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 the Departments of Health in both North Dakota and South Dakota. You will also find information we thought would be useful, including telehealth billing and coding guidance, legislative updates, direction for human resources and employment law, and communication resources.

CHCs in the News!
Horizon CEO John Mengenhausen highlights the role of community health centers in caring for South Dakota’s rural and remote communities. - Click here to read full article.
Find this and other stories on the CHAD website.
CHAD Celebrates National Public Health Week
COVID-19 is highlighting the critical, life-saving importance of public health and the incredible public health workforce. CHAD thanks our public health professionals across North Dakota and South Dakota for helping us understand our current pandemic and responding effectively. CHAD also thanks community health centers for all they are doing in 52 communities with over 120,000 patients to protect our population’s health. CHCs are screening and testing patients, effectively segregating well and sick patients to ensure continuous access to needed health care services, and making an amazingly fast transition to offering a wide range of health care services through telephone and video. We know that effectively caring for patients in their community reduces pressure on hospitals and emergency rooms, which is more important now than ever.

To assist health centers as they communicate with patients via social media, CHAD designed a marketing campaign toolkit for National Public Health Week. The campaign’s focus is “call first” directions and highlighting the availability, ease, and importance of telemedicine. These messages can be easily adapted and will extend far beyond this week. The toolkit can be found here.

HRSA COVID-19 Survey Updates
The Health Resources and Services Administration (HRSA) will continue to ask for COVID-19-related data from health centers, but there will be changes to the survey starting Friday, April 10. HRSA will no longer ask for cumulative data. Instead, they will ask for health centers’ experiences over the last week. Given the dynamic nature of the pandemic and its evolving impact on health centers nationwide, the surveys will allow HRSA to track changes over time. Each survey will indicate the time period for reporting.

The survey will open ONCE per week on Friday afternoons and will close the following Monday at 10:59 pm CDT. Health centers will receive an email from this Friday, April 10.
South Dakota Legislature Wraps Up
The 2020 South Dakota legislative session officially adjourned on March 31, at 3:30 am, when they wrapped up veto day proceedings. Most legislators attended veto day virtually, though members of leadership attended in person. Governor Noem put forth 12 bills to address COVID-19, and the legislature passed nine of those bills. Those that passed included:

Senate Bill 187 expanded the circumstances someone can be eligible for unemployment benefits to include layoffs from COVID-19.

Senate Bill 188 waives the minimum contact hours for kindergarten-12th grade schools to allow online instruction to be counted toward the school year.

Senate Bill 189 also pertains to education. This bill cancels the standardized exams given to kindergarten-12th grade students and other required activities of a school district, such as fire drills and the school accountability provisions.

Senate Bill 190 waives the requirements for a driver’s license renewal and allows for a 90-day extension of a driver’s license during a declared emergency. 

Senate Bill 192 creates the small business economic disaster relief subfund. This bill creates a COVID-19 business release fund with $11 million. It allows the South Dakota Governor’s Office of Economic Development (GOED) to issue 0% interest rate loans of up to $75,000 to businesses impacted by COVID-19.

Senate Bill 193 revised the FY budget to receive one-time federal stimulus money approved by Congress. The money coming into this fund is approximately $90 million. The money allocated in this bill includes:
  • $55.7 million to the Bureau of Finance and Management (BFM) to be distributed as federal stimulus throughout state government;
  • $27.8 million for two calendars of Federal Medical Assistance Percentage (FMAP) at a 6.2% federal enhancement;
  • $1 million for Woman Infants Children (WIC) coverage for eligible women and children
  • $3.8 million for unemployment insurance services; and
  • $1.2 million for congregate and home-delivered meals for older residents.

Two bills that failed tried to address issues of authority during the state of emergency.
Senate Bill 191 would have provided emergency authority to counties, community improvement districts, and municipalities in the event of a public health crisis. This bill proposed to allow counties and municipalities to declare a public health emergency for their jurisdiction. Opponents of the bill argued the municipalities and counties have no mechanism or expertise to declare an emergency and the state’s power to do so allows for a more uniform approach.

House Bill 1297 would have granted the SD Secretary of Health certain authority during a public health emergency. This bill proposed to allow the Secretary of Health to declare a public health emergency and limit access to public spaces during the emergency. Opponents of the bill argued the Governor already has the power to limit access to public spaces during an emergency and the Governor, not the Secretary of Health, should be vested with the power to make such a decision.

The legislature will reconvene for a special session in June. The purpose of the special session will be adjusting the FY21 budget primarily because of the COVID-19 emergency. It is likely that the focus of that session will be the budget. CHAD will stay in touch with legislators during this interim time to address any health centers’ priorities that might need state funding attention. Please feel free to reach out to our policy and partnerships manager, Jessica Gilbertson, if you have recommendations.

Additionally, Governor Noem issued guidance recommending that South Dakota Schools stay closed for the remainder of the school year. On Monday, April 6, the Governor announced that students would continue with distance learning to end out the school year. More guidance will come from the Governor’s office on the educational requirements of distance learning.

South Dakota does not have a formal stay at home order issued as of this week, and the Governor does not have a plan to issue one. South Dakota, North Dakota, Iowa, Nebraska, and Arkansas are the remaining states that have not issued a stay at home order. Governor Noem has addressed the issue several times in her daily updates with the press. Despite urging from several health care organizations, including the South Dakota State Medical Association, the South Dakota Association of Healthcare Organizations, and Horizon Healthcare, Governor Noem said these calls to apply a one-size-fits-all approach to this problem is “a herd mentality.”

North Dakota Legislative Actions
The budget section of North Dakota’s legislature met on April 7 and approved accepting the federal funding for state agencies. The money comes mostly from the CARES Act, which is the third stimulus package passed by Congress in response to the COVID-19 emergency. This meeting comes after the North Dakota’s emergency commission first approved the requests to accept the money last week, and then, those requests require legislative approval. The money totals approximately $133.5 and goes to support several state agencies.
North Dakota Medicaid Update
North Dakota Medicaid is accepting responses to its provider survey until April 10. The survey can be found here. The responses will be used to measure the short-term impact of COVID-19 on North Dakota’s Medicaid providers.
South Dakota Medicaid Update
South Dakota Medicaid has released frequently asked questions (FAQs) related to COVID-19 for Medicaid providers. They highlight covered services, coverage requirements, and new coverage flexibilities offered in response to the pandemic. The FAQs also include additional details related to how providers can bill for COVID-19 testing and the reimbursement rate for the test. The codes to bill for the testing are U0001 and U0002 and are accepted starting April 1, for services provided on or after February 4.

Also provided is additional information related to the coverage of telemedicine visits, including:
  • distant site requirements and reimbursement for telehealth, including the coverage when the patient participates from home;
  • audio-only visits for physician services are covered for established patients if the recipient is experiencing COVID-19 symptoms, at high risk for COVID-19, under quarantine, or social distancing during the declared emergency;
  • audio-only telemedicine behavioral health services delivered by a substance use disorder (SUD) agency, a community mental health center (CMHC), or an independent mental health practitioner (IMHP) are covered when following the specified circumstances;
  • telephonic evaluation and management services are also covered for new patients experiencing symptoms consistent with COVID-19;
  • the temporary coverage of physical therapy, occupational therapy, and speech-language pathology services;
  • coverage criteria for tele-dentistry for a limited oral exam (HCPC D0140); and,
  • coverage criteria for applied behavioral analysis (ABA) services provided via telemedicine for recipients and providers at high risk for COVID-19, under quarantine, or social distancing during the declared emergency.

South Dakota Medicaid will also allow recipients to get extra medicine and supplies. The FAQs provide additional details on the outpatient retail prescription benefit for all medications as allowed by federal or state law. They also address the licensure of out of state providers and their ability to provide services during the public health emergency per Governor Noem’s Executive Order 2020-07.

Billing and Coding for Telehealth Visits
Shellie Sulzberger of Coding and Compliance Initiatives delivered a webinar on Friday, April 3, about billing and coding for telehealth visits. The training covered new Medicaid rules for North Dakota, South Dakota, and Wyoming, as well as those for Blue Cross and Blue Shield and Medicare. She also covered ICD-10 code updates for COVID-19-related diagnoses. The slide deck and recording of the training are available on the CHAD website in the Past Event Resources section. Additional telehealth resources, including Avera Health Plan, Sanford Health Plan, and Wellmark Blue Cross Blue Shield guidelines, can be found on the CHAD COVID-19 resources page, under telehealth.

Representatives from the Medicaid offices of each state joined the meeting to answer questions specific to the rule changes in their states. Telehealth is being implemented quickly in many organizations to respond to the public health emergency, and many rules for reimbursement are being updated and revised frequently. CHAD has contracted with Ms. Sulzberger to offer an additional opportunity for Q & A on Friday, April 17, at noon CT. Register here. CHAD will schedule additional office hours sessions as needed.
Telehealth Etiquette and Best Practices
As telehealth continues to expand within our health centers, now is a good time to review telehealth best practices. Staff have developed the right skills when interacting with patients face-to-face but may need to be reminded of appropriate etiquette when using telehealth technologies. Some examples of poor etiquette are not being prepared, the technology not setup correctly, poor eye contact, background noise, inappropriate clothing such as busy-patterned shirts, and lack of attention and empathy. To make the experience pleasurable for the patient here are some items to keep in mind:
  • Lighting, camera placement, and background are important. For a background, a suggestion is to have the health center name and logo. Be positioned to remove distractions like family pictures;
  • Be familiar and test the functionality of technology before the appointment;
  • Be in a secure, private room. For example, place a sign on the door stating that a telehealth consultation is in-progress;
  • Be aware of body language and the tone of your voice;
  • Make introductions and confirm both parties can hear and see each other;
  • Explain telehealth and confirm with the patient that they are comfortable with it;
  • Make the consultation patient-centric and focused; and
  • There should be a clear beginning, middle, and end to the consultation.

For more information, watch this telehealth etiquette video series from the South Central Telehealth Resource Center and this Wyoming telehealth network webinar by the University of Wyoming.
CHAD and HCAN Offer Capital Link Financial Resources Overview April 10
CHAD and the Health Center Association of Nebraska (HCAN) have invited Jonathan Chapman, chief project officer with Capital Link, to provide an overview of the many cashflow and payroll opportunities available to health centers and other small businesses. In addition to the overview, Jonathan will take questions to help health centers decide which of these opportunities might be their best option. For questions or to have specific information included, contact Mary Hoffman at CHAD as soon as possible. The meeting is scheduled for Friday, April 10, at 10:00 am MT/ 11:00 am CT. Click here to register.
IRS Issues Guidance on Claiming Refundable Tax Credits
The Families First Coronavirus Response Act (FFCRA), signed by President Trump on March 18, provides small and midsize employers refundable tax credits that reimburse them for the cost of providing paid sick and family leave wages to their employees for COVID-19-related leave. In addition to the guidance and frequently asked questions issued by the Department of Labor, the Internal Revenue Service (IRS) has now issued their guidance on the refundable tax credits and the procedures to receive payment of the advance credit. See “How to Claim the Credits” or visit the IRS website for more questions and answers to COVID-19-related tax credits for required paid leave.
NACHC CHC Store – Limited Availability of PPE
The National Association of Community Health Centers (NACHC) has created an online store,, to offer health centers access to discounted branded products and apparel. The store currently has a limited supply of PPE. They are presently highlighting two different options for face masks but expect to have varying levels of availability and pricing. To order masks, contact NACHC account manager, Adam Biats.
Health Center Program Deadline Extensions
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, 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.
Technical Assistance for COVID-19 Supplemental Funding for Health Centers
The Health Resources and Services Administration (HRSA) is hosting two question and answer sessions to help health centers in responding to the reporting requirements for the FY 2020 Coronavirus Supplemental Funding for Health Centers. Reporting is due in HRSA’s electronic handbooks (EHBs) on Thursday, April 23. The next call is scheduled for Friday, April 17, at 12:00 pm MT/ 1:00 pm CT. Call-in details and additional technical assistance (TA) is available on the COVID-19 Supplemental Funding for Health Centers TA webpage.

Highlights from the first call on Wednesday, April 8 include:
  • If you have questions or need direction on locating your supplemental funding in HRSA’s EHBs, there is a Youtube tutorial available with step-by-step instructions. This will be an H8C grant number. Once you add the grant to your organization’s folder, you can view the Notice of Award and submission requirements.
  • Two forms that may be uploaded into EHBs are the SF-424A, required from all applicants, and an equipment list if you are requesting to purchase equipment. Both forms are available for download on the COVID-19 Supplemental Funding for Health Centers TA webpage.
  • An example budget narrative is available to use as a guide in developing your budget.
  • There is no form required for listing activities. Any format will be accepted by EHBs. Applicants should group their activities into three areas of focus for this round of funding: preparation, prevention, and response. Limit the length to one-two pages of bullets under the three headings.
  • If technical difficulties occur or any need for an extension, contact your project officer.
  • This is not an application. Funds have already been awarded. This is a post-award document to explain how funding has been or is being used.
  • The second TA call on Friday, April 17 will be modified to include responses to the most frequently asked questions, so it is recommended to join that call even if you attended the first call.
  • Materials shared from the first COVID-19 supplemental funding TA call are on the CHAD COVID-19 webpage.
Health Center Program Deadline Extensions
The following updates have been shared during the past week through the Bureau of Primary Health Care’s (BPHC) frequently asked questions (FAQs) page:
  • Tri-annual reporting for progress toward 2019 Integrated Behavioral Health Services (IBHS) supplemental funding goals is no longer required. Instead, progress will be assessed through 2020 Uniform Data System (UDS) reports.
  • Year-two funding to IBHS recipients will be issued this spring, but the deadline for the 0.5 FTE requirement has been extended by a full year. The IBHS Staffing Impact Form will is required to be submitted prior to April 30, 2021. Additional information will be included in the Notice of Award providing the year-two funding.
  • HRSA is referring health centers to the Centers for Medicare & Medicaid Services Guidance for Infection Control and Prevention of Coronavirus Disease (COVID- 19) in Outpatient Settings for information on COVID-19 infection control. This includes recommendations on mitigating transmission, screening, restricting visitors, cleaning and disinfection, and closures. The CDC website and state health departments can offer further guidance on patient safety and infection control. Another valuable source for this topic is the ECRI website’s COVID-19 Resource Center.
  • No change in scope is required for health centers to temporarily change their hours of operation during the declared emergency. Permanent changes to hours of operation at one or more site requires a scope adjustment request. Patients should be made aware of any changes that impact access to care, whether permanent or temporary.
  • Health centers can utilize a provider to deliver care that is outside of their routine duties defined by their licensure or certification only if it does not violate state laws or regulations. If your state authorizes this and it is being done, it should be documented in the health center’s credentialing files.
NACHC Introduces Team Care Connections
Last week, CHAD discussed the topic of moral injury and distress as it relates to health care workers and the challenges of working during the COVID-19 pandemic. The National Association of Community Health Centers (NACHC) recently conducted a training on this topic and specifically focused on community health centers and primary care. Find a recording of the training here. During this training, NACHC introduced a new online magazine titled Team Care Connections. This magazine provides research and information about helping health care workers who may be experiencing moral injury. Find the online magazine here.
Intimate Partner Violence in Quarantine
The stress and isolation of COVID-19 have had an impact on everyone. Unfortunately, some individuals are more vulnerable during this time of social distancing and isolation. Recently, there have been increased reports of intimate partner violence as victims are forced to remain in quarantine with their abusive partner. The National Domestic Violence Hotline has shared these unique ways that a partner could use COVID-19 as an abusive tactic:
  • Abusive partners may share misinformation about the pandemic to control or frighten survivors, or to prevent them from seeking appropriate medical attention if they have symptoms.
  • Abusive partners may withhold insurance cards, threaten to cancel insurance, or prevent survivors from seeking medical attention if they need it.
  • Programs that serve survivors may be significantly impacted –- shelters may be full or may even stop intakes altogether. Survivors may also fear to enter a shelter because of being in close quarters with groups of people.
  • Survivors who are older or have chronic heart or lung conditions may be at increased risk in public places where they would typically get support, like shelters, counseling centers, or courthouses.
  • Travel restrictions may impact a survivor’s escape or safety plan – it may not be safe for them to use public transportation or to fly.
  • An abusive partner may feel more justified and escalate their isolation tactics.

Health care organizations may be the only safe place that victims of domestic violence can call without arousing suspicion from their abusive partner; therefore, healthcare centers are being encouraged to continue with proper screening and referrals for assistance.
Webinars & Meetings
Find these and other events on the CHAD website.

Flattening the COVID-19 Curve: Latest Updates

The National Association of Community Health Centers (NACHC) will hold webinars for the next few Thursdays. 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.

Capital Link Financial Resources Overview

CHAD and the Health Center Association of Nebraska has invited Jonathan Chapman, chief project officer with Capital Link, to provide an overview of the many cashflow and payroll opportunities available to health centers and other small businesses.

Friday, April 10
10:00 am MT/ 11:00 am CT
Click here to register

COVID-19 Response Open Discussion – Members Only

CHAD will host a weekly call for health centers to convene to share any questions, concerns, ideas, etc. as they continue to develop and execute their COVID-19 response plans. The April 14 meeting will be earmarked for discussion of the financial impact of COVID-19 and will be for health centers only. Supplemental and CARES Act funding will also be discussed.

Tuesday, April 14 (reoccurring)  
2:00pm MT/ 3:00pm CT
Contact to be added to these meetings.   

PCMH Office Hours: Health Centers, PCMH, & COVID-19

During this session, the National Committee for Quality Assurance will respond to health center questions regarding changes to its Patient-Centered Medical Home (PCMH) policies during the March 1–September 1 time frame.

Tuesday, April 14
9:00 am MT/ 10:00 am CT
Register here

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.

Thursday, April 16 (reoccurring)
10:00am MT/ 11:00am CT
For weekly call-in information, please join the listserve here. Archived calls and slides can be viewed here.

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.

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 #2
Friday, April 17
12:00-1:00 pm MT/ 1:00-2:00 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

Today with Macrae: Health Center Program Updates

Today with Macrae: health center program updates are now weekly in response to health centers’ requests for more information.

Thursday, April 9
12:00 pm MT/ 1:00 pm CT
Call-in: 800-779-1633
Passcode: 5143271

Save the date for these future calls:

Wednesday, April 15
1:00 pm MT/ 2:00 pm CT
Call-in: 800-988-9470
Passcode: 1763467

Friday, April 24
2:00 pm MT/ 3:00 pm CT
Call-in: 800-988-9470
Passcode: 1763467

Missed recent Today with Macrae calls? Recordings and transcripts are posted on the Bureau of Primary Health Care’s Emergency Preparedness and Recovery Resources for Health Centers webpage as soon as possible after each call.
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 15 – 12:30 pm MT/ 1:30 pm CT
  • Wednesday, April 22 – 12:30 pm MT/ 1:30 pm CT
  • Wednesday, April 29 – 12:30 pm MT/ 1:30 pm CT
CHAD Network Team Meetings

Tuesday, April 14 at 2:00 pm CT - Marketing and Communications

Wednesday, April 15 at 12:00 pm CT - Clinical COVID-19 response call (bi-weekly)

Wednesday, April 15 at 2:00 pm CT
– Great Plains Health Data Network (GPHDN) Telehealth implementation and best practices

Thursday, April 16 at 11:00 am CT – Human Resources (weekly)

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