CHAD Connection - November 11

In celebration of National Rural Health Day next week, we are highlighting some of the excellent work you all are doing in your rural communities. Below, you’ll see photos of Horizon Health Care breaking ground on a new site in Plankinton and South Dakota Urban Indian Health’s new space in downtown Piere. Further down in this newsletter, you can read about Family HealthCare’s new mobile unit and the important services they are offering while eliminating the barrier of access.

Our rural communities face unique health care needs. Today more than ever, rural communities must tackle accessibility issues, a lack of health care providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of uninsured and underinsured people. Rural health care providers have stepped in to play critical public health roles through this ongoing pandemic. Our providers have been the last and only source of COVID-19 testing in many communities and are now leading in COVID-19 vaccinations.

Rural health centers also have an enormous impact on the long-term economic viability of rural communities throughout the Dakota. For our smaller communities, access to local health care is crucial to a town’s ability to recruit new companies and maintain a healthy workforce without long out-of-town trips to the doctors or to pick up prescriptions. When a small town is able to retain access to health care, it can serve as a main street anchor, keeping other small businesses viable. The economic impact of rural community health centers is over $30 million in North Dakota and nearly $75 million in South Dakota. Health centers keep health care affordable by providing health care services regardless of ability to pay and by helping patients find health coverage options that are right for them.

The pandemic has shined a light on the value and importance of rural health care. So, National Rural Health Day is a great opportunity to express our heartfelt thanks and appreciation to rural health care providers, including primary care teams of medical assistants, nurses, advanced practice providers, and physicians, behavioral health providers, dental teams, front office staff, health IT professionals, administrators and others who are literally saving lives every day even when it takes a heavy personal toll. You are all real live health care heroes!

Shelby Kampmann joined CHAD this month as a navigator on the outreach and enrollment team. She will provide education about the health insurance Marketplace and assist consumers with enrolling in coverage. Previously, Shelby was a certified nursing assistant. She aided patients with daily activities, registered patients for the hospital and ER, obtained vital signs, and assisted with finding nursing home placement if needed.

Shelby is currently attending Purdue University Global pursuing a bachelor’s degree in health care administration. She lives in South Dakota with her family, where she enjoys baking, cooking, crafting, hunting, camping, hiking, and recreational sports.

The Centers for Medicare and Medicaid Services (CMS) released its Interim Final Rule (IFR) with comment period establishing the federal vaccine mandate on health care providers, including federally qualified health centers (FQHCs). This Federal Vaccine Mandate Toolkit has been updated to reflect the new information in the IFC.

Along with updated and expanded FAQs, there is a two-page summary of the new requirements and the text of the new regulatory language being applied to FQHCs and rural health clinics. In addition to vaccinating staff, FQHCs must also have an extensive new set of policies and procedures in place by December 6 to implement the IFC.

Family HealthCare is reducing barriers to care by bringing high-quality health care directly to people in their communities. In September, the health center officially opened its new 40-foot mobile clinic, which is equipped to provide comprehensive medical and dental care, including immunizations of all kinds. Just in the past month, Family HealthCare hosted 17 outreach events with the mobile clinic, visiting schools, public housing, and other sites with immunizations and other care. In preparation for an outreach event, Family HealthCare staff work with the partner organization to collect paperwork from scheduled patients in advance so that the process is as seamless as possible. They also maintain the flexibility to accept walk-ins at the mobile outreach events.

In many cases, they see new patients at the mobile unit and establish care with individuals who may not have had convenient access previously. Kory Wolden, the administrative project coordinator who has overseen the launch of the mobile unit, says it has been a dream of Family HealthCare staff for many years. Congratulations to the Family HealthCare team on a dream realized.

November is Native American Heritage Month, a time to celebrate the rich and diverse cultures, traditions, contributions, and histories of Indigenous people. Native American Heritage Month is also a great time to educate the general public about tribal nations, raise awareness about the unique challenges Indigenous people have faced both historically and in the present, and how Indigenous people have conquered these challenges and found resilience.

Our goals this month are to provide our patients and supporters with education about Indigenous people and traditions, as well as an opportunity to engage with us through fundraisers and swag giveaways. We’re hosting several events and sharing content designed to educate both our Native and non-Native audiences throughout the month. We divided the month into themed weeks:

Winyan (Woman);
Wicasa (Man);
Nagi Numpa (Two-Spirit);
Wakan (Elder); and,
Wakanyeja (Children).

Each week starts with a video shared on Facebook, introducing the theme and significance of each role in Native American society, and includes a Lakota or Dakota vocabulary word. On Tuesday during Winyan week, our staff wore red to recognize the murdered and missing indigenous women (MMIW) epidemic that continues to take mothers, daughters, and sisters from Native families. Each Saturday morning, we share a video of one of our staff reading Native American children’s books. On Friday, November 12, we are welcoming the community to visit our clinic during our cultural health department open house. It will be an opportunity to introduce our new cultural health staff and encourage participation in our clinic’s cultural programming every week.

We’re asking for donations throughout the month to support the cost of medications we provide to patients who are otherwise unable to afford vital prescriptions. We partnered with artist Jennifer White to produce a limited run of tee shirts with her artwork on the front and the seven Dakota values listed on the back (these shirts are gorgeous and available for a suggested donation of $25 to SDUIH).

November is also Diabetes Awareness Month. Native Americans are twice as likely to develop diabetes in their lifetime as White people, and not by coincidence. There’s a direct correlation from the historical disenfranchisement of Native Americans to the current determinants of health which foster an environment for diabetes to take hold. On Monday, November 15, Matte Wilson of the Sicangu Food Sovereignty Initiative will prepare an Indigenous recipe at the Sioux Falls clinic and talk about the food sovereignty movement and its potential to break the grasp of diabetes on Native American communities.

We hope you’ll join us and follow along this month on our website and Facebook page. Ultimately, this month we celebrate Indigenous joy and resilience and remind our non-Native relatives of two things: we are still here; and Mitakuye Oyasin, which means, “We are all related.”

South Dakotans Decide Healthcare filed paperwork with the Secretary of State this week to place Medicaid expansion on the November 2022 ballot and let the voters of South Dakota decide the issue.
Following the filing, there was a media availability where supporters discussed how expanding Medicaid would benefit South Dakota and South Dakotans. Speakers included Jill Franken, retired executive director of Falls Community Health, and Tami Hogie-Lorenzen, CMO at South Dakota Urban Indian Health.

The Centers for Medicare and Medicaid Services (CMS) issued the final version of the Medicare Fee Schedule regulation for CY2022. Under this regulation, federally qualified health centers (FQHCs) and rural health clinics (RHCs) will now be eligible for reimbursement for mental health visits provided via telehealth – including audio-only visits – even after the pandemic ends.

Other FQHC payment provisions in the final rule include:

Starting in January, FQHCs and RHCs can bill for chronic care management and transitional care management services for the same patient during the same period;
Starting in January, certain FQHC (and RHC) providers can be reimbursed for providing attending physician services for hospice patients; and,

Infrastructure Bill Headed to the President’s Desk

The US House of Representatives passed a $1.2 trillion infrastructure bill last week, which the Senate passed in August. The bill now goes to President Biden’s desk for his signature. The infrastructure package makes huge investments in roads, bridges, broadband internet, drinking water, rail, and public transit without raising taxes on corporations. One amendment, which passed with overwhelming support, allows Urban Indian Organizations (UIOs) to use existing funds for necessary infrastructure projects to serve patients and families better.

Build Back Better Clears First Hurdle

Last week, the US House of Representatives passed a version of the Build Back Better (BBB) bill. Here is a summary. While passage in the House does represent progress for the bill, it has still not passed the Senate, which was always the major hurdle. If a final bill does pass, it may include changes, but the outline pass through the House does have several health- and health center related provisions:

Provides $2 billion for health center capital;
Provides $3.37 billion for Teaching Health Center GME;
Provides $2.5 billion for the National Health Service Corps and Nurse Corps;
Extends the higher premium subsidies on Affordable Care Act (ACA) Marketplace plans through 2025;
Closes the “Medicaid coverage gap” by enabling people below 100% FPL in non-expansion states to access free ACA Marketplace plans through 2025;
Expands Medicare to cover hearing benefits;
Permanently improves Medicaid coverage for home care services for seniors and people with disabilities; and,
Permanently authorizes the Children’s Health Insurance Program (CHIP) and makes all CHIP drugs eligible for Medicaid-like rebates.
Requires 12 months continuous Medicaid & CHIP coverage for pregnant and postpartum individual’s children; and,
Expands the 100% FMAP for Urban Indian Organizations (UIO) and Native Hawaiians to four years. Under the American Rescue Plan Act (ARPA), this provision will last only two years.

In partnership with the University of North Dakota and Project ECHO™, the ND Department of Health Oral Health Program hosted an eleven-part series focused on improving oral health in North Dakota through services provided by primary care and public health professionals. Learn more by visiting the program webpage. Topics covered in this series include:

The need to address oral health in primary care settings;
Completing pediatric dental screens in primary care settings;
Applying and billing for fluoride varnish application in a health care setting;
Talking with patients about safe drinking water, community water fluoridation, and oral health in the pediatric and young adult patient;
Screening for and discussing oral health concerns among older adults;
Importance of discussing and addressing oral health with pregnant persons;
Providing oral health care for adults who are covered by Medicaid or who are uninsured;
Preventing use of non-dental facilities for dental care in North Dakota;
Implementing medical-dental integration in North Dakota;
Working with patients who are American Indian or Native Alaskan: oral health screening, referral, and education; and,
Discussing oral health and prevention strategies with patients in non-dental settings.

If you have any questions about this ECHO series, contact Julie Reiten, the project ECHO coordinator at Julie.a.reiten@UND.edu. For specific questions about the North Dakota Department of Health Oral Health Program, contact the program director at ckiefer@nd.gov.

Securing Your Legacy

Health care organizations rely on many technical systems to deliver their services. The HIPAA Security Rule requires covered entities and their business associates to implement safeguards that reasonably and appropriately secure the electronic protected health information (ePHI) that these organizations create, receive, maintain, or transmit. As health care entities’ technological footprint grows, the number of systems these organizations need to identify, assess, and maintain grows as well. Many health care organizations rely on legacy systems, which is a term for an information system with one or more components that have been supplanted by newer technology and for which the manufacturer is no longer offering support. But despite their common use, the unique security considerations applicable to legacy systems in an organization’s IT environment are often overlooked.

Ideally, all organizations would only use information systems that are fully patched and up to date. However, in reality, health care organizations must balance competing priorities and obligations. There are many reasons why a health care organization may elect to keep using a legacy system, such as:

The organization may not be able to replace the legacy system without sacrificing the availability of data, disrupting critical services, or compromising data integrity. For health care providers, this can apply to medical devices, electronic health records, and other systems offering critical services.
The organization is reluctant to tinker with technology that appears to be working or deploy a new and unfamiliar system that may reduce efficiency or increase user errors.
The organization is reluctant to replace a system that is well-tailored to its business model or has a high degree of competence.
The organization’s other systems depend on the legacy system or are incompatible with newer systems.
The organization is unable to dedicate the time, funds, or human resources needed to retire and replace the legacy system.

While many factors may contribute to an organization’s decision to continue to use a legacy system, the organization must include security in its considerations, especially when the legacy system could be used to access, store, create, maintain, receive, or transmit ePHI.

EHI and Information Sharing for Improved Care Quality

Please register for the next webinar in the Office of the National Coordinator (ONC) for Health Information Technology’s clinician-focused webinar series on information sharing and the information blocking regulation. ONC experts will explain how ONC supports secure, appropriate sharing of electronic health information and how information sharing leads to more affordable and equitable care and improved care quality.

Wednesday, November 17
12:30 pm CT/ 11:30 am MT
Register here.

Cybersecurity CIO Roundtable: Strategic Investments in Cybersecurity for Health Centers in 2021 and Beyond

Presented by HITEQ, this final webinar in the two-session roundtable series will bring together chief information officers, chief information security officers, and other IT leaders from health centers. Speakers will discuss strategic investments in cybersecurity, including those that can leverage recent American Rescue Plan Act (ARPA) funding and sustain those investments for the future. Participants will have the opportunity to connect with each other and subject matter experts about implementation, considerations, and the future of cybersecurity and data protection in health centers.

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

Maternal Health Learning Collaborative

The CHAMPS 2022 Maternal Health Learning Collaborative will be offered on January 13, January 27, and February 10. This free series, created in partnership with the Denver Office of Intergovernmental and External Affairs, will bring together health center care team members to discuss the latest in maternal mortality and morbidity data, the impact of substance use disorders in new mothers, screening recommendations, clinical resources, and more. Visit the upcoming live distance learning events page to learn more and for registration coming soon.

Health Center Supervisors and Managers Trainings

On Wednesdays from April 27-May 25, CHAMPS will host the CORE Competencies for Health Center Supervisors and Managers training. This online intensive, aimed at newer supervisors/managers, will offer intensive, hands-on, and immediately applicable skills-building to successfully navigate management and supervisor roles in the fast-paced and challenging health center environment.

The Next Level Skills for Health Center Supervisors and Managers training on Thursday mornings from September 1- October 6, intended for more experienced supervisors/managers, will begin with a review of crucial skills needed to hire, coach, retain, and manage others. Attendees will then shift to higher-level learning to effectively engage a diverse workforce, avoid, circumvent, and de-escalate conflict, strengthen day-to-day decision-making practices, and more. To learn more about both offerings, please visit the CHAMPS leadership learning opportunities webpage.

November is National Diabetes Awareness Month. Diabetes is almost twice as prevalent among health center patients when compared to the general population. What’s more, diabetes rates are on the rise from a combination of delayed care and other barriers caused by the COVID-19 pandemic.
Community health centers, as primary care hubs, play an important role in preventing and treating diabetes. Health centers in North Dakota and South Dakota served 7,888 patients with diabetes in 2020.

Check out these resources to celebrate National Diabetes Awareness month:

Prediabetes Risk Test: https://doihaveprediabetes.org/;
US Preventative Services Task Force: Diabetes Screening Recommendations;
National Association of Community Health Centers Diabetes Change Package: PDF |Self-paced learning module; and,
Guiding Principles for the Care of People with or at Risk for Diabetes.

CHAD is currently hosting Diabetes Lunch and Learn sessions on Mondays at noon CT through November 22. Register to attend the remaining two sessions here.

Diabetes Lunch-and-Learn Training – November 2021

Diabetes is almost twice as prevalent among health center patients when compared to the general population. Moreover, rates are on the rise – a combination of delayed care and other barriers caused by the COVID-19 pandemic.

Join CHAD and the Great Plains Quality Innovation Network (GPQIN) for a diabetes lunch-and-learn series featuring health experts from North Dakota and South Dakota. The series will provide relevant updates, actionable information, and resources to primary care teams as they celebrate National Diabetes Awareness Month and work to ensure all patients receive high-quality preventative and chronic care.

Mondays, November 15 and 22
12:00 - 12:45 pm CT/ 11:00-11:45 am MT
Register here.

Transgender Awareness Week

Transgender Awareness Week is November 13-19. The Health Resources and Services Administration’s (HRSA’s) Office of Intergovernmental and External Affairs Region 2 invites you to their webinar, presented in collaboration with the New York State Department of Health AIDS Institute’s Clinical Education Initiative. Speakers will provide an overview of the most appropriate language, best practices, and key terms to use when providing quality health care to patients who identify as transgender or non-binary. With the use of case studies, attendees will be walked through the various barriers that impact access to care that is specific to the trans and non-binary communities.

Wednesday, November 17
11:00 am CT/ 10:00 am MT
Register here.