If you have been to the capitol in Bismarck recently, you may have seen community health center (CHC) advocates working hard to make a case for the value of the care we provide and the need for additional state support to sustain and continue to grow our impact across North Dakota. We have been getting great questions about why these resources are needed now, why health centers specifically, and how we might use additional funds.

Right now is a difficult time for all health care providers. There are workforce shortages across the state caused by long-standing provider shortages and exacerbated by COVID-19-related burn-out. The main cost center for all health care providers is wages, which have increased significantly over the last few years from entry-level staff to high-level providers. In contrast, reimbursement levels and grant funding have remained constant. As providers that care for underserved populations, we will be especially hard hit by likely reductions in Medicaid coverage related to unwinding continuous eligibility as the public health emergency wraps up. One study estimates a loss in the range of $2 million to health centers in North Dakota – and to the challenge of recruiting staff in rural, frontier, and hard-to-serve areas of the state.

CHCs in the state face unique challenges in that they – by mission and program requirements – see all patients regardless of insurance status or ability to pay. We aren’t able to “manage” our payor mix when times get tough. As this chart shows, health centers provided nearly $11 million in uncompensated care over the last biennium. At the same time, we saved other providers and state money by providing a model of care that keeps patients healthy and out of the emergency room.

Health centers typically provide care in the hardest-to-serve communities, which could mean a frontier community where it would be difficult to sustain a traditional doctor’s office due to low volume or a population in an urban community that needs extra services because of a language barrier or lack of access to stable housing. They provide dental care for uninsured and underinsured patients as the state faces a crisis in dental access for those communities. Because of the unique role health centers play in filling gaps in the health care system, 29 states currently allocate funds to support their mission. We’d like to see North Dakota added to the list.

It has been exciting to hear directly from health centers about how they would use additional resources from the state. Family HealthCare described a mobile van equipped with dental equipment that could travel to meet the dental access needs of Fargo and beyond. Northland Health Centers discussed expanding access to behavioral health services in communities with very few local providers. Spectra Health talked about the lives they have saved through its opioid treatment programs. In general, this appropriation would help CHCs respond to workforce challenges and shortages, enable health IT investments that support quality improvement, put more resources towards social and environmental barriers to health in underserved communities, and sustain outreach, translation, transportation, and other non-billable services.

We know that many CHAD Connection readers are partners and supporters of health centers in your communities. We’d welcome your voice in support of Senate bill 2155. To learn more ways to get involved, reach out to our advocacy team, Jenn Folliard or Amber Huez.

CHAD Welcomes Amber Huez as the
Policy & Partnership Manager

Amber Huez, MBA, BSN, RN, joined CHAD in January as the policy and partnership manager. She builds relationships through collaboration with health centers, community leaders, key legislative and congressional leaders, state partners, state Medicaid offices, and Insurance Commissioners to improve access to affordable, high-quality care for all Dakotans. She is also responsible for facilitating the North Dakota Oral Health Coalition.

Previously, Amber served as the North Dakota Medicaid quality and dental manager. She was instrumental in establishing the Medicaid Quality Program to drive high-quality care for Medicaid beneficiaries and led the effort to reduce the administrative burden for Medicaid dental providers. She was also the project manager for the CMS Oral Health Affinity Group, which partnered with the North Dakota Oral Health Program to promote the medical-dental integration model to increase topical fluoride varnish application for Medicaid beneficiaries.

Amber graduated from the University of Texas at Tyler with an MBA in health care management. She obtained her BSN from Drexel University. Amber enjoys spending time with her husband and three boys. She is a member of the American Quarter Horse Association and National Reining Horse Association, where she competes in horse shows in ranch riding and reining.

Congratulations to April Matson, outreach coordinator at South Dakota Urban Indian Health, who was recently selected as a recipient of the 2023 First Peoples Fund Cultural Capital Fellowship! This fellowship honors and supports the work of artists and culture bearers committed to passing on ancestral knowledge and cultural practices within their tribal communities. Read more about April here.

CHAD is offering limited sponsorship opportunities for the 2023 CHAD Annual Conference: Celebrate the Difference. This annual event allows leaders from community health centers across Wyoming, North Dakota, South Dakota, and South Dakota Urban Indian Health to come together for educational and networking opportunities.

The North Dakota and South Dakota legislative sessions have been busy. South Dakota is about halfway through the session; North Dakota will be halfway through at the beginning of March. CHAD continues to work with partners across both states to advance priorities. For example, in North Dakota, CHAD has received formal support from local public health officials, labor unions, and community action agencies for appropriations requests to offset uncompensated care. (Read more about SB 2155 in the CEO note). In South Dakota, CHAD continues to partner with organizations like AARP, the American Heart Association, the American Cancer Society Cancer Action Network, and many others to support Medicaid expansion implementation.

Passing good policy requires good partnerships. CHAD is grateful for these and other partners that support health centers. Please contact Jennifer Folliard, policy and communications director at CHAD, to get involved.

North Dakota Priority Updates
State Community Health Center Investment

• SB 2155 – Passed out of the Senate Appropriations Committee. This bill will be heard on the Senate floor soon.

Community Health Workers (CHW)

• HB 1029 – Defeated
• HB 1028 – Amended to include health centers in a CHW taskforce and passed out of House Human Services Committee.

Food Security

• HB 1494 – Addresses lunch shaming in North Dakota schools. Passed in the House.
• HB 1491 - Eliminates the need for reduced-price lunches for ND children. Referred to Appropriations. 

Child Care

• SB 2301 – Referred to Appropriations.

Workforce

• SB 2344 – Provides a public health professional to the health care professional loan repayment program. Referred to Appropriations.
• SB 2287 – Addition of registered nurses to student loan repayment program. Referred to Appropriations.

 
South Dakota Priority Updates
Medicaid Expansion

• HJR 5004 – Includes an option to put work requirements for Medicaid on the ballot. Passed the House and referred to the Senate Health and Human Services Committee.

Workforce

• HB 1044 – Creation of a fund and scholarship to support students studying to be behavioral health providers. Referred to Appropriations.
• SB 175 – Allows physician assistants to work to the highest level of their scope. Defeated on the Senate floor.

Food Tax

• There are competing bills related to food tax repeal. CHAD supports the use of this policy lever to address food insecurity.

In March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily waived certain Medicaid and Children’s Health Insurance Program (CHIP) requirements and conditions. The easing of these rules helped prevent people with Medicaid and CHIP from losing their health coverage during the pandemic. With the Public Health Emergency (PHE) officially ending, states will soon be required to restart Medicaid and CHIP eligibility reviews. According to some estimates, when states resume these reviews, up to 15 million people could lose their current Medicaid or CHIP coverage through a process called “unwinding.”

In an effort to minimize the number of people that lose Medicaid or CHIP coverage, CMS is working with states and other stakeholders to inform people about renewing their coverage and exploring other available health insurance options if they no longer qualify for Medicaid or CHIP.

To assist this effort, CMS has released a communications toolkit. Using the CMS information, CHAD has created unwinding webpages and customized social media messages for each state that will be distributed to the CHAD Marketing Network Team. Find the South Dakota website here and the North Dakota website here. For access to the customized social media toolkits, contact Kayla Hanson at CHAD. The State of North Dakota also has a webpage with unwinding information and communications materials.

Last month, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced it would no longer require nor accept applications for the DATA 2000 Waiver previously needed to prescribe the drug most frequently used for treating opioid use disorder (OUD). The change comes from Section 1262 of the Consolidated Appropriations Act, 2023, which removes the federal requirement for practitioners to submit a Notice of Intent to prescribe medications for the treatment of OUD.

A letter from the Drug Enforcement Administration (DEA) confirms:

• A DATA-Waiver registration is no longer required to treat patients with buprenorphine for OUD;
• Going forward, all prescriptions for buprenorphine only require a standard DEA registration number. The previously used DATA-Waiver registration numbers are no longer needed for any prescription;
• There are no longer any limits or patient caps on the number of patients a prescriber may treat for OUD with buprenorphine; and,
• The Act does not impact existing state laws or regulations that may be applicable.

The DEA also noted that another section of the Act (Medication Access and Training Expansion or MATE Act) introduced new training requirements for all prescribers of controlled substances. It includes an eight-hour training in identifying and treating addiction when a practitioner applies for or renews their DEA registration to prescribe controlled substances. This requirement will go into effect on June 21, 2023.

Health centers have long responded to the social drivers of health: social and economic factors which have a major impact on health outcomes. Knowing where to find the needed community resources can be challenging when food insecurity, housing, transportation, and other needs arise. Luckily, there are local organizations that take the guesswork out of this. 2-1-1 resource databases, area extension agents, and community action agencies are critical in facilitating access to vital community resources.

Join CHAD for this panel-style webinar with speakers from the Helpline Center, FirstLink, Community Action Partnership of ND, SD Community Action Partnership, and NDSU and SDSU Extension. Hear how each of these organizations can be key partners in helping you identify local community resources to address social drivers of health so that you can optimize your time spent with patients.

Social workers, community health workers, navigators, nursing staff, care coordinators, and others who facilitate community resource referrals are encouraged to attend. Register here.

According to the Centers for Disease Control & Prevention (CDC), heart disease is the leading cause of death in the United States. Health centers and other organizations can reinforce the importance of heart health by promoting and educating the public on the prevention of heart disease and a healthy lifestyle and regular visits with their provider.

This year, the American Heart Association (AHA) recognizes the impact of heart disease on rural communities across the Dakotas. According to recent data from Medicare, a significant gap in statin therapy exists among rural patients, especially those with diabetes. At the same time, the National Quality Forum confirms hypertension control as a key measure for rural health.

The AHA has funding available to help in the efforts for improved outcomes of health center patients with cardiovascular disease, diabetes, and those at higher risk for these chronic conditions. Along with this funding opportunity, the AHA offers resources and recognition from three ambulatory quality programs, including Target: BP, Check. Change. Control. Cholesterol™, and Target: Type 2 Diabetes.

Applying for the grant is easy, and every organization that completes step one will receive technical assistance from the AHA regarding improving blood pressure measurement accuracy, offering a self-measured blood pressure program, and more based on health center needs. The core data for this grant aligns with what health centers report to UDS for hypertension. These questions need to be answered in the online portal, which also opens the door for recognition.

While funding is limited to three grants, the AHA strongly encourages all health centers to apply as it allows them to identify the need for funding to pursue additional grants. Register for one or more of the Ambulatory Quality Programs by Tuesday, February 28, and confirm the intent to submit the relevant data by Sunday, April 30. Submit this brief form sharing how the grant would be used if selected. For questions regarding this funding opportunity or available resources, contact Tim Nikolai, senior rural health director at the American Heart Association, by email or at 414-502-8780.

The South Dakota Department of Health (SDDOH) is taking steps to improve the health of South Dakota residents by evaluating and improving the public health system. As part of the process, the department will seek accreditation from the Public Health Accreditation Board (PHAB). Becoming PHAB accredited will strengthen the department to better serve South Dakota communities through continuous quality improvement, multi-sector partnerships, accountability to external stakeholders, workforce enhancement, utilization of resources, and focus on community health.

Partner organizations, community members, and stakeholders play an essential role in helping understand the health needs and issues impacting South Dakota residents. Input throughout the State Health Assessment (SHA) and State Health Improvement Plan (SHIP) process is vital to informing a comprehensive statewide health assessment and shaping a statewide health improvement plan that addresses priority health issues.

Throughout the accreditation process, SDDOH will use the South Dakota Public Health Bulletin to inform partners of our progress and provide opportunities for input. To subscribe to the public health bulletin via email, click here.

The South Dakota Tobacco Control Program (SDTCP) is excited to announce two grant opportunities. The Tobacco Disparities Grant promotes health equity by incorporating long-term change to reduce disparate commercial tobacco use among the following SDTCP priority populations: American Indians, pregnant and postpartum people, people experiencing poverty, and people with a diagnosis of a behavioral health disorder. The Tobacco Youth & Community Engagement Grant is designed to engage youth, young adults, and their community in tobacco efforts, including tobacco prevention (including e-cigarettes) and cessation.

Grantees should focus on supporting and implementing evidence-based interventions and activities specifically for youth (under 18 years old), young adults (18-24 years old), or community-based efforts to learn about tobacco prevention and cessation. These two grant opportunities will close at 5:00 pm CT/ 4:00 pm MT on March 10. To view more details, visit doh.sd.gov/prevention/tobacco. These funding opportunities support Priority One of the SD Cancer Plan: Reduce Tobacco Use and Exposure.

The Good & Healthy Community Grant is designed to support local community and organization-based efforts, foster collaboration among organizations, and support the mission of the SDDOH, which is to promote, protect, and improve the health of every South Dakotan. The application opened on January 6 and will close on March 3 at 5:00 pm CT/ 4:00 pm MT. The anticipated award amount is a minimum of $5,000 minimum up to a maximum of $125,000. This funding opportunity supports Priority 2 of the SD Cancer Plan: Increase Healthy, Active Lifestyles.

This article was cross-posted with permission from the South Dakota Association of Healthcare Organizations (SDAHO).

The 2023 program provides small grants for quick-action livability projects that benefit people of all ages. This year, there are two new opportunities: capacity-building microgrants specifically for walkability or community gardens and larger demonstration grants for projects focusing on transportation systems change or accessory dwelling units (ADUs).

Learn more about all three grant opportunities and important program dates here. Please pass this information on – all are invited to apply for grant funding. Contact Lindsey Holmquist with questions about the AARP Community Challenge or any AARP Livable Communities needs.

Join the #BlueForCRC efforts for March by amplifying the grassroots and community efforts to raise awareness throughout Colorectal Cancer Awareness Month. Health centers are urged to engage community partners to turn buildings and landmarks in their community blue on Tuesday, March 7. Toolkits are available to support health center efforts, including social media posts, sample language for proclamations, and other creative ideas to build awareness about the importance of colorectal cancer screening.

Online & In-the-Know: Measles and the MMR Vaccine
With more measles cases emerging in the US, the next session of Immunize South Dakota’s Online & In-the-Know will take a closer look at the MMR vaccine and the diseases it protects against.

Tuesday, February 21
12:30 pm CT/ 11:30 am MT
Register here.

Save the Date: 2023 Virtual PCMH Health Equity Technical Assistance Symposium
Participants will have the opportunity to hear about and discuss best practices and lessons learned from peers and experts in the fields of health equity, quality improvement, and accreditation/recognition.

March 29 - 30
Register here.

CHAD Network Team Meetings
Tuesday,  February 28 at 2:00 pm CT/ 1:00 pm MT – CFO and Finance Manager Network Team
Tuesday,  February 28 at 3:00 pm CT/ 2:00 pm MT – CFO and Finance Manager Roundtable
Thursday, March 2 at 12:00 pm CT/ 11:00 am MT – Clinical Quality Network Team
Tuesday, March 7 at 12:00 pm CT/ 11:00 am MT – Behavioral Health Work Group
Friday,  March 10 at 2:00 pm CT/ 1:00 pm MT – CFO and Finance Manager Network Team