’ social determinants of health, 211 can be a critical link in identifying appropriate resources. Join this hour-long "how to" on incorporating Helpline Center community resources into your daily work. This training is intended for all patient-facing staff.

Tuesday, September 28

12:00 pm CT / 11:00 am MT

211 University for North Dakota Community Health Centers

FirstLink’s 211 database houses the largest, most comprehensive list of statewide community resources in North Dakota. As health centers continue to respond to patients’ social determinants of health, 211 can be a critical link in identifying appropriate resources. Join this hour-long "how to" on incorporating FirstLink’s community resource database into your daily work. Firstlink staff will share tips and tricks, including searching and finding community resources through the online database, texting services, and more. This training is intended for all patient-facing staff and has been pre-approved for a continuing education unit (CEU) from the North Dakota Board of Social Work.

Thursday, September 30

12:00 pm CT / 11:00 am MT

Evaluating and Supporting Patients Presenting with Fatigue
Following COVID-19

During this clinician outreach and communication activity (COCA) call by the Centers for Disease Control and Prevention (CDC), presenters will discuss post-COVID-19 conditions (PCC), an umbrella term for the wide range of health consequences that present four or more weeks after infection with SARS-CoV-2, which includes Long-COVID. It can be difficult to distinguish symptoms of fatigue and post-exertional malaise caused by PCC from symptoms that occur for other reasons. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) has recently published a multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in PCC. It provides practical guidance to clinicians when assessing and treating individuals with fatigue and a history consistent with PCC. The burden of PCC is expected to reflect the disproportionate burden of infection by race, ethnicity, and socioeconomic status and to highlight ongoing inequities in health care. The health equity work group of the AAPM&R has developed guidance to highlight the central role that principles of diversity, equity, and inclusion play in delivering quality health care.

If you are unable to attend the live COCA call, the recording will be available for viewing on the COCA call webpage a few hours after the live event ends. The slide set will be available on the day of the call under "call materials." Free continuing education credits will be offered for this COCA call. Registration is not required.

Thursday, September 30
1:00 pm CT/ 12:00 pm MT
A few minutes before the webinar starts, please click on the Zoom link to join.
Passcode: 907646
Webinar ID: 160 374 2224

Helping Clients Pay for PrEP in the Dakotas

In collaboration with Washington University in Saint Louis, the Dakotas AIDS Education Training Center (DAETC), and NASTAD, the South Dakota Department of Health is excited to offer this skills-building workshop to enhance providers’ skills in helping clients pay for PrEP (pre-exposure prophylaxis). Speakers will discuss PrEP coverage and expected costs to the client. Attendees will learn best practices and hear lessons learned for covering PrEP costs in Medicaid-expanded and Medicaid-unexpanded areas.

This event is intended for health care providers and leaders who currently offer PrEP, want to offer PrEP, or are seeking more information about PrEP. It will also be helpful for HIV prevention staff who work with prep-eligible clients from health departments, clinics, and community-based organizations in North Dakota and South Dakota.

Continuing education units will be offered for CMEs, CPEs, CNEs. Certificates of attendance will be available for all other professions. Please indicate that you would like CEUs during registration and contact Katelyn Mason with any questions.

Tuesday, October 5
12:00 pm CT / 11:00 am MT
Register here.

BPHC UDS Webinar Series

CHAD will be hosting its UDS training in three virtual sessions on November 2-4. We are working to finalize the details and will be sending out more information soon. In addition to our training which will focus on the Dakotas, the Bureau of Primary Health Care (BPHC) has scheduled technical assistance webinars through the end of the year.

UDS Clinical Tables Part 1: Screening and Preventive Care Measures
Thursday, September 23
12:00-1:30 pm CT/ 11:00 am-12:30 pm MT
Register here.

UDS Clinical Tables Part 2: Maternal Care and Children’s Health
Tuesday, September 28
12:00-1:30 pm CT/ 11:00 am-12:30 pm MT
Register here.

UDS Clinical Tables Part 3: Chronic Disease Management
Wednesday, October 6
12:00-1:30 pm CT/ 11:00 am-12:30 pm MT
Register here.

Reporting UDS Financial and Operational Tables
Thursday, October 14
12:00-1:30 pm CT/ 11:00 am-12:30 pm MT
Register here.

Successful Submission Strategies
Wednesday, October 20
12:00-1:30 pm CT/ 11:00 am-12:30 pm MT
Register here.