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 in order to adequately cover COVID-19-related news and updates for our members. We are 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), and the Departments of Health in both North Dakota and South Dakota. You will also find information we thought would be useful, including telehealth billing and coding guidance, legislative updates, direction for human resources and employment law, and communication resources.

Billing and Coding for Telehealth Services Webinar – Friday, April 3
Please join CHAD for an interactive training on telehealth billing, coding, and reimbursement, and the latest updates on coverage for services delivered through telehealth on Friday, April 3 from 12:00pm – 1:15pm CT.

Shellie Sulzberger from Coding and Compliance Initiatives will present a training to cover the details of recent telehealth billing and coding changes as a result of the CMS rule implemented to increase flexibility during this public health emergency. The presenter will cover important definitions used in telehealth and the different applications of telehealth visits. She will also address state-specific Medicaid changes for North Dakota, South Dakota, and Wyoming, as well as updates to Medicare rules. She will complete her presentation with an overview of ICD-10 coding for conditions tied to COVID-19 symptoms and diagnoses. The training will include time for Q & A.

CHAD has also invited representatives from Medicaid offices in ND, SD, and WY for Q & A. The training will include virtual breakouts for participants to ask state-specific questions on Medicaid reimbursement services delivered via telehealth. Click here
to register.
North Dakota Insurance Department Bulletins
The North Dakota Insurance Department issued several bulletins to guide insurance coverage for both insurance providers and consumers during the COVID-19 pandemic. The first bulletin addressed coverage for COVID-19 testing. The department has asked insurance carriers to ensure there are no barriers to testing and treatment for COVID-19, specifically to waive any cost-sharing, including co-pays deductibles and co-insurance for COVID-19 testing and provider visits. Insurance carriers are also being asked to make sure they can meet the increased demand for telehealth services. There are other provisions in the first bulletin included waiving prior authorization, access to prescription drugs, and protections to the insured against surprise medical bills. A third bulletin was issued ordering insurance companies to follow the same telehealth guidance issued by the Centers for Medicare and Medicaid Services. For more information on health insurance and COVID-19, visit the ND Insurance Department’s website.
North Dakota and South Dakota Medicaid Updates
North Dakota
North Dakota Medicaid is requesting assistance from Medicaid providers on this brief survey. Click here to find the survey. The survey will be used to determine the short-term impact COVID-19 has on ND Medicaid’s enrolled providers. The deadline to complete the survey is April 10.

North Dakota Medicaid is hosting a webinar on Friday, April 3rd from 1-2pm CT. The webinar will provide updated information and answer Medicaid related questions concerning Medicaid services and COVID-19. The webinar can be accessed here and will be recorded for later viewing here.

North Dakota Medicaid hosted a call on Friday, March 27, to give an update on the Families First Coronavirus Response Act, which included a section on the Federal Medicaid Assistance Percentage (FMAP). The FMAP for each qualifying state will temporarily increase by 6.2%, beginning January 1, 2020. Other updates included enrollment changes.

They also provided updates on the response to the 1135 waiver request. The response from the Centers for Medicare and Medicaid (CMS) can be found here. Many of the 1135 waiver requests from North Dakota Medicaid were approved. The provisions that weren’t approved were anything that required an update to the state plan, such as a reprieve from the primary care case management (PCCM) program which requires that patients receive primary care from their assigned primary care provider or get a referral. CHAD has communicated the importance of relief from this provision to Medicaid leaders in North Dakota.

South Dakota
Department of Social Services offices in South Dakota are closed until May 2. DSS asks that whenever possible, providers use the Medicaid Portal. South Dakota Medicaid received a response to their 1135 waiver request to CMS on March 29. DSS will continue to work with CMS to clarify flexibilities that were requested but not directly answered in the CMS response. CMS’s answer to South Dakota’s 1135 waiver can be found here. 
Medicaid Continuous Eligibility During Public Health Emergency
The Families First Coronavirus Response Act includes a mandate that all Medicaid members eligible for benefits on March 18 remain eligible through the end of the month when the COVID-19 public health emergency is no longer in effect. This means that Medicaid members will not be terminated for failure to return verifications or for income changes during this time. Click here for an updated memo from the Center on Budget and Policy Priorities on how states can maximize Medicaid to address the impact of COVID-19.
Families First Coronavirus Response Act Employment Guidance
The US Department of Labor’s Wage and Hour Division (WHD) has published more guidance to provide information to employers about the Families First Coronavirus Response Act (FFCRA) that went into effect on April 1.

The latest round of guidance includes
questions and answers addressing critical issues such as the definition of a "health care provider" and the scope of the small business exemption for purposes of exclusion from the provisions of the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act.

This guidance adds to a growing list of compliance assistance materials for employers, including a
fact sheet for employers, and a required poster, as well as questions and answers about posting requirements, and a field assistance bulletin describing WHD’s 30-day non-enforcement policy.

Each state has also expanded its guidance on unemployment insurance with the passing of the COVID-19 stimulus bill, dubbed the CARES Act. One major part of the law expands unemployment insurance to offers recipients an additional $600 a week for up to four months on top of what their state programs pay. Visit each state’s website, North Dakota Unemployment Insurance FAQ and South Dakota Reemployment Assistance Program for more information.
COVID-19 Operations Resource Packet
Health centers are serving on the frontline, providing critical health care services in communities dealing with COVID-19. The National Association of Community Health Centers (NACHC) has provided a COVID-19 operations resource packet that provides sample procedures for health center drive-thru clinics. This packet contains procedures developed by or contributed to by health centers that are currently implementing drive-thru COVID-19 screening clinic sites. These materials are offered as general samples for health centers to consider as they determine the most tailored operations appropriate for their organization, staff, patients, and community. CHCs should also refer to applicable state, local, and organizational regulations. Health centers may be considering drive up, drive-thru, or walk up COVID-19 screening/testing sites.

Enclosed in this packet are:
  • Scripts for patient phone calls;
  • Drive-thru clinic procedures;
  • Patient screening tool;
  • Patient self-monitoring tool; and
  • Sample budget for drive-thru clinic
Bureau of Primary Health Care Updates
On March 27, Congress authorized $1.32 billion for health center COVID-19 response. It is the intention of Bureau of Primary Health Care (BPHC) staff to make those resources available to health centers by mid-April. The distribution allocation will be similar to that for the previous $100 million (health centers received those allocations on March 24). There will be a base funding level and then additional resources for number of patients served and number of uninsured patients. The second allocation will also cover expenses going back to January 20, 2020. The second allocation will be more broad than the first and will enable health centers to address revenue losses due to COVID-19 and will be focused on enabling them to maintain capacity over the next several months.

Health centers have completed their first COVID-19 survey. BPHC plans to release the data publicly to share national and state results. They will share additional information with CHAD regarding specific health centers. In response to further input, the Bureau will be changing the survey questions and protocols starting the week of April 10. They will move to once per week reporting. The new question set is here.

Please note: BPHC is planning to reach out directly to health centers regarding current testing capacity. They are asking that you please be quickly responsive to the request for information.

The Health Center Program COVID-19 Frequently Asked Questions on the Bureau of Primary Health Care (BPHC) webpage were updated with responses to many new questions as of Tuesday, March 31. Click here to view the comprehensive list of FAQs.

Health centers will use the same PIN they use to access their H80 grant funding through the Payment Management System (PMS).

The National Health Service Corps and Nurse Corps: Coronavirus (COVID-19) Frequently Asked Questions is a resource site for anyone currently placed or scheduled to be placed to find the most current information about these programs and their response to COVID-19.

  • Health centers’ diabetes action plans and related reporting are being postponed for the next quarterly submission. Health centers with active diabetes action plans from 2019 operational site visits (OSVs), or action plans associated with forthcoming 2020 OSVs, should work with their project officer to discuss a timeframe for quarterly diabetes action plan reporting that is feasible for the health center.

  • Temporary sites not currently within the scope of project, such as tents, modular units, or trailers, may be added by providing key information to your project officer by email or phone.  HRSA has developed a streamlined process for adding temporary sites during emergencies, which is described here.

  • HRSA approval is not required for the provision of in-scope health center services at the following locations if these locations are already within your approved scope of project and already documented on Form 5B or Form 5C:

    • A health center service site (on Form 5B), including any new modular units, tents, or trailers on the grounds of the 5B site;

    • Mobile units (on Form 5B), including delivering in-scope services via mobile units at additional locations in the health center’s service area;

    • Home visits (on Form 5C) to health center patients, including visiting health center patients in assisted living facilities and nursing homes; or

    • Portable clinical care or health fairs (on Form 5C), where health center staff conduct clinical care or COVID-19 testing outside of health center sites (for example, conducting screenings, testing, or consultations in a parking lot or on the street to individuals experiencing homelessness). These activities may be coordinated with state or local health departments or other community providers as long as these services are provided on behalf of the health center.
Cyber Threats and IT Security
Just like COVID-19 is spreading across the globe, computer viruses are also on the rise and infecting computer systems at increasing rates. Cybercriminals are aware that during times of crisis, organizations may not be as diligent on security. They will target and prey on staff’s fears and curiosity for additional information to find a weak link to exploit. Health centers are especially vulnerable because of the sensitive data stored within their systems. Now is a good time to remind staff to be more diligent on security, especially COVID-19-related phishing attempts and scams.

COVID-19 is also impacting the way organizations operate, including allowing staff to work remotely to help flatten the curve and protect employees from COVID-19. But most organizations are not adequately prepared for large numbers of employees to be remote for long periods, which increases the security risk. Now is a good time for organizations to review and update their procedures and policies for working from home. Part of this includes confirming that the IT infrastructure is set up to allow staff to work in a secure and protected environment. Read more about ensuring securing across a remote workforce here.
Free Rural Health COVID-19 "Call First" Communications Toolkit
Rural health leaders have been working diligently on communications regarding important issues such as social distancing, handwashing, and overall messaging around practices to flatten the curve. An additional concern is taking all steps possible to not overburden rural health care facilities while demonstrating leadership in communities to promote a sense of vigilance and an environment of security and calmness.

In this spirit, the National Rural Health Association (NRHA), through donated services of partner Legato Healthcare Marketing, is providing free access to a communications toolkit -- designed to allow customization and branding -- with messaging focused on:

  • Calling first to determine if you should be seen
  • Your rural hospital/clinic is taking a leadership role to protect your community

Toolkit components include items such as print and digital ads, radio scripts, social media posts, and media materials. Legato is donating its services not only for the production and use of these materials, based on CDC messaging and input from a rural health task force but also for complimentary assistance in helping to download materials.
American Cancer Society and CareMessage Partnership
for Health Centers
With the continued impact of COVID-19 across the US, safety net organizations need expanded capability to disseminate real-time information to and collect data from hundreds or thousands of patients on a regular basis. The American Cancer Society is proud to partner with CareMessage, the largest 501(c)(3) not-for-profit patient engagement organization in the United States, on an initiative to address this need. CareMessage focuses solely on the underserved with more than 200 safety-net provider partners in nearly 40 states and nearly four million active underserved patient users. In the last two weeks, CareMessage has enabled over 100 of its FQHC, FQHC look-a-like, and Free & Charitable Clinic partners to send over 3.65 million messages related to COVID-19.

Together, the American Cancer Society and CareMessage are offering safety net providers:

  • FREE use of CMLight for at least 60 days: Through the generosity of major philanthropic donors, CareMessage has released CMLight, a COVID-19-only version of its texting platform, made available at no cost for 60 days to any health center that isn’t currently using CareMessage. No EMR integration is required to use this version of the platform, and setup takes one hour.

  • FREE COVID-19 Message Templates for any organization, regardless of if they are using CareMessage. Best practices are updated daily based on insights and trends from our existing customers.
Moral Injury and Its Impact on Healthcare Providers
During COVID-19
The term "moral injury" was first used to describe the experiences that soldiers sometimes have when they must watch, participate in, or hear about situations that deeply conflict with their sense of morality. As the journalist Diane Silver worded it, moral injury is "a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society."

For soldiers, some of their moral injury has been related to the act of taking a life, or lives. For health care workers, it is about the inability to save lives or provide what they believe is good health care. During this COVID-19 crisis, health care providers have described their worry about having to decide which patient lives or dies based on the equipment available. They have grieved over the need to deny family members the ability to say goodbye to loved ones face-to-face.

Some health care providers have shared that they think about quitting, only to feel a sense of moral guilt. They describe the pull of wanting to be with their families during these intensely frightening times and yet feeling called to help others. These feelings and thoughts are normal, given the highly unusual circumstances that everyone is experiencing.

Community health centers have tremendous talent, creativity, and can function as a team better than anyone. To combat moral injury and continue to provide the best servies, they must seek support and practice self-compassion.
Webinars & Meetings
Find these and other events on the CHAD website.

Leading in the Crisis: Flattening the COVID-19 Curve
Planning, Managing, and Caring for the Workforce Now and in the Future

Leaders from NACHC, CDC, and HRSA/BPHC will provide critical updates for health centers. Attendees will also have the opportunity to hear from health center leaders on successful operational strategies for staffing and leadership team functions during this critical time. This webinar is a part of NACHC’s on-going COVID-19 webinar series designed to address health centers’ most pressing questions.

Thursday, April 2
11:00am MT/ 12:00pm CT
Link to Join

The webinar transcript and recording will be made available at:
Clinical Management of Critically Ill Adults with COVID-19
During this CDC clinician outreach and communications activity (COCA) call, clinicians will provide an overview of the clinical characteristics of COVID-19 patients, including case presentations of critically ill adults and clinical management challenges, and summarize recently published guidelines on clinical management of critically ill adults.

Thursday, April 2
12:00pm - 1:30pm MT/ 1:00pm - 2:30pm CT
For more information or to register, click here

Billing and Coding for Telehealth Services
Shellie Sulzberger from Coding and Compliance Initiatives will present a training to cover the details of recent telehealth billing and coding changes as a result of the CMS rule implemented to increase flexibility during this public health emergency.

Friday, April 3
11:00am – 12:15 MT/ 12:00pm – 1:15pm CT
Click here
to register
North Dakota Medicaid Services and COVID-19
The meeting will include update on a disaster Medicaid state plan amendment submitted to the federal Centers for Medicare and Medicaid Services (CMS) to temporarily amend the existing Medicaid state plan due to the COVID-19 pandemic. Department officials will also discuss online resources available for providers and members and share updates on provider enrollment and Medicaid temporary eligibility policies.

Friday, April 3
12:00 pm MT/ 1:00 pm CT
The webinar will be available through Skype video conference at
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 7 (reoccurring)  
2:00pm MT/ 3:00pm CT
Contact to be added to these meetings.   

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, infection preventionists, long-term care facilities, EMS providers, and other health professionals.

Thursday, April 9 (reoccurring)
10:00am MT/ 11:00am CT
Click here to join the meeting

Technical Assistance for COVID-19 Supplemental Funding for Health Centers
HRSA recently awarded $100 million through the FY 2020 as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act. 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.

The COVID-19 award is a separate grant (H8C) from the H80 operational award.
This tutorial describes how award recipients can add the H8C grant folder to their HRSA electronic handbooks (EHBs) portfolio.  

HRSA will host two 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.

COVID-19 Supplemental Funding for Health Centers Q&A Session #1
Wednesday, April 8
12:00-1:00 pm MT/ 1:00-2:00 pm CT
Join the webcast the day of the session
Call-in: 888-790-3515
Passcode: 5509950

COVID-19 Supplemental Funding for Health Centers Q&A Session #2
Friday, April 17
12:00-1:00 pm MT/ 1:00-2:00 pm CT
Join the webcast the day of the session
Call-in: 888-469-2076
Passcode: 6250835

CHAD Network Team Meetings

Thursday, April 2 at 3:00pm CT
– Great Plains Health Data Network (GPHDN) Telehealth: Zoom

Friday, April 3 at 10:00am CT – GPHDN Telehealth: WebEx, updox,

Thursday, April 9 at 11:00am CT – Human Resources (weekly)

Tuesday, April 14 at 2:00pm CT - Marketing and Communications

Wednesday, April 15 at 12:00pm CT - Clinical COVID-19 response call (bi-weekly)

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