Thank you for reading this special edition of the CHAD Connection. CHAD plans to release weekly editions of the COVID-19 Digest over the next few months to cover COVID-19-related news and updates for our members adequately. 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 (CMS) and both North Dakota and South Dakota. You will also find information we thought would be useful, including telehealth guidance and reimbursement, legislative updates, and mental health resources.

New to the weekly COVID-19 Digest, 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, April 16 to Wednesday, April 22.
CHCs in the News!
Dr. Matthew Eaton discusses emergency dental care at Family HealthCare in Fargo.
Find this and other stories on the CHAD website.
Federal Legislative Update
On Tuesday, the Senate passed its fourth legislative response to the COVID-19 pandemic. This bill is called the Paycheck Protection Program and Health Care Enhancement Act. It is considered an extension of the CARES Act and provides additional money for the paycheck protection program (PPP) and health care providers. The text of the bill can be found here.

The bill in its current form provides another $310B for the PPP as well as $75B for the Public Health and Social Services Emergency Fund which is directed to the Centers for Medicare and Medicaid Services to distribute to health care providers including health centers. There is also $25B to increase testing capacity, of which $600M will go to community health centers. This money can be used to prevent, prepare for and respond to COVID-19 and for necessary expenses to administer and expand capacity for testing. $1B was appropriated for paying for tests for the uninsured.

This bill still has to pass through the House and be signed by the President. It passed the Senate by unanimous consent, so Senators did not have to travel back to Washington for a vote. House members have been asked to come back to Washington DC for a potential vote on Thursday, April 23.
North Dakota Medicaid Presents Primary Care
Management Reform Series

Last week, ND Medicaid hosted a representative from Connecticut on primary care management reform. This presentation was the third in a series of three presentations from other states to learn from other state Medicaid programs that have implemented care management models. Previous months included information from South Dakota and Alabama. Click here to see the presentation from Connecticut.
Senator Hoeven hosts Health Care Round Table
On April 16, Senator John Hoeven hosted a virtual round table with health care leaders from North Dakota. Several panelists, including CHAD CEO Shelly Ten Napel, presented to Senator Hoeven and officials from the Federal Emergency Management Agency (FEMA), the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS). CHAD followed up with Senator Hoeven’s health care staff regarding the need for additional emergency response funds as well as long-term funding for the health center program. Click here
for the full set of funding requests being put forward by the National Association of Community Health Centers.
Health Centers Embrace Teledentistry
With dental clinics closed across the Dakotas and with increased concerns about the public health impact of hand-on dentistry, there is a growing discussion about the potential of teledentristry. The purpose of a teledentistry visit in the COVID-19 context is to triage the patient to prevent an emergency room visit or to determine if the patient can be treated in a remote location using medication. The goal is to continue to care for patients while reducing the number of dental visits to emergency rooms and protecting staff from COVID-19 spread. The American Dental Association released a billing and coding resource on teledentistry, which can be found on the CHAD website under the dental section of the Coronavirus COVID-19 Resources page.

The Great Plains Health Data Network (GPHDN) hosted a teledentistry webinar with health centers that provide dental care on Tuesday, April 21. Participants were able to network with peers concerning technology, workflows, coding and billing, and PPE supplies to help clarify operations within their own health centers. To provide on-going support, the GPHDN has scheduled a follow-up meeting for Tuesday, May 5, at 1:00 pm CT.
Medicare Releases Telehealth Guidance
On Friday, April 17, CMS released its guidance on the temporary expansion of telehealth services in response to the COVID-19 public health emergency (PHE). These changes will be in place for the duration of the PHE, and additional discretionary changes will be made as necessary to ensure patients have access to the care they need. Key elements of this guidance include:

  • The service requires interactive audio and video telecommunications.
  • Any health care provider, working within their scope of practice, can provide distant-site telehealth services from any location, including their home.
  • Click here for a list of services approved for distant site telehealth under the Physician Fee Schedule.
  • Distant site telehealth services payment is set at $92.
  • FQHCs will be reimbursed at the current PPS rate until July 1 at which time the Medicare claims process system will be updated and claims from January 27 through June 30 will be automatically reprocessed and adjusted to the $92 rate. FQHCs do not need to resubmit these claims for the payment adjustment.
  • For services furnished between January 27 and June 30, claims must include modifier 95: synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.
  • For online digital evaluation and management (E/M) services and virtual communication services (claims with HCPCS Code G0071), claims from March 1 and throughout the PHE will be reimbursed at $24.76. Until the Medicare claims processing system is updated with the new rates on July 1, claims will be reimbursed at the current rate of $13.53. After July 1, claims from March 1 to June 30 will be automatically adjusted to the temporary rate of $24.76.
  • After July 1 and throughout the COVID-10 PHE, FQHCs will use code G2025 to identify services provided via telehealth, and reimbursement will be made at the adjusted rate.

For more details on the temporary Medicare guidance for expanded telehealth services in response to the COVID-19 PHE, click here. For this and interim guidance issued by other payors in ND and SD, please go to the telehealth section of the COVID-19 Resources section on the CHAD website.

ND Creates Temporary Shelter Program for those Impacted by Coronavirus and Homelessness
A multi-agency task force in North Dakota launched a temporary shelter program for vulnerable individuals who are impacted by coronavirus and homelessness. The program will serve individuals who cannot safely stay at existing homeless and domestic violence shelters because they tested positive for COVID-19, exhibit symptoms, are awaiting test results, or need to be quarantined.

Individuals must be referred by a homeless or domestic violence shelter, hospital, public health unit, or another partner agency to utilize the program.
Information on the shelters’ locations is not being disclosed to the public due to health-related privacy concerns and safety considerations, including those who are fleeing domestic violence.

The new shelter and support program is currently serving a couple of communities will eventually serve individuals in Bismarck, Devils Lake, Dickinson, Fargo, Grand Forks, Jamestown, Minot, and Williston.

The program is funded through federal and state dollars, with major support from the Federal Emergency Management Agency (FEMA). It was set up through the North Dakota Interagency Task Force on Homelessness, Domestic Violence and Food Insecurity. Multiple government agencies and groups that help fight poverty are involved in the task force.

For additional resources, please visit the CDC interim guidance for homeless service providers, homeless information - North Dakota, and homeless information - South Dakota.
COVID-19-Related Treatment Training and Continuing Education Credits Available Treatment Website Launched by University of Washington IDEA Program
The main goal of the University of Washington’s COVID-19 treatment website is to provide up-to-date information and teaching slide decks focused on clinical trials and published data related to potential high-impact treatments of persons with COVID-19. There are quick links to US clinical trials and expanded access programs, treatment information including medication summaries, selected treatment guidance from major organizations and teaching slide decks. The UW infectious diseases education and assessment (IDEA) program has developed four federally-funded curricula with free continuing education credits, including the National HIV Curriculum, National STD Curriculum, Hepatitis C Online, and Hepatitis B Online.
Bureau of Primary Health Care FAQ Updates
The Bureau of Primary Health Care (BPHC) continues to update its Health Center Program COVID-19 frequently asked questions (FAQs). Updates published over the last week include:

  • HRSA has postponed planned operational site visits (OSVs) through at least July 31.

  • HRSA is exploring what flexibilities may be available for upcoming deadlines for Service Area Competition/Renewal of Designation or Budget Period Renewal/Annual Certification Progress Report or any supplemental reporting.

  • The Health Resources and Services Administration (HRSA) has determined that, due to the declared COVID-19 public health emergency and its impact on health center operations, the due dates for responses to Progressive Action conditions will be extended an additional 90 days. Further extensions of Progressive Action condition deadlines may be available as needed. This decision does not change the consequences of having unresolved Progressive Action conditions.

HRSA will resume Progressive Action condition progression and enforcement as soon as it is practicable and will provide advance public notice of activity. Health centers are encouraged to continue to submit documentation to demonstrate compliance to the extent possible. Project officers are available to provide guidance with the Health Center Program Compliance Manual and Progressive Action Conditions Library.
Supplemental Funding Budget Information Due Today! Technical Assistance for Supplemental and CARES Act Funding Available
COVID-19 supplemental funding activity (H8C) and budget information is due in EHBs by 10:59 pm CT on Thursday, April 23. The submission requirement will appear in the H8C grant folder, and a pending task will appear in EHBs. CARES (H8D) supplemental funding activity and budget information is due in EHBs by 10:59 pm CT on Friday, May 8.

Each Q&A session included the same basic slide deck but had unique questions submitted by health center grantees. The slides can be found on the CHAD website’s COVID-19 Resources section titled "HRSA Supplemental Funding for CHCs." The Q&A portion of the April 22 call included:

  • Supplemental funds may be used for salaries of staff performing in scope work that is usually paid with funds other than base grant funds. Costs for items previously funded from another source are allowable if they fall within the guidelines for the supplemental funding. Avoid "double-dipping" or the perception of doing so by ensuring you have a very robust time and effort reporting system.
  • Funds may be used for things such as childcare for staff and bonuses for positions with high-risk of exposure, but this must follow your internal policies and procedures. Keep in mind that salaries, including bonus pay, must not exceed the salary limitation of $197,300.
  • The threshold for minor alterations and renovations (A&R) within the current footprint of a building is $100,000. The multiple bid rules still apply as there is no waiver on the competitive bid process.
  • Funds may be used to bring an exam room "up to code" as it is considered minor A&R.
  • Comfort items to accommodate staff working in parking lots, such as tents, chairs, heaters, etc. are allowable supplies and must be kept under the $5,000 threshold and justified as COVID-19 related needs. Food for staff is still unallowable.
  • All awards have a one-year project period and are eligible for extension requests to spend funds or complete activities. Extension requests must be made at least 30 days before the initial deadline.
Health Care Volunteer Opportunities
In early April, Governor Doug Burgum announced the activation of North Dakota’s workforce coordination center (WCC) to serve emergency workforce needs in support of health care providers, industries, and agencies affected by COVID-19. The state established the WCC to create a pool of potential workers and volunteers that can be available to help as the COVID-19 pandemic progresses. The program is seeking those that are out of work, retired, or want to volunteer during this emergency. Visit here for more information or to register with the WCC.

On a national front, the Medical Reserve Corps (MRC) is used to recruit volunteers to respond to in-state and out-of-state missions. The MRC is designed to have a pool of health care and medical personnel to deploy for a specific purpose in an emergent situation. Those that are interested in being deployed to respond to an emergency should register with the MRC.
Mental Health Resources for Providers and Patients
During this time of crisis, many people are feeling a deep sense of loneliness. After all, public health officials are asking people to isolate themselves from others and to set aside their natural tendency to engage with friends, coworkers, and even family. In an effort to respond to the potential needs of health center staff, CHAD’s behavioral health and substance use disorder program manager, Dr. Robin Landwehr, is available to offer health center providers and staff free telephone or video-based informal conversations as an additional support resource. Discussions can be about anything that would be helpful during this difficult time, such as work, health, family, and relationships. While not considered therapy, these conversations will be kept confidential.Health centers can make this informational flyer available to employees.

In addition to the CHAD Chat resources, CHAD has indentifed several other mental health-related phone apps that may be helpful for staff and patients.

  • WYSA – The Artificial Intelligence (AI) Penguin 
    It may sound cutesy, but the information on WYSA and the helpful tips can be useful. WYSA does have a paid therapist service, but that is not necessary to get some excellent information that can be accessed for free. With WYSA, participants chat with the AI penguin, which has been programmed to give a wide range of information on many topics. The AI penguin can discuss grief and loss, anxiety and depression, and other topics.
  • Booster Buddy
    A common complaint among people now is finding motivation during the days of social isolation. Booster Buddy was developed using feedback from young adults with mental health disorders so that it may be appealing to them. This application comes with a medication reminder, a task manager, a journal, and an extensive list of coping skills. Every day you check in with your buddy and are given three tasks to complete that build motivation for getting through the day. When you complete the tasks, you earn coins that you can exchange for a reward. You will need to download the app to find out what they are.

  • #SelfCare
    This app can be helpful if you struggle with anxiety. It also has coping skills and relaxing exercises. The app allows you to pretend that you are staying in bed all day with your pet enjoying the things around you, and the app shares very encouraging and uplifting messages that focus on self care.

  • Talkspace  
    Talkspace is donating free therapy to medical workers fighting COVID-19. Medical and health care workers across the country can get access to a free month of online therapy that includes unlimited text, video, and audio messaging with a licensed therapist. To sign up, health care workers should register via the app by verifying with their NPI and state of residence. Once certified, they will gain access to the Talkspace Unlimited Messaging Plus plan.

  • Headspace – Mildfullness for Everyday Life
    Try Headspace and learn the essentials of meditation and mindfulness through guided meditations, animations, articles and videos. Headspace is offering all US health care professionals who work in public health settings free access to their paid subscription, Headspace Plus, through 2020. The subscription includes exercises to add extra mindfulness to your day, and hundreds of meditations on everything from stress to sleep.

    Health care professionals can redeem a Headspace Plus subscription using a National Provider Identifier (NPI) and email address. Nurses without an NPI can provide organization information to verify credentials.
Webinars & Meetings
Find these and other events on the CHAD website.

Flattening the COVID-19 Curve: Health Equity and Economic Supply Chain Survival Strategies

The National Association of Community Health Centers (NACHC) will hold webinars for the next few Thursdays. The webinar will start with critical updates from NACHC, the Center for Disease Control, and the Bureau of Primary Health Care. Leaders from the field will speak to the role of health center controlled networks (HCCNs) in a public health crisis and the valuable data these organizations are contributing to the COVID-19 response. These webinars are a part of NACHC’s on-going COVID-19 webinar series designed to address health centers’ most pressing questions.

Thursdays in April
11:00am MT/ 12:00pm CT
Visit NACHC’s website to register or view past recordings

Non-Traditional Financing Sources for FQHCs during COVID-19: Payroll Protection Program

There are several non-traditional financing opportunities for health centers dealing with a financial downturn during COVID-19. Learn the latest developments in the Payroll Protection Program (PPP) administered by the Small Business Administration (SBA) and tips for strengthening health center participation in the PPP. The National Association of Community Health Centers and Capital Link are co-hosting this webinar.

Friday, April 24
9:00 am MT/ 10:00 am CT
Register here.

North Dakota Medicaid Provider Webinar

North Dakota Medicaid is hosting a webinar to provide an update on their response to the pandemic and answer any Medicaid-related questions pertaining to medical services and COVID-19. The webinar will be recorded and available for later viewing on the department’s website at
Agenda topics include:
  • Coronavirus Aid, Relief, and Economic Security (CARES) Act;
  • Disaster Medicaid state plan amendments recently approved by the Centers for Medicare and Medicaid Services (CMS);
  • Impact of North Dakota’s hospital and nursing home surge plan on Medicaid;
  • Simplified enrollment process for qualified service providers who provide home and community-based services to older adults and people with disabilities; and
  • Results from a recent COVID-19 Medicaid provider survey.

Friday, April 24
12:00 pm MT/ 1:00 pm CT
Access the webinar here
or by phone 701-328-0950
conference ID code 429118138#

Today with Macrae: Health Center Program Updates

Friday, April 24
2:00 pm MT/ 3:00 pm CT
Call-in: 800-988-9470
Passcode: 1763467

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.
Technical Assistance for COVID-19 Supplemental Funding for Health Centers

HRSA is hosting one more question and answer (Q&A) session, which will focus on guidance for the CARES Act (H8D) activities and budgets. The funding supports prevention, preparation for, and responding to coronavirus disease. Visit the COVID-19 supplemental funding for health centers technical assistance (TA) webpage for resources.

HRSA will host another question and answer sessions to help award recipients develop their responses to the COVID-19 response reporting requirement due in EHBs on Thursday, April 23.

CARES Supplemental Funding for Health Centers Q&A Session
Monday, April 27
12:00 pm MT/ 1:00 pm CT
Join the webcast the day of the session
**UPDATED** Call-in: 888-787-0206
**UPDATED** Passcode: 8754397

COVID-19 Response Open Discussion – Members Only

CHAD will host a 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, April 28 (reoccurring)  
2:00pm MT/ 3:00pm CT
Contact Carmen Toft to be added to these meetings.   

Region VIII Health Care for the Homeless Collaborative Online Meeting

Join health center colleagues from Region VIII (CO, MT, ND, SD, UT, WY) for a special session of the Health Care for the Homeless Collaborative online meeting on COVID-19. The collaborative will include peer discussion of current challenges, burgeoning victories, and innovative solutions. Health center staff that focus on serving people experiencing homelessness are welcome, regardless of funding type. A representative from the National Health Care for the Homeless Council will also be in attendance to discuss the council’s resources and strategies. For more information, including the meeting Zoom link, contact the CHAMPS programs coordinator, population health.

Wednesday, April 29
11:30 am MT/ 12:30 pm CT

NCFH COVID-19 Webinar Series: Resource-Sharing and Discussions with the Frontline

Join the National Center for Farmworker Health (NCFH) for the final webinar 4-part series. As this current crisis is impacting health centers across the country, there is a need amongst health center staff to share how service delivery, such as outreach strategies and enabling services, are being adjusted to maintain patient care. This series that began on April 8 will provide health centers with the resources and strategies to continue enabling access to care for their patient populations. Each webinar will focus on a specific theme related to service delivery modalities.

Wednesday, April 29
12:30 pm MT/ 1:30 pm CT
Register here.

South Dakota Department of Health COVID-19 Update

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

Thursday, April 30 (reoccurring)
10:00am MT/ 11:00am CT
For weekly call-in information, please join the listserve here. Find archived calls and slides here.

Cost Accounting for Behavioral Health Integration using Telehealth

The Health Resources and Services Administration (HRSA) Center of Excellence for Behavioral Health Technical Assistance is hosting a webinar to assist health centers in cost accounting for behavioral health services. Presenters will share strategies that health centers can use to assess their organization’s level of behavioral health integration and identify strategies and resources they can use to guide telehealth billing during COVID-19.

Thursday, April 30
1:00 pm MT/ 2:00 pm CT

To register for the webinar, set up an account on the new HRSA Center of Excellence for Behavioral Health TA website. Account access requires approval, as this site is only available to select HRSA programs. HRSA recommends participants create an account as soon as possible to ensure access on the day of the webinar.
I’ve Had Just About Enough of This: A Virtual Coaching Re-Charge for Senior Leaders

Join Joe Mull, M.Ed, CSP, and Alyssa Mullett, SHRM-CP, PC, for a 30-minute leadership-recharge webcast. Designed to help you re-fill your personal gas tank, speakers will tackle the energy drainers, emotional traps, and leadership challenges senior leaders are facing right now and identify evidence-based strategies and tactics to ensure you are showing up as your best leadership self in these unique times. The program is free, and capacity is limited.

Friday, May 1
10:00 am MT/ 11:00 am CT
Register here

CHAD Network Team Meetings

Tuesday, April 28 at 11:00 am CT – Great Plains Health Data Network (GPHDN) leadership committee

Tuesday, April 28 at 1:00 pm CT – Outreach & Enrollment

Wednesday, April 29 at 12:00 pm CT - Clinical COVID-19 response call (bi-weekly)

Thursday, April 30 at 11:00 am CT – Human Resources (weekly)

Tuesday, May 5 at 1:00 pm CT – GPHDN teledentistry implementation discussion

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