CHAD Connection - December 9

The time has come for the Great Plains Health Data Network (GPHDN) to submit the second competitive application for the Health Center Controlled Network (HCCN). The first three years have been a successful journey with new friendships formed, initiatives developed, and the power of collaboration witnessed. One of the first accomplishments of the GPHDN was establishing the organizational mission, which is to support our members through collaboration and shared resources, expertise, and data to improve clinical, financial, and operational performance. The first three years consisted of developing the infrastructure and learning the work that can be done within an HCCN.

The GPHDN has provided over 125 training sessions and nearly 400 hours of coaching and technical assistance to the members in the first couple of years. The GPHDN selected Azara Healthcare as the network population health management vendor. Currently, seven of the 11 members have begun to implement the population health management tool. GPHDN has also assisted members in selecting a security risk assessment (SRA) tool to ensure health centers are able to maintain privacy and security within their organizations. Eight of the members have completed this process and are currently in the mitigation phase, and two members have started the SRA process. We have also begun working with our members to develop a data strategy for each organization.

As we prepare the new competitive application, we will continue with the current initiatives and expand upon initiatives using data to improve clinical quality, enhance patient-centered care, and will continue to focus on provider and staff well-being. As I reflect on the opportunities ahead using data as our guide, I can’t help but think of the quote from Dr. Seuss’ book Oh the Places You’ll Go: "You’re off to great places! Today is your day! Your mountain is waiting, so…get on your way!" I am grateful for the relationships we started, and I look forward to the adventures that await within the GPHDN.

Eugene Giago joined CHAD in November as the community engagement manager, where he is responsible for developing and implementing a strategic vision for deepening community engagement activities. He will guide health centers in successfully integrating community health workers into their primary care practice. In this role, Eugene will enhance the capacity of health centers to respond to social determinants of health at both the patient and community levels, bringing an equity lens to best practice community engagement strategies. Eugene is an enrolled member of the Oglala Sioux Tribe.

Previously, Eugene served in many roles under the Great Plains Tribal Leaders Health Board (GPTLHB), including program coordinator under the Great Plains Good Health and Wellness program, patient navigator and program manager under the Great Plains Colorectal Cancer Screening Initiative, fatherhood coordinator under the Great Plains Healthy Start program, and as president of GPTLHB’s Wellness Council. Through these experiences, Eugene has made lasting connections in the Great Plains region and serves as a bridge to close the gaps between communities and health centers.

In 2017, Eugene was awarded the Area/Regional Impact Award under the National Indian Health Board. He has certifications as a health coach in nutrition under the Dr. Sears Wellness Institute, certified personal trainer and medical exercise under the Native American Wellness Council, and patient navigator under Harold P. Freeman, MD. He earned his bachelor’s degree in business management at Haskell Indian Nations University in Lawrence, Kansas.

Eugene is a proud father, and in his personal time, he pursues his passion for Lakota traditions by mentoring Lakota youth and engaging in traditional Lakota ceremonies. He lives in Rapid City with his son, three cats and is soon expecting a Bloodhound.

Last week, a judge in Missouri issued an injunction against the Centers for Medicare and Medicaid Services (CMS) COVID-19 vaccine mandate that impacts the ten states party to the suit, including North Dakota and South Dakota. Since then, an additional injunction has been instituted that affects the remaining states. Prior to the injunctions, the CMS mandate required health centers to have policies and procedures in place to verify that all employees, volunteers, and contractors received an initial COVID-19 vaccine by December 6 and the final COVID-19 vaccine by January 4, 2022.

These injunctions delay the implementation of the federal vaccine mandate. The preliminary injunction will remain in place pending the court’s final decision or another order from an appellate court or the Supreme Court. An appeal from CMS is expected, though one has not yet been filed.

In most states, covered entities can continue implementing vaccination policies. In North Dakota, health care providers must now comply with the state law that requires them to make several exceptions (including proof of anti-bodies, periodic COVID-19 testing, or exemptions for medical, religious, philosophical, or moral beliefs).

The COVID-19 mandate for federal contractors remains in effect. While health centers are not federal contractors due to their Section 330 grant, they may have other federal contracts in place and are encouraged to evaluate services and funding streams in light of the federal contractor rule.

Infrastructure Bill Signed by the President

The US House of Representatives passed the $1.2 trillion infrastructure bill on November 5, which the Senate passed in August. The President signed the bill on November 15. The infrastructure package makes considerable investments in roads, bridges, broadband internet, drinking water, rail, and public transit without raising taxes on corporations. The legislation allows Urban Indian Organizations to use existing funds for necessary infrastructure projects to serve patients and families better.

Government Funding Act-Continuing Resolution (CR) H.R. 6119

On December 2, the day before the federal government was scheduled to run out of money, Congress approved a temporary spending bill to keep federal agencies running through February 18, 2022. President Biden signed it before the midnight deadline on Friday, December 3, to avoid any lapse in funding. This gives Congress 11 more weeks to resolve the disputes over funding levels and policy riders that have delayed progress on the FY22 appropriations process. If lawmakers do not reach a compromise by mid-February, they must fund the government through additional CRs, which would be disruptive to public health efforts and health workforce programs.

Build Back Better Package Update

The House passed the Build Back Better bill on November 19, approving $2.2 trillion in spending over the next decade to battle climate change, expand access to health care, and improve the nation’s social safety net. The Senate is still negotiating paid family and medical leave, climate provisions, electric vehicle tax credit, methane emission fee, individual or corporate tax rates, Medicare drug prices, and immigration. The Senate wants to pass the bill before the Christmas holiday, although passage is more likely be in January, and any changes made by the Senate will force the spending bill to go back to the House and be passed a second time. Find more information in this article from The New York Times.

The No Surprises Act

December 2020, Congress enacted the "No Surprises Act" to ban surprise billing. The bill focuses on high-cost services and providers. While most provisions do not apply to federally qualified health centers (FQHCs), the US Department of Health and Human Services released an Interim Final Rule (IFR) on September 30 with an important provision that does impact FQHCs. This rule requires health care providers (including FQHCs) to provide uninsured and self-pay patients with a "good faith estimate" (GFE) of their expected total out-of-pocket charges upon request or if they schedule an appointment at least three business days in advance. These rules go into effect on January 1, 2022.

Much of this regulation does not fit with the FQHC model. The main enforcement mechanism doesn’t apply unless a GFE understates actual charges by at least $400. In summary, per the IFR, starting on January 1, 2022, GFEs must be provided to patients who are either uninsured or self-pay patients. The National Association of Community Health Centers (NACHC) is hosting a webinar related to implementing this rule on Friday, December 17 at 1:00 pm CT/ 12:00 MT. Register here.

North Dakota Legislative Special Session

North Dakota Legislators accomplished the original purpose for the special session between November 8-12, which was redistricting the state lines and allocating around $1 billion from the American Rescue Plan Act (ARPA). Before the special session, legislators and the public provided proposals and testimony on allocating the state’s ARPA funding. Due to the House and Senate Appropriation Committees meeting three weeks prior to the special session, the ARPA appropriation bills had little debate.

Legislators spent much of the week listening to testimony and reviewing potential amendments for critical race theory, COVID-19 vaccination mandates and exemptions, and bills protecting prescribing providers and pharmacies dispensing off-label COVID-19 treatments. HB1508 passed banning the teaching of critical race theory in schools in ND. HB1511 will effectively prevent employers from requiring employees to be vaccinated, except in the case where federal law or guidance requires it. HB1514 passed protecting providers prescribing and pharmacists dispensing ivermectin. Click here for a complete summary of the special session bills.

South Dakota Budget Update

South Dakota Governor Kristi Noem provided her annual budget address to the state House and Senate on Tuesday, December 7. Find slides and the budget report for the fiscal year (FY) 2023 here.

Noem summarized the state’s response to COVID-19 to outlining the state’s economic position, including revenues and expenses. The budget encompasses public health concerns with people’s mental and emotional needs, their economic livelihoods and social connections, and liberty, among many other important factors.

The first four months of FY 2022 show ongoing general fund receipts are up 7.3%, and total general fund receipts are up 11.4% above last year’s historic numbers. She projects $215.5 million in one-time dollars for FY 2022 and an additional $157.6 million in ongoing general funds.

Key items covered in the address:
Workforce

Allocation of $150 million of the one-time dollars will support programs to address housing. That equates to about 70% of the one-time money from FY 2022. This includes proposing $17 million in spending for enhanced training at technical programs to try to meet workforce needs. Noem is also proposing capacity investments for training nurses as part of her workforce initiative. Childcare programs have access to $100 million to help fill the childcare gaps for the workforce.
A 6% Medicaid provider increase is included in the budget to help fund workforce needs in healthcare. Her Medicaid budget includes the mandatory inflation for FQHCs. There are some additional FMAP enhancements in the budget for certain providers (nursing homes, residential youth providers, etc.), but that money has specific federal requirements.

Infrastructure

The budget proposes $665 million for water, sewer, and dam repair projects. This is largely federal funding that will run through the Department of Agriculture. This includes upgrades to the public health lab through public funds and an investment in Custer State Park for more capacity. Noem noted that this once-in-a-generation investment in infrastructure would allow people all across South Dakota to have access to what they need to live where they want and to be able to handle the influx of people coming to the state.
$50 million for broadband is in the budget. This combines $25 million state/$25 million federal funds. This is in line with previous requests made to make sure all areas of the state are connected to allow options for work, education, and delivering health care.
There were several other proposals not mentioned in the speech that are included in the budget. These are largely specific infrastructure projects. The Bureau of Finance Management created a page with all the budget documents. There are specific information sheets on each of her proposals, including those she did not mention in her speech. Some sheets give more detail than others. Links can be found below.

Public Safety

Governor Noem noted the state faces a large bill (over $600 million) in needed improvements to the prison system. Those cannot all be made at once, but she is proposing to set aside money for that project by increasing the money put into reserves. She also proposed a $28 million work center for female inmates in Rapid City. Targeted increases for correctional staff were also highlighted. Another $24 million on spending to address EMS issues in rural communities is included in her budget.
The Governor mentioned an investment in behavioral and mental health in the public safety section of her address. There are a number of fact sheets on the Governor’s website (link below).

Resources

CHAD and Get Covered South Dakota collaborative partners, including Community Health Center of the Black Hills, Falls Community Health, Helpline Center, Horizon Health Care, South Dakota Urban Indian Health, and Western South Dakota Community Action, are busy helping consumers with their health insurance options and facilitating enrollment through the health insurance Marketplace. They offer free, unbiased assistance to consumers across South Dakota. Open enrollment runs through January 15, 2022. However, if consumers want their insurance coverage to start on January 1, 2022, they must complete their enrollment by December 15.

People enrolling in a plan on HealthCare.gov are guaranteed to receive comprehensive coverage with no pre-existing condition exclusions or markups. These plans cover essential benefits, including doctor and hospital visits, prescription drugs, mental health treatment, and maternity care. In addition, enrollees receive free preventive care services, such as vaccines and health screenings.

This year, 38,000 uninsured South Dakotans are eligible for discounts that lower their health insurance costs to $10 per month or less, and about 35,000 of them can enroll in a plan with no monthly cost at all. People whose income was too high to qualify them for financial help in the past are now also eligible for generous discounts due to the American Rescue Plan Act (ARPA), enacted earlier this year.

Millions more people qualify for help. Previously, financial help (in the form of tax credits) was available to people who made less than 400% of the federal poverty level. Now, it’s expanded to include families that make more than that. Some people find they qualify for coverage in their state’s Medicaid or Children’s Health Insurance Program (CHIP).

The Centers for Medicare & Medicaid Services (CMS) reports that during the open enrollment period, to date, approximately 3,004,000 people have selected individual market plans on HealthCare.gov. Enrolling in health insurance can be confusing, but free local help is available. To find a trained professional to help navigate the enrollment process, visit GetCoveredSouthDakota.org or dial 2-1-1.

Join CHAD for a six-part learning collaborative on responding to social determinants of health at the individual and community levels. This is a free web-based series where participants will reunite around the shared goal of responding to social determinants of health (SDOH), celebrate the past year’s milestones, and deepen skills in social interventions.

Through this interactive and action-oriented learning collaborative, participants will learn effective communication techniques for discussing SDOH with patients, best practices for documenting social needs and enabling services, and strategies for utilizing SDOH data to deepen community partnerships.

Each health center is asked to identify a core team to participate in the full series. This may include quality staff, HIT, social work or enabling services, or others. Additional staff may choose to attend specific sessions of interest. Register for session one here. Register for any or all remaining sessions here.

Session 1: Poverty Competencies with Grandma Julia’s Stories, Songs, Poetry, & Humor
Tuesday, January 11 | 12:00 – 2:00 pm CT / 11:00 am – 1:00 pm MT
Audience: The core learning collaborative team + any staff interested in better understanding experiences of poverty.

Julia Dinsmore uses storytelling and her own life experiences to talk about class and poverty in America. During this creative and engaging session, Julia will introduce key poverty competencies, including understanding how people become poor, the history and causes of poverty, and how to end it. She’ll share how this larger context can inform how health professionals understand and communicate with individuals experiencing poverty.
Register here.

Session 2: Leveraging Data to Advance Social Interventions
Tuesday, January 25 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT
Audience: The core learning collaborative team.

In this session presented by the Association of Asian Pacific Community Health Organizations (AAPCHO), participants will learn the usefulness and applicability of data in advancing social interventions, including specific case examples. Participants will identify the key questions they are trying to answer with their population SDOH data.

Session 3: How to Ask: Collaborative Screening for Social Determinants of Health
Tuesday, February 8 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT
Audience: The core learning collaborative team + any frontline staff involved with SDOH screening.

Many health centers have expressed the need for additional training in effective communication for SDOH screening. In this session, participants will gain skills in collaborative screening, a person-centered approach to gathering information, and following up with referrals in health and social service settings. This approach elevates the perspective, expertise, and autonomy of the individual being served to create relational safety.

Session 4: Effective Documentation and Reporting for Social Needs and Social Interventions
Tuesday, February 22 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT
Audience: The core learning collaborative team + coding/billing leads.

Presented by AAPCHO, this session will introduce a standardized protocol to document patient social needs. Participants will learn to track the social interventions provided to patients in response to identifying social needs. This will include use case scenarios for social intervention documentation, activity codes, and strategies for closing the loop on referrals.

Session 5: Addressing Social Needs: Food as Medicine
Tuesday, March 8 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT
Audience: The core learning collaborative team + any staff involved in community development and partnerships.

Get ready to put data into action! This panel session will focus on effective strategies for addressing social needs with a spotlight on food insecurity, including action planning time in breakout groups. Participants will learn about food bank and health care partnership models, including local case examples. Panelists will include representatives from the Great Plains Food Bank, Feeding South Dakota, Family HealthCare, and the Community Health Center of the Black Hills.

Session 6: Taking it to the Next Level: Keys to Effective Community
Engagement and Partnership
Tuesday, March 22 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT
Audience: The core learning collaborative team + any staff involved in community development and partnerships.

How can SDOH data drive community partnerships and inform stakeholder priorities? What does an effective and meaningful community partnership look like? This session will demonstrate cross-sector partnership examples and PRAPARE impact stories at the community level. Participants will examine their SDOH data to identify strengths and gaps in community partnerships and opportunities for growth. Speakers will share case examples from two local health centers.

The North Dakota Department of Health Oral Health Program has partnered with the University of North Dakota and Project ECHO to offer free, one-hour, live, virtual trainings carrying continuing education credit for dental team members and other health professionals. These sessions will provide training and case presentations on dozens of topics. The series will run on the second and fourth Wednesday of each month, beginning January 12, 2022. Register for each session here. If you have any questions about this ECHO series, please contact the Project ECHO coordinator, Julie Reiten, at Julie.a.reiten@UND.edu.

The first session in January will be featuring Rear Admiral Timothy L. Ricks, who has served as the chief professional officer (CPO) for the dental category since September 2018. As the CPO, RADM Ricks advises the Office of the Surgeon General and the U.S. Department of Health and Human Services (HHS) on the recruitment, assignment, deployment, retention, and career development of oral health professionals. RADM Ricks has shared that there are 28.2 million Americans who visit an oral health professional each year but not a medical provider. Screening for acute and chronic conditions in a dental setting not only improves oral health but can also improve overall health.

Future topics include:

Dental and emergency department (ED) partnerships to reduce the use of the ED for dental pain;
Importance of, and how-to, complete blood pressure screenings in dental settings;
Conversations on nutrition and obesity in dental settings;
Talking with patients about fluoridation and safe drinking water;
The role of North Dakota dental teams in addressing pediatric oral health: School-based programs; and,
Cancer treatments and oral health: how diagnoses, chemotherapy, and radiation impact oral health.

There are multiple spring training programs for South Dakota health centers developing community health worker (CHW) programs. The training tuition and the staff time spent in training can be billed to the state grant.

Lake Area Tech

The training certificate program begins in January. Find the program summary and registration information here.
There is an eight-week course starting in March (40 hours/ week)

MN West Community & Technical College has a nine-month course starting in February (10 hours/ week).

Medicare Mental Health Services: Coverage of New Telecommunications Technology Begins January 1, 2022

Beginning Saturday, January 1, 2022, federally qualified health center (FQHC) mental health visits with Medicare beneficiaries can be furnished using interactive, real-time telecommunications technology. The Centers for Medicare and Medicaid Services (CMS) formalized this regulatory change through the calendar year 2022 Medicare physician fee schedule final rule. It is not tied to the COVID-19 public health emergency and is permanent in the absence of further regulatory action.

In the same way, they currently do when visits take place in-person, FQHCs will be allowed to report and receive payment for mental health visits furnished via real-time telecommunication technology, including audio-only visits when the beneficiary is not capable of or does not consent to the use of video technology. An in-person, non-telehealth visit must be furnished at least every 12 months for these services; however, exceptions to the in-person visit requirement may be made based on beneficiary circumstances.

FQHCs will be reimbursed 80% of the lesser of their actual charges or the prospective payment system (PPS) rate when these services are furnished to a Medicare beneficiary through telecommunication technology, including audio-only.

Additionally, beginning Saturday, January 1, 2022, FQHCs must add modifier 95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system) to claims for mental health visits furnished via audio-video telecommunications and must add modifier FQ (service provided using audio-only communication technology) to claims for mental health visits furnished via audio-only telecommunications.

Streamlining Information Technology Infrastructure for a Successful
Telehealth Program

The Health Information Technology, Evaluation, and Quality (HITEQ) Center presents a four-part learning collaborative on information technology infrastructure for a successful telehealth program. Topics will include assessing technology and identifying best practices for streamlining telehealth workflows, aligning telehealth technology with financial sustainability, telehealth technology vendor considerations, and operationalizing telehealth technology strategies. Register here.

Each year, CHAMPS presents awards to staff and board members of Region VIII health centers and related organizations to recognize exceptional contributions to the health center community. Over the years, this process has allowed CHAMPS to honor numerous highly deserving individuals from across the region for their outstanding advocacy, leadership, and dedication to the health center mission. The 2021 CHAMPS Awardees were honored at a live, virtual ceremony on Monday, November 22.
Visit the CHAMPS Awards webpage to learn more about this year’s awardees. This page includes photos of each awardee, recordings from the 2021 CHAMPS awards ceremony, and lists of awardees from prior years.

Advancing Health Equity Through Improved Access to Patient-Centered Contraceptive Care

Join Families USA for a conversation on advancing health equity through improved access to patient-centered contraceptive care. This webinar will feature a discussion on Families USA’s latest paper on patient-centered contraceptive care, an overview of the state and federal policy contraceptive care landscape, and examples of how advocates are working to advance contraceptive equity at the state level. Participants will walk away with ideas to proactively address contraceptive needs in their communities.

Wednesday, December 15
2:00 pm CT/ 1:00 pm MT
Register here.

End of Year 340B Update: The Latest Federal and Litigation Update

As this year comes to a close, please join the National Association of Community Health Centers (NACHC) for an overview of the latest 340B litigation and federal legislation. This webinar will provide an overview of 340B contract pharmacy litigation and the impact on health centers and an update on the 340B alternative dispute resolution litigation. Speakers will also walk through federal legislation and advocacy efforts and give some insight into 2022 and the road ahead. Registration is open to all, but live event attendance is limited to a first-come, first-serve basis.

Thursday, December 16
11:00 am CT/ 10:00 am MT
Register here.

Health of Immigrants and Refugees

Join the Indiana Primary Health Care Association as Dr. Rachel Fabi speaks on the ethics of policy that affects immigrants and refugees’ health in the United States. This includes policies affecting access to care for undocumented immigrants, the resettlement of refugees, the treatment of people in immigration detention, and how institutional policies can protect immigrants’ health care rights and privacy.

Tuesday, January 18, 2022
10:00 am CT/ 9:00 am MT
Register here.

Maternal Health Learning Collaborative

The CHAMPS 2022 Maternal Health Learning Collaborative will be offered on January 13, January 27, and February 10. This free series, created in partnership with the Denver Office of Intergovernmental and External Affairs, will bring together health center care team members to discuss the latest in maternal mortality and morbidity data, the impact of substance use disorders in new mothers, screening recommendations, clinical resources, and more. Visit the upcoming live distance learning events page to learn more and for registration coming soon.