CHAD Connection January 20, 2022

As the ninth year of open enrollment ended on January 15, we at the Get Covered collaborative navigator program are reflecting on the immense impact of the Affordable Care Act. Over 14.2 million Americans, including over 29,000 North Dakotans and over 40,000 South Dakotans, enrolled in affordable health insurance plans through the Marketplace for 2022 coverage. Access to coverage is associated with many beneficial effects, including having a regular provider, receiving timely preventive care services, better management of chronic health conditions, improved health status, particularly among people with chronic health problems, greater workforce participation, and longer life expectancy.

Families without health insurance have limited access to comprehensive care. Assisters like me who help consumers enroll in Marketplace plans see firsthand the detrimental effect of not having access to necessary medical procedures such as MRIs or obtaining an appointment with a specialist. Without affordable health coverage, people with emergencies or chronic health conditions can incur substantial medical bills and, in some cases, face financial devastation from unpaid medical bills.

We hear stories every day about how consumers’ lives are impacted for the better due to having health insurance. A self-employed rancher received a letter that his off-Marketplace insurance policy would be increasing to over $12,000 per year. Instead, he was able to purchase Marketplace insurance for under $25 a month for 2022 after receiving advanced premium tax credits used to lower his monthly health insurance premium.

Although the open enrollment period for 2022 coverage has ended, some life changes may trigger a special enrollment period (SEP) that allows a consumer to enroll in Marketplace health plans outside the yearly open enrollment period, which starts again on November 1. Some SEP qualifications include a loss of health coverage, moving, getting married or divorced, having a baby, or adopting a child. People can check their eligibility here.

Members of federally-recognized American Indian tribes can enroll in a Marketplace plan at any time. They are also able to change plans up to once per month. Limited or zero cost-sharing plans through the Marketplace offer exemption from most cost-sharing when receiving essential health benefits. Even if consumers go to Indian Health Service (IHS) for care, having health insurance gives consumers the ability to get care where there is no IHS, access to services IHS does not provide, and the choice to see any provider.

As a Navigator grantee, we are always looking for community partners to enhance efforts to enroll eligible South Dakotans in affordable health plans. If you are interested in helping, email me or give me a call at 605-277-8405.

The South Dakota Urban Indian Health Pierre team wore blue with red Xs on their hands in support of Human Trafficking Awareness Day on January 11. Human trafficking disproportionately affects Indigenous communities. Federal reports show that hundreds of thousands of Americans are trafficked for sex in the United States each year. In 2015, the National Congress of American Indians found that an estimated 40% of women who are victims of sex trafficking identify as American Indian, Alaska Native, or First Nations, even though Indigenous people represent 10% of America’s population.

Please join CHAD in welcoming Brenda Bader as its administrative coordinator. In this role, she assists staff in support of conferences, trainings, and meetings. She also maintains grant and program documents, data reporting, and the central electronic filing system. Brenda also serves as an executive assistant to the CEO, scheduling meetings and travel, coordinating calendars, and preparing board meeting packets and meeting notes. Previously, Brenda worked as the projects and logistics manager for Ideal Tents & Events in Sioux Falls, where she created and executed clients’ visions with a personal touch. Her eye for detail and enthusiasm provided exceptional customer service and helped the company coordinate over 250 events annually.

Brenda graduated from Dakota State University with an associate degree in small business management and accounting. For ten years, she served on the board of directors of Theresa’s House, an orphanage in the Democratic Republic of Congo, and just finished a six-year term as a church worship elder. Brenda has four sons and three grandsons and enjoys camping, hiking, and bike riding.

CHAD is seeking multiple dynamic, self-motivated, and innovative individuals to join the team. These are full-time remote positions with ideal candidates having a physical location in North Dakota or South Dakota. For more information or to apply, visit CHAD’s job board.

The training and education coordinator is responsible for coordinating and managing all in-person and virtual CHAD events, trainings, and workshops, from planning the logistics to the report out of the evaluation results and everything in between. Strong attention to detail and extensive organizational skills are needed. This role requires computer skills and experience with virtual platforms such as Zoom, GoToWebinar, and SurveyMonkey to assist in running breakout rooms, online surveys, tracking Q&As, and providing technical assistance to create a positive experience for our members and attendees.

The health information technology (HIT) and data manager will manage the Great Plains Health Data Network (GPHDN). The GPHDN is a collaboration that harnesses the strength of the Health Center Controlled Networks (HCCN) program to support the technical capacity of some of the most remote and under-resourced health centers in the country. This position assists the 11 participating health centers in North Dakota, South Dakota, and Wyoming to improve access to care, enhance the quality of care, and achieve cost efficiencies by redesigning practices under the federally-funded HCCN grant. The purpose of the network is to support health centers to leverage HIT and data, focusing on clinical quality, patient-centered care, provider and staff wellbeing, and enhancing virtual care.

Last Thursday, the US Supreme Court reinstated the Centers for Medicare & Medicaid Services (CMS) vaccine mandate on health care providers in multiple states, including North Dakota and South Dakota. CMS also announced the compliance deadlines for community health centers (CHCs) and other covered providers. The most important deadline -- the date by which 100% of covered "staff" must either be fully vaccinated or have an approved exemption or delay -- is Wednesday, March 16.

For specific information on the CMS measures and deadlines, see this CMS attachment that is specific to CHCs.
For more information on the CMS vaccine mandate in general, see the CMS vaccine mandate toolkit. The toolkit has been updated to reflect new compliance dates.
The National Association of Community Health Centers (NACHC) is hosting a webinar on the vaccine mandate on Friday, January 21, at 1:00 pm CT/ 12:00 pm MT. Register here.

Last week, President Biden announced that the administration would make high-quality masks available to the American public for free to ensure the nation’s underserved communities and those disproportionately affected by COVID-19 have equitable access to public health tools, like masks, to prevent the spread of COVID-19.

Health centers that meet the Health Resources & Services Administration’s (HRSA’s) criteria for this program and elect to participate will be eligible to receive N95 respirator masks from the Department of Health and Human Services (HHS) Strategic National Stockpile for free distribution to patients and people in their communities. These masks are approved by the National Institute for Occupational Safety and Health (NIOSH).

The program’s initial phase will make available adult, NIOSH-approved N95 masks to a group of 300 health centers. HHS and HRSA will expand the program to additional health centers in the coming weeks. If health center leadership has questions, please submit them to Health Center Program Support. Select "HRSA Health Center COVID-19 Mask Program" on the "Health Center Program Questions" screen.

Governor Noem joined legislators to give her annual State of the State address on Tuesday, January 11. The governor touched on a wide array of topics and listed a number of the policy bills her administration will be bringing this session. Her speech highlighted that the state is now $166 million ahead of the estimated revenue for the current fiscal year as of December 2021.

Health policy highlights of the speech included:

A proposal to fund rural emergency medical technicians (EMTs) recruitment and to equip EMT teams with modern tools to provide emergency medical services;
Funding one million at-home test kits to allow people who want to test for COVID-19 to do so for free;
Reducing barriers to bringing licensed health care professionals from other states to assist the health care workforce and to recruit more health care workers to the state;
Allocation of resources to support regional crisis centers for addiction and mental health services; and,
Codifying medical and religious exemptions for the COVID-19 vaccine and recognizing natural immunity.

CHAD will monitor several bills of interest to the health center community. The current bill list can be found here.

There is less than one week until the deadline for community health center providers to apply to the Nurse Corps and three weeks until the deadline to apply to the National Health Service Corps for up to $100,000 in student loan forgiveness. At this point, the number of applications submitted to the Health Resources and Services Administration (HRSA) is far short of the amount of funding available. Unless there is a dramatic increase in applications in the next few days, HRSA could be forced to return a large amount of the funds to the US Treasury – even after funding every application.

As a reminder, the following types of providers (and more) are eligible for federal loan repayment if they work at a health center and have outstanding student loans: doctors, nurse practitioners, physicians’ assistants, certified nurse midwives, psychologists, licensed clinical social workers, marriage and family therapists, licensed professional counselors, dentists, dental hygienists, substance abuse disorder counselors, pharmacists, and registered nurses.

Medicare Behavioral Health Service Telehealth Updates

Beginning in January, the Centers for Medicare & Medicaid Services (CMS) will reimburse federally qualified health centers (FQHCs) for the following new services.

FQHC mental health visits will include visits furnished through interactive, real-time telecommunications technology, but only when furnishing services for diagnosis, evaluation, or treatment of a mental health disorder;
FQHCs can furnish mental health visits using audio-only interactions in cases where beneficiaries were not capable of or did not consent to, the use of devices that would permit a two-way, audio/video interaction;
FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits;
FQHCs to append the -95 modifier (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the service was furnished using audio-video communication technology and to append a new service level modifier in cases where the service was furnished audio-only; and,
FQHCs would continue to report and be paid for furnishing medically necessary virtual communications services per the requirements for HCPCS code G0071 (83 FR 59686).

The new regulations officially require a patient to have an in-person behavioral health appointment within the six months prior to starting behavioral health services via telehealth and at least once every 12 months while receiving those services. These requirements for in-person appointments will begin after the federal public health emergency (PHE).

There are limited exceptions to the requirement that there be an in-person, non-telehealth service every 12 months based on the beneficiary circumstances, including assessing the risks and burdens on in-person services supported by documentation.

The National Nurse-Led Care Consortium is actively recruiting health center staff for focus groups later this month and in February. Employees of federally qualified health centers (FQHC) or look-alike community health centers are invited to participate in "All-Hazards Emergency Preparedness and Response Competencies for Health Center Staff" focus groups. Click the link below to learn more about the project, verify eligibility, and register for a paid focus group. Participants will be asked to participate in one 90-minute session via Zoom; every participant will receive a $50 incentive for their time.

Up to eight focus groups will be held in January and February. All information collected will be deidentified and utilized in aggregate to inform the final competency set for health center all-hazards preparedness. Priority registration closes on January 21. More information can be found in the registration form. For questions, please reach out to lrockoff@phmc.org.

Each year, CHAMPS offers intensive, conversational, and medical Spanish language training (SLT) for clinicians at Region VIII health centers who have an immediate need to use the new language skills with Spanish-speaking patients. This year, CHAMPS is offering four trainings throughout April, all currently open and accepting registrants. The traditional four-day medical Spanish language course for beginner and intermediate speakers will be held on April 14-15 and April 21-22. Visit the CHAMPS Upcoming Live Distance Learning Events webpage to register or learn more.

Other SLTs offered this year are:

Spanish for Oral Health Providers, April 11-12;
Spanish for Behavioral Health Providers, April 18-19; and,
Medical Spanish for Advanced Spanish Speakers, April 25-26.

CHAMPS will host the CORE Competencies for Health Center Supervisors and Managers training on Wednesday mornings, from April 27-May 25. This online intensive is aimed at newer supervisors and managers. It will offer intensive, hands-on, and immediately applicable skill-building to successfully navigate management and supervisory roles in the fast-paced and challenging health center environment. Registration is anticipated to open very soon. Watch for updates on the CHAMPS Leadership Learning Opportunities webpage.

People First: Responding to Social Determinants of Health at the Individual and Community Levels

Join CHAD for a 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 was 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 any or all sessions 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

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

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

Session 5: Addressing Social Needs: Food as Medicine
Tuesday, March 8 | 12:00 – 1:30 pm CT / 11:00 am – 12:30 pm MT

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

Disaster Mental Health Care Support for Health Center Personnel

Health center staff play a pivotal role in the health and wellbeing of the individuals and communities they serve. To be effective in this important role, they must prioritize maintaining their own mental health. This 60-minute webinar, presented by Connect Consulting, will explore current research and trends in mental health in this uniquely stressful time. Attendees will discuss barriers to access help and make suggestions for overcoming them. The presenter will share creative ideas for creating workplaces and cultures where staff feel valued and supported. Local resources will be provided for staff and administrators. The intended audience for this presentation includes people in emergency preparedness, leadership roles, operations, quality improvement, and behavioral health.

Thursday, February 10
9:30 am CT/ 8:30 MT
Register here.

Maternal Health Learning Collaborative

The CHAMPS 2022 Maternal Health Learning Collaborative will be offered on 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. Presenters will also address the impact of substance use disorders in new mothers, screening recommendations, clinical resources, and more. Register here.

Putting Infection Prevention into Everyday Practice

Everyone working in a health care facility needs to have a foundational knowledge of infection prevention and must be ready to implement basic measures throughout their workday and at home. In this session, presenters will discuss how infections spread and identify ways to break this chain, the differences in standard and transmission-based precautions, and methods for controlling infections while providing care—presented by the Great Plains Quality Innovation Network.

Tuesday, February 22
2:00 pm CT/ 1:00 pm MT
Register here.