CHAD Connection October 5, 2023

Open Enrollment for 2024 coverage starts soon! Get ready now.

Starting November 1 through January 15, 2024, individuals and families may buy or change their health insurance through Healthcare.gov. Open enrollment is the time to enroll in an affordable health insurance plan for people who do not yet have comprehensive insurance through their employer, Medicare, or Medicaid. In both North Dakota and South Dakota, about 20 percent of patients served by health centers are uninsured.

Many of the previous barriers to health insurance have been significantly reduced. For instance, health insurers can no longer charge more or deny coverage because of a pre-existing health condition, and all plans offered in the Marketplace must cover essential health benefits. These health benefits include ambulatory patient services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; and pediatric services, including oral and vision care.

There is more good news for those seeking coverage this year, as temporarily expanded subsidies were extended through 2025 in the Inflation Reduction Act, which became law in August. This means there is no income cap to qualify for subsidies. Through 2025, if you make over 400% of the federal poverty level (FPL), tax credits gradually decrease as your taxable income rises. Before the changes, assistance was generally only available to households with income from 100% to 400% of the FPL. The marketplace subsidies are based on factors that include income, age, and geographic area. Four out of five people are eligible for health insurance plans for $10 or less per month.

The Affordable Care Act, signed into law on March 23, 2010, also brought expanded access to Medicaid, which means that people can access Medicaid much more quickly and easily than before. North Dakota expanded Medicaid in 2013, and South Dakota’s Medicaid expansion went into effect on July 1, 2023. This means adults with incomes at or below 138% of the federal poverty level (FPL) are now eligible to receive coverage through Medicaid.

Although you can apply for Medicaid anytime, open enrollment means all applicants will be assessed for Medicaid eligibility and subsidized coverage on Healthcare.gov through a single application. States and the Marketplace electronically share eligibility information.

Support is available to help consumers choose a Marketplace plan. In South Dakota, CHAD’s Get Covered South Dakota and its partners have Navigators who assist consumers throughout the state with enrollments. In North Dakota, Minot State University operates a similar program. Since August 2021, South Dakota Navigators have provided more than 22,800 consumer assists, completed nearly 1,700 marketplace applications, and over 1,400 Medicaid/CHIP applications or referrals.

Health centers play a vital role in connecting patients to health coverage. Here are some ways you can get involved or learn more:

Utilize CHAD marketing tools to promote open enrollment (coming soon!),
South Dakota only: Encourage your Navigators and Marketing staff to attend the Navigating OE 11 Workshop in Sioux Falls October 17 – 19.
Attend the Coverage to Care webinar on October 10 at 11:00 am CT.

Thank you for connecting uninsured patients with health insurance counselors or navigators. With any questions, please email penny@communityhealthcare.net.

Each year Community HealthCare Association of the Dakotas (CHAD) and Community Health Association of Mountain/Plains States (CHAMPS) work together to gather valuable information via the Annual Health Center Training & Technical Assistance Needs Assessment, and your input is critical!

Your responses will allow CHAD and CHAMPS to develop new and innovative trainings and technical assistance (T/TA) to support your health center this upcoming year. As a participation incentive, respondents will have the option of being entered into a drawing for one of several Amazon.com gift certificates. Your contributions are very important to us!

CHAD health center members should have received the survey via email already. If you have not yet received it and believe you should have, please contact Darci Bultje, CHAD training and education specialist, at darci@communityhealthcare.net or 605-273-5669.

On Monday, Oct. 2, 2023, the South Dakota Department of Health (DOH) opened the 2023 application period for the State Loan Repayment Program (SLRP). This program is designed to improve access to health care services by assisting underserved communities with recruiting and retaining care providers.

Eligible disciplines include physician, dentist, dental hygienist, nurse practitioner, certified nurse-midwife, physician assistant, health service psychologist, licensed clinical social worker, psychiatric nurse specialist, licensed professional counselor, marriage and family therapist, registered nurse, pharmacist, and alcohol/substance abuse counselor. Selected awardees must participate in a 2-year service commitment at an eligible health care practice site in a South Dakota Health Professional Shortage Area (HPSA).

Applications are currently available online and will be reviewed and approved on a first-come, first-served basis. The application period will close on Oct. 31, 2023, at 5:00 pm CT.

Congratulations to Horizon Health Care, Inc. on their Advocacy Center of Excellence (ACE) recognition from the National Association of Community Health Centers (NACHC). They are the first health center in the Dakotas to achieve this status, which recognizes consistent engagement and commitment to making advocacy an organizational priority. CHAD sat down with Lexy Eggert, Chief Development and Strategy Officer with Horizon Health Care, Inc., to learn more.

CHAD: What made you decide to pursue ACE recognition and prioritize advocacy as a health center?
Eggert: I was inspired to pursue ACE recognition after a NACHC advocacy education event last January. As I looked at the activities needed to achieve ACE status, I realized we were already doing many of them at Horizon, and the other requirements were in-line with the advocacy culture we wanted to build.

CHAD: What are some of the steps you took to achieve this recognition?
Eggert: I put together an advocacy plan that supported our goals as an organization. Our plan is not just focused at a national level, but also building better relationships with our representatives at the state level. We began to talk about advocacy more consistently throughout our organization and with our Board of Directors, asking them to sign up as advocates and help us take action. A few other activities we did were: hosted a National Health Center Week event, sent a Letter to the Editor to our local papers from our CEO around National Health Center Week, passed an advocacy board resolution (NACHC provides examples), and hosted a meeting/tour with an elected official.

CHAD: What have you learned along the way?
Eggert: I have learned a lot about what the difference between advocacy and lobbying and what is permissible at a legal level. I have also been positively surprised at the great conversations we have been able to have meeting with our local legislators and their genuine interest to learn more about community health centers.

CHAD: What advice do you have for other health centers considering ACE recognition?
Eggert: Go for it! NACHC has created many tools recently to help you go through the requirements (all available on their external website) and I am excited about CHAD’S new Advocacy Action Team.

Monday, October 9th, is Native American Day (also known as Indigenous Peoples Day). This holiday, which celebrates Indigenous peoples and commemorates their histories and cultures, is officially observed by the state of South Dakota and by certain cities in North Dakota. To learn more about the holiday, check out this article.
There are many ways to get involved in recognizing this important day, and we’ve included a few local events here:

Fargo-Moorhead Indigenous Peoples Day Event Guide
Grand Forks Indigenous Peoples Day events at UND
Rapid City Native American Day Parade, NDN Collective Event, and Remembering the Children Memorial Walk.
Sioux Falls Native American Day Parade & Wacipi

Effective October 1, 2023, South Dakota Medicaid has implemented coverage of the following services:

Remote Patient Monitoring: Permanent coverage of Remote Patient Monitoring of physiologic functions is covered when medically necessary for recipients with acute or chronic conditions who meet certain criteria. Services must be ordered and billed by providers eligible to bill Medicaid for E/M services. Refer to the Telemedicine Services manual for more information, including coverage criteria and billing guidance.

Fluoride Varnish for Adults: Topical application of fluoride is covered up to twice in a benefit year for adult recipients determined to be at moderate or high risk of developing caries according to an approved caries risk assessment. Refer to the Adult Dental Services manual for more information.

Blood Pressure Home Monitoring Device: Self-measured blood pressure monitoring devices are a covered service when prescribed by a physician or other licensed practitioner to assist in making a diagnosis or for monitoring individuals with a condition or disease that requires in-home monitoring daily to at least weekly. Refer to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies manual for more information, including coverage criteria.

Please refer to the appropriate fee schedule to view the reimbursement for each of these services. The CHAD team is looking into the implications of this for health centers and will follow up with additional information. Contact Shannon Bacon with questions.

CHAD convened the North Dakota Oral Health Coalition for the annual in-person meeting in September. It was an inspiring day, with presentations from the American Dental Association, the North Dakota Dental Foundation, and the North Dakota Oral Health Program. A large portion of the day was spent identifying actionable strategies to improve oral health in North Dakota, and this comprehensive report on Oral Health in North Dakota was used as a data-driven guide for helping the group prioritize actions.

Participants from various organizations (including health centers, professional associations, state agencies, and more) were highly engaged, and several themes arose throughout the meeting. Next, the Steering Committee will meet to begin synthesizing these into a 2024 action plan. If you’d like to learn more about the North Dakota Oral Health Coalition, contact Shannon Bacon at shannon@communityhealthcare.net.

Great Plains Quality Innovation Network (GPQIN) offers training and technical assistance to implement the National CLAS Standards. Culturally and Linguistically Appropriate Services (CLAS) are a set of 15 action steps that organizations can take to ensure responsive and appropriate service delivery to a community. To learn more, check out “The Blueprint,” an implementation guide to help you advance and sustain CLAS within your health center. You can also work with your team to complete this Implementation Checklist for the National Class Standards to identify areas of opportunity and create your CLAS Action Worksheet. If you have questions or would like technical assistance on implementing the National CLAS Standards, contact a member of the Great Plains QIN Team.

October is National Breast Cancer Awareness Month. According to the Centers for Disease Control, each year in the United States, about 240,000 women are diagnosed with breast cancer, and 42,000 women die from the disease. You can help spread the word about early detection through mammograms and encourage communities, organizations, families, and individuals to get involved.

Most breast cancers are found in women age 50 or older, but breast cancer also affects younger women. Other than skin cancer, breast cancer is the most common cancer among American women. The USPSTF (U.S. Preventative Services Task Force) released updated recommendations for breast cancer screening. The draft recommendation includes biennial screening for breast cancer beginning at age 40 for women of average risk. This proposes a change in the USPSTF recommendation that previously recommended the age of 50. The American Cancer Society and Susan G. Komen view these updates as a significant positive change, as these recommendations dramatically increase the screening population. The main difference relates to lowering the age recommendation to begin screening for women at average risk for the disease to age 40 (instead of 50 as previously recommended, with people in their 40s making individual decisions).

Regular breast self-exams, an annual exam, and Mammograms are essential tools in breast cancer detection — especially early detection, when cancers may be more treatable. Being a woman and growing older are the two most significant risk factors for breast cancer. Those factors are difficult to change, but other risk factors exist, such as smoking, drinking alcohol, and not exercising regularly.

Health Centers can use this opportunity to spread the word about taking steps to detect breast cancer early.

Ask providers to speak to women about the importance of getting screened for breast cancer.
Encourage women ages 40 to 49 to talk with their doctors about when to start getting mammograms.
Raise awareness of helpful resources, care services, and support groups.
Provide messaging that involves using culturally appropriate language, imagery, and examples that resonate with specific communities.
Screen for potential barriers to breast cancer screening and connect patients to community resources.

Additional Resources
Women's Way Resources and Materials
Women's Way Toolkit
CDC Breast Cancer Resources

Throughout the fall, CHAD brought the one-day training “Managing with Intent and Purpose to Build Engaged Teams” to 77 participants through sessions in Sioux Falls, Pierre, Fargo, and Bismarck. This uniquely designed workshop was created in response to needs expressed in an HR and leadership focus group. The workshop, facilitated by Nikki Dixon-Foley of FutureSYNC International, explored the dynamics of current management challenges, such as building trust within teams, holding people accountable, aligning teams to goals and achieving outcomes, and improving communications across teams and locations.
Congratulations to these graduates!

Using DRVS to Support Patient-Centered Practices: 2024 Updates
With the recent release of the 2024 NCQA PCMH Annual Reporting Requirements, it is a great time to take stock of the reports and features available within DRVS that can support you in delivering against new and old criteria elements. During this webinar, we will review both the 2023 and 2024 NCQA PCMH Annual Reporting requirements and do a deep dive into PCMH concepts. Come ready to discuss how to use DRVS tools and create custom content to be successful in long-term annual reporting.

Thursday, October 12
1:00 pm CT/12:00 pm MT
Register here

The Calm Before the Storm: Leveraging DRVS to Prepare for your 2023 UDS Submission
The 2023 Uniform Data System (UDS) submission deadline will be here before you know it! Get a head start on your validation efforts. This webinar will cover the key changes to the 2023 UDS CQMs and tables and review the related mapping & data categories to help ensure success come February. We will also discuss considerations for the UDS countable visit changes and where this information can be found in DRVS. Submit any questions you have on the 2023 updates with your registration.

Thursday, October 19
1:00 pm CT/12:00 pm MT
Register here

Uniform Data System (UDS) Training
Join CHAD for the 2023 Uniform Data System (UDS) training sessions on November 14 from 1:00 – 4:15 pm CT/ 12:00 – 3:15 pm MT and November 16 from 1:00 – 4:15 pm CT/ 12:00 – 3:15 pm MT. These free virtual trainings are designed to provide assistance navigating and preparing the 2023 UDS report. This training is for people of all levels of prior UDS experience and covers all aspects of the UDS report. All financial, clinical, and administrative staff are invited to learn updates, hone reporting skills, and share questions and experiences with their peers.

November 14, 1:00 – 4:15 CT / 12:00 – 3:15MT
The first session will allow participants to gain an understanding of the UDS reporting process, review key materials, and a walk-through of the patient demographic and staffing tables 3A, 3B, 4, and 5.

November 16, 1:00 – 4:15 CT / 12:00 – 3:15 MT
The presenter will cover the clinical and financial information required on tables 6A, 6B, 7, 8A, 9D, and 9E in addition to the forms (Health Information Technology, Other Data Elements, and Workforce Training) during the second session. The presenter will also share valuable tips for success in completing the UDS report.
Register here.

Evaluating and Measuring the Success of your Care Management Program – October 11 and November 8 | 12:00 pm CT
Join CHAD and Shannon Nielson of Curis Consulting for a two-part series on evaluating and measuring the success of your care management program. Session 1 will focus on evaluating your care management program from the patient and provider perspective, and session 2 will focus on measuring the impact of care management on your organization.
Learn more and register here.

Beyond the Basics – Billing and Coding Excellence - October 12, November 9, and December 14 | 3:00 pm CT
Join CHAD and Community Link Consulting for a billing and coding training series that goes Beyond the Basics. Billing and coding departments have an incredibly important role in ensuring the financial success of health centers. In this three-part training series, attendees will tackle three difficult and important issues, including staffing for revenue cycle success, revenue opportunities and insurance credentialing.
Learn more and register here.

Making the Most of Mobile Care: A Virtual Mobile Health Summit – October 17 | 9:00 am – 12:00 pm CT
Join CHAD for a virtual mobile health summit focused on Making the Most of Mobile Care. Delivery of mobile health services is on the rise – heightened by a need to address social drivers of health, make healthcare more accessible, and respond to local emergencies. But how do you get started? What policies, staff, and equipment do you need to develop an effective mobile care program? During the three-hour virtual summit, presenters will chart a course for health centers to better understand how to get started with mobile care and operate mobile health programs. Participants will also hear best practices and learnings from health centers in different stages of operating mobile health programs. Register here.

2023 NWRPCA/CHAMPS Conference – October 21-24, 2023|Seattle, WA US
For over two and a half decades, CHAMPS and NWRPCA have partnered to offer the health centers of Region VIII (CO, MT, ND, SD, UT, and WY) and Region X (AK, ID, OR, and WA) great speakers, excellent educational sessions, numerous networking opportunities, exhibits by industry experts, and more designed to meet the needs of Region 18 (Regions VIII and X) Community Health Center staff and boards.

Continuing Education credit hours are offered for physicians, nurses, accountants, human resources professionals, social workers, and board members. The NWRPCA/CHAMPS Fall Conference is the favorite conference of many due to its robust blend of learning and networking and its size. Learn more and register here.

Come to the Table |Tuesday, November 14, 2023 |11:00 am MT
The Root Cause Coalition is proud to be working with the USDA to achieve the goal of ending hunger in the United States by 2030, as set forth by President Biden. Building on the momentum of the White House Conference on Hunger, Nutrition, and Health, this virtual event is an opportunity to hear from leaders in the field who will share their expertise and experiences in addressing nutrition security and health equity in the UDSA’s Mountain Plains Region (Montana, North Dakota, South Dakota, Wyoming, Colorado, Nebraska, Kansas, and Missouri).
Register here.

Recruitment Bootcamp: Mental Health Staff Edition |October 18 and 25, November 1 and 8 |1:00 – 2:15 pm ET.
Join the Association of Clinicians for the Underserved (ACU) for our upcoming Recruitment Boot Camp: Mental Health Staff Edition (Fall 2023). Building on the success of the previous boot camps, ACU’s STAR² Center team will provide a focused look at the most pertinent topics affecting the successful recruitment and retention of mental health providers.

Please complete the application by the close of business on October 11. Participants will be notified about their conditional acceptance on October 13.

CHAD Network Team Meetings

Thursday, October 5 @ 12:00 pm CT/11:00 am MT - Clinical Quality Network Team
Tuesday, October 10 @ 2:00 pm CT/1:00 pm MT – Communications & Marketing Network Team
Wednesday, October 11 @ 2:00 pm CST/1:00 pm MT GPHDN Security User group
Monday, October 16 @ 10:00 am CT/11:00 am MT – Operational Excellence/Compliance
Tuesday, October 31 @ 1:00 pm CT/12:00 pm MT - Outreach and Enrollment Network Team
Tuesday, October 31 @ 3:00 pm CT/2:00 pm MT – CFO/COO and Finance Manager Network Team