CHAD Connection - COVID-19 Edition May 7

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 (BPHC), the National Association of Community Health Centers (NACHC), the US Department of Labor, the Centers for Medicare and Medicaid 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 human resources guidance, federal funding updates, and mental 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, April 30 to Wednesday, May 6.

There continue to be a larger than state average number of cases in Cass and Grand Forks counties. There are 22.4 active cases per 1,000 people in Cass County and 23.9 active cases per 1,000 people in Grand Forks County. North Dakota’s average is 9.3 active cases per 1,000 people. As a result of the more significant numbers in these two counties, Governor Burgum has formed the Red River Valley Task Force. This task force’s goal is to slow the spread of COVID-19 in the Red River Valley and bring those counties closer to the state average of active cases. The task force is made up of elected representatives and state and local health officials.

Governor Burgum announced that Family Healthcare (FHC) in Fargo will be part of a more-aggressive daily testing schedule. The state realizes that drive-thru testing will miss many populations, including individuals experiencing homelessness and people who rely on mass transit, and FHC will help to mitigate some of those barriers.

The task force will ramp up testing and contact tracing, as well as deploy rapid response teams to the area. The task force is working to partner with agencies in Minnesota, considering Fargo-Moorhead is a regional economic hub, and the communities, counties, and states will need to work together to contain the virus.

The North Dakota Department of Health updated guidance on May 5 for the discontinuation of isolation for COVID-19 across health care and non-health care settings. Based on growing evidence, a symptom-based strategy is now considered acceptable.

The symptom-based strategy includes the following:

At least 10 days have passed since symptoms first appeared, AND
At least 72 hours have passed since recovery, defined as:

Resolution of fever, without the use of fever-reducing medications, AND
Progressive improvement or resolution of respiratory symptoms (e.g., cough, shortness of breath)

The test-based strategy includes the following:

Resolution of fever without the use of fever-reducing medications, AND
Improvement in respiratory symptoms (e.g., cough, shortness of breath), AND
Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected at least 24 hours apart (total of two negative specimens).

See the full health advisory for considerations on the time-based strategy and the test-based strategy for patients with laboratory-confirmed COVID-19 who have not had any symptoms.

Based on the evolving information about COVID-19 infectiousness, the South Dakota Department of Health is simplifying the existing CDC guidance on isolation discontinuation into a single uniform recommendation.

The symptom-based strategy includes the following:

At least 10 days have passed since symptoms first appeared, AND
At least 72 hours have passed since recovery, defined as:

Resolution of fever, without the use of fever-reducing medications, AND
Progressive improvement or resolution of respiratory symptoms (e.g., cough, shortness of breath)

The test-based strategy includes the following:

Resolution of fever without the use of fever-reducing medications, AND
Improvement in respiratory symptoms (e.g., cough, shortness of breath), AND
Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive nasopharyngeal swab specimens collected at least 24 hours apart (total of two negative specimens).

Considerations:

For patients with laboratory-confirmed COVID-19 who have not had any symptoms, medical providers might use either:

Time-based Strategy: At least 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test. Because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness.
Test-based Strategy: Because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. Follow the test-based strategy above with the modification that testing can begin immediately.

Medical providers might consider the test-based strategy for immunocompromised persons when there is a concern of continued shedding of the virus after recovery or for populations of individuals where there might be an increased risk of transmission and/ or morbidity and mortality from infection.

The Department of Health & Human Services (HHS) is releasing additional funds for targeted purposes, including COVID-19 high impact areas, treatment of the uninsured, rural providers, and Indian Health Services. HHS is planning further funding announcements for skilled nursing facilities, dentists, and providers that solely take Medicaid.

Funding for rural providers will have the most impact on health centers in the Dakotas, with each health center site eligible to receive a base amount of $100,000, plus an additional amount calculated as 4% of the site’s operating expenses (as reported on their 2018 Medicare cost report). The funds will be distributed within the next few days by direct deposit, and there will be a one-time reporting requirement to be defined soon. This funding is intended to help cover operating expenses and revenue loss due to the COVID-19 public health emergency. HHS indicates that they are making efforts to provide as much regulatory flexibility as they can for providers to use the funds.

Find more information about this funding on the HHS website. Find details on how HHS distributed the funds by state here.

The US Department of Labor (DOL) recently released a new final rule that temporarily extends the period in which eligible employees can elect COBRA health insurance coverage and the deadline to begin making COBRA premium payments. Along with the rule, the DOL posted a new set of COVID-19 FAQs for participants and beneficiaries.

The rule extends most COBRA deadlines beyond the “outbreak period,” which the DOL defines as March 1 to 60 days after the end of the declared COVID-19 national emergency, or another date if provided by the agencies in future guidance. For instance, if the emergency declaration expires as written on June 29, the outbreak period will end on August 28. (Currently, the emergency declaration does not have an expiration date.) There is no extension granted for the 14-day deadline for plan administrators to furnish COBRA election notices.

The new rule applies as follows:

The COBRA election period. Under COBRA, employees and dependents who lose active coverage because of a qualifying event, such as termination of employment or reduction of hours, previously had 60 days to elect continuation of coverage after receiving a COBRA election notice. Under the new rule, the 60-day timeframe doesn’t start until the end of the outbreak period.
The COBRA premium payment period. COBRA enrollees previously had 45 days from COBRA election to make the first premium payment and subsequent monthly payments within a 30-day grace period. The new rule extends the initial premium payment and grace period deadlines beyond the outbreak period.

There are still many questions on which employers and plan administrators are seeking guidance. Providing additional time for individuals to both elect and pay for COBRA coverage may create uncertainty about an individual’s coverage status. It’s also unknown when the national emergency will end. Finally, many employers are deciding how to update or revise their current COBRA forms and notification procedures and to contact former employees that have recently left under previous COBRA deadlines. CHAD will continue to provide additional guidance when available.

On April 30, the Centers for Medicare and Medicaid Services (CMS) announced an interim rule with changes related to the COVID-19 emergency. Among the changes is an allowance for health centers to provide audio-only services to their Medicare patients for the duration of the public health emergency. The updated guidance expands the number of services offered via audio-only technology to including behavioral health and patient education services. It also increases the payment for audio-only visits. The new guidance is retroactive to March 1. For more information, see the announcement from CMS here.

CMS also provided information on the distant site provision for health centers, including more detail on billing and coding services. More information can be found in a special edition of the Medicare Learning Network (MLN) Matters here.

The Office of the Assistant Secretary for Preparedness and Response (ASPR) within the United States Department of Health and Human Services (HHS) put together this curated set of resources and tools for decision-makers managing health care workforce challenges in response to the COVID-19 emergency. It provides links to tools and resource collections relating to federal regulatory and funding flexibilities, licensure and scope of practice expansions, liability protections, workforce resilience and protection, and COVID-19-related training resources. The toolkit resources can be found on the HHS website along with individual links to each topic collection.

Co-hosted by the North Dakota Rural Health Association, the Area Health Education Center, and the North Dakota Center for Rural Health, CHAD is excited to promote this workshop dedicated to the recruitment of health care professionals to rural, underserved areas. Benjamin Anderson, a former CEO of a critical access hospital in western Kansas, will share his story on how he has successfully recruited more than 15 mission-minded family practice physicians to a diverse and underserved region within a short period. He will describe the development of the mission-minded recruitment and retention model while highlighting the innovative approaches required to achieve and sustain a robust medical staff. A virtual panel of family practice faculty and residents will discuss what they are looking for in practice opportunities and share feedback about the mission-minded recruitment model. Additional presentations and discussions will include the importance of workplace culture, aligning the motivations of medical providers with the values of an organization, and community readiness and collaboration.

This event is targeted to health professionals, health care administrators and leadership, human resource professionals, and anyone interested in learning what health care professionals are looking for in an employer. Continuing education credits will be available. Find more details and registration information here.

The American Dental Association’s (ADA) advisory task force on dental practice recovery has developed a toolkit to help dentists return to more normal practice operations while taking precautions to protect staff, patients, and themselves from COVID-19 as some states reopen. The return to work interim guidance toolkit focuses on the short-term management of dental practices. It includes a sample “welcome back” letter to patients, pre-appointment screening guidance, in-office patient registration procedures, reception area preparation strategies, a chairside checklist, staff protection strategies, and a supplies shopping list. The toolkit also includes interim guidance previously released by the ADA on the personal protective equipment recommended to practice during the COVID-19 pandemic and minimize the risk of virus transmission, as well as a chart that highlights the characteristics of several common types of masks and their appropriate uses.

Areas of the country will return to practice at different times and under different circumstances. Dentists will need to use their professional judgment and consider COVID-19 cases in their area, the needs of their patients, and the availability of necessary supplies as they begin to provide elective dental care again. For all COVID-19 resources from the ADA, visit the ADA coronavirus (COVID-19) center for dentists. The ADA will continue to update its guidance as more information becomes available about COVID-19.

As Community Health Centers in North Dakota and South Dakota consider offering expanded dental services and as they begin offering those services, there have been several ad hoc conversations on about how health centers will proceed. In response to interest in a discussion that includes the range of staff involved in dental, CHAD is working with the Wyoming Primary Care Association to plan an oral health networking opportunity in early June. The date and time will be announced shortly. This will be an opportunity for health centers to share current practices, to learn from those who have begun to expand services, and to ask questions of your peers.

Homeless service provider sites (such as sites for overnight emergency shelters, day shelters, and meal service providers) can present unique challenges for COVID-19 public health action. Because homeless service provider sites can be crowded settings, the virus may spread easily. Additionally, clients at homeless service provider sites are often older adults or have underlying medical conditions, making it more likely for them to have severe complications from COVID-19.

The CDC offers guidance specific to homeless service providers and people experiencing homelessness. In addition, the Alameda County Emergency Hotel Shelter Handbook offers this tool to provide details for the general referral process, handling belongings and storage, presence of minor children, companion animals, transportation, admissions, medical monitoring, withdrawal, and medication support.

The Hotel-Hospital COVID-19 Response Playbook was developed to assist American Hotel & Lodging Association members with top-line guidance for hotels that are utilized for alternate care sites. It could be a useful reference for health centers when partnering with local hospitality establishments. The playbook provides guidelines that detail the conversion and operations of a hotel to house non-medical patients, COVID-19 crisis responders, and medical patients. The information provided is from publicly available sources, including federal agencies and governmental entities, member companies, and other leading trade associations and consultants. Additional resources are available at National Health Care for the Homeless Council.

Feldesman Tucker Leifer Fidell released an overview of the Department of Health and Human Services (HHS) claims reimbursement for testing and treatment to health care providers and facilities serving the uninsured. This document can be found on the COVID-19 Resources section of the CHAD website and includes additional details that explain the terms of the reimbursement program. Some of the main elements of the program include:

Providers considered excluded by HHS or who have had their Medicare enrollment revoked by CMS are not eligible to participate.
The program pays for testing, testing-related visits, specimen collection, and treatment for a positive diagnosis of COVID-19, including FDA-approved drugs, should they become available.
Reimbursements will be at current Medicare fee schedule rates except where otherwise noted.
Registration for this program consists of enrolling as an eligible provider, checking patient eligibility, submitting patient information, submitting claims, and accepting payment via direct deposit.
Providers must acknowledge that they may be subject to post-reimbursement audit review.
This is effective for services rendered on or after February 4. Health centers can begin submitting claims on or after May 6, with reimbursements beginning by mid-May.

The Bureau of Primary Health Care (BPHC) continues to update its health center program COVID-19  frequently asked questions. Updates published over the last week include:

Health centers seeking certification under the clinical laboratory improvement amendments (CLIA) program have increased flexibility during the COVID-19 public health emergency. The Centers for Medicare and Medicaid Services (CMS) will be expediting the review of applications for CLIA certification and will allow for testing to begin as soon as a CLIA number is assigned. CMS is also waiving the need to apply for a separate certificate for laboratory testing at temporary sites as long as the temporary site performs tests consistent with the existing certificate for the primary laboratory location. The temporary testing location must operate under the supervision of the lab director for the primary location and must comply with all existing lab policies for documentation, quality control protocols, and quality assurance procedures approved and in place in the primary laboratory location.
Clinical laboratories must also comply with any required state certification and licensure requirements. For questions regarding laboratory testing requirements for North Dakota, contact the North Dakota Board of Clinical Laboratory Practice, and for South Dakota, contact the South Dakota Department of Health: Office of Health Care Facilities Licensure & Certification.
Health centers are encouraged to work with their primary care association and local public health agencies for technical assistance resources and best practices related to addressing special population needs during the COVID-19 pandemic. Supportive and enabling services such as translation, case management, outreach, patient education, and transportation are even more critical for at-risk, vulnerable populations during emergencies. Health centers may employ and intensify existing outreach services to ensure they are meeting the needs of their patients.
Health centers have the discretion to amend policies (with board approval) and/ or modify operating procedures in response to the COVID-19 public health emergency, as long as such changes are consistent with applicable statutory, regulatory, and policy requirements.
Health centers may not have a separate sliding fee discount schedule for telehealth. However, health centers may have different charges on a fee schedule.
As part of providing health services to their patients, health centers have a role to play in COVID-19 contact tracing. Health center activities must be within the scope of section 330, should follow CDC and other applicable public health guidance, and should be coordinated as appropriate with federal, state, and local public health response efforts. CHCs participating in community-wide intervention efforts—which may include partnering with state and local health departments for contact tracing—would be operating within their scope of project, so long as the related services are conducted on behalf of the health center.
Health centers should continue to follow all applicable standards of practice, which would include CDC guidance and any additional guidance from state and local public health authorities regarding the delivery of dental services during the COVID-19 public health emergency.
HRSA’s approval of the temporary service site will automatically expire 90 days after the temporary service site’s approved effective date. To request an extension to operate a temporary site beyond 90 days, contact your Project Officer by email or phone.
Health centers should consult with their state and local health departments regarding what diagnostic tests may be purchased and used for COVID-19 testing.

The last episode of Today with Macrae was held on Monday, May 4. Slides from this episode are available on the Health Resources and Services Administration (HRSA) website. Highlights from this broadcast include:

Funding

CARES Act supplemental funding (H8D) budget narratives and reports are due in EHBs by 10:59 pm CT on Friday, May 8.
Expanding capacity for coronavirus testing funding (H8E) will be available for immediate drawdown with submissions due at a later date. There is $600 million to be distributed first to FQHCs, and then to FQHC Look-Alike organizations. This funding is intended for personnel and equipment or supplies costs related to increasing capacity for coronavirus testing.

Health center survey data overview

COVID-19 testing turn-around-times

3% within 12 hours or less
13% within 12-24 hours

Total number of tests done by health centers is 81,000

54% of these were ethnic and minority patients

Health center visits have increased slightly from the previous week
Telehealth visits have increased
Adequate supplies of PPE have increased

Heat maps were shared on the slides for this broadcast to illustrate:

Health centers with COVID-19 testing capacity;
Health centers with walk-up/drive-up COVID-19 testing capacity;
Sites temporarily closed due to COVID-19;
Health center staff unable to work due to COVID-19; and
Percent of virtual care visits.

BPHC has the approval to make updates to the 2020 Uniform Data System (UDS) tables to reflect the impact of COVID-19 and will issue a webinar to cover the reporting changes on Thursday, May 7, at 11:00 am MT/ 12:00 pm CT. Click here to register. CHAD will provide more detail to members following this webinar.

Self-compassion is something that many people rarely afford themselves. It is not the same thing as self-care, although self-care is part of it. Self-compassion is more than just going for a mani/pedi with friends or taking a luxurious bath; it is about kindness to oneself on a much more personal level.
Right now, many health care professionals are feeling pushed to their limits. This can not only affect how we treat others, but also how we treat ourselves. We can become very self-critical and give ourselves no grace to make mistakes.

Dr. Kristin Neff is a leading researcher and expert on self-compassion. Providers often hear that as caregivers, they must take care of themselves first to be effective in treating patients. Click here for an online quiz to see how you are doing in the area of self-compassion. After finishing, ask these questions.

What new insights did I gain?
Am I surprised by the amount of self-compassion or self-criticism I experienced?
Are there areas in my life where I can show more self-compassion?

Knowing this information can help target areas to begin to build self-compassion. Visit Dr. Neff’s website to find more information to develop more self-compassion.

National Women’s Health Week (NWHW) is a weeklong health observance led by the U.S. Department of Health and Human Services’ Office on Women’s Health. The week May 10-16 serves as a reminder for women and girls, especially during the outbreak of COVID-19, to make their health a priority and take care of themselves. It is extremely important for all women and girls, especially those with underlying health conditions, such as hypertension, diabetes, obesity, cardiovascular and respiratory conditions, and women 65 years and older, to take care of their health now. NWHW is a great time for community health centers to remind patients that telehealth appointments available, and they are committed to ensuring that health coverage status and ability to pay are never barriers to receiving care.

2020 Uniform Data System Reporting Requirement Changes

Join the Health Resources & Services Administration (HRSA) for a presentation on the changes to the calendar year 2020 Uniform Data System (UDS) reporting. The reporting window will be open Friday, January 1, 2021, to Monday, February 15, 2021. They will provide an overview of the changes and a question and answer session. For additional information, see here.

Key reporting changes include:

Addition of HIV screening measure (CMS349v2);
Addition of prescription for Pre-Exposure Prophylaxis (PrEP) international classification of Diseases (ICD) 10 codes and current procedural terminology (CPT) codes; and,
Revision of Appendix D to capture information on prescription drug monitoring programs and social determinants of health.

Thursday, May 7
11:00 am – 12:30 pm MT/ 12:00-1:30 pm CT
Register here

Flattening the COVID-19 Curve: Strategies for Testing in a Public Health Crisis

The National Association of Community Health Centers (NACHC) will hold one final webinar in their Leading in a Crisis series. This webinar will begin with updates from NACHC, CDC, and HRSA/BPHC. Health center leaders from Christ Health Center in Alabama will share their testing strategies and innovations, testing technologies, and community and partner engagement. AllianceChicago will also speak about collecting data in the COVID-19 response.

Thursdays, May 7
11:00 am MT/ 12:00 pm CT
Visit NACHC’s website to register or view past recordings.

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.

Implementing Teledentistry During COVID-19

During this national emergency, teledentistry has become an emerging strategy to continue providing preventive dental care and triage for dental emergencies. Presented by the National Network for Oral Health Access, attendees will learn from subject matter experts on effective implementation strategies for teledentistry. Then, three health centers will share their experience in teledentistry during COVID-19, including their lessons learned and specific state regulations. 1 CDE will be offered.

Tuesday, May 12
1:00 pm - 2:15 pm MT/ 2:00 pm - 3:15 pm CT
Register here

The Power of Rural

This final presentation in the two-part webinar series is presented by the Wyoming Telehealth Network (WyTN). Participants can submit questions in advance here.

Cybersecurity, Not an Afterthought
Presented by Cyber Wyoming, this webinar will teach participants to spot phishing emails, obtain a phishing policy template, and identify the next steps to embed cybersecurity throughout your organization.

Wednesday, May 13
12:00 pm MT/ 1:00 pm CT
Register here

COVID-19 Dental Clinic Reopening Listening Sessions

As many states lift stay-at-home orders for COVID-19, dental clinics are preparing to reopen and resume non-emergency dental services. The National Network for Oral Health Access is hosting listening sessions to give health center dental programs the opportunity to have an open discussion with colleagues. Participants can listen and share plans and strategies on reopening dental clinics with their peers.

Wednesday, May 20
12:00 pm MT/ 1:00 pm CT
Register here

Thriving in an Online Work Environment

The 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.