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 Department of Health and Human 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, health center data trends, 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 21 to Wednesday, May 27.
Jill Franken Wins EmBe Tribute to Women Award
Firmly rooted in its foundation as the YWCA’s Leadership Luncheon, EmBe’s Tribute to Women has honored the best of the Sioux Falls community for 47 years, recognizing people in nine categories ranging from mentoring, business achievement, and community service. 

Jill Franken, Sioux Falls public health director and executive director of Falls Community Health, was the 2020 award recipient in the government and law category that acknowledges "individuals serving local, state, or federal government, law, politics or military service." Sioux Falls Mayor Paul TenHaken nominated Jill, saying, "I am absolutely humbled and honored to have Jill’s expertise, leadership, [and] her intelligence alongside me as we’ve dealt with COVID over the last month. I’m just very honored to have her playing this role for the city." His short nomination video is available here.

"As the CEO of CHAD, I have had the opportunity to see Jill’s leadership skills up close for many years, and I can’t think of anyone more deserving of this award. She is a great leader in her own right and she has the ability to develop leadership among staff and colleagues," said Shelly Ten Napel, CEO of the Community HealthCare Association of the Dakotas. "She was a kind and wise mentor to me when I started in my role and I know she has done that for many others as well."

Photo credit: Walter Portz with Studio Blu Photography
Deadline for Reporting on the Provider Relief Fund – June 3
The Department of Health and Human Services (HHS) has announced that June 3 is the deadline for all health care providers receiving funds from the Provider Relief Fund (PRF) of the CARES Act. There are two parts to this deadline. The first part is to attest to acceptance of the terms and conditions on the HHS portal. Health centers that have received more than one allocation of PRF funds must attest to separate terms and conditions for each allocation.

The second part of the deadline is that health centers need to provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements. HHS needs this information to ensure the allocation from the second distribution of funds will reflect the provider’s share of total patient revenue. For health centers that haven’t yet received the second distribution, providing this information will help HHS calculate the allocation. For those that have already received the second distribution, this information will help HHS verify the amount provided. It is very important to meet these deadlines, as health centers that fail to submit this financial information to HHS by June 3 will be ineligible for funding from the second distribution and will have to return any funding already provided.
North Dakota State Government Updates
On Wednesday, May 27, Governor Doug Burgum announced a leadership change at the North Dakota Department of Health (NDDoH). State Health Officer Mylynn Tufte has submitted her resignation, and Dr. Andrew Stahl has been appointed as interim state health officer. Dr. Stahl has been working in an advisory capacity with the COVID-19 response in collaboration with unified command.

The governor also announced the creation of a new temporary position within the NDDoH called the chief health strategist. Dr. Joshua Wynne, interim president of the University of North Dakota, has been appointed as the state’s first chief health strategist. Dr. Wynne has also served as UND’s vice president for health affairs and the dean of the UND School of Medicine and Health Sciences. Read more about the appointees here.
Red River Valley Task Force Updates
The State of North Dakota formed the Red River Valley Task Force (RRVTF) to prevent and mitigate community spread of the novel coronavirus. The task force is made up of mayors in the Red River Valley area and public health officials. The task force has been in development over the last several weeks and now has a webpage where updates will be posted, including information on how to view live streams of their meetings. The RRVTF held a meeting on May 27, where they walked through their strategy of targeted testing, contact tracing, and isolating. Their testing is targeted based on people’s occupation, if they live in a congregant living setting, and contact with other positive cases. More information on their testing matrix is also available on their webpage. They feel the current strategy of targeted testing is a better use of their testing resources for the present time, but as testing capacity increases, they may expand.
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 15, indicated the following changes from the previous week:

Patient Testing
  • Drive up and walk up testing capacity has increased to 100% of health centers in ND and 50% of health centers in SD.
  • Both states saw an increase in the number of patients tested for COVID-19.

  • SD reported an increase in visits; last week they provided 55% of pre-COVID 19 visits.
  • ND reported a slight decrease in visits; last week they provided 46% of pre-COVID 19 visits.
  • Both states reported a decrease in the number of visits conducted virtually.
  • Health center staff that are unable to work due to site or service closure, exposure, family or home obligations, lack of PPE, etc. decreased in both states.
South Dakota Medicaid Audio-Only Telehealth Billing Update
South Dakota Medicaid recently updated its guidance for telehealth. FQHC reimbursement for audio-only visits will be reimbursed at 75% of the applicable encounter rate for evaluation and management services with CPT codes 99201 – 99215 with modifier-52 added. Previously, health centers were receiving roughly $12 per claim. Claims for telephonic visits dating back to March 13 should be submitted using your PPS NPI after June 10. If services previously billed under 98966-98968 meet the requirements outlined in the manual for billing under 99201-99215 with the 52-modifier, void the claims and resubmit under the FQHC PPS NPI after June 10. Click here for the full guidance for FQHC provider reimbursement for telehealth.
Blue Cross Blue Shield of North Dakota Extends the Deadline for Telehealth Coverage
Blue Cross Blue Shield of North Dakota announced that the expansion of coverage for telehealth visits, including waiving of cost-sharing and expansion of benefits, will extend throughout the public health emergency period. Previously the expanded coverage was to end on May 31. If there are any questions, please reach out to
Finance Training and Technical Assistance for COVID-19 Funding Management
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, presented the first webinar The COVID-19 Funding Dance on Thursday, May 28. A recording of the webinar and related materials is available on the CHAD website under past event resources.

Amy will facilitate a CFO/ finance manager roundtable on Thursday, June 4. This one-hour meeting will offer an opportunity for open discussion among finance leaders at health centers in the Dakotas. CHCs should use this as an opportunity to learn what their peers are seeing and doing at their organizations in response to new responsibilities for COVID-19 funding management. She will also capture any training or technical assistance needs identified in this discussion for follow-up. Click here to register.

CLC will hold a second webinar, Creating a Financial Emergency Plan, on Thursday, June 11. Amy will outline a 10-step process to create a comprehensive financial emergency response plan (FERP). With health centers losing between 40% to 70% of patient revenues, the need for a plan is urgent. Among the key takeaways from this webinar, participants will identify areas of opportunity within current processes, understand how to plan and forecast for the impact of COVID-19, and gain an Excel FERP tool. Click here to register.

Office hours are included in the agreement with CLC. 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. To schedule an office hour session with Amy, please contact Dani Gullickson, event and project manager at CHAD, for available times.

Upcoming events are:
CFO/ Finance Manager Roundtable
Thursday, June 4, at 11:00 am MT/ 12:00 pm CT
Register here

Creating a Financial Emergency Plan
Thursday, June 11, at 11:00 am MT/ 12:00 pm CT
Register here

Resources for Fit Testing Employees
The State of South Dakota recently embarked on a plan to test every resident and employee of long-term care (LTC) facilities and assisted living homes in the state. One barrier for many LTC facilities was having staff who have been fit tested. A "fit test" tests the seal between the respirator’s facepiece and a person’s face. It takes about fifteen to twenty minutes to complete and is performed at least annually. After passing a fit test with a respirator, one must use the exact same make, model, style, and size respirator on the job. Respirator fit testing is required by the federal Occupational Safety and Health Administration (OSHA), and state OSHA agencies require employers to fit test workers who must wear these respirators on the job. Several fit testing requirements have been temporarily changed in light of COVID-19. A link to updated requirements can be found here.

Last week, the South Dakota Department of Health released a list of organizations that are able to aid businesses in fit testing their employees. A copy of the list can be found on CHAD’s website under COVID-19 resources.
HRSA Seeking Input on HPSA Scoring Criteria
A request for information (RFI) has been released to solicit stakeholder input on the scoring criteria for health professional shortage areas (HPSA). The Health Resources and Services Administration (HRSA) is looking for feedback on the scoring criteria and possible future approaches. CHAD will coordinate a response to this RFI with other primary care associations and with input from health centers. Contact Jessica Gilbertson if you have any questions. Click here for more information on the current scoring methodology.
PRAPARE & Social Risk during COVID-19 Survey -
Respond by June 1

As COVID-19 continues to affect marginalized and vulnerable communities disproportionately, the need to assess and address social determinants is greater than ever. Considering that things have changed dramatically in health care settings and communities, the PRAPARE team wants to know how best to support community health centers (CHCs) as they address COVID-19 and their community’s growing social needs.

The national PRAPARE team at the National Association of Community Health Centers (NACHC) and the Association of Asian Pacific Community Health Organizations (AAPCHO) is conducting this survey. It should take approximately 10 minutes to complete and will ask if, and how, CHCs are using PRAPARE during COVID-19 and how the PRAPARE team can offer support in social risk response work during the pandemic.
SDAHO Rural Health Leaders Virtual Conference June 10-11
The impact of COVID-19 has created financial uncertainty, altered strategic plans, changed priorities, created constant changes with regulations, and exhausted resources. As health care leaders look to the future and post-COVID operations, it will be essential to learn from this experience and adapt to the new normal.

This year the South Dakota Association of Healthcare Organizations (SDAHO) will be hosting their Rural Health Leaders Conference virtually. Expert speakers will discuss the future of rural health care, dynamics of effective organizational changes, requirements of emergency preparedness amid an infectious disease disaster, and the importance of developing a facility development strategy and capital vision (even during a pandemic). For the conference agenda, speaker information, and registration, visit the SDAHO website. 
Bureau of Primary Health Care Updates
Below are new updates from the Bureau of Primary Health Care (BPHC) that have been developed during the past week. A complete set of frequently asked questions can be found on the the BPHC website.

  • July 10 is the due date for the first quarterly report to the Secretary of the Pandemic Response Accountability Committee for any entity that has received more than $150,000 in HHS funding.
  • There is clarification on allowable use of HRSA supplemental funding for Expanding Capacity for Coronavirus Testing (ECT) (H8E):
    • Health centers may use ECT supplemental funds to test any individual, whether they are an existing health center patient or not.
    • Health centers that are doing contact tracing may use ECT supplemental funds to support contact tracing activities only if the person who tested positive is a health center patient.
Behavioral Health Provider Perspectives during Mental Health Awareness Month
CHAD had the privilege of interviewing four behavioral health providers in North Dakota and South Dakota in recognition of Mental Health Awareness Month. Although it is always necessary to recognize the importance of good mental health, the emotional toll that COVID-19 has taken on our society has made it even more noticeable.

Each provider shared unique ideas about mental health, and there were a few common themes. There is absolute agreement that behavioral health care belongs in community health centers (CHCs), and that integrated primary care and behavioral health care serves our patients and communities well. The on-site working relationships allow for easy referrals to behavioral health, better communication, and quite often leads to fewer appointment no-shows and better outcomes.

Unfortunately, some people wait until they feel like they are barely hanging on before they consider counseling. The routine screening and ease of access to behavioral health at CHCs may prevent mental health issues from worsening or alert the clinic that they must address a mental health crisis.
CHCs serve a population of patients that may be more at-risk for behavioral health disorders. Many of their patients have complex health and psychosocial histories and social determinants of health that can be linked to poor health outcomes. Some patients have food and housing insecurities, challenges affording their medications, and other issues that have a direct impact on their mental health. This is why several providers mentioned the CHC social workers and case managers as being an integral part of helping a patient’s overall mental health.

More than anything, the interviews with the behavioral health providers underscored their commitment to the mental health of CHC patients and their appreciation and respect for all other members of the health care team. As health centers continue to make behavioral health a focus, it will be exciting to see what they accomplish. All of the provider interviews can be found on CHAD’s YouTube channel.
Webinars & Meetings
Find these and other events on the CHAD website.

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.

Guidance for Dental Settings during the COVID-19 Response

During this Clinician Outreach and Communication Activity (COCA) call, presenters will provide an overview of the updated guidance for dental settings, including recommendations for resuming non-emergency dental care during the COVID-19 pandemic. Presenters also will discuss strategies for dental healthcare facilities to optimize personal protective equipment (PPE).

A recording will be available for viewing on the COCA call webpage and the slide set will be available under the "call materials" tab. It will be available for viewing on COCA’s Facebook page immediately after the live event ends at 1:00 pm MT/ 2:00 pm CT.

Wednesday, June 3
12:00 pm MT/ 1:00 pm CT
Join the webinar here. Due to the high demand we anticipate for this COCA Call, we encourage participants to consider viewing it on Facebook Live.

Centering Equity in Health and Housing Partnerships in Times of Crisis

Please join the Corporation for Supportive Housing (CSH), the National Health Care for the Homeless Council, and health center partners for an interactive discussion on how health centers can center equity in their work with housing partners in times of crisis, including the current response to COVID-19.

Panelists will discuss how to center equity in both immediate response work as well as long-term planning, opportunities for re-imagining and strengthening the role of health centers in addressing structural inequities, and building stronger health and housing partnerships in crisis and beyond. This webinar is free for participants.

Thursday, June 4
10:00 am- 11:30 am MT/ 11:00 am-12:30 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.

Thursdays in June (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.

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, June 9 (reoccurring, bi-weekly)  
1:30pm MT/ 2:30pm CT
Contact Carmen Toft
to be added to these meetings.   
Creating a Financial Emergency Response Plan

Presented in partnership with CHAD, Capital Link Consulting will lead this one-hour webinar to outline a 10-step process to create a comprehensive financial emergency response plan (FERP). With health centers losing between 40% to 70% of patient revenues, the need for a plan is urgent. Among the key takeaways from this webinar, participants will identify areas of opportunity within current processes, understand how to plan and forecast for the impact of COVID-19, and gain an Excel FERP tool.

Thursday, June 11
11:00 am MT/ 12:00 pm CT
Click here to register.  

Harm Reduction & Isolation during COVID-19

Join the Corporation for Supportive Housing (CSH) for a webinar on best practices for supporting patients actively using and/ or in recovery (including medication assisted treatment recipients) during the COVID-19 pandemic. Participants will discuss harm reduction, relapse risk, overdose prevention/ response, safety planning, and practical considerations to support patients. This webinar is free for participants.

Monday, June 15
12:00 pm – 1:30 pm MT/ 1:00 pm – 2:30 pm CT
Register here.
CHAD Network Team Meetings

Thursday, June 4, at 11:00 am MT/ 12:00 pm CTCFO/ Finance Manager Roundtable

Tuesday, June 9 at 1:00 pm MT/ 2:00 pm CT – Marketing and Communications Network Team Meeting

Tuesday, June 9 at 1:30 pm MT/ 2:30 pm CT – COVID-19 Response Open Discussion (bi-weekly)

Thursday, June 11 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

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