As your primary care association, we were pleased to learn of White House plans to increase access to COVID-19 vaccines through a direct partnership with community health centers (CHCs). The program’s stated goal is to promote equitable access to vaccines for underserved populations and those who have been hardest hit by COVID-19. It is just one tactic in a larger strategy to work toward the equitable distribution of vaccines.

CHCs are particularly experienced in providing care to hard-to-reach populations, including rural and frontier populations, people who are experiencing homelessness, agricultural and migrant workers, low-income groups, and those with limited English proficiency. Many of these populations have also been disproportionately impacted by COVID-19. It is also worth noting that CHCs are trusted providers to many underserved populations that may also experience some degree of vaccine hesitancy or lack information about vaccines’ safety and efficacy. We have found that when patients receive accurate information from a health care provider they know and trust, their willingness to get vaccinated improves.

According to research from the South Dakota Department of Health, American Indians in South Dakota had a mortality rate from COVID-19 in 2020 that was about 50% higher than that of the rest of the state. Within the 50-69 age group, American Indians in South Dakota have a death rate more than 10x higher than their white counterparts.

In North Dakota, most races lag significantly behind whites in their vaccination rates. While 19.4% of whites in North Dakota had received their first vaccine as of February 17, only 6.4% of Black or African American residents and 8.7% of Asian North Dakotans had received their first vaccine. The notable exception is that American Indians are currently receiving vaccines on par with whites, with 19.4% having received their first vaccine. This reflects a targeted strategy at both the state and national levels to ensure access to vaccines for American Indians and shows what proactive and intentional policies can achieve.

National data has revealed higher overall COVID-19 death rates among counties with higher poverty levels. Research has also demonstrated that influenza vaccinations are less available to poorer counties within the US than those living in more affluent areas.

CHCs are in 51 communities in the Dakotas and providing substantial primary care services across many underserved areas. 71.7% of CHC patients in South Dakota live at or below 200% of the federal poverty level (as compared 28 % of all South Dakota residents), and 35.6% of patients at SD community health centers identify as racial or ethnic minorities (as compared to 16% of state residents). 76.8% of CHC patients in ND live at or below 200% of the federal poverty level (as compared to 25% of all North Dakota residents), and 36.7% of patients at community health centers identify as racial or ethnic minorities (for comparison, 15% of North Dakota residents are racial and ethnic minorities).

While CHCs are well-positioned to promote equitable access to vaccines, it is also important that we continually ask ourselves what more we can do to ensure access to care and needed vaccines. Are we providing proactive outreach to elderly or homebound patients? Could we utilize trusted ambassadors or partner organizations to connect with additional people in need? I was excited and proud to see this type of proactive outreach taking place last week when Falls Community Health hosted several vaccination clinics for the unhoused in Sioux Falls. CHC staff offered on-site vaccinations to guests of the Banquet, St. Francis House, and the Union Gospel Mission. Holding clinics off-site increased the workload but also the success rate. When Falls’ staff met people in their trusted and safe places, they felt secure in their decision to be vaccinated against COVID-19. Staff at the Bishop Dudley Hospitality House noted their appreciation for the fact that their residents were being prioritized as an important population to receive vaccines.
The direct federal allocation to CHCs will be a slow and purposeful rollout. We do not yet know what early allocation amounts will be or how long it will take to grow the program. CHCs will align with state tiers and priorities as they vaccinate patients.
CHCs in the News
KELOland Living’s Ashley Thompson recently sat down with Jessica Sona, registered dental hygienist with Falls Community Health’s dental clinic, to talk about children’s oral health care.
Horizon Health Care Elk Point is currently undergoing renovations to improve community health care via the Leader Courier Times.
State Legislative Sessions Underway
The state legislative sessions are underway in North Dakota and South Dakota. Currently, CHAD is monitoring more than sixty pieces of legislation. For more information on CHAD’s legislative priorities, visit our website.

North Dakota bill list
South Dakota bill list
Special Enrollment Underway in the Dakotas
Making sure our friends and neighbors have quality health insurance coverage is more important than ever. As a result of new direction from the White House, there will be an additional open enrollment opportunity, or special enrollment period, that is now open and runs through May 15. It’s time to put health and well-being first in 2021 with Marketplace health insurance. Many people may benefit from a change, and the marketing toolkit CHAD distributed this week directs people to visit for more information. Contact Kayla Hanson at CHAD to receive the toolkit. People can also reach out to their local CHC to ask questions or for one-on-one help signing up for coverage.
CDC COVID-19 Vaccine Toolkit for Community-Based Organizations
Soon communities will have increased access to vaccines to help protect against COVID-19. The Centers for Disease Control and Prevention (CDC) has designed a toolkit to help community-based organizations (CBOs) educate communities about this crucial prevention tool.

This toolkit can be used to educate community members about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns. It is designed for organizations serving communities affected by COVID-19. CBOs could include social service organizations, faith-based organizations, school organizations, meal delivery services, senior centers, and others.
First cases of COVID-19 Variant Confirmed in North Dakota  
This week, the North Dakota Department of Health (NDDoH) announced the new variant strain of the SARS-CoV-2 virus was identified by genomic sequencing in positive specimens from two individuals in North Dakota. One individual had recently returned from domestic travel before becoming ill, and the second individual was a close contact of the first. One additional case suspected to be the UK variant is currently under investigation.

Preliminary studies have indicated the COVID-19 vaccines currently in use are effective against the UK variant strain. This variant strain of the virus was first detected in the United Kingdom in September 2020 and has been found in numerous countries worldwide, including the United States. To date, the Centers for Disease Control and Prevention has reported 1,173 cases from 41 states. For more information, see CDC: New COVID-19 Variants.
340B Updates
340B Recertification March 1 Deadline
Covered entities that do not recertify by the deadline of Monday, March 1, will be terminated from the HRSA 340B Program starting on Tuesday, March 2. They will require a new registration and will not be eligible to participate in the 340B Program until July.
To recertify, authorizing officials and primary contacts must first set up user accounts by visiting the HRSA 340B Office of Pharmacy Affairs Information System (340B OPAIS) and choosing "I am a participant." It is the covered entity’s responsibility to ensure they have created their accounts before recertification to allow successful completion of the process. For questions or assistance, email the 340B call center or call 888-340-2787 (Monday-Friday, 8:00 am-5:00 pm CT).
Public Confusion over the Regulation on Insulin and Epipens

Some press coverage and social media chatter incorrectly portray the Biden Administration’s delay of the 340B insulin and EpiPen regulation as a deliberate attempt to raise the price of insulin for patients. Community health centers (CHCs) share patients’ concerns about the skyrocketing insulin prices. From 2009-2019, drug makers tripled the prices of common types of insulin without making any changes or improvements to it. 

Drug affordability is the right problem to tackle, but this regulation was not the right approach. It’s important to note that the regulation would not change the pricing structure among health centers in the Dakotas, which are already committed to making prescription drugs as affordable as possible. It does have the potential to add red tape to the program and reduce the services that CHCs can provide their patients. Instead of adding burdensome and unnecessary requirements on providers who already help patients access high-priced drugs, we hope the Biden Administration will work on the real problem -- how quickly drug makers are raising prices.

CHAD will inform the 340B group as new information becomes available. To be added to the 340B distribution list, contact Carmen Toft. For more information on the 340B regulation, see the resources page on the CHAD website.
Hearing Scheduled for Presumptive HHS Secretary Becerra
The first Senate hearing for the US Department of Health and Human Services (HHS) Secretary nominee Xavier Becerra is scheduled for next Tuesday, February 23. This will be a courtesy hearing with the Senate Health, Education, Labor and Pensions (HELP) Committee; the official confirmation hearing will be with the Senate Finance Committee.  The Finance Committee has not yet set a date for its hearing. 

Becerra is a former member of Congress and is currently serving as the Attorney General of California. He has a lengthy reputation for defending the Affordable Care Act in court.
CDC Recommendations for Vaccinated Persons
While mRNA COVID-19 vaccines have demonstrated high efficacy at preventing severe and symptomatic COVID-19, there is currently limited information on how much the vaccines might reduce transmission and how long protection lasts. In addition, the efficacy of the vaccines against emerging SARS-CoV-2 variants is unknown. At this time, vaccinated persons should continue to follow current guidance to protect themselves and others.

No quarantine is required for vaccinated persons exposed to someone with COVID-19 if criteria are met:
  • Are fully vaccinated (14 days or more after receipt of 2nd dose);
  • Are in the three-month window period after receipt of 2nd dose; and,
  • Remained asymptomatic since being exposed.
If the vaccinated person does not meet all three criteria above, they should follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19.

Fully vaccinated persons who do not quarantine should still watch for symptoms of COVID-19 for 14 days following exposure. If they experience symptoms, they should be clinically evaluated for COVID-19, including SARS-CoV-2 testing, if indicated. These criteria could also be applied when considering work restrictions for fully vaccinated health care personnel with higher-risk exposures as a strategy to alleviate staffing shortages. Of note, exposed health care personnel would not be required to quarantine outside of work.

These quarantine recommendations for vaccinated persons, including the criteria for timing since receipt of the last dose in the vaccination series, will be updated when more data become available and additional COVID-19 vaccines are authorized.

CHAMPS Virtual Training Opportunities Available
Submitted by CHAMPS

CHAMPS/RMPHTC Addressing Suicide in Primary Care Project ECHO Learning Community

This series, offered in partnership with the Rocky Mountain Public Health Training Center (RMPHTC), aims to support primary care team members by addressing evidence-based practices for suicide screening and treatment in the primary care setting. Throughout the series, primary care staff will discuss clinical and operational strategies to address suicide and provide suicide safe care for health center patients. Practical tools and resources will also be discussed and shared by content experts and peers. Sessions will be held on Thursdays throughout March 2021.

To learn more and to register by March 3, visit the CHAMPS Project ECHO Learning Communities webpage.
CHAMPS CORE Competencies for Health Center Supervisors and Managers

Managers and supervisors play a pivotal role in the success of the health center. Yet, many are hired or promoted into their roles without the core skills to hire effectively, train, manage, engage, retain, and develop others. This course, specifically designed for supervisors and managers at community, migrant, and homeless health centers, offers intensive, hands-on, and immediately applicable skill-building to successfully navigate management and supervisory roles in the fast-paced and often challenging health center environment.

This training is an excellent opportunity to ensure the nuts-and-bolts knowledge, skills, and strategies to be successful in a management role. Due to our Region VIII state primary care associations’ generous support, discounted registration rates are available to all Region VIII health centers. A limited number of registration scholarships are available. To learn more and to register by March 1, visit the CHAMPS Leadership Learning Opportunities webpage.
CHAMPS Spanish Language for Health Care Professionals – April 2021

CHAMPS will host the annual medical Spanish language training for clinicians at Region VIII health centers in a virtual format. This training is an intensive, conversational, and medical Spanish workshop consisting of medical dialogues, role-plays, visual aids, cross-cultural discussions, and daily practice. The course curriculum provides an experience of immersion learning, an approach that is highly suitable for those with limited time and who must use their new language skills immediately with their Spanish-speaking patients. All courses within the Spanish Language for Health Care Professionals training will be held via Zoom.

In addition to the traditional four-day Medical Spanish Course for Beginner and Intermediate Spanish Speakers course, three new two-day Spanish language courses will be offered: Medical Spanish for Advanced Spanish Speakers, Spanish for Oral Health Providers, and Spanish for Behavioral Health Providers. To learn more and to register by March 31, visit the CHAMPS Events and Trainings webpage.
Health Center Employees Encouraged to Complete RTAT Survey
As community health centers (CHCs) across the nation feel the pressures of COVID-19 and the lack of trained and qualified staff, the pandemic has emphasized the importance of growing a diverse and robust workforce. One way to achieve this is by designing training programs for health professionals.
Health centers around the country have been invited to participate in the Bureau of Health Workforce/ Bureau of Primary Health Care strategic workforce initiative. It is important to make sure the Dakotas’ health centers’ input is included by filling out the Readiness to Train Assessment Tool (RTAT) survey.

The RTAT is a survey designed to look at health center readiness to develop and improve health professions training. In partnership with Community Health Center, Inc., CHAD is inviting all CHC staff in the Dakotas to join in the first step of creating an ever-growing and replenishing workforce by completing the RTAT survey.

GP11 Network News
21st Century CURES Act and Information Blocking

In this webinar, the HITEQ Center will discuss how the 21st Century CURES Act defined interoperability and information blocking and how that relates to health centers. With the US Department of Health and Human Services (HHS) recently extending the provider compliance date to April 5, we will review how the Office of the National Coordinator for Health Information Technology’s (ONC’s) final rules defined information blocking requirements and exceptions. Presenters will discuss common scenarios and health center policy practices that might be considered information blocking, and how they can reduce health center risks with early planning and policy definitions.

Tuesday, February 23
12:00 pm MT/ 1:00 pm CT
Register here.

Webinars & Meetings
Find these and other events on the CHAD website.

South Dakota Department of Health COVID-19 Update

The South Dakota Department of Health hosts a weekly COVID-19 webinar for health care facilities, medical providers, laboratorians, long-term care facilities, EMS providers, and other health professionals.

Thursdays in February (reoccurring)
10:00 am MT/ 11:00 am CT
For weekly call-in information, please join the listserv here. Find archived calls and slides here.

South Dakota Department of Health COVID-19 Mass Vaccination Planning

The South Dakota Department of Health hosts a weekly COVID-19 vaccination planning webinar for health care facilities, medical providers, laboratorians, long-term care facilities, EMS providers, and other health professionals.
Tuesdays (reoccurring thru March 2021)
12:00 pm MT/ 1:00 pm CT
Meeting link or call (669) 900 9128
Meeting ID: 845 2763 1820
Passcode: 719500
CHAMPS 2021 Resiliency Collaborative

The CHAMPS Resiliency Collaborative is a facilitated peer support group using concepts from the evidence-based framework, Finding Meaning in Medicine, online. Each session will incorporate the practice of mindfulness techniques and practical body awareness exercises. The remaining time will be comprised of group discussions on topics selected by the participants. For more information or to register, visit the CHAMPS Events and Trainings webpage.

First and third Wednesdays of the month (reoccurring through May 2021)
12:00 pm MT / 1:00 pm CT

Bystander Intervention Training: Standing with Our Neighbors in Love

This two-part online training is hosted by the Faith & Justice Collective of the Black Hills, a coalition of individuals and organizations committed to educating, organizing, and advocating for peace and justice as an expression of members’ various faiths.

Often, bystanders recognize something is wrong but are unsure how to intercede safely and helpfully. As a result, they may remain silent and allow the problematic behavior to continue. Bystander intervention training provides individuals the confidence and practical skills they need to intercede when they recognize something is wrong.

The presenter will increase awareness of violence in communities, who and how people are affected, and how the community is responding. Attendees will learn practical skills to become positive bystanders. The training will be held over two 1.5 hour sessions on Zoom: In addition to expert training, participants will be invited to share their own experiences and practice their new skills in small groups.

Tuesdays, February 23 and March 2
6:00-7:30 pm MT/ 7:00-8:30 pm CT
Register here.

Innovative Strategies for Home-Based Colorectal Cancer Screening

Sponsored by The American Cancer Society, the North Dakota Colorectal Cancer Roundtable, and CHAD, this webinar will explain how a national pilot project is integrating colorectal cancer screening into efforts to provide medically underserved patients the tools they need to manage their health safely in their home. Speakers from the National Association of Community Health Centers (NACHC) will list strategies for providing patient self-care tools (supplies, instructions, education) combined with
follow-up coaching. Participants will leave with sample models and workflows for use in patient care kits and remote patient monitoring. This webinar includes 1 CEU credit from the ND Board of Nursing, pending approval.

Wednesday, February 24
11:00 am MT/ 12:00 pm CT
Register here.

Colorectal Cancer Screening in 2021

Sponsored by the American Cancer Society and GetScreenedSD, this webinar will address current colorectal cancer screening guidelines, screening during COVID-19, and expectations for future disease and trends.

Thursday, February 25
12:00 pm MT/ 1:00 pm CT
Register here.

CHAMPS 2020 Region VIII Health Center Workforce Data Webcast

During the spring and summer of 2020, CHAMPS undertook a survey of Region VIII’s community, migrant, and homeless health centers to collect salary, benefits, and other workforce data from 47 organizations. The CHAMPS 2020 Region VIII Health Center Workforce Data Webcast: Understanding and Utilizing Statistics from the CHAMPS Salary, Benefits, Turnover, and Vacancy Survey Project will explain the history and methodology of the survey and highlight findings relating to salaries and benefits for all health center staff including a look at base vs. additional pay and the structure of health center benefits packages. The presenter will also address trends in additional workforce metrics including vacancies, turnover, challenging areas of recruitment and retention, etc. To learn more, visit the CHAMPS Upcoming Live Distance Learning Events webpage.

Wednesday, March 24
11:30AM-1:00PM MT / 12:30-2:00PM CT
Register here.

CHAD Network Team Meetings

Friday, February 19 at 11:00 am MT/ 12:00 pm CT – Behavioral Health Work Group
Tuesday, February 23 at 12:00 pm MT/ 1:00 pm CT – O&E Network Team Meeting
Tuesday, February 23 at 2:00 pm MT/ 3:00 pm CT – CFO & Finance Manager Roundtable
Tuesday, March 9 at 1:00 pm MT/ 2:00 pm CT – Communications & Marketing Network Team Meeting

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