Thank you for reading this special edition of the CHAD Connection. CHAD plans to release weekly editions of the COVID-19 Digest as needed to cover COVID-19-related news and updates for our members. 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, the National Association of Community Health Centers, and the North Dakota Department of Health. You will also find information we thought would be useful, including federal legislative updates, health center data trends, and behavioral health resources.

CEO Message
This has been a sad and impactful week for many of us. In addition to the pandemic, where racial inequities were already being felt in both rates of infection and mortality rates, the video and news of George Floyd’s untimely and tragic death at the hands of a Minneapolis police officer and the subsequent demonstrations across the country are weighing on us all. In that vein, I thought I would share NACHC’s news release on the subject.

As we all grapple with how to respond to injustice in our own lives and communities, I do take heart that equal access to health care and actively working to end racial disparities in health care is core to the health center mission. Our movement was founded in the civil rights era. Community boards were conceived to ensure that patients had a voice in their own care. Actively looking for gaps in access to care and then seeking to fill those gaps for the underserved with high quality care is central to the health center mission and culture.

And, we know that gaping health disparities still exist and there is more we can do. First, we can look at our own work. Do we have diversity in our staff? Do we provide culturally sensitive care? Do our boards really reflect our patient populations and do the various communities we serve have a real voice in the governance of our health centers? Are there communities whose needs are still unmet in our states? Can we speak up collectively or advocate for specific policies that would make a difference? CHAD will be starting conversations internally, and we would love to engage others who are interested.

If you would like to learn more about current health disparities by race, visit here for North Dakota and here for South Dakota and here for a national health disparity report produced by the Health Resources and Services Administration.

CHAD will be publishing weekly data representing the number of positive COVID-19 tests for the current week as compared to the previous week, the cumulative number of cases diagnosed, current and cumulative hospitalizations, the percent of health center visits compared to the determined baseline, and the percent of visits that are being done virtually. This data will be compiled for North Dakota and South Dakota each week. This week’s data covers the week beginning Thursday, May 28 to Wednesday, June 3.
Horizon Health Care Completes Mass Testing Event
Horizon Health Care organized and executed two mass testing events this week for LSI employees in the Jack Link’s parking lot in Alpena, SD. Jack’s Links is a meat processing facility that took over the existing jerky plant in Alpena in 1994. Horizon has three delivery sites near Alpena in Huron, Wessington Springs, and Woonsocket and provides health care services for many LSI employees.

Nearly 30 Horizon employees administered 113 tests on Sunday and 188 tests on Wednesday for a total of 301. LSI employs nearly 800 individuals, and the COVID-19 tests were offered as an option. Educational materials on COVID-19 were provided in three different languages. As of Wednesday, the South Dakota Department of Health reported 84 positive cases, and local news has reported one death among LSI employees.

Paycheck Protection Program Provisions Likely to be Extended
The House passed the Paycheck Protection Program Flexibility Act of 2020 on May 28 and the Senate did the same last night, June 3, clearing the legislation for approval by the President. This bill modified provisions related to the forgiveness of loans made to small businesses under the Paycheck Protection Program implemented in response to COVID-19. If enacted, this legislation would extend the program through December 31, expand the loan term from eight weeks to 24 weeks, and reduce the amount of the loan that must be spent on payroll from 75 percent to 60 percent. More information can be found here.
North Dakota Surpasses 100,000 COVID-19 Tests
North Dakota has surpassed the 100,000 mark for total tests administered. The state of North Dakota remains in the top five states for COVID-19 testing per capita. With new testing machines online, the state lab now has the potential to process 4,000 tests per day. There have been 101,327 tests administered in total, with 74,502 unique individuals being tested as of Wednesday, June 3.

Scott Davis, North Dakota Indian Affairs Commissioner, provided a report on Wednesday on tribal testing and partnerships with the state. There has been at least one testing event on all five reservations in North Dakota. Three thousand three hundred eighty-six tribal members in North Dakota have undergone COVID-19 tests, which includes the urban American Indian population. There have been 129 positive cases among North Dakota’s American Indian population, which is a 3.7% positive rate. Further testing is planned for the Standing Rock Sioux Tribe (SRST) in the coming week. Testing events have been started and planned in eight communities across the SRST reservation in both North Dakota and South Dakota.
North Dakota Department of Health Provides Updated COVID-19 Testing Guidance
The North Dakota Department of Health (NDDoH) indicates that COVID-19 testing is critical to identify cases and prevent further spread through case investigation and contact tracing. Clinicians should consider testing any patient with one of the following signs/symptoms with new or worsening onset:
  • Cough;  
  • Shortness of breath;  
  • Difficulty breathing;  
  • Fever;  
  • Runny nose;  
  • Sore throat;  
  • Chills;  
  • Myalgia;  
  • Fatigue;  
  • Headache; or,
  • Loss of taste and/ or smell.

Health care providers should not turn patients away for COVID-19 testing who have an upper or lower respiratory illness. They should continue to use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.

The NDDoH has also provided priorities for testing, which includes:

High Priority:
  • Hospitalized patients;  
  • Health care facility workers, workers in congregate living settings (long term care, correctional facilities, group homes, homeless shelters, etc.), and first responders with symptoms;   
  • Residents in long-term care facilities or other congregate living settings with symptoms; and,  
  • Persons identified through public health clusters and selected contact investigations.

  • Persons with symptoms of potential COVID-19 infection; or,  
  • Persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans; and,
  • Asymptomatic close contacts may be tested after exposure to COVID-19. Testing should occur ideally 7 to 10 days after the last exposure.  

Providers no longer need to complete the COVID-19 evaluation and test report form. The full North Dakota health advisory can be found here.
Antibody Testing Available Through the North Dakota Department of Health; South Dakota Department of Health Announces Target Date of June 29 for the Public Health Lab
North Dakota health care providers may now order Food and Drug Administration (FDA) emergency use authorizations (EUA) COVID-19 IgG serology (antibody tests) from the North Dakota Department of Health (NDDoH) division of microbiology. The acceptable specimen is 2mL serum or plasma, and the turn-around time is expected to be 48 hours after the receipt of the specimen. There is no charge for this test. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains.

Serology testing can be offered as a method to support the diagnosis of acute COVID-19 illness for persons who present late and when patients present with late complications of COVID-19 illness, such as multisystem inflammatory syndrome in children. Insurance will not reimburse for serology testing that is not ordered by a provider. For additional information on COVID-19 serology, see the full North Dakota health advisory, which can be found here.

The South Dakota Department of Health announced that the state public health lab has a target date of June 29 for being able to process antibody tests at the state public health lab. They recognize that antibody testing is already happening elsewhere in the state. They will test for IgM and IgG antibodies.
Abbott ID Now Point of Care Test Can Produce False Negative Results
Health care providers should be aware of the potential for false negative results associated with the Abbott ID Now, the Food and Drug Administration announced on May 14. Positive results should be presumed positive. Negative results inconsistent with clinical signs and symptoms or necessary for patient management should be tested with an alternative molecular assay.

The company is also reinforcing proper sample collection and handling instructions. Further testing is being conducted to better understand the potential for inaccurate results with Abbott ID Now. The FDA will keep working with Abbott to further evaluate these accuracy issues and will publicly communicate any updates.

Positive and negative results from the Abbott ID Now are required to be reported to the NDDoH division of disease control. To order ID Now reagents, please visit the website at For additional information on the Abbott ID Now update, see the full North Dakota health advisory, which can be found here.
Health Center COVID-19 Survey Data Trends
Each week, the Health Resources and Services Administration (HRSA) requests information from community health centers across the country to track the impact of COVID-19 on capacity, operations, patients, and staff. The data is used to plan for training and technical assistance, funding, and additional resources. The latest report, dated May 22, indicated the following changes from the previous week:

Patient Testing
  • COVID-19 testing capacity is 100% of health centers for both North Dakota and South Dakota.
  • ND reported an average turn-around of 2-3 days for COVID-19 test results and SD reported turn-around times ranging from less than an hour to 2-3 days.
  • ND reported a decrease in the number of patients tested for COVID-19 while SD reported an increase.

  • Both states reported an increase in weekly visits compared to pre-COVID-19 visits, with ND at 50% and SD at 57% of pre-COVID visits.
  • Both states reported a decrease in the number of visits conducted virtually. ND health centers conducted 37.5% of visits virtually and SD conducted 11.7% of visits virtually.
Finance Training and Technical Assistance for COVID-19 Funding Management
CHAD has partnered with Community Link Consulting (CLC) to provide training and technical support to our members on managing the multiple emergency funding sources. The first webinar, The COVID-19 Funding Dance, was held at the end of May. CLC provided an overview of funds issued in response to COVID-19 and the importance of clear documentation. A recording of that webinar and the materials shared can be found on the CHAD website in the past event resources section.

CLC will hold a second webinar, Creating a Financial Emergency Plan, on Thursday, June 11. Ken Stewart will outline a 10-step process to create a comprehensive financial emergency response plan (FERP). With health centers losing between 40% to 70% of patient revenues, the need for a plan is urgent. Among the key takeaways from this webinar, participants will identify areas of opportunity within current processes, understand how to plan and forecast for the impact of COVID-19, and receive an Excel FERP tool. Click here to register.

CHAD has also contracted with CLC for assistance in facilitating CFO/finance office hours sessions for one-on-one consulting. To find available times for office hours and schedule a consulting session, please contact Dani Gullickson, event and project manager at CHAD, for available times.

Expect Disruptions in Health Care IT as a Result of COVID-19
The Great Plains Health Data Network (GPHDN) encourages health center to watch for both risks and opportunities in the health information technology (HIT) space as a result of COVID-19. Key entities to watch are your current electronic health record (EHR) vendor as they roll out new updates, existing vendors, and new players in the market who could start to disrupt the norm and help us change how we deliver health care. There is also a need to be cautious – as vendors race to market – to ensure that companies and products can truly deliver on promises. If you have questions as you navigate the market, you can continue to call on Kyle Mertens at the GPHDN for help.

COVID-19 had an immediate impact on health care IT and will continue to drive change in areas such as patient engagement, remote patient monitoring, population health, telehealth, and portals. This change will expand functionality and technologies such as application programming interfaces (APIs) using the fast health care interoperability (FHIR), and artificial intelligence (AI). Electronic health records (EHR) vendors and health care application companies have recognized the shift in demands from patients, providers, and health centers. They must respond by investing time and effort to address known gaps and add needed functionality to improve the patient and provider experiences, especially around engaging patients remotely. Make sure you continually review the release notes and/or contact an EHR representative to check on updates that could address needed areas.

In addition to existing vendors, new players could also enter the health care arena to disrupt the norm and change the health care dynamic. Large IT organizations like Google, Apple, Microsoft, and Amazon were already dabbling in health care. COVID-19 could be an opportunity for these organizations to change how health care IT is used by patients and health centers. Along with the large IT companies, small startups will start popping up because they see a revenue source. The timing for disruption could be appropriate as health centers are evaluating and shifting IT priorities to address the pandemic.

It is an exciting time in health care IT. Current EHR vendors will be pushing new updates as improvements are made and new vendors can offer new tools that might enable us to improve care through new approaches. At the same time health centers need to be wary of vendors pushing the "perfect solution" because it could be vaporware.
Bureau of Primary Health Care Deadlines
Below are important upcoming deadlines for the Bureau of Primary Health Care (BPHC). The complete list of deadlines and frequently asked questions can be found on the BPHC website.

  • The submission deadline in the electronic handbooks (EHBs) for funding source H8E: Expanding Capacity for Coronavirus Testing (ECT) is June 6.
  • The FTCA deeming application has an extended deadline of July 13.
  • The weekly health center COVID-19 survey deadlines are now extended to each Tuesday at 9:59 pm MT/ 10:59 pm CT.
  • Service area competition (SAC) applications due in FY2021 that have a 2- or 3- year project period will be granted a 12-month extension with funds. A budget period renewal (BPR) will be required instead of the SAC application. Health centers that have a 1-year project period will be required to submit a full SAC application. HRSA expects to release the FY2021 SAC notice of funding opportunity in June, approximately one month later than usual.
  • Health Resources and Services Administration (HRSA) is in the process of streamlining the BPR or annual certification process to reduce the amount of time it will take to complete the submission. HRSA expects to release the documents for the BPR in July and for annual certification in August.
  • Operational site visits (OSVs) have been postponed at least until September 30. The exception is for those with extenuating circumstances such as 1-year project periods, in which case the health center will be contacted by BPHC to schedule a visit.
  • July 10 is the due date for the first quarterly report to the Secretary of the Pandemic Response Accountability Committee for any entity that has received more than $150,000 in HHS funding.
Emotional and Psychological Impacts of COVID-19
COVID-19 has turned upside down many of the foundational things that we want and even yearn for as individuals. When these things are in jeopardy, it has a real impact on us emotionally and psychologically. Here are a few observations based on some of the work by Dr. Steven Hayes:

We have a desire for belonging. Not being around our friends and family during quarantine has made it challenging to feel that sense of belonging. People have made a point to stay as connected as possible during this time. Some people have found their sense of belonging in other ways, not even realizing it. For example, people are sorting themselves into the mask wearers or non-mask wearers and open-back uppers or not-open back uppers. We tend to align with likeminded people, and that does produce a sense of belonging, which is something humans value more than we realize.

We have a strong desire for coherence. We like our world to make sense, and we will problem solve and overthink until we feel like we have a handle on it. We like order and feeling in control, and if there is one thing that COVID-19 has taken away from us, it is the sense of order and control.

Human beings love feelings, but mostly the good ones. At this point, most people have uttered something like, "That’s it, I’m shutting off the news" or "I think I am going to shut down my Facebook!" We do not say this because of the emotions pictures of cute kittens evoke in us; we say this because the feelings of anger, sorrow, hopelessness, and helplessness run so deep that it’s our biological instinct to want to run away.

We like to have a feeling of orientation, self-directed meaning, and competence. We want to know where we are at in this drama and if there is an end in sight. To get oriented, we look to the past for answers, which can cause a flood of stress over things that may not even happen. 

In our culture, we encourage self-directed behavior and attitudes. We like to feel like we have choices. We like to feel like we have individual liberty over things, and we can get quite upset if we feel this is restricted. Many grievances have been demonstrated over the perception that we cannot express personal choice.

And finally, we like to have a feeling of competence. We like to think that we know what we are doing. We do not like feeling unsure of ourselves. Many people have wondered if they are doing the pandemic correctly. Am I being too careful? Am I not careful enough? How many articles have people read, and Zoom meetings have people attended just to help them develop a sense of competence? It is not only important for us to feel competent but for some, it is even more important to be seen as competent.

These things are part of our human nature, and there really is no way to dismantle them completely. They are not necessarily bad things until they start getting the better of us. The best thing to do is simply recognize when you may be stuck in one. For example, after your 50th rabbit-hole article search of the day that has led you to ignore food, perhaps you will notice that this is just your yearning for competence, and decide to take a break. Or when there is a sense of loneliness, you can give yourself grace, realizing that belonging is something that is important to all of us.
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 June (reoccurring)
10:00 am MT/ 11:00 am CT
For weekly call-in information, please join the listserve here. Find archived calls and slides here.

Re-Imagining Care: Re-Opening Dental Practices

Join the National Association of Community Health Centers (NACHC) as they begin a new five-part webinar series, Re-Imagining Care. This series will focus on how health centers will continue to lead the primary health care industry through flexibility and innovation in a post-COVID world.

Guest speakers and panelists will change from webinar to webinar as the topics change and as new issues emerge, but will feature individuals from NACHC, CDC, HRSA / BPHC, community health centers, and/or key experts from the field. Save the date for future webinars on June 25, July 9, July 23 & August 6 from 11:00 am MT/ 12:00 pm CT.

Thursday, June 4
11:00 am MT/ 12:00 pm CT
Visit NACHC’s website to register or view past recordings.

Today with Macrae: Health Center Program Updates

Thursday, June 4
12:00 pm MT/ 1:00 pm CT
Join the webinar on the day of the session

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. Save the date for the next Today with Macrae on Monday, June 29.
Implementing Telemedicine Webinar Series

The COVID-19 pandemic is demanding that health care providers rethink how they deliver care in ways that reduce the risk of further spreading infection. In response, the Mountain West AIDS Education Training Center (MWAETC) has designed a 6-session webinar series on implementing telemedicine. The focus of the series will be on helping providers build a successful telemedicine strategy for their clinics, and will be led by John D. Scott, MD, MSc, associate professor of medicine, Division of Allergy and Infectious Diseases, and medical director of digital health at the University of Washington.

This series is free and separate registration is required for each session. Participants may attend the whole series or chose only to select the sessions of most interest. All sessions will begin at 11:30 am MT/ 12:30 pm CT.

Session #1: Getting Started in Telemedicine
Monday, June 8
Session #2: Workflows in Telemedicine
Monday, June 15
Session #3: Telemedicine and Payment Policy
Monday, June 29
Session #4: Telemedicine Technology
Monday, July 13
Session #5: Clinical Best Practices for Telemedicine
Monday, July 20
Session #6: Telemedicine Q&A
Monday, July 27
COVID-19 Response Open Discussion – Members Only

CHAD will host a bi-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.

Tuesday, June 9 (reoccurring, bi-weekly)  
1:30pm MT/ 2:30pm CT
Contact Carmen Toft to be added to these meetings.   

Creating a Financial Emergency Response Plan

Presented in partnership with CHAD, Capital Link Consulting will lead this one-hour webinar to outline a 10-step process to create a comprehensive financial emergency response plan (FERP). With health centers losing between 40% to 70% of patient revenues, the need for a plan is urgent. Among the key takeaways from this webinar, participants will identify areas of opportunity within current processes, understand how to plan and forecast for the impact of COVID-19, and gain an Excel FERP tool.

Thursday, June 11
11:00 am MT/ 12:00 pm CT
Click here
to register.
Developing a Business Plan and Financial Forecast for a Health Center Capital Project

Capital Link will present a webinar designed to assist health centers in planning new or expanded facilities in developing a detailed business plan for its capital project. Drawing on the recently updated publication, Creating a Business Plan for Community Health Centers, this session examines each of the key components of a business plan, including financial forecasts, and how health centers can use this important document to help secure financing for their projects.

Thursday, June 11
12:00 pm MT/ 1:00 pm CT
Register here

Harm Reduction & Isolation during COVID-19

Join the Corporation for Supportive Housing (CSH) for a webinar on best practices for supporting patients actively using and/ or in recovery (including medication assisted treatment recipients) during the COVID-19 pandemic. Participants will discuss harm reduction, relapse risk, overdose prevention/ response, safety planning, and practical considerations to support patients. This webinar is free for participants.

Monday, June 15
12:00 pm – 1:30 pm MT/ 1:00 pm – 2:30 pm CT
Register here.

PrEP Train-the-Trainer Interactive Virtual Training

The National LGBT Health Education Center, a program of The Fenway Institute, is providing a train-the-trainer session on how to use its newly revised PrEP detailing kit and readiness assessment tools. These clinical resources help providers incorporate PrEP into their practices, including helpful resources such as tips on taking a comprehensive sexual history, frequently asked questions about PrEP, and a pocket card about PrEP prescribing and monitoring. Sessions will cover basics and case scenarios for PrEP and empower clinicians to train their teams on how to use the PrEP detailing kit to make fast and well-informed decisions about PrEP management and care.

This engaging and interactive three-hour session will cover PrEP basics, logistics management, pharmacy, and financing around PrEP, and prepare providers and administrators to train their staff on best practices for PrEP. Participants will receive several tools that have been developed for this training and will be made available to participants for use in-clinic. Two CME credits will be available to participants after the training.

Wednesday, June 17
11:00 am – 2:00 pm MT/ 12:00 pm – 3:00 pm CT
Register here.

Workforce Grand Rounds Webinar Series: Combating Healthcare Provider Burnout in Clinical Settings

Presented by the Bureau of Health Workforce (BHW), the Workforce Grand Rounds webinar series’ goal is to improve health professions training with the intention to increase the number of high-quality health professionals, particularly in rural and underserved communities. This webinar, Combating Healthcare Provider Burnout in Clinical Settings, is meant to increase awareness of provider burnout in a clinical setting, including risk factors and preventative measures. Attendees will learn the causes and appearance of clinician burnout, recognize risk factors for new providers, and identify preventative measures for early intervention and resources for those experiencing burnout.

Wednesday, June 17
12:00 – 1:30 pm MT/ 1:00 – 2:30pm CT

Registration information will be available soon.
Virtual COVID-19 Conference

Join health center peers and virtually to learn about innovative new approaches to meeting the mission of health centers in light of the pandemic. Northwest Regional PCA has announced a virtual conference available to all health centers and primary care associations. It will feature four weeks of educational sessions with subject-matter experts who break down the key issues around board governance, workforce & HR considerations, financial planning, and care model optimization. Virtual roundtables will promote peer-to-peer learning.

While there are fees associated with the full conference, the opening plenary and the roundtable sessions are free. The opening plenary will feature Bureau of Primary Health Care (BPHC) associate administrator, Jim Macrae, and senior BPHC staff.

Friday, June 19
1:00-2:30 pm MT/ 2:00-3:30 pm CT
Register here for the opening plenary

CHAD Network Team Meetings

Tuesday, June 9 at 1:00 pm MT/ 2:00 pm CT – Marketing and Communications Network Team Meeting

Tuesday, June 9 at 1:30 pm MT/ 2:30 pm CT – COVID-19 Response Open Discussion (bi-weekly)

Thursday, June 11 at 10:00 am MT/ 11:00 am CT – Human Resources (bi-weekly)

Wednesday, June 17 at 11:00 am MT/ 12:00 pm CT – 2020 ECQIP: CCM/ Annual Wellness Patients

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