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, the Centers for Disease Control and Prevention, 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, dental FTCA guidance, health center data trends, effective crisis communications tools, and behavioral health resources.

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 14 to Wednesday, May 20.
CHCs in the News!
Rural Health Care Inc. nurse Jessica Olivier rallied the community to provide over 100 fabric facemasks to patients and visitors at the Onida clinic via the Onida Watchman.
Find this and other stories on the CHAD website.
Spectra Health Receives Nonprofit Partnership Award
Congratulations to Spectra Health for being selected to receive the 2020 Partnership Building Award from the North Dakota Association of Nonprofit Organizations (NDANO). This award is given to an organization that has demonstrated community leadership and built partnerships within the North Dakota nonprofit sector.

Spectra Health has shown its commitment to the community by partnering with nonprofits to help address issues as they arise, such as reducing preventable emergency room visits, tackling the rise in substance use, and creating an accessible vision program. Employees are encouraged to engage with their community by participating in advisory committees, community forums, serving as board members, and engaging in community events. The organization will receive its award virtually at the NDANO conference on May 28.
Federal Policy Updates
The United States House of Representatives passed the HEROES act on May 15 with a mostly party line vote. Representatives Armstrong (R-ND) and Johnson (R-ND) voted against the legislation. The $3 trillion legislation is not expected to pass the Senate in its current form. Currently included in the bill is $7.6 billion for a Community Health Center Emergency Fund, another $100 billion for the Provider Relief Fund, and an increased Federal Medical Assistance Percentages (FMAP) of fourteen percent for one year starting on July 1. Read more about the passage of the HEROES Act here.

Many members of the North Dakota and South Dakota delegations feel that now is the time to evaluate how the previous bills are working and not rush another major piece of spending legislation. Many members of the Senate want liability protections for businesses and individuals included, which is something that was mentioned by Senators Rounds and Thune during their televised town hall meeting on May 18.
North Dakota State Government Updates
Governor Doug Burgum continues to hold press events to make announcements and provide updates on the COVID-19 response in North Dakota. On Friday, May 15, the governor announced guidelines from the state on large group gatherings. The plan is to use a phased approach to recovery from the pandemic. The North Dakota Department of Commerce crafted the plan with a workgroup made up of industry leaders. According to the initial guidelines, large gatherings can be up to fifty percent of posted occupancy levels, up to 250 people. Click here for more information.
NDDoH Announces Community Health Partnership
The North Dakota Department of Health (NDDoH) announced a community health partnership to plan and execute COVID-19 testing. Community Health is a collaboration between local public health units, critical access hospitals, community health centers, pharmacies, and others. The NDDoH is calling on the Community Health partnership to get communities scheduled and tested for COVID-19 based on locally determined priorities.

NDDoH will make 300 tests per day available to Community Health with additional capacity built soon. Community Health partners will conduct scheduling and testing at the local level. To schedule testing, receive testing supplies, or for further information, please apply here.
North Dakota COVID-19 Testing Goals Begin June 1
The state of North Dakota has a goal to complete 3,000 COVID-19 tests per day, beginning on June 1. Click here for a graphic of the testing goals. The 3,000 tests are broken down into five different categories to include:
  • Diagnostic: 400 tests
  • Long-term Care/ Congregate Living: 1,500 tests
    • Sentinel of an entire facility;
    • Serial point prevalence testing; and,
    • Corrections, group homes, etc. integrated into the serial point prevalence testing
  • Testing Response and Vulnerable Population Protection Plan (VP3): 300 tests
    • Retests of positives in congregate living;
    • Diagnostic resulting in testing a specific facility or units;
    • Assist with sentinel /serial point prevalence; and,
    • Infection control/patient transfer.
  • Mobile testing: 500 tests
  • Community Outreach: 300 tests
    • Supplying local public health for county support; and,
    • Supplying critical access hospitals, community health centers, and others for diagnostic and potentially sentinel testing.
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 8, indicated the following changes from the previous week:  

Patient Testing
  • ND reported a decrease in COVID-19 testing numbers due to a community testing event that contributed to the significant increase last week. SD reported a slight increase in testing numbers. 
  • Of the patients tested, 64% were of racial or ethnic background other than white in SD and 71% in ND.

  • SD reported an increase in visits, while ND reported a slight decrease.
  • ND reported a slight increase in the number of visits conducted virtually while SD reported no change.
  • SD showed a decrease in an adequate supply of N95/PPR masks and gowns 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.  
Battelle N95 Decontamination Process to Address Shortage
The North Dakota Department of Health has been awarded a Battelle CCDS Critical Care Decontamination System to help address the current shortage of N95 respirators across the United States. The Battelle CCDS can decontaminate thousands of N95 respirators using high-concentration, vapor-phase hydrogen peroxide, and the same respirator can be decontaminated up to 20 times without degrading mask performance. The North Dakota Department of Health is asking everyone who can to take advantage of the decontamination service so the state can conserve its supply of masks and continue to make masks available as they are needed throughout the pandemic.

The state of North Dakota will provide this service at no charge, including shipping to and from Bismarck, to health care organizations, emergency medical services (EMS) agencies, public health, public safety (law enforcement and fire departments), etc. The process has been issued an Emergency Use Authorization (EUA) by the United States Food & Drug Administration (FDA) and has passed evaluation by the 3M Personal Safety Division.

For any questions related to the Battelle CCDS Critical Care Decontamination System, contact Nicole Brunelle at or Joe Vetter at To sign up for the program and to get more information on the Battelle CCDS process, please visit

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19
Recently the Centers for Disease Control and Prevention (CDC) provided background information regarding multisystem inflammatory syndrome in children (MIS-C). Providers in the United Kingdom and the United States have reported a previously unrecognized syndrome among pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C is not well understood but has been described as having Kawasaki disease-like features. It is currently unknown if the multisystem inflammatory syndrome is specific to children or if it also occurs in adults.

There is limited information available about risk factors, pathogenesis, clinical course, and treatment for MIS-C. The case definition for MIS-C includes the following:
  • An individual aged <21 years presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); and
  • No plausible alternative diagnoses; and
  • Positive for current or recent SARS-CoV-2 infection by reverse transcription-polymerase chain reaction (RT-PCR), serology, or antigen test; or COVID-19 exposure within the four weeks prior to the onset of symptoms.

Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C. Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection. The CDC recommends health care providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.

The North Dakota Department of Health (NDDoH) is requesting providers to report patients meeting the case definition by calling 1-800-472-2180. Click here for the full NDDoH Health Advisory. The South Dakota Department of Health is requesting that clinicians report any potential cases by calling 605-773-3737 or by secure website under the Unexplained illnesses or deaths in humans or animal condition. Click here for the full South Dakota Department of Health Advisory.
Feldesman Tucker Leifer Fidell releases Memorandum regarding
Re-opening of Dental Practices

Feldesman Tucker Leifer Fidell (FTLF) released a memorandum to address FTCA coverage and other malpractice liability concerns that may arise should a health center begin to provide elective dental services during the novel coronavirus pandemic. Health centers have expressed concerns due to conflicting guidance from state and local government, the American Dental Association (ADA), state health departments, state dental associations, state Boards of Dentistry, the Centers for Disease Control and Prevention (CDC), and rules from the Occupational Safety and Health Administration (OSHA). The memo outlines the legal background of each guidance provided and offers recommendations. Dental staff will be able to use the memo to weigh the guidance in their specific circumstance in order to make decisions to re-open dental practices to non-emergent visits and maintain malpractice liability coverage through FTCA. The memo can be found in the dental resources section of the CHAD COVID-19 webpage.
Finance Training and Technical Assistance for COVID-19 Funding Management – May 28
CHAD has partnered with Community Link Consulting (CLC) to provide training and technical support to our members on managing the multiple emergency funding sources. Amy Brisson, partner and finance consultant at CLC, will present the first webinar The COVID-19 Funding Dance on Thursday, May 28, at 11:00 am MT/ 12:00 pm CT. Register here. A second webinar is scheduled for Thursday, June 11, at 11:00 am MT/ 12:00 pm CT, and will focus on creating a financial emergency response plan (FERP). In addition to the webinars, this partnership will bring health center financial expertise to CFO/ finance manager roundtable discussions. The dates for these networking opportunities are tentatively planned for early June, with details coming soon.

Office hours are included in the agreement with Community Link Consulting. Health centers may schedule one-on-one time to meet with Amy to discuss specific questions and concerns and get targeted technical assistance on managing budgets from multiple funding sources. Information on how to schedule office hours with CLC will be available soon. For questions regarding office hours or the CFO/ finance manager roundtable discussions, please reach out to CHAD director of training and operations, Mary Hoffman.
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 WYPCA for the Zoom link.
North Dakota Medicaid Claims Processing Data
North Dakota Medicaid is now posting monthly outcome data on claims processing. The information will be posted on their website each month and includes information on the number of claims that are processed and the length of time it takes to process the claims. Data for Medicaid Expansion is also being reported. Visit the webpage to see the most recent data.
Bureau of Primary Health Care Updates
CHAD has summarized highlights from the May 19 episode of Today with Macrae, as well as other news coming from the Bureau of Primary Health Care (BPHC), including relevant updates to the frequently asked questions section of the BPHC website.

  • The BPHC updated deadlines for reporting and applications.
    • 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.
  • 2020 Quality Improvement Awards will continue as planned and will be based on top performers identified by 2019 UDS data. 2021 awards will be modified given the reality of COVID-19.
  • HRSA will be sponsoring regional patient-centered medical home (PCMH) trainings through a collaboration with PCAs, HCCNs, and the National Committee for Quality Assurance (NCQA). The Region 8 lead for this project is the Wyoming PCA, and the training will be delivered through a series of live webinars. The series will be over the course of two weeks in September and will cover both the Introduction to PCMH Program: Foundational Concepts of the Medical Home, and Advanced PCMH Program: Mastering the Medical Home Transformation. More detailed information will be coming soon.
  • The first quarterly report on the use of funding released in response to COVID-19 will be due the beginning of July. The purpose of the report is to share progress on staff and patient safety, testing capability and capacity, maintaining and/ or increasing operational levels, telehealth implementation, minor alteration and renovation projects to support operations, etc. A separate quarterly report will be required for each funding opportunity. Health centers must make sure there is a clear delineation of funds, and that there is no "double-dipping" of funds.
  • Health centers may not use program funds to do contact tracing unless they are working with the state department of health, and they are only doing contact tracing for a person who is a health center patient.
Effective COVID-19 Crisis Communication
The Center for Infectious Disease Research and Policy (CIDRAP) has issued a report on effective COVID-19 crisis communications. Lead experts include Dr. Peter Sandman, creator of the "Risk = Hazard + Outrage" formula for risk communication, is a preeminent expert and consultant on crisis communication and Dr. Jody Lanard has advised the World Health Organization (WHO) on outbreak communication and wrote the first draft of the WHO’s Outbreak Communications Guidelines.

Whether communities have been hit hard by COVID-19 or has been relatively unscathed so far, one thing has remained constant. Messages from government leaders and even public health officials have been all over the map, leaving in their wake much confusion and anxiety. One reason for this is that the principles of crisis communication have often been ignored by officials, experts, journalists, and other commentators during this early phase of the COVID-19 pandemic. The report outlines six key points that make for good leadership during infectious disease outbreaks. They include:

  1. Don’t over-reassure;
  2. Proclaim uncertainty;
  3. Validate emotions – your audience’s and your own;
  4. Give people things to do;
  5. Admit and apologize for errors; and,
  6. Share dilemmas.

Health center leaders may want to consider these same crisis communication principles as they navigate future exposure risks of patients and staff, community outbreaks, and changes in clinic operations. Click here to view the materials.
North Dakota Employer Behavioral Health Toolkit
The North Dakota Behavioral Health Division has published a toolkit that employers can utilize to help support the mental health of their employees. At a time when employees are anxious about being at work, working from home, or returning to work, these recommendations may make work transitions easier.

The toolkit provides a list of warning signs in someone who is struggling to cope emotionally. These may include mood changes, using substances or alcohol, and demonstrating problematic behaviors at work. The toolkit gives strategies on what a company can do from the administrative level down to direct supervision and how people can incorporate these suggestions into the workplace.

One useful piece is the examples the toolkit shares of how specific businesses, like Culligan Water, are already working to protect the mental well-being of their employees. Some organizations are publishing weekly videos by leaders in the organization or writing newsletters specifically to encourage self-care. Some are promoting healthy lifestyle suggestions that are important for a healthy body and mind. Some are doing live meditation exercises with their employees. With creativity, the workplace can be a source of support for employees.

The toolkit provides suggestions for how employers can support staff who are working from home, and how to encourage social connection to reduce stress, and even depressive thinking. An important recommendation is for employers to be discussing employee benefits with insurers and employee assistance programs (EAPs) to ensure that employees are receiving the benefits to which they are entitled.

Finally, the toolkit discusses children in different stages of development and how this crisis can impact them. It provides suggestions to parents on how to communicate with and assist their children in coping.
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.
Flattening the COVID-19 Curve: Roadmap to Re-opening and Re-imagined Care

Join the National Association of Community Health Centers (NACHC) for a timely and important webinar, Leading in a Crisis: Flattening the COVID-19 Curve – Roadmap to Re-opening and Re-imagined Care. The webinar will begin with updates from NACHC, CDC, and HRSA/BPHC. Leaders from Piedmont Health and Roanoke Chowan Community Health Center will review their strategies and next steps for moving forward. The webinar transcript and recording will be available here.

Thursday, May 21
11:00 am MT/ 12:00 pm CT 
Register 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.
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 Impacts in American Indian Communities in Great Plains Area

Co-sponsored by the Great Plains Tribal Chairmen’s Health Board, American Cancer Society, North Dakota Cancer Coalition, North Dakota Colorectal Cancer Roundtable, Iowa Cancer Consortium, and Nebraska Cancer Coalition, this webinar will feature Dr. Donald Warne from the UND School of Medicine & Health Sciences and Dr. Durado Brooks from American Cancer Society.

Participants will learn about the COVID-19 impact among local American Indian communities and understand cancer screening recommendations during and after COVID-19.

Tuesday, May 26
11:00 am MT/ 12:00 pm CT
Register here.

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.     

Medicaid in the Time of COVID-19

The National Association of Community Health Centers (NACHC) is presenting a 3-part virtual peer-learning opportunity on Medicaid in the time of COVID-19. These virtual sessions are the year-end wrap-up to the 2019 Payment and Delivery Reform Summit. PCAs and HCCNs are encouraged to view the pre-recorded webinars (Sessions 1 and 2) prior to the live virtual sessions (Session 3) which are designed for smaller cohorts to engage in peer-to-peer learning, share promising practices and lessons learned, leverage resources, and receive tailored training and technical assistance from NACHC and other experts.

Session 1 | COVID-19 Emergency Enhanced Medicaid FQHC Payment Options: Moderated by Roger Schwartz, Mary Cieslicki, and Edward T. Waters. View the pre-recorded webinar on the Medicaid: COVID-19 Toolkit and then complete a 3-question evaluation here.

Session 2 | COVID-19 and Beyond: Medicaid Delivery System Options for FQHCs: Moderated by Mary Cieslicki. View the pre-recorded webinar on the Medicaid: COVID-19 Toolkit and then complete a 3-question evaluation here.

Session 3 | Live Peer-to-Peer (P2P) Virtual Sessions for PCA/HCCN Cohorts: After viewing the pre-recorded webinars, please access the appropriate regional cohort’s live P2P virtual session on the date indicated. In each virtual session, NACHC staff and subject matter experts will facilitate a PCAs and HCCNs discussion on Medicaid-related payment and delivery reform activities in the time of COVID-19.

West Region: Join the live P2P conversation here on May 27 at 2:00 MT/ 3:00 pm CT
Phone number: 1-866-469-3239
Access Code: 213 715 020
State/Territory: Wyoming

Central Region: Join the live P2P conversation here on May 28 at 1:00 MT/ 2:00 pm CT
Phone number: 1-866-469-3239
Access Code: 216 150 234
State/Territory: North Dakota and South Dakota

Email with any questions or comments.
The COVID-19 Funding Dance

This is the first of two webinars presented by Capital Link Consulting in partnership with CHAD. The presenter will address the many questions regarding the use of funds, how to anticipate spending with many unknowns, and ways to be prepared to provide clear documentation of the use of funds.

Thursday, May 28
11:00 am MT/ 12:00 pm CT
Register here.

Save the date! A second webinar will focus on creating a financial emergency response plan.
Thursday, June 11
11:00 am MT/ 12:00 pm CT
Registration information coming soon.
Oral Health Peer Networking Opportunity

CHAD and Wyoming Primary Care Association (WYPCA) 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 WYPCA for the zoom link.

Thriving in an Online Work Environment

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

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

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

Thursday, May 28 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

Email Marketing by ActiveCampaign