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, North Dakota Medicaid, and South Dakota Medicaid. You will also find information we thought would be useful, including federal legislative updates, state June primary election summaries, health center data trends, and multilingual COVID-19 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, June 11 to Wednesday, June 17.
CHCs in the News!
Free rapid HIV testing is available at Falls Community Health in Sioux Falls via KELO.
Recent Efforts in Congress Prioritize Telehealth
Last week, Representatives G.T. Thompson (PA-15) and G.K. Butterfield (NC-01) introduced H.R. 7187, the Helping Ensure Access to Local Telehealth (HEALTH) Act. This act would permanently allow community health centers to provide telehealth services in Medicare as "distant sites" and be paid equal to an in-person visit. The bill also removes the geographic restrictions related to originating sites.

On Monday, June 15, a group of bipartisan representatives sent a letter to Majority Leader McConnell and Minority Leader Schumer requesting that the telehealth provisions in the COVID-19 legislation be made permanent, including the provisions specific to health centers. Senator Cramer (R-ND) and Senator Rounds (R-SD) have both signed on to the letter. The National Association of Community Health Centers (NACHC) has released a fact sheet on telehealth and community health centers during the COVID-19 pandemic, which demonstrates the importance of extending these provisions.

North Dakota June Primary Election Summary
The North Dakota primary elections were held on June 9. There were several contested races around the state. Some of the more notable races include the defeat of House Appropriations Chairman Jeff Delzer (R-Underwood). Delzer came in third in the Republican primary election in District 8. He has served in the House since 1995 and has been the chair of the House Appropriations Committee since 2011. Another notable primary was the race for North Dakota State Treasurer. State Representative Thomas Beadle (R-Fargo) won the Republican party nomination for treasurer against State Representative Daniel Johnston (R-Kathryn). To read more about other notable races, see this article from Prairie Public Broadcasting.
North Dakota Plans Multiple Mass Testing Events
North Dakota is focused on ramping up testing efforts to use the full capacity of the state’s lab. The current capacity in North Dakota is 5,000 tests per day, with 4,000 tests to be processed at the state lab and another 1,000 through partner labs. To utilize that testing capacity, the state of North Dakota is working with partners around the state to set up mass testing events that are open to anyone and available free of charge. The first of these events started last week in Fargo and ran for two days. On Wednesday, June 17, a testing event was held at the State Capitol from 9:00 am – 6:00 pm.

Upcoming testing locations and dates include:
  • June 18-19
10:00 am - 6:00 pm
Fargodome, Fargo
  • June 19
8:00 am – 4:00 pm
State Fairgrounds, Minot

The state encourages participants to fill out the necessary information ahead of time to expedite the testing process. The online form can be found here.

Multilingual Resources Available
The Red River Valley Task Force (RRVTF) has developed COVID-19 resources in eight different languages, and they are available for download. Languages include Spanish, Arabic, Arabic (Sudanese), Chinese, Chinese (Zho), Nepali, Swahili, and Somali. The resources can be found here.
South Dakota June Primary Election Summary
The June primary election in South Dakota was held on June 2 and impacted 27 Republican races and two Democrat races. In each race, the parties were deciding who the final candidates are for the November general election. In the House races, the primaries narrowed the field for each party to two candidates, and in the Senate races, the primaries narrowed the field to one candidate. Overall, the Republican winners of the primary races were more moderate than the candidates they beat. This is a good indication of an effort to refocus the legislature from some of the social issues that have taken up a significant amount of policy bandwidth in the last two sessions, and it may result in wholesale changes in leadership. A change in leadership will impact everything from committee chairs and committee assignments to how the legislature interacts with the Governor’s agenda.

Of note in specific races:
  • House majority leader Lee Qualm was defeated in his attempt to move to the Senate by Erin Tobin, a nurse practitioner in Winner, by a 61% to 39% margin. The key issue in the is race was Qualm’s sponsorship and support of the anti-vaccination bill during 2020.
  • Dean Wink, of Howe, came back to the legislature by beating out a member of the more conservative wing of the House. Wink previously served as Speaker of the House and Chair of Appropriations and is unopposed in the general election.
  • Larry Tidemann, Brookings, also came back to the legislature by defeating Doug Post, a one-term House member who generally opposed any government spending on any program. Tidemann previously served as Chair of Appropriations.
  • Three appointees of Governor Noem were defeated in primaries in their first go as candidates.
  • There are recounts in two races before the election is certified.

This story from South Dakota Public Broadcasting gives more perspective on some of the actions and efforts that were behind the primary results this year.
South Dakota Interim Summer Study on Mental Health Services Continues
South Dakota’s Legislative Executive Board met last week and set the interim summer study topics for 2020. There will be a continuation of the committee that has met to look at mental health services over the last two years. This year, the committee will look at changes to existing models for service delivery or alternative models for services on a regional basis. CHAD will submit a letter to the committee chairperson to offer input from a health center perspective. CHAD is requesting to assign a representative to the committee if they decide to allow public members on the committee. If that is not an option, CHAD will ask to present information to the committee over the course of the study.
North Dakota Medicaid Training – June 24
North Dakota Medicaid announced an in-depth training opportunity on the North Dakota Health Enterprise Medicaid Management Information System (MMIS) that will take place on Wednesday, June 24. Earlier this year, North Dakota Medicaid released a brief survey to gather feedback on improving support to Medicaid providers. This training is in response to the results of that survey. The training will be held over Microsoft Teams on June 24 from 1:00 – 3:00 pm CT. You can access the training using this link or by phone at 701-328-0950, conference ID 453 899 354#.
South Dakota Medicaid Updates for Serology Testing and Remote Patient Monitoring
South Dakota updated their COVID-19 frequently asked questions (FAQs) on June 15 related to serology/antibody testing and remote patient monitoring. The complete provider bulletin can be found here.

South Dakota Medicaid covers serology/antibody testing under the following conditions:
  • The test must be medically necessary and cannot be used for the convenience of recipients; 
  • The test must be performed using a test with the U.S. Food and Drug Administration (FDA) Emergency Use Authorization; and,
  • The test must have 99% or higher sensitivity and 99% or higher specificity.

Serology/antibody testing can be billed using Healthcare Common Procedure Coding System (HCPCS) codes 86769, reimbursed at $42.13, and 86328, reimbursed at $45.23. Claims for serology testing for COVID-19 must include the name and developer of the test. Billing for these codes is retroactive to April 10 and can begin on June 25.

South Dakota Medicaid temporarily covers remote patient monitoring for a recipient diagnosed with COVID-19, who has not recovered, and meets one of the following additional criteria:
  • The recipient was hospitalized due to COVID-19, and further monitoring is required after discharge; or
  • The recipient is at risk for severe illness due to being 65 years or older or in an assisted living facility; or,
  • The recipient is at risk for severe illness due to having an underlying medical condition including chronic lung disease, moderate to severe asthma, a serious heart condition, being immunocompromised, severe obesity, diabetes, chronic kidney disease, and undergoing dialysis, or liver disease.

A physician, physician assistants, nurse practitioners, or certified nurse-midwife must order remote monitoring and document the medical necessity of the service. The technology used for remote patient monitoring must be approved for remote patient monitoring by the FDA.
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 June 5, indicated the following changes from the previous week. 

Patient Testing
  • COVID-19 testing capacity is 100% of health centers for both North Dakota and South Dakota. As of June 5, the health centers have reported collecting over 2500 COVID-19 specimens for testing.
  • ND reported an average turn-around of 2-3 days for COVID-19 test results, and SD reported turn-around times ranging from less than an hour to 2-3 days.
  • Both ND and SD saw an increase in testing, with SD’s increase being significant due to a testing event
  • Both states reported an increase in weekly visits compared to pre-COVID-19 visits with each state reporting they are at 70% of pre-COVID visits.
  • Both states reported a decrease in the number of visits conducted virtually. ND health centers conducted 32.5% of visits virtually, and SD conducted 8.75% of visits virtually.
Bureau of Primary Health Care Updates
The Bureau of Primary Health Care (BPHC) has recently added to its extensive list of frequently asked questions section of the BPHC website. Below is a summary of new responses.

  • In 2016, the Centers for Medicare and Medicaid Services (CMS) released a regulation for emergency preparedness that is applicable to all health care providers who are registered with CMS. The regulation became effective in November of 2016 and allowed one year for providers to become compliant with and implement the regulations. The CMS Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule outlines the expectations for health centers to develop and maintain an emergency preparedness communication plan and develop and maintain annual training and testing programs. Health centers must also coordinate with state and local health departments as part of their emergency management planning, preparedness, mitigation, and response efforts. Resources and information specific to health centers, and specific to North Dakota and South Dakota, can be found on the CHAD Emergency Preparedness webpage.
  • CMS has offered flexibilities to health centers that open temporary sites due to the COVID-19 public health emergency. These flexibilities are related to telehealth services, Medicare billing, and the physician supervision requirement for nurse practitioners. Detailed information on these flexibilities can be found on the CMS website.
  • Health centers are allowed to provide COVID-19 testing data to sentinel surveillance systems that are consistent with applicable law. A sentinel surveillance system utilizes a limited network of reporting sites to rapidly signal trends, identify outbreaks, and monitor the burden of disease such as COVID-19.
Need for Mental Health Parity Intensifies during COVID-19
Ever since the inception of the first mental health parity law back in 1996, employers and insurers have attempted to circumvent the requirements. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, and in November of 2013, the federal government issued rules on implementing the law.

The passing of the Affordable Care Act (ACA) strengthened the MHPAEA in several important ways. In a report generated through a collaboration between the National Alliance on Mental Health and Georgetown University titled Mental Health Parity at Risk, the authors describe some of the problems with behavioral health coverage before the ACA. During that time, 28 states did not require individual market health insurance plans to cover or even offer mental health services. Health plans screened out applicants who had mental health or substance use disorders to avoid enrolling them. Even when coverage was accessible, insurers essentially fined people who had these histories by applying a 20-50% increase in premiums and excluding mental health and substance use services.

While the ACA and MHPAEA have certainly improved mental health access and parity, things are not perfect. Many patients can testify to difficulties with insurers and coverage. In June 2019, Representative Katie Porter from California introduced a bill titled the Mental Health Parity Compliance Act (H.R. 3165), which currently has 58 bipartisan cosponsors. The purpose of the bill is to enforce the parity laws that already exist. In addition to the Mental Health Parity Compliance Act (H.R. 3165), Representative Porter has also introduced the Stopping the Mental Health Pandemic Act (H.R. 7080). This bill is designed to provide funding to state and local governments, non-profits, and service providers to meet the mental health needs of those impacted by COVID-19.

Parity issues are particularly important in the time of COVID-19. New research is already demonstrating that COVID-19 has had a major impact on the mental health of our society. A survey from the Kaiser Family Foundation found that one-half of the adult responders indicated that their mental health had been negatively affected due to the virus.
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 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.

Best Practices for Re-Opening Dental Clinics: Evolving and Adapting

There are still many questions that may need answers to ensure the dental clinic workplace is safe for both staff and patients. This joint webinar from the DentaQuest Partnership and the Organization for Safety Asepsis and Prevention (OSAP), will focus on guidance provided by the ADA, OSHA, the CDA, and other dental associations to re-open dental practices.

Presenters will help dental professionals identify resources to ensure their clinic remains current with the evolving COVID–19 pandemic and discuss measures to reduce the likelihood of the spread of infection as patient care increases. A recording will be made available. One continuing education credit is offered.

Thursday, June 18
11:00 am MT/ 12:00pm CT
Register here

Virtual COVID-19 Conference

Join health center peers and virtually to learn about innovative new approaches to meeting the mission of health centers in light of the pandemic. Northwest Regional PCA has announced a virtual conference available to all health centers and primary care associations. It will feature four weeks of educational sessions with subject-matter experts who break down the key issues around board governance, workforce & HR considerations, financial planning, and care model optimization. Virtual roundtables will promote peer-to-peer learning.

While there are fees associated with the full conference, the opening plenary and the roundtable sessions are free. The opening plenary will feature Bureau of Primary Health Care (BPHC) associate administrator, Jim Macrae, and senior BPHC staff.

Friday, June 19
1:00-2:30 pm MT/ 2:00-3:30 pm CT
Register here for the opening plenary

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 23 (reoccurring, bi-weekly)  
1:30pm MT/ 2:30pm CT
Contact Carmen Toft to be added to these meetings.   

2020 Virtual Prevent Cancer Dialogue

Keeping with the true spirit of the Prevent Cancer Dialogue, the Prevent Cancer Foundation will have engaging presentations as part of moderated panels, interactive Q&A with panelists, facilitated peer-to-peer conversations on trending topics, and informative poster presentations. Nurses, nurse practitioners, and nationally certified health education specialists can earn up to nine continuing education credits by attending the full series. Separate registration is required for each presentation.

This year’s virtual event will continue in two free webcasts.

Part 2: Innovative Technologies to Expand Cancer Screening
Wednesday, June 24
10:30 am – 2:30 MT/ 11:30 am – 3:30 pm CT

Part 3: Challenges and Opportunities for Cancer Prevention and Screening in Indian Country
Wednesday, July 1
10:30 am – 2:30 MT/ 11:30 am – 3:30 pm CT
COVID-19 and Oral Health

This webinar, organized by the Mountain West AIDS Education and Training Center (MWAETC), is aimed at helping private dentists, dental hygienists, and dental assistants deliver patient care during the pandemic. The presenter will review recent CDC guidance for dental settings during the COVID-19 response and discuss options to mitigate the risks of COVID-19 transmission in dental settings. Participants will be able to share lessons learned of recent clinical practice alterations.

Friday, June 26
10:30 am MT/ 11:30 am CT
Register here

Implementing Telemedicine Webinar Series

The COVID-19 pandemic is demanding that health care providers rethink how they deliver care in ways that reduce the risk of further spreading infection. In response, the Mountain West AIDS Education Training Center (MWAETC) has designed a 6-session webinar series on implementing telemedicine. The focus of the series will be on helping providers build a successful telemedicine strategy for their clinics, and will be led by John D. Scott, MD, MSc, associate professor of medicine, Division of Allergy and Infectious Diseases, and medical director of digital health at the University of Washington.

This series is free and separate registration is required for each session. Participants may attend the whole series or chose only to select the sessions of most interest. All sessions will begin at 11:30 am MT/ 12:30 pm CT.

Session #3: Telemedicine and Payment Policy
Monday, June 29
Session #4: Telemedicine Technology
Monday, July 13
Session #5: Clinical Best Practices for Telemedicine
Monday, July 20
Session #6: Telemedicine Q&A
Monday, July 27
CHAD Network Team Meetings

Thursday, June 18 at 10:00 am MT/ 11:00 am CT – HR Network Team Meeting

Friday, June 19 at 11:00 am MT/ 12:00 pm CT – Behavioral Health Workgroup
Tuesday, June 23 at 1:30 pm MT/ 2:30 pm CT – COVID-19 Response Open Discussion (bi-weekly)
Tuesday, June 30 at 12:00 pm MT/ 1:00 pm CT – O&E Network Team Meeting

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