World AIDS Day on Tuesday this week marks 40 years since the first cases of AIDS were reported in the United States. This year, our nation struggles through another pandemic with striking parallels. In commemoration, the National AIDS Memorial held a national conversation forum to hear compelling voices from the AIDS pandemic and hopeful testimony from leaders through two pandemics. David Ho, M.D., and Anthony J. Fauci, M.D. were honored for their medical and scientific advancement efforts.  

As part of the National AIDS Memorial, the Community Health Center of the Black Hills (CHCBH) had the privilege to be one of the South Dakota display hosts for the AIDS Memorial Quilt virtual exhibition. Visit the full list of displays by state and territory through March 31, 2021.   

In 2017, CHCBH established an HIV clinic within the health center to integrate HIV treatment and prevention into primary care. Their goal, in coordination with local and state partners, is to provide compassionate and comprehensive care for people living with HIV throughout the community. Jenn Sobolik, CNP, said, "The Community Health Center of the Black Hills wants to make patients feel welcome and to end the stigma associated with an HIV diagnosis." CHCBH launched the Iris Clinic this summer to provide specialized LGBT+ youth care in an affirming atmosphere to advance this effort.

As with the COVID-19 response, community health centers are well-positioned to be key partners to integrate HIV care, treatment, and prevention into primary care. They play an important role in the strategies to reduce HIV infections and HIV-related health disparities, which aligns with the Ending the HIV Epidemic: A Plan for America (EHE) initiative. A toolkit for health centers to integrate HIV care, treatment and prevention services into primary care can be found here.  

CHCBH is a practice transformation site working with the Dakotas’ chapter of the Health Resources and Services Administration’s (HRSA) AIDS Education and Training Center (AETC) Program, which supports national HIV priorities by building clinician and care team capacity along the HIV care continuum. This network of eight regional centers (and more than 130 local affiliated sites) and two national centers conduct targeted, multidisciplinary education and training programs for health care providers treating people living with HIV. Two excellent resources developed at the University of Washington Infectious Diseases Education and Assessment (IDEA) Program are the National HIV Curriculum and COVID-19 treatment websites.  

To access additional resources, including education, training, and capacity-building for health care professionals and agencies servicing people living with HIV or individuals at high risk for HIV infection, contact Jill Kesler, Dakotas AETC (DAETC) program manager, for more information.  

CHCs in the News!
Providers with Family Healthcare talked with Prairie Public News about managing the pandemic and dental services.
Horizon Health Foundation celebrates ‘Giving Toothsday’ via the Yankton Daily Press & Dakotan.
South Dakota Public Broadcasting featured Horizon Health Care and Community Health Center of the Black Hills during its Diabetes in South Dakota series.
2020 CHAMPS Awards Honored CHAD and GPHDN Leadership
Recently the Community Health Association of Mountain/Plains States (CHAMPS) was honored to recognize the 2020 CHAMPS awardees during an online ceremony. Each year, these awards allow CHAMPS to recognize exceptional contributions to the health center community, focusing on outstanding advocacy, leadership, and dedication to the health center mission.

Among the esteemed awardees was CHAD’s own, John Mengenhausen, CEO of Horizon Health Care. CHAMPS awarded John the 2020 Stanley J. Brasher Legacy Award. This award was created to honor individuals who have dedicated their careers to solving the problems of health, poverty, and human rights and who have contributed toward the mission and recognition of community and migrant health centers in our region. In addition, CHAMPS renamed the Presidential Award the John Mengenhausen Presidential Award. This award recognizes contributors to CHAMPS leadership and governance. John was one of the CHAMPS founders, was the first CHAMPS president, and served as board president for a combined seven years. Congratulations, John! This year also included the 2020 Outstanding Advocate of the Underserved awardee, Juanita Sapp, MD, of Heritage Health Center, WY, part of the Great Plains Health Data Network (GPHDN) family.

Please visit the new CHAMPS awards webpage for more details about this year’s awardees, including photos and nomination statements. CHAMPS will be adding recordings from the recent ceremony in the coming weeks, and the webpage also includes lists of individuals who have received CHAMPS awards in prior years.

Top Counties and Trends in the Dakotas
As of Wednesday, December 2, North Dakota and South Dakota are ranked 2 and 3 in total new cases per population over the last seven days, according to the New York Times COVID-19 database.

The emerging hot spots in the two states with the most cases in the last seven days per population are:

In South Dakota, the positivity rate over the last 14 days is 14%, which has decreased from 19.6% during the previous two-week period. In North Dakota, the 14-day rolling average positivity rate is 12.39%, a slight decrease from the last two-week period.

Hospitalization capacity and trends tend to be difficult to track with staffed bed numbers constantly in flux. South Dakota has 531 people currently hospitalized, a number that remained fairly steady in the last month. North Dakota reports 301 currently hospitalized, up over 150 in the past six weeks.

Here are some trusted websites that show data, trends, hospitalization rates, hot spots, etc.
Federal Funding Update
The National Association of Community Health Centers (NACHC) provided several federal updates related to Congressional action before the end of 2020. As you may know, health center funding is currently set to expire on December 11. NACHC does not believe long-term (mandatory) health center funding is likely at this time, but rather Congress could take one of two likely approaches to short-term funding extensions that would avoid a government shutdown and a health center funding cliff.

The first likely option is that funding would be extended through an omnibus funding package, which would mean a short-term cliff fix through federal fiscal year 21 for health centers. The other possibility is that funding will continue by way of a continuing resolution (CR). This would take funding through February 2021. If the funding comes in the form of an omnibus funding package, it is likely to increase slightly. If it comes in the form of another CR, the funding will likely remain level.

CHAD has sent communication to the Members of Congress in the Dakotas requesting the following:

  • 5 year re-authorization of the Community Health Center Fund of $41.9 billion to ensure long-term funding stability for CHCs;
  • $7.8 billion over five years to support the critical expansion of workforce programs to address the growing shortfall of our nation’s primary care health care workers;
  • Telehealth Extension and Payment Parity for Medicare visits for health centers;
  • Protection of the 340B Program for pharmacy drug discounts; and,
  • Emergency COVID-19 relief funds over the next six months for CHCs and for Health Center Look-Alikes (LALs).
COVID-19 Relief Funding
A $908 billion bipartisan COVID-19 relief package was released on Tuesday, December 1. Members of Congress who sponsored the bill are hoping for it to pass before the end of the year. South Dakota Representative Dusty Johnson is among the lawmakers calling for the passage of the more than $900 billion relief bill.

The bill would provide $160 billion for states and cities, $180 billion for unemployment insurance, and $288 billion for more small business assistance through the Paycheck Protection Program. It also includes billions in assistance for transportation-related industries, like the airline industry. There is also $16 billion for vaccine development and distribution. The funds would run through the first quarter of 2021. The bill’s amount is less than the $2.2 trillion package in the House and more than the bill being pushed by Senate Majority Leader Mitch McConnell.

South Dakota
South Dakota announced that it anticipates remaining CARES Act funding to distribute after funding the Small Business and Healthcare Provider Relief Program applications. Governor Kristi Noem is looking at options on how to expand the grant and looking at ways to use this money to help those that have been affected by the pandemic. CHAD will continue to monitor any opportunities for health centers as the state works to expend the resources before the end of the year.  
State Legislative Updates
North Dakota
The North Dakota Legislature met from December 1 – 3 for the organizational session. During this time, new legislators are sworn in, legislative leadership is selected, committees are assigned, and administrative rules are agreed upon. The governor will also present his budget to the legislature this week. The deadline for executive agencies to file bills with the Legislative Council is Friday, December 4. CHAD is planning for the upcoming legislative session and holding several meetings with state legislators to discuss the policy agenda. See a copy of CHAD’s 2021 North Dakota Legislative Priorities here. The legislative session in North Dakota starts on January 5, 2021.

South Dakota
Governor Kristi Noem is expected to present her budget to the legislature on December 8. The South Dakota Legislature will convene on January 14, 2021, for their regular legislative session, which is slated to last for 40 working days. CHAD has put together a strategic plan for the legislative session and a robust policy agenda, which can be found here.
The CDC Introduces Options to Decrease COVID-19 Quarantine Timeframe
The Centers for Disease Control and Prevention (CDC) announced Tuesday new options to reduce quarantine for close contacts based on local circumstances and resources. The new guidance includes reducing from 14 days to 10 days for asymptomatic close contacts who have NOT been tested and seven days for close contacts who receive a negative test on day five or later. The CDC based their recommendation on this research.

The 14-day quarantine period is used to ensure that infected persons do not transmit the virus to others, particularly since it can take many days for symptoms to present. It is also used so those who have been exposed and become symptomatic can be evaluated and rapidly get the care they need. However, a 14-day quarantine period can present many challenges, including physical, mental, and economic hardships. Reducing the length of quarantine will reduce the burden and hopefully increase community compliance.

The following notes explain the shortened quarantine period options for those persons who have been identified as close contacts:

  • Without testing:
    • The quarantine period can end after day 10 without testing, assuming the person remains asymptomatic and continues to monitor for symptoms through day 14.
    • Residual post-quarantine transmission risk is estimated to be about 1%, with an upper limit of about 10%.
  • With a negative test:
    • If diagnostic testing resources are sufficient and available, quarantine can end on day 8 if the asymptomatic person tests negative on days 5, 6, or 7; and,
    • The patient continues to monitor for symptoms for the remainder of the 14-day period.
    • The residual post-quarantine transmission risk is estimated to be about 5%, with an upper limit of about 12%.

The research is ongoing, and guidelines and recommendations will continue to need to be updated. The South Dakota Department of Health announced this week that they would begin to follow these recommendations on Thursday, December 3.
Recommended Priority Populations for COVID-19 Vaccines
On Tuesday, December 2, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted 13 to 1 on the recommended priority populations who should receive the COVID-19 vaccine first. The two priority groups identified are frontline health care workers and long-term care residents, which is consistent with what the states have been planning. The states have been working on their vaccination distribution plans for months but have been waiting for this very specific meeting to take place before they prioritize the highest risk priority populations for vaccination. The ACIP stated that this is interim guidance, and it will continue to be updated and changed as more vaccine supply becomes available.  

The initial allocation is estimated to arrive before the end of the year and will be proportional to each state’s adult population. South Dakota will receive approximately 7,800 Pfizer vaccines, and North Dakota will receive around 6,825 Pfizer doses. ND estimates 13,000 doses of the Moderna vaccine the week after the Pfizer allocation. SD does not currently have an approximated number of Moderna allocation, nor the timeline or amounts of a second allocation.  

The initial allocation coming to the states will not come close to the amount needed to vaccinate both of those groups right away. The states will determine who out of those priority groups will receive the vaccine first. North Dakota has developed an ethics committee that is helping the state make those recommendations. South Dakota’s Department of Health is making this decision internally. The states are not required but are anticipated to follow ACIP recommendations. It is estimated that the vaccine will be available to the general public by May 2021.  
National Health Service Corps Loan Repayment Program – Update on Numbers in the Dakotas
In October, the Health Resources and Services Administration (HRSA) announced nearly $500 million in awards to support, recruit, and retain qualified health professionals and students through the National Health Service Corps (NHSC), Nurse Corps, and other workforce development programs. The top-line funding level for the NHSC was $430 million in both FY 2019 and FY 2020. Read more about the budget here on page 80.

This year, 22 new NHSC loan repayment awards were made to federally qualified health center (FQHC) clinicians in North Dakota and South Dakota, across three practice areas: dental, mental health, and primary care. There were 16 awardees in South Dakota and six awardees in North Dakota. Of those awardees, the lowest health professional shortage area (HPSA) score funded was a 14, and the highest score funded was a 26. Dental loan repayment awards in North Dakota and South Dakota were made to 3 FQHC clinicians in HPSAs ranging from a low of 16 to a high of 23. Mental health loan repayment awards in North Dakota and South Dakota were made to seven FQHC clinicians in HPSAs ranging from a low of 14 to a high of 20. Primary care loan repayment awards in North Dakota and South Dakota were made to 12 FQHC clinicians in HPSAs ranging from a low of 15 to a high of 21.
CHAMPS COVID-19 Resources
CHAMPS has created a carefully curated clearinghouse of resources pertinent to health center staff, operations, and training in the face of COVID-19, as well as resources that address and promote wellness during and beyond this pandemic. CHAMPS recently overhauled this webpage and created seven new, easy-to-read COVID-19 resources webpages. Check out the new and improved CHAMPS COVID-19 Resources here.
GP11 Network News
DAAS and Population Health Management Review Webinar December 9

The Great Plains Health Data Network (GPHDN) will be hosting a webinar on Wednesday, December 9, to provide an overview of the Data Aggregation and Analytics System (DAAS) and the process used to determine the recommended population health management (PHM) vendor. The PHM tool will be an essential component of the DAAS, and the vendor recommended by the GPHDN Leadership Committee will be available to do a brief demonstration if needed. The target audience is health center staff, including leadership, who may need additional information to help the decision-making process or have any questions on a PMH system or the DAAS. The goal is to have a general discussion on the PHM vendor and provide health centers with the necessary information to support decision-making related to the selection of a vendor and the value of a PHM tool in general. Register here.

Cybersecurity: Imminent Threat Posted

At the end of October, the Cybersecurity and Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI), and the Department of Health and Human Services (HHS) released an alert regarding an imminent cybercrime threat to health centers, hospitals, and health care providers across the U.S. The purpose of the alert was to warn these organizations and individuals to ensure they take "timely and reasonable precautions to protect their networks" from possible threats. To assist health care organizations, CISA released the joint cybersecurity advisory documents along with a cybersecurity checklist and ransomware fact sheet, which provides background information, mitigation recommendations, and guidance to help protect networks.  
At the end of last week, CISA posted an update stating that they continue to "assess the threat of ransomware cybercriminal activity targeting the HPH sector. At this time, we consider the threat to be credible, ongoing, and persistent." Also, they noted that "some recent health care sector victims have experienced very short periods of time between initial compromise and activation – even under a few hours," and they continue to urge organizations "to work towards enduring and operationally sustainable protections against ransomware threats both now and in the future."

This alert is a reminder to health centers to be vigilant in protecting the organization’s critical IT assets. CISA has posted on their ransomware page helpful documentation, including fact sheets, guides, training materials, and alerts. Please contact Kyle Mertens at CHAD for additional questions.

Holidays and Mental Health
One of many popular mental health myths is that most suicides occur during the holidays, especially at Christmastime. The truth is, suicide rates are usually the lowest in December and peak in the spring. During a typical year, the holidays act as a buffer for many people and their mental health. The social events, family visits, magical lights, and the sounds of the holidays tend to improve moods. It is understandable why people believe this myth, however. In-laws, poor weather, stressful travel, house guests, and overspending can parade on someone’s last nerve. For some with no family or friends to celebrate with, the holidays can be very lonely. Still, most people make it through despite these challenges.  

It may seem strange, but the winter months typically lead to a lack of motivation and energy, which also acts as a buffer to suicide. People may lack the motivation and energy to act on suicidal thoughts, but when the warmer months come around, that seems to change. The holiday suicide myth may seem harmless, but it can have consequences. For example, one article spoke of a rural community that had high suicide rates at Christmastime. People assumed this was expected because they believed the myth that more suicides occur at that time. However, people were financially ruined by a round of layoffs at the local factory. By merely believing the myth, people may fail to look for the actual reason.  

Everything mentioned so far is true in a typical year, but we know that this year has been far from typical. The same protective factors that may have staved off suicidal thoughts and behaviors may not be available this year. Rising COVID-19 rates may prevent family gatherings and social events. People who may not have worried in the past about affording gifts may suddenly be wondering how to maintain their family traditions. Others may completely go without. Holiday grief, the grief that occurs when going through a holiday without someone for potentially the first time, will no doubt be a serious challenge this year. This type of grief is hard no matter what, but there is no doubt that the great many losses due to COVID-19 will add an extra layer of anguish. Some families will have members spending the season in hospitals and not be able to visit them.  

Suicide rates have already risen because of the stress of COVID-19. It is impossible to know how all of this will impact suicidal behavior during the holidays. It is critical to make depression and suicide risk an essential part of screening.  

In our personal lives, it is important to tell people if we are feeling overwhelmed and to ask those we love about suicide if we feel like they are at risk. Self-care is always important, but it is even more necessary now and during this time of year.  
Open Enrollment Ends December 15
We are nearing the end of the open enrollment period for health insurance plans on the state-based marketplaces. Health centers have been encouraging patients to actively re-enroll during this period as prices and policies can change from year to year. CHAD is helping to spread the word about this opportunity to get health insurance that will allow people to access health care services needed to protect them and their families. For more information, visit GetCoveredSD or GetCoveredND.  
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 December (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
Data Aggregation and Analytics System and Population Health Management Review

The Great Plains Health Data Network (GPHDN) will be hosting a webinar to provide an overview of the Data Aggregation and Analytics System (DAAS) and the process used to determine the recommended population health management (PHM) vendor. The PHM tool will be an essential component of the DAAS, and the recommended vendor, Azara, will be available to do a brief demonstration if needed. The target audience is health center staff, including leadership, who may need additional information to help the decision-making process or have any questions on a PHM system or the DAAS. The goal is to have a general discussion on the PHM vendor and provide health centers with the necessary information to make a final decision.

Wednesday, December 9   
10:00 am MT/ 11:00 am CT
Register here.

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.

Wednesdays (reoccurring January through May 2021)
12:00 pm MT / 1:00 pm CT

CHAD Network Team Meetings

Tuesday, December 8 at 1:00 pm MT/ 2:00 pm CT – Communications/Marketing Network Team Meeting
Thursday, December 17 at 10:00 am MT/ 11:00 am CT – Great Plains Health Data Network Leadership Meeting
Friday, December 18 at 11:00 am MT/ 12:00 pm CT – Behavioral Health Work Group
Tuesday, December 29 at 12:00 pm MT/ 1:00 pm CT – O & E Network Team

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