NC DHHS Launches New Format for COVID-19 Data Dashboard
Beginning on March 23, the Summary page of the NCDHHS COVID-19 Dashboard will be updated weekly on Wednesdays and will include a focus on seven key metrics:

1. Wastewater testing can detect and quantify the SARS Co-V-2 virus in community wastewater systems. This testing may be an early indicator of increases in other metrics.   

2. COVID-like illness in hospital emergency departments is a percentage of total emergency visits. It is also an early indicator of rising cases, and it warns about increasing strain on hospital capacity.  

3. COVID-19 hospital admissions, when high, can indicate strained capacity at hospitals, which may lead to difficulty caring for people with COVID-19 and for people with non-COVID-19 emergencies or elective procedures. 

4. COVID-19 reported cases reflect people who have tested positive for COVID-19. This number gives an idea of community transmission, even though it does not reflect all COVID-19 cases.  

5. Booster rates give an indication of how much of the population is up-to-date on their COVID-19 vaccinations, which is one indicator of immunity and protection against severe disease and need for hospital level care. This data is also available at the county level.  

6. A new variant, and its levels in the state, may cause a shift in the state’s response or in individuals’ choices about layered protection. 

7. The CDC’s COVID-19 community levels is based on hospital beds in use, hospital admissions and cases. This tool can help people understand COVID-19 spread in their community.

Covid Testing, Vaccinations for Uninsured at Risk as Funds End (Bloomberg Law)
Every phase of the Covid-19 pandemic has thrown Laura Owens a curveball. Now, as a result of congressional inaction, she isn’t sure how she’ll hit the latest one. Owens is chief executive officer for Carolina Family Health Centers, a group of health centers that serve eastern North Carolina and the seasonal farm workers who migrate there starting each spring. Many of the workers are entering the area in need of Covid vaccine boosters and tests, but lack insurance coverage.

With a stalemate on Capitol Hill over approving more funds to deal with the pandemic, health centers such as the one Owens runs may have to scale back Covid testing and vaccination programs if the virus again surges in the community. The federal program created to reimburse these health centers for serving the uninsured is set to stop accepting claims Wednesday. “Our options at this point are: do we try to absorb the cost of continuing our operations, or do we limit or stop our Covid testing and eventually Covid vaccination efforts,” Owens said.

Moderna to Seek Emergency Authorization for Vaccine for Young Children (New York Times)
The move comes after interim results from a clinical trial showed that volunteers under 6 had a similar immune response to young adults when given a dose one-fourth as strong.

HRSA Uninsured Claims Portal Exhausts Funding; CHCs Advised to Submit Vaccine Administration Claims By April 5 End Date
Because the program is set to exhaust funding and was not funded by Congress in the latest Omnibus Appropriations bill, the HRSA Uninsured Claims Portal for COVID-19 testing, treatment, and vaccines announced the portal will stop accepting claims as follows:

• Testing claims: March 22, 2022, at 11:59 p.m. ET

• Treatment claims: March 22, 2022, at 11:59 p.m. ET

• Vaccine administration claims: April 5, 2022, at 11:59 p.m. ET (Note: this deadline also applies to vaccine administration claims through the COVID-19 Coverage Assistance Fund for underinsured patients)

At this point in time, there does not appear to be a clear political path forward for the portal and other federal COVID-19-related funding needs to be funded. All FQHCs should plan accordingly. See these FAQs for more details.

Resources for Compliance with CMS Vaccine Mandate
The following links may be helpful as CHCs seek to comply with this mandate:

• The Federal Vaccine Mandate toolkit.  This is updated regularly with new information. 

• Easy-to-use chart of compliance deadlines – see Tab One.  This chart is also on page 6 of the toolkit, but this version is easier to read and edit.

• Flowchart for determining which staff, contractors, etc., are subject to the CMS vaccine mandate.  This flowchart (and a related FAQ) are also contained in the toolkit, but this link takes you to it directly.

• NACHC’s CMS COVID-19 Vaccine Mandate Interim Final Rule FAQ and Operational Resource Guide for sample policies and procedures. You can visit NACHC’s Employee COVID-19 Vaccine Mandate Technical Assistance webpage for more resources.

• Link to the recording and slides from Colleen’s Jan. 18 webinar discussing compliance, definitions, P&Ps, enforcement, etc. for the CMS vaccine mandate.

Requesting N95s from NC
NCDHHS requests that CHCs that are not in the HRSA mask program first request masks from their local health departments. If the LHDs don’t have any to share, proceed in the following manner:

Please request N95 masks online at https://covid19.ncdhhs.gov/RequestMasks, and requests will be prioritized.  DHHS testing and vaccine vendors can use the “Critical Infrastructure PPE Request Form.”  Under “Type of Partner”, select “Other Critical Infrastructure Partner” and the team will identify the vendors by their agency name.  Please request an amount that you believe you can distribute over the next 1-2 months.  We are grateful for your partnership in our Test, Vax and Mask strategy.  For questions or more information about N95 requests, please contact OEMSSupportCell@dhhs.nc.gov.

Drugmaker Johnson & Johnson Announces 340B Restrictions But Exempts FQHCs & Other Grantees
On March 21, drug manufacturer Johnson & Johnson (J&J) announced restrictions on 340B pricing to contract pharmacies of hospital-based 340B covered entities to take effect on May 2. Like 10 other drugmakers, J&J has decided to exempt community health centers and other 340B “grantees” from these restrictions.

Drugmaker Gilead Announces 340B Restrictions on Hepatitis C Drugs to Contract Pharmacies
Drug maker Gilead announced plans to restrict shipments of its 340B-priced, brand-name Hepatitis C drugs to contract pharmacies. All 340B covered entities, including FQHCs, with contract pharmacies are now required to register with 340B ESP and submit data by May 2, 2022 to continue receiving 340B pricing. Any covered entity that does not have an in-house pharmacy may designate one single contract pharmacy location.

This policy change will have significant financial impacts on many CHCs’ pharmacy programs, and the services supported through 340B savings. Please review NACHC’s toolkit on promising practices to mitigate the impact of manufacturer restrictions developed by health center peers.

While there is no “silver bullet” that will resolve these concerns, we would like to share the following thoughts:

In-house pharmacies:  The restrictions currently impact only Gilead’s brand-name Hepatitis C drugs dispensed by contract pharmacies, and do not impact prescriptions for these drugs filled by CHC-owned (aka in-house) pharmacies. However, CHCs are reminded that patients have the right to choose which pharmacy they go to.  For more information on this issue, see the excerpt below from the NACHC 340B Manual for Health Centers.

Generic alternatives:  There are at least four generic medications available for treating Hepatitis C – two from Gilead, Mavyret from Abb-Vie, and Zepatier from Merck.  However, there is a noticeable difference in the level of 340B savings available on the generic versions compared to the Gilead brand names.  Also, some state Medicaid plans only cover the brand-name drugs. 

Sharing data with 340B ESP:  Gilead says it will continue shipping its brand-name Hepatitis C drugs to contract pharmacies at the 340B price if the CHC (or other 340B provider) submits claims-level data to the website 340B ESP.  Since September 2020, we have strongly warned CHCs against submitting data to this website due to several risk factors. And while we feel the same today, we are aware of the mounting financial pressure CHCs are feeling and understand if CHCs are weighing providing their claims data. When deciding please consider these points below: 

• Most importantly, in the absence of comprehensive Federal anti-pickpocketing legislation, providing this data will lead to CHCs’ losing the 340B savings on those drugs. Drug makers use this data to show PBMs which drugs were purchased under 340B, so they don’t have to pay the PBMs rebates on these drugs.  In turn, PBMs “make themselves whole” by reducing reimbursement to the CE for those drugs. 

• Providing the data is time-consuming and costly, and CHCs should not be required to incur these costs in order to save drug makers money. 

• The more covered entities who submit data to ESP 340B, the more manufacturers will require them to do so (and the harder it is to argue to state and Federal policymakers that we shouldn’t be required to do so).

• Once we provide the data, we have no assurances about how it will be used – and it could likely be used in ways that further harm CHCs or their patients.

Please note that in states like North Carolina that have passed strong “anti-pickpocketing” laws, CHCs that report data to 340B ESP should be protected from “pickpocketing” on drugs dispensed to commercially insured patients.  However, they are not protected on drugs dispensed to Medicare Part D patients.  This development highlights the urgent need for Congress to pass the PROTECT 340B Act.  If that bill were law, CHCs across the country could comfortably share claims-level data with Gilead (and other manufacturers), without concerns about having their savings pickpocketed.  

Personal Protective Equipment Request Process

Request PPE here from the state of North Carolina
See PPE reports for North Carolina

Now is the time to become an NHSC site!
The 2022 NHSC New Site Application Cycle is now open for sites that have never been approved for NHSC or are currently an inactive NHSC. Why be NHSC approved? 

• Recruit and retain qualified providers using NHSC loan repayment programs and attract NHSC scholars who are ready to fulfill their service obligation at sites like yours.

• Post vacancies to the Health Workforce Connector.

• Participate in HRSA Virtual Job Fairs to connect with job-seeking primary care trainees and practicing clinicians.

Click Here to learn more.

Nurse Faculty Loan Program (HRSA 22-047): This program provides funding to accredited schools of nursing to establish and operate a student loan fund and provide loans to students enrolled in advanced education nursing degree programs who are committed to becoming nurse faculty.  

New SEP for Low-Income Households
A new Special Enrollment Period (SEP) is available to households earning 100 - 150% of the federal poverty level (FPL). Qualifying households with a projected 2022 income between 100 - 150% FPL can enroll in coverage through the Marketplace during any month of the year without having to experience a qualifying life event. Coverage for consumers who enroll under the new SEP begins on the first day of the month following plan selection. Consumers can access the new SEP by calling the Marketplace Call Center (800-318-2596) or by completing an application at Healthcare.gov. Learn more. 

Teaching Health Centers GME Program Funding Opportunity to Establish & Expand Programs
Deadline March 31, 2022
On Thursday, HRSA’s Bureau of Health Workforce announced the release of a Notice of Funding Opportunity (NOFO) to provide an additional $19.2 million in funding to support Teaching Health Centers’ Graduate Medical Education (THC-GME). The funds will support 120 full-time residents at THC-GMEs. The funding opportunity is available to both existing THC-GME programs seeking to increase the number of resident FTEs they support and to other CHCs seeking to establish a program.

Workforce Self-Care Resource Repository
The Association of Clinicians for the Underserved’s (ACU) STAR2 Center is excited to share a new resource bundle focused on self-care for the health center workforce. It is important to remember the importance of organizational support, community care, accessibility, and cultural differences. This resource repository is meant to serve as a starting point for organizations to grow their support of self-care for their workforce. ACU is a HRSA-funded NTTAP.

STAR2 Center Pay Equity Checklist: Ensure Equitable Compensation in Your CHC
ACU's (Association of Clinicians for the Underserved) STAR2 Center has developed a valuable checklist to support health center teams in holistically assessing their compensation practices to ensure they are providing equitable and effective compensation for their workforce. The checklist will help you recognize the quality of your employees' work, rather than other factors that have historically kept marginalized groups from advancement.