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 (BPHC), the National Association of Community Health Centers (NACHC), the Centers for Medicare and Medicaid Services, and both the North Dakota Department of Health and the South Dakota Department of Health. You will also find information we thought would be useful, including federal legislative updates, reimbursement guidelines, multi-language educational materials, and mental health resources.

CHCs in the News!
Northwestern Energy donated $10,000 to Horizon Health Care’s relief fund in memory of South Dakota State Representative Bob Glanzer via KELO.
Falls Community Health starts rapid in-house COVID-19 testing via KELO
Find these and other stories on the CHAD website.
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 7 to Wednesday, May 13.
Federal Legislative Updates
The United States House of Representatives released draft legislation on Tuesday afternoon for a fourth comprehensive COVID-19 response package. The bill, known as the HEROES Act (or CARES 2), includes increased funding for several of the programs featured in the first CARES Act. A vote is scheduled to take place in the House later this week, requiring members of Congress to return to their offices in Washington. However, it is expected that it will be several weeks before the Senate considers this bill or any additional legislative efforts. Of importance to health centers in that bill are:
  • An additional $100B for the Provider Relief Fund;
  • $7.6B for the Community Health Center Emergency Fund; and,
  • A 14% percent increase in the federal medical assistance percentage (FMAP).
Testing Dollars Received from the Supplemental Funding to the CARES Act
Community health centers across North Dakota and South Dakota have received money for testing as part of the supplemental funding for the CARES Act. The full funding amount for each state can be found here. These funds may only be used for necessary expenses to purchase, administer, and expand capacity for testing to monitor and suppress COVID-19.

The Health Resources and Services Administration (HRSA) provided approximately $583 million to Health Center Program award recipients. Each Expanding Capacity for Coronavirus Testing (ECT) award was calculated using the following formula:
  • Base value of $98,329; plus,
  • $15 per patient reported in the 2019 Uniform Data System.
State COVID-19 Situation Reports, Websites, and Dashboard
The North Dakota COVID-19 daily situation report has been replaced with a permanent website dashboard. Along with testing data and hospitalizations, the site also includes the percent of positives for each ND county, graphs to illustrate daily data, percent of the population tested by county, and a state map with numbers of total positives by county.

South Dakota provides similar information via the Department of Health’s coronavirus webpage, and a daily situation report is available by signing up for the Epi Listserv through this link. The city of Sioux Falls, SD, has also developed a dashboard for the latest COVID-19 data, which can be accessed here
COVID-19 Multi-Language Resources
The Multi-Cultural Center of Sioux Falls has partnered with Avera Health, the City of Sioux Falls, the South Dakota Department of Health, Keloland Media Group, and Dakota News Now to source and produce accurate and reliable information surrounding the coronavirus pandemic to non-English speakers. The South Dakota COVID-19 language resources page provides COVID-19 informational videos and documents in languages other than English to the population of South Dakota.

This page also highlights a
COVID-19 assistance hotline for non-English speakers at (605) 906-3266. The hotline can provide assistance with help procuring food and basic necessities to allow people to stay home and recover or look after a family member recovering from COVID-19.
ND Medicaid Updates
North Dakota Medicaid has clarified its COVID-19 guidance. Federally qualified health centers (FQHCs) are able to bill North Dakota Medicaid for the collection of test specimens even when no other services are provided to the patient. You can find North Dakota Medicaid’s FAQ document here.
School-based Providers Reach Students Via Educational Videos
Like many school-based sites, Hawthorne Elementary, Hayward Elementary, & Terry Redlin Elementary in Sioux Falls are closed due to COVID-19 precautions. Despite a lack of students, Falls Community Health (FCH) has found innovative ways to communicate with their young patients via distance learning platforms. School-based provider Megan Nagel, PA-C, made a video answering questions about COVID-19 from a local 2nd grader. School-based dental hygienist Jayme Tubandt co-starred in this video with Sparkes the unicorn and shared oral health tips for kids to stay on track with their dental habits now and over the summer. School-based patients are welcome at the main FCH site, located downtown Sioux Falls, which remains open for medical appointments and dental emergencies.
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 needed training and technical assistance, funding, and additional resources. The latest report, dated May 1, indicated the following changes from the previous week:

Patient Testing

  • ND and SD reported an increase in COVID-19 testing numbers. One ND CHC participated in a community testing event which contributed to the significant increase seen in ND.  
  • SD reported a faster turnaround time with 33% of test results being received within 12 hours or less.
  • Of the patients tested, 46% were of racial or ethnic background other than white in SD and 62% in ND.  


  • SD reported an increase in visits while ND reported a slight decrease.
  • Both states reported a decrease in number of visits conducted virtually.
  • Although the data shows an adequate PPE supply for the next week, CHC leadership has indicated that current supply quantities will not be sufficient as visits begin to return to pre-COVID-19 levels.  
  • Additional state and national data can be found here.  

Reimbursement for COVID-19 Testing and Treatment for Uninsured
Providers who have conducted COVID-19 testing or provided COVID-19 treatment for uninsured individuals on or after February 4 can begin the process to file claims for reimbursement for testing and treating the uninsured. Accepting reimbursement under this program does not require that health centers change their sliding fee policy; they just treat the uninsured program as another payer. If health centers have already collected payment from patients, they must return those funds.

As part of the Families First Coronavirus Response Act (FFCRA), the Paycheck Protection Program and Health Care Enhancement Act, and Coronavirus Aid Relief and Economic Securities (CARES) Act, the U.S. Department of Health and Human Services (HHS), will provide claims reimbursement to health care providers at Medicare rates for testing uninsured individuals for COVID-19 and treating uninsured individuals with a COVID-19 diagnosis. This reimbursement program started with approximately $2 billion in available funds and will continue as long as funds are available.

In order to submit claims, providers must have a current Optum ID, enroll as a participating provider through the claims portal, and attest to the following:
  • Verified the patient does not have health care coverage as an individual, employer-sponsored, Medicare or Medicaid coverage, and no other payer will issue a reimbursement for COVID-19 testing and/ or care for that patient;
  • Accept defined program reimbursement as payment in full. There is no process for submitting for adjusted claims;
  • The health center agrees not to bill the patient to cover any portion of the cost; and,
  • Accept program terms and conditions and that the health center may be subject to post-reimbursement audit review.

Providers who have registered may participate in on-demand training for a step-by-step tutorial on using the claims portal. As of May 6, the claims portal was available for submissions with reimbursements starting by mid-May. For more detail, including covered services and reimbursement amounts, visit the HRSA webpage. For assistance in setting up and using the claims portal, see the COVID-19 uninsured program portal user guide.

Oral Health Peer Networking Opportunity – May 29
CHAD is pleased to partner with the Wyoming Primary Care Association to offer a networking opportunity for oral health providers and staff from North Dakota, South Dakota, and Wyoming to share current practices and learn from those who have begun to re-open services. The first meeting is scheduled for Friday, May 29, at 8:30 am MT/ 9:30 am CT. Follow-up meetings will be scheduled as needed or requested. Contact Brenda at WPCA for the Zoom link.
Bureau of Primary Health Care Updates
The Bureau of Primary Health Care (BPHC) continues to update its health center program COVID-19 frequently asked questions. Updates published over the last week include:

  • Health centers can charge patients for COVID-19-related diagnostic testing and treatment as long as they remain consistent with their billing and collections procedures. Health centers should ascertain whether the patient has insurance coverage and any related cost-sharing for COVID-19-related diagnostic testing before billing patients. If there are any patient out-of-pocket costs (i.e., cost-sharing) associated with such testing, health centers should apply their sliding fee discounts. If there is no associated patient cost-sharing, health centers should submit claims for reimbursement to the applicable payor sources and should not charge patients directly.
  • Health centers will use the same PIN they use to access their H80 grant funding through the payment management system (PMS) for accessing other COVID-19-related funds. If you experience any issues accessing your supplemental grant funding, please contact your PMS accountant, whom you can identify here, and/ or contact the assigned grants management specialist identified in your notice of award.
  • While there is no specific form or format health centers should use to submit their COVID-19 (H8C), CARES (H8D), and ECT (H8E) activity overviews, the files must be an acceptable format to upload to the electronic handbooks (EHBs).
  • Health Center Program (H80), COVID-19 (H8C), and CARES (H8D) funds may be used to support the rent of an approved temporary site to perform in-scope activities. ECT (H8E) funds can only be used for sites or locations where in-scope testing or testing-related activities occur.
  • Health Center Program ECT (H8E), along with (H80), COVID-19 (H8C), CARES (H8D) funds, may be used to purchase supplies necessary for health center personnel to use telehealth to perform in-scope services to prevent, prepare for, and respond to coronavirus, including maintaining and increasing health center capacity. However, it is important to note that H8E funds may only be used for such supplies if they support COVID-19 testing-related in-scope activities.
  • Health Center Program (H80), COVID-19 (H8C), and CARES (H8D) funding may not be used for food for patients experiencing unemployment and/or homelessness, unless the provision of food is specifically part of your health center’s treatment plan (e.g., special meals for diabetic patients), supported by written health center policies, and part of the health center’s scope of project. ECT (H8E) funds may not be used to purchase food for patients.
  • As a COVID-19 prevention strategy, COVID-19 (H8C) and CARES (H8D) funding may be used for temporary housing costs for patients who must be isolated at a location that does not meet the definition of a site. Funds cannot be used for long-term housing/lodging costs beyond the isolation/treatment stage. Such costs must be supported by written health center policies. Neither Health Center Program (H80) operational funding nor ECT (H8E) funds may be used for temporary housing costs.
  • HRSA acknowledges that health center and community testing needs, access to testing supplies, and/or roles in public health responses vary across the country. Proposed activities should take into account testing needs and guidance that may evolve over the 12 months that health centers have to use the H8E funds (e.g., available tests, workflows, personnel skills and knowledge, technology, supplies).
Alcohol Use Disorder Amid COVID-19
According to one marketing research firm, alcohol sales in the United States spiked by 55% by the end of March. Spirit sales increased by 75% from the same date in 2019. Statistics like these and others have health and substance use disorder treatment providers worried.

COVID-19 has laid bare the fact that many in society only have so many healthy coping resources in the tank, and once that runs dry or just is not cutting it, some people reach for alternatives. This fact is sometimes humorously put on display by the sheer number of “quarantini” recipes one can find on Google.

On a certain level, normalizing alcohol use is seen almost as a no-brainer way to handle what is happening. But those in recovery and watching this messaging may find it triggering and frustrating because they have been told over and over that they must cope with life’s challenges without alcohol. As with alcohol abuse in general, some people may develop a pattern of at-risk drinking, but will eventually slow down or stop. In contrast, some people will develop an alcohol use disorder. Unfortunately, we have no way of knowing who or how many people will fall into these categories.

SBIRT (screening, brief intervention, and referral to treatment) is a model that encourages mental health and substance abuse screenings as a routine preventive service in health care. It may be more critical now than ever, considering the trends that we are seeing. As providers, it is important to demonstrate empathy and understanding about patients’ frustrations with COVID-19 while informing them that adding an alcohol or substance use disorder onto their current struggles will make matters worse.
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 May (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.
Building Resiliency Skills: Walking Together Towards Healing in a Time of Collective Loss

This learning community, developed by CHAMPS and Western Montana Area Health Education Center and sponsored by the Rocky Mountain Public Health Training Center, will provide health centers and primary care associations (PCAs) in Region VIII (CO, MT, ND, SD, UT, WY), as well as other health care organizations in Montana, access to four, 60-minute interactive learning sessions, focused on building individual resiliency skills. Learn more here.

Thursdays in May
12:30-1:30 pm MT/ 1:30-2:30 pm CT
Registration is now open HERE. There is no cost for staff from health centers and PCAs in Region VIII to participate in this series. Participants must register for the entire series.
Today with Macrae: Health Center Program Updates

Tuesday, May 19
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.
COVID-19 Dental Clinic Reopening Listening Sessions

As many states lift stay-at-home orders for COVID-19, dental clinics are preparing to re-open and resume non-emergency dental services. The National Network for Oral Health Access is hosting listening sessions to give health center dental programs the opportunity to have an open discussion with colleagues. Participants can listen and share plans and strategies on re-opening dental clinics with their peers.

Wednesday, May 20
12:00 pm MT/ 1:00 pm CT
Register here
Technical Assistance for Expanding Capacity for Coronavirus Testing (ECT) Supplemental Funding for Health Centers

HHS awarded nearly $583 million to 1,385 health centers in all 50 states, the District of Columbia, and eight U.S. territories to expand COVID-19 testing. HRSA is hosting a second question and answer (Q&A) session to answer health centers’ questions about developing their FY 2020 expanding capacity for coronavirus testing (ECT) (H8E) activities and budgets. Additional information about the purpose and allowed uses of ECT funds is available on the coronavirus-related funding FAQ webpage.

Thursday, May 21
1:30 pm MT/ 2:30 pm CT
Join the webcast the day of the session
Call-in: 800-857-9804
Passcode: 2207925

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, May 26 (reoccurring, bi-weekly)  
2:00pm MT/ 3:00pm CT
Contact Carmen Toft to be added to these meetings.   

Oral Health Peer Networking Opportunity

CHAD and Wyoming Primary Care Association partnered to offer a networking opportunity for oral health providers and staff from ND, SD, and WY to share current practices and learn from those who have begun to re-open services.

Friday, May 29
8:30 am MT/ 9:30 am CT
Contact Brenda at WPCA for the zoom link.

Thriving in an Online Work Environment

The Midwestern Public Health Training Center, the Rocky Mountain Public Health Training Center, and the Region IV Public Health Training Center have collaborated to create the course, Thriving in an Online Work Environment. Full of useful tips, practices, and resources for staying productive and connected in an online environment, this course can be viewed in its entirety or by individual topics. Visit here for more information or to start the course.

Topics covered include:
  • addressing equity issues in a virtual environment;
  • converting in-person trainings to online trainings;
  • managing stress and productivity;
  • virtual meeting facilitation; and,
  • working remotely.
CHAD Network Team Meetings

Thursday, May 14 at 10:30 am MT/ 11:30 am CT – Human Resources (bi-weekly)

Friday, May 15 at 1
1:00 am MT/ 1
2:00 pm CT – Behavioral Health Workgroup

Wednesday, May 20 at 12:00 pm MT/ 1:00 pm CT –
Equitable Preparedness for Vulnerable Populations

Tuesday, May 26 at 1:30 pm MT/ 2:30 pm CT –
COVID-19 Response Open Discussion (bi-weekly)

Tuesday, May 26 at
12:00 pm MT/ 1:00 pm CT
O&E Network Team Meeting

Wednesday, May 27 at 11:00 am MT/ 12:00 pm CT -
Clinical COVID-19 response call (bi-weekly)

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