Health centers strive to provide equitable health care to all people, and this concept is built into the very foundation of the community health center mission. Health equity is about more than disparities. It is about understanding and addressing historical and social disadvantages. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. To achieve this, we must remove obstacles to overall health and wellness, not only health care. We must look at where people live, work, and play at an individual, community, and societal level. We know that in order to achieve health equity, health centers cannot do this alone. Patients must be screened for social needs, but it is not just about asking a question; it is about building a strong referral system with community partners and the surrounding communities.

CHAD is committed to supporting health centers in providing equitable care to all Dakotans. We are incredibly excited to announce that we have hired a health equity manager to lead this work. You might recognize our new team member as she has spent the last seven years working to improve cancer prevention and screening rates with the American Cancer Society in North Dakota. Shannon Bacon will lead health centers in an upstream movement in health care, identifying populations, needs, and trends that may impact outcomes, health care experiences, and cost of care through analysis of social risk factors. She will also build community and state partnerships that help overcome barriers to health care access.

Shannon holds a Master of Social Work from the University of Michigan-Ann Arbor with a community organization concentration and a Bachelor of Social Work and Bachelor of Arts in women’s studies from Minnesota State University Moorhead.

Please join us in welcoming Shannon to the CHAD team!
CHCs in the News!
Horizon Health Care’s Elk Point Community Health is currently undergoing renovations to improve patient experience and optimize space by renovating their current clinic location via the Leader-Courier & Times.
Community Health Center Funding Included in Late 2020 Spending Package
Congress passed, and the president signed a massive spending bill just before the end of the year. The package included $1.4 trillion in government funding through the remainder of FY2021 and $900+ billion in emergency COVID-19 relief.
Of significant importance is the inclusion of mandatory and discretionary funding for community health centers (CHCs). After over a year of diligent work pushing for long-term, stable funding for CHCs, this is great news.
  • Three years of mandatory funding from FY 2021 to FY 2023 at $4 billion per year (this is level funding); and,
  • Approx. $1.7 billion in discretionary funding (appropriations) for FY2021 (an increase of $57 million from FY2020).

Teaching health centers with graduate medical education (THCGME) programs and National Health Service Corps (NHSC) mandatory funding:
  • $310 million per year for NHSC for three years from FY2021 to FY2023; and,
  • $126.5 million per year for THCGME for three years from FY2021 to FY2023.

Other funding areas of note:
  • Provider Relief Fund fix and funding: an additional $3 billion general (non-CHC specific) allocation and flexibility to calculate lost revenues;
  • $7 billion for broadband activities including $250 million for the FCC’s COVID-19 telehealth program to cover health care providers’ expenses for providing services using communications equipment; and,
  • $284 billion in funding for the Paycheck Protection Program (PPP). Second-time loan criteria apply.

The National Association of Community Health Centers (NACHC) was very clear that the work is not done, and there are many more priorities to tackle with the new administration, notably:
  • CHC-specific COVID-19 vaccine funding;
  • Extension, expansion, and reimbursement of telehealth coverage and services;
  • Additional funding for critical workforce programs to support health centers; and,
  • Protect and preserve the original statutory intent of the 340B Drug Pricing Discount Program.
340B Update
On December 30, the US Department of Health and Human Services (HHS) Office of the General Counsel (OGC) issued an official advisory opinion concluding that drug manufacturers must ship 340B-priced drugs to contract pharmacies. With regards to recent manufacturer actions to stop shipping 340B-priced drugs to contract pharmacies, the OGC stated:

"To champion a policy, ungrounded in the language of the statute, that would foreclose 340B discounts to 95 percent of covered entities and foreclose discounts to the neediest of this cohort is inconsistent with [the] purpose of the Program and common sense."

As this advisory opinion does not have the force of law, it is not yet clear how the manufacturers who are currently refusing to ship 340B-priced drugs to contract pharmacies will respond.  More information is expected shortly from the National Association of Community Health Centers (NACHC) on how this advisory opinion will impact their current litigation on this issue. 

South Dakota Medicaid Provider Manual Updates
South Dakota Medicaid has posted a new version of the federally qualified health center (FQHC) and rural health clinic (RHC) provider manual. The manual has been updated to include a list of medical procedure codes that are considered a prospective payment system (PPS) visit. These services are reimbursed at the providers’ per diem rate.

The manual now includes a list of codes that can be billed under the FQHCs or RHCs billing national provider identifier (NPI) and generate a per diem payment. Previously the manual only described what services were reimbursed at the per diem rate but did not include a list of applicable procedure codes. Providers should continue to refer to the dental services fee schedules for a list of dental services reimbursable at the per diem rate.

In addition, the telemedicine originating site fee (HCPCS Q3014) should continue to be billed for under the FQHC or RHC’s billing NPI and will also be reimbursed at the fee schedule rate. Incidental services are considered part of a physician, nurse practitioner, or physician assistant PPS visit. These services do not generate a per diem payment. Read the full memo from South Dakota Medicaid here.
North Dakota Launches New Child Protection Services Intake Process
This week, the North Dakota Department of Human Services and the state’s 19 human service zones announced the launch of a statewide toll-free child abuse and neglect reporting line that is part of a new child protection services (CPS) intake process. Individuals who suspect a child is being abused or neglected in North Dakota should call 833-958-3500 during regular business hours.

The department’s chief operating officer Sara Stolt explained that the change is part of the ongoing collaboration between the state and local partners to provide human services more efficiently and effectively. She said this will allow local CPS professionals to act more quickly to protect children while devoting more time to strengthening and supporting families while still together, helping children remain safe in their family homes. This aligns with a key department priority: building stronger families. Information about North Dakota’s child protection program is online here.
HRSA Updates Weekly Survey Questions
Starting this week, the Health Resources and Services Administration (HRSA) will add new questions on COVID-19 vaccine administration to help them understand the technical assistance and resources needed to deploy the COVID-19 vaccine. New questions include:
  • What challenges does your health center face in deploying the COVID-19 vaccine?
  • How many health center staff members have initiated or completed their COVID-19 immunization series in the last week?
  • By race and ethnicity, how many patients have initiated or completed their COVID-19 immunization series in the last week?

At the same time, HRSA will remove two existing questions about tests for antibody detection (serology). They are also in the process of updating the survey user guide to be more user-friendly, including question numbers and other improvements within the survey. Visit the user guide to jump to instructions related to a specific question quickly.

This week, HRSA added a vaccines category, with several new questions, to the COVID-19 FAQ webpage. Other resources available include the coronavirus-related funding FAQ webpage and the COVID-19 Information for Health Centers and Partners webpage.
Annual Health Center Training and Technical Assistance Needs Assessment Due January 15
Each year, in preparation for developing the coming year’s training plan, CHAD and the Community Health Association of Mountain/Plains States (CHAMPS) work together to gather valuable information via the annual health center training & technical assistance needs assessment. The responses allow CHAD and CHAMPS to develop new and innovative trainings and technical assistance (T/TA) to support health centers.

Participation is encouraged by the entire health center team. More advanced logic is built into the survey this year, which helps keep the length of the survey to a minimum and helps ensure that participants are only asked for feedback in areas where they are most informed. As a participation incentive, respondents will have the option of being entered into a drawing for one of several Amazon gift cards.

Please take some time between now and Friday, January 15, to provide input. Only one person per computer may respond to the survey. Participants are able to exit and re-enter the survey as often as needed between now and Friday, January 15. The survey links were provided in a bulk email to CHAD members on Monday, January 4. You may also see the email with instructions and links coming from your CHAD network team lead.

Should you have any questions or need the survey link, please contact Mary Hoffman, director of training and operations, at 701-751-1226. The results of the assessment help to drive the CHAD training plan for the coming year. Health center time and input are greatly appreciated and valued.

Health Center Employees Encouraged to Complete RTAT Survey
As community health centers (CHCs) across the nation feel the pressures of COVID-19 and the lack of trained and qualified staff, the pandemic has emphasized the importance of growing a diverse and robust workforce. One way to achieve this is by designing training programs for health professionals.
Health centers around the country have been invited to participate in the Bureau of Health Workforce/ Bureau of Primary Health Care strategic workforce initiative. It is important to make sure the Dakotas’ health centers’ input is included by filling out the Readiness to Train Assessment Tool (RTAT) survey.

The RTAT is a survey designed to look at health center readiness to develop and improve health professions training. In partnership with Community Health Center, Inc., CHAD is inviting all CHC staff in the Dakotas to join in the first step of creating an ever-growing and replenishing workforce by completing the RTAT survey.

GP11 Network News
Improving Telehealth with TytoCare

Using funds awarded through the Federal Communications Commission (FCC) COVID-19 Telehealth Program, the Great Plains Health Data Network (GPHDN) is assisting six of the participating health centers to improve patient care via telehealth by partnering with TytoCare. With TytoCare, a health care provider can examine a patient’s heart, lungs, ears, skin, abdomen, heart rate, and temperature remotely through a device that can be used by non-physicians who are present with the patient in a different location. This device will allow providers to diagnose and treat many of the most common conditions for patients. The benefit of this partnership is that health centers can continue to provide care in rural areas that may not have a provider available on-site or to protect providers that may need to be quarantined during the pandemic by keeping them isolated but still able to care for patients.

TytoCare is a simple, handheld device that captures clinical data and images using the exam camera, thermometer, otoscope, stethoscope, tongue depressor, and optional blood pressure cuff and pulse oximeter. Along with the device, TytoCare provides the TytoVisit application that allows for live video and communication functionality during the telehealth visit between the patient and the provider. The device and application are both very simple and user-friendly, requiring little training on use.

For more information, a recording of a TytoCare demonstration by Horizon Health Care can be found under the resources section on the GPHDN website, or contact Kyle Mertens at CHAD for additional questions.

COVID-19 Vaccine Education Resources
The Ad Council and the COVID Collaborative have launched a video series featuring Anthony Fauci and other experts to address health care professionals’ questions about COVID-19 vaccination. Also available is a partner amplification toolkit that features resources, including talking points and customizable social media copy, which health centers can use to share information on their channels.
Webinars & Meetings
Find these and other events on the CHAD website.
Cervical Cancer Screening in the Pandemic Era: Recommendations & Interventions

Through this webinar, speakers will address the American Cancer Society’s 2020 cervical cancer screening guidelines and rationale for changes. Participants will learn about evidence-based interventions for cervical cancer screening during the COVID-19 pandemic. This presentation is intended for physicians, nurse practitioners, PAs, nurses, and staff in quality improvement, health systems leadership, communications, and marketing.

Wednesday, January 13
11:00 am MT/ 12:00 pm CT
Register here

South Dakota Department of Health COVID-19 Update

The South Dakota Department of Health hosts a weekly COVID-19 webinar for health care facilities, medical providers, laboratorians, long-term care facilities, EMS providers, and other health professionals.

Thursdays in January (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
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.

First and third Wednesdays of the month (reoccurring January through May 2021)
12:00 pm MT / 1:00 pm CT

CHAD Network Team Meetings

Tuesday, January 12 at 1:00 pm MT/ 2:00 pm CT – Communications and Marketing Network Team Meeting
Thursday, January 15 at 9:00 am MT/ 10:00 am MT – CFO and Finance Manager Roundtable
Thursday, January 15 at 11:00 am MT/ 12:00 pm CT – Behavioral Health Work Group
Tuesday, January 26 at 12:00 pm MT/ 1:00 pm CT – O & E Network Team

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