CCHN has created this page for CHCs to gather and provide up to date information related to the COVID-19 public health emergency. If you have any suggestions for this page or specific questions please don’t hesitate to reach out to anyone at CCHN.
CARES Act Summary and Resources
This document provides available information on the $2 trillion Coronavirus Aid, Relief and Economic Security Act – the CARES Act. This document is under development and will be updated as information is released.
CCHN Summary of State and Federal Policies for CHCs re: COVID-19 Response
This document is a summary of state and federal policies recently enacted to help in the response to the novel coronavirus, COVID-19. The policies summarized here include executive orders, directives, emergency rules, legislation, and other official guidance that impacts Colorado’s CHCs and their operations and funding. CCHN staff are updating this document regularly.
Click on any of the below for additional resources and information
(Last Updated: March, 23, 1:04 PM)
FAQs from Office of Pharmacy Affairs: The Office of Pharmacy Affairs (OPA) has posted FAQs on the 340B pharmacy program as it relates to COVID-19. Importantly, they indicate no flexibility in the definition of patients. However, there is guidance related to the 340B pharmacy program and telemedicine, included below:
- Given the coronavirus 2019 pandemic, what flexibilities are available to entities to allow a provider to offer telehealth services? HRSA understands that the use of technology in health care delivery during this time is critical, and that telemedicine is merely a mode by which the health care service is delivered. For the 340B Program, HRSA recommends that covered entities outline the use of these modalities in their policies and procedures and continue to ensure auditable records are maintained for each eligible patient dispensed a 340B drug.
340B Flexibilities During Disasters: This page provides guidance for 340B providers participating in relief efforts during a declared public health emergency. Provisions of the guidance include:
- In a declared emergency, an abbreviated health record may be adequate for purposes of the 340B Program.
- In the event of a declared emergency, where volunteer health professionals are providing health care, emergency documentation should be generated to make the relationship between the provider and the covered entity clear and to make clear the covered entity’s responsibility for providing care.
(Last Updated: March, 19, 12:15 PM)
NACHC Action Alert March 16: Our nation is in a state of emergency and Community Health Centers (CHCs) are again on the front lines implementing preventive and protective practices. Congress has counted on CHCs for over 50 years to care for people in medically underserved communities — over 29 million patients this year. Ask your Senators to declare their support by signing onto the bipartisan Wicker-Stabenow Health Center Program funding letter by March 20. As health center advocates, we must remind Congress that our partnership in the fight against the novel coronavirus depends upon them to pass crucial funding. Click here to contact your Senators today.
The Health Center Response to COVID-19: Blog post from NACHC
(Last Updated: March 31, 9:18 AM)
Ag Worker Access Campaign Task Force Resources: COVID-19 resources compiled by the National Center for Farmworker Health include Voucher Program meeting notes; COVID Resources from NC and PA, including guidelines, protocols, and a Letter to Grower; HRHCare Transportation sample protocols; Indigenous Language resources; FJ letter sent to DOL, DOS, and DHS outlining recommendations to protect H-2A workers from COVID-19; and UFW articles. Resources will continue to be added as they are made available.
COVID-19 Resources for Agriculture: Resources from the UC Davis Western Center for Agricultural Health and Safety related to COVID-19 as it affects agricultural workers, including frequently asked questions for growers and farmworkers, and audiovisual COVID-19 videos in Mixteco and Spanish.
(Last Updated: March, 20, 8:15 AM)
Billing Information: Updates on policies, codes and other important information for providers will be posted on the new COVID-19 Provider Information web page. Communications will continue to be sent out via bulletins and newsletters. Please sign up for updates on the Provider News web page.
Providers Who Bill for Laboratory Tests: New HCPCS codes U0001 and U0002 have been released for dates of service on or after February 4, 2020. Providers who test members for the 2019 Novel Coronavirus (COVID-19) using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill using code U0001. Providers may use code U0002 to bill for non-CDC laboratory tests for COVID-19. Billing with these specific codes will allow for better tracking of the public health response for COVID-19. Claims for U0001 and U0002 will initially suspend for EOB 0000 – “This claim/service is pending for program review.” Suspended claims will be released when the Colorado interChange is updated.
(Last Updated: March, 24, 5:05 PM)
Health Center Boards and Novel Coronavirus (COVID-19) – resource from NACHC
This document discusses how health center boards are exercising their governance duties related to COVID-19. Examples include ensuring there are plans in place, considering resource needs and long-term strategic implications, ensuring they can stay connected and continue to meet monthly, and continuing to serve as community ambassadors The full document is available here.
(Last Updated: March, 19, 1:20 PM)
Colorado Department of Public Health and Environment (CDPHE): Coronavirus Disease 2019 (COVID-19) in Colorado
The Colorado Department of Public Health and Environment (CDPHE) has assemebled COVID-19 resources for healthcare providers and local public health agencies. This includes information on the following:
- Patient care
- Emergency medical services
- Long-term care facilities
- Water quality
- Veterinarian practices
(Last Updated: March, 19, 3:29 PM)
NACHC Sample Drive Thru Clinic Resources: The National Association of Community Health Centers (NACHC) has put together a resource packet CHCs can utilize for drive thru clinics. The packet includes a script for patient phone calls, sample procedures, a patient screening took, a patient self-monitoring tool, and a sample budget for setting up a drive through clinic. Find the resource here.
(Last Updated: March, 20, 8:15 AM)
DOI Regulation Creates a Special Enrollment Period for COVID-19
The Colorado Division of Insurance (DOI) released Emergency Regulation 20-E-02 which creates a special enrollment period (SEP) due to COVID-19. The SEP allows uninsured Coloradans to enroll in health insurance through Connect for Health Colorado from March 20 – April 3, 2020. Coverage will be effective starting April 1, regardless of when someone enrolls during the SEP. Only people who are currently uninsured are eligible to enroll. Uninsured spouses and children will be allowed to enroll even if one spouse or a child’s parent is already insured. Connect for Health Colorado developed a step by step job aid for assisters and brokers to use when enrolling customers in coverage.
Guidance from FTLF on FTCA Coverage for COVID-19 Work: On March 20 FTLF hosted a webinar to address common questions related to FTLF and COVID-19. CCHN’s full notes from the call can be found on CCHN’s members page, here.
(Last Updated: April, 2, 1:31 PM)
Novel Coronavirus (COVID-19) Information and Resources for Community Health Centers from NACHC, available here. The website includes advocacy alerts, important updates and FAQs, and sign up for a the COVID-19 networking group.
Novel COVID-19 Frequently Asked Questions: HRSA published a list of FAQs for CHCs and PCAs in addressing the coronavirus. These questions are updated frequently. Recent answers include:
- HRSA has extended the deadline for the 2021 FTCA deeming application to July 13, 2020. The application will still open in the EHB on April 13.
- HRSA will consider the impact of the COVID-19 public health emergency on the ability of health centers to demonstrate compliance with Health Center Program requirements when making future compliance determinations.
- Diabetes action plans and related reporting are also being postponed for the next quarterly submission.
- HRSA has issued a particularized determination that clarifies eligibility for FTCA coverage during the COVID-19 pandemic. It applies to grant-supported health services to prevent, prepare, or respond to COVID-19 to individuals who are established or non-established patients of the health center, whether in person at the health center, offsite, or via telehealth.
COVID-19 Grantee FAQs: HRSA has posted a list of FAQs for grantees, available here. Questions answered include:
- Will HRSA extend the deadlines for our grant competition since many organizations have been impacted by COVID-19 and have not been able to focus on grant applications?
- My project period is expiring soon. What can I do if additional time is needed to complete previously approved activities on my grant award?
- I may not be able to submit my Non-Competitive Continuation progress report on time. Should I request an extension?
- Can we use grant funds to pay salaries for staff on the budget who are not in the office due to closures because of COVID-19?
(Last Updated: March, 30, 1:03 PM)
ECRI COVID-19 Resource Center: This site includes preparation and patient handling checklists, equipment and alternative supplier lists, patient care equipment evaluations, including portable ventilators, recommendations for infection control, and links to Centers for Disease Control and World Health Organization. Some resources of note:
- List of PPE alternative suppliers
- ECRI Guidelines Trust will have access to updated COVID-19 guidelines (a log in is required)
- Disinfectant Guidelines
- Outbreak Preparedness and Response: The Essentials
- Access the full page here
Updated Infection Control Toolkit from ECRI (Requires a free ECRI Login). The toolkit includes:
- Comprehensive Checklist and Resources: What You Can Do Right Now to Respond to COVID-19
- Brief Checklist: What You Can Do Right Now to Respond to COVID-19
- COVID-19 Triage Algorithm: In-Person Triage
- COVID-19 Triage Algorithm: Telephone Triage
How to optimize PPE: Due to the limited supply of PPE and the unknown availability of additional resources through the State EOC, it is imperative to optimize the use of PPE or utilize the following alternative suggestions to PPE. The following four links provide information on the optimization and alternatives to PPE:
Coronavirus COVID-19 resources from the Centers for Disease Control
- Click here for the most recent updates.
- Here are Exposure Guidelines for health care workers. This document shares the need for PPE and how to prevent exposure to COVID-19.
Tools for monitoring staff symptoms
- This resource, from UMC, is a protocol for staff regarding how they should respond when returning from travel and if an employee gets sick.
- Below are two examples of staff self-certification forms for staff to use related to COVID-19.
- Below are two examples of staff screening procedures from Washington
(Last Updated: March, 26, 4:02 PM)
COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance From SAMHSA: The increased need for telehealth services during the COVID-19 public health emergency has led to instance in which providers may not be able to obtain written patient consent for disclosure of substance use disorder records. In these cases the prohibitions on use and disclosure of patient identifying information under 42 C.F.R. Part 2 would not apply to the extent that, as determined by the provider(s), a medical emergency exists. The full guidance from SAMHSA is available here.
DEA Regulations: Providing MAT via Telemedicine During COVID-19: For the duration of the designated public health emergency, practitioners with a DATA 2000 waiver may issue prescriptions for buprenorphine and other controlled substances to patients for whom they have not conducted an in-person medical evaluation, with provisions:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
- The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system*; and
- The practitioner is acting in accordance with applicable Federal and State laws.
See details here.
*Federal guidance currently includes only audiovisual (video) systems. CCHN is actively seeking guidance on whether MAT via audio-only (telephonic) meets these provisions and will provide an update when available.
ASAM National Practice Guidelines – OUD and Alcohol Withdrawal Management: ASAM released updates in March 2020 to the following guidelines:
- National Practice Guideline for the Treatment of Opioid Use Disorder
- ASAM Guideline on Alcohol Withdrawal Management to include non-benzodiazepine methods of withdrawal management
- ASAM also convened the ASAM Caring for Patients During COVID-19 Task Force, which is working to produce resources around telehealth, adjustments to drug testing protocols, and infection mitigation. Visit ASAM’s COVID-19 page here.
HRSA Supplemental Integrated Behavioral Health Services (IBHS) Funding: CHCs with IBHS awards should continue work related to these funding requirements. While BPHC is trying to provide flexibility with how grant funds are used, the IBHS supplemental funding should continue to be used for its intended purpose.
(Last Updated: April 2, 1:40 PM)
Colorado Health Services Corps Contract Obligations: The Primary Care Office has shared with CCHN that any disruption to normal practice time directly related to the COVID will “count” under the CHSC provider direct care contract requirements for the time being. If furloughs or layoffs occur, then the PCO will suspend contracts for up to a year. Given the extraordinary disruption all this has caused, they will reassess whether a year suspension is sufficient for folks to get back to work at a later date.
Message on NHSC and Nurse Corps: HRSA understands the COVID-19 outbreak will have a direct impact on our National Health Service Corps and Nurse Corp clinicians and sites. We are committed to providing flexibility to allow our clinicians and sites to focus on facing this unprecedented public health emergency. NHSC or Nurse Corps participants may encounter situations directly related to COVID-19 that might impact their ability to complete their service obligation. The NHSC and Nurse Corps have mechanisms in place to ensure that, in the event of an emergency or disaster, participants are able to remain in compliance with their service obligation. Participants whose circumstances change – for example, they are required to be away from their approved service site more than the allotted seven weeks per service year; they become unemployed as a direct result of the outbreak; or they are directed by their employer to provide care outside of the NHSC approved site – should contact a program analyst immediately via the customer service portal for assistance. We will continue to update you on additional provisions relating to your NHSC or Nurse Corps service. Thank you for your commitment to providing care to the nation’s underserved communities.
- At the discretion of the NHSC or Nurse Corps site/institutions loan repayment recipients can request approval for shifting their clinical service to telehealth to accommodate infection control, social distancing, or other appropriate measure to assist in meeting recommended outbreak reduction/control measures. Additional details on this and other flexibilities are available on the NHSC COVID-19 FAQs page.
(Last Updated: March 25, 4:14 PM)
OIG Portal for COVID-19 Resources: OIG created a portal for all information and announcements related to COVID-19. The portal can be accessed here.
(Last Updated: April 2, 10:40 AM)
For information about teledentistry, please visit CCHN’s dedicated page for telehealth resources and click on “Telehealth – Dental.”
American Dental Association:
- Coronavirus Frequently Asked Questions
- *New* Interim Guidance for Minimizing COVID-19 Transmission (Updated 4/1/2020)
- *New* Flowcharts for Triaging Emergency and Urgent Dental Care (Updated 4/1/2020)
Colorado Dental Association: COVID-19 Guidance for your Practice
National Network for Oral Health Access: COVID-19 Resources
Centers for Disease Control and Prevention (CDC): CDC Guidelines for COVID-19 in Dental Settings
(Last Updated: April, 3, 10:14 AM)
This webpage from OSHA provides information for workers and employers about COVID-19. The information includes links to interim guidance and other resources for preventing exposures and infection. Resources available on the page include:
- Key OSHA standards for COVID-19
- Hazard Recognition
- Medical Information
- Control and Prevention
(Last Updated: March, 19, 1:45 PM)
COVID-10 Just-In-Time ECHO for Primary Care: ECHO Colorado, a leader in developing primary care practice support and clinical education across the state, has developed an effort with numerous statewide key stakeholders to support primary care practices and safety net practices in managing the outbreak of COVID-19. ECHO Colorado has developed a program that is offered three times per week with all Colorado health providers eligible to participate. The virtual sessions offer these practices a connection with a multidisciplinary team and are structured to share a range of topics as a COVID-19 toolkit, followed by questions and case review. Register here.
(Last Updated: March, 24, 5:10 PM)
Remote Work Best Practices from the Colorado Department of Labor and Employment: As COVID-19 takes its toll on our communities, many employers are moving to telework/remote work. This preventive step is important from a public health perspective, but it leaves many workers, managers, and businesses who have never worked remotely or managed remote teams with some concerns. This page includes resources and answers to some common questions that arise when faced with the experience for the first time. View the full page here. Some of the questions answered include:
- This is my first time working remotely: what should I know?
- Sometimes I struggle to be productive and focused when working from home? Help!
- I’m a manager of a remote worker and I want to make sure I’m holding people accountable. What are reasonable management practices?
- What are unreasonable management practices?
- What are some remote team activities I can do to keep our connection and culture alive?
- How can I have a productive virtual meeting?
- I struggle with some of the technology we rely on for remote work…what are some quick resources to refresh my skills?
- We haven’t gone remote…yet. What should I be considering to prepare?
Examples from CHCs
(Last Updated: March, 20, 10:13 AM)
The Governor announced on 3/18/20 that the following will be prioritized for testing at the State Laboratory:
- Identify and monitor for community transmission of COVID-19.
- Investigate potential outbreaks in health care and residential facilities.
- Ensure a safe workforce in health care and other facilities serving high-risk populations.
- Test critically ill patients for whom commercial testing will not provide timely enough results.
Read more here.
(Last Updated: March, 27, 1:43 PM)
CCHN has a dedicated page for Telehealth Resources available here: https://cchn.org/covid-19-telehealthresources.
(Last Updated: March, 24, 5:18 PM)
Help Colorado Now Website : This website launched just a few days ago will be updated soon to add an intake form for health care workers (providers and others) to indicate their availability to volunteer. This new intake form is being set up at the request of Colorado hospitals in coordination with the Governor’s Office. When ready, health care organizations, including CHCs should be able to request volunteers, and similarly, available providers can sign up to volunteer in the COVID-19 response effort. Pleas not it appears it will be the responsibility of the health care organization accepting the volunteers to assure proper credentialing and malpractice coverage. CCHN will share more information when we have it.
(Last Updated: March, 30, 2:05 PM)
Paid Sick Time Requirements – State and Federal
State Requirements: From the CO Department of Labor and Employment: Under normal circumstances, Colorado wage law does not require employers to provide time off due to illness or injury. However, the Colorado Health Emergency Leave with Pay (HELP) rules has been put into place due to COVID-19. The HELP rules do not apply to CHCs unless staff fall under one of the covered fields:
- Applies to any employer in the field of leisure and hospitality, food services, child care education at all levels, home health care (working with high-risk individuals), operating a nursing home, or operating a community living facility.
- Must provide up to four days of paid sick leave for an employee with A) flu-like symptoms and B) who is being tested for COVID-19. Sick leave ends if an employee receives a negative COVID-19 test result.
- These rules do not require an employer to offer additional days of paid sick leave if it already offers all employees an amount of paid leave sufficient to cover four days. However if an employee has exhausted paid leave allotted but then has flu-like symptoms or is being tested for COVID-19 then he or she is entitled to additional paid sick days.
Families First (FFCRA) Information:
NACHC COVID-19 Human Resource Issue Resource Packet: NACHC has released a complete COVID-19 FQHC Employment Issues/Human Resource Guidance and Resource packet to support CHC workforce leadership in navigating their COVID-19 response. This packet contains FAQs regarding paid and family leave, legal guidance on emerging and immediate human resource/employment, and additional resources relevant to federally qualified health centers (FQHCs). Within the document you can find:
- Links to Additional Resources – On Page 1
- Frequently Asked Questions – Begins on Page 2
- High level legal overview – Begins Page 15
Emergency Paid Sick Leave and Emergency Family Leave Established in FFCRA: This document shared by NACHC reflects information available as of March 25, 2020, and provides details on the following topics:
- Employers to whom FFCRA Applies – Page 4
- Types of Emergency Leave – Page 5
- Payment for FFRCA Leave – Page 5
- Emergency Paid Sick Leave – Page 6
The document linked here, also from NACHC, provides a nice breakdown of which employees are eligible for the types of leave provided by the legislation. The power point, linked here, provides a flow chart for determining how leave is applied based on an individual employees circumstances.
The US Department of Labor has shared answers to commonly asked questions about the FFCRA, available here. It includes the definition of health care providers that may be excluded.
Federal programs to address cashflow and payroll concerns: NACHC has prepared this document summarizing new Federal programs to assist health centers, PCAs, and HCCNs address cashflow and payroll concerns created by the COVID-19 pandemic. This will be an evolving document, and will be updated with new information as it becomes available. Please contact firstname.lastname@example.org with questions. Within the document you can find:
- Summary of options – Page 3
- Paycheck Protection Program – Page 4
- Emergency Leave – Page 5
- Economic Injury Disaster Loans through the Small Business Administration – Page 7
- Pandemic Unemployment Insurance – Page 8
- Other programs that might be beneficial to health centers with over 500 employees – Page 9
Emergency Childcare for Essential Emergency Service Workers: Beginning Monday, March 23, childcare options will be available to all essential health care workers at no cost for at least two weeks. Those needing to utilize this service will need to sign up here as soon as possible so that local providers can be activated and ready to go starting next week. Every effort will be made to match those who need care with a licensed facility near you that has available capacity to help.
Update as of March 30: Child care for essential health care employees has been extended and expanded until Sunday, May 17. There is an expanded list of critical workers in the latest CDPHE guidance who can participate, allowing as many available as 5,000 more families to enroll. The parent and provider matching transitioned to an app that matches parents with providers – details here.
Work-Share Program Information: This program, as part of the Colorado Employment Security Act, permits employers to allow for staff to work reduced hours and be paid part of their regular unemployment benefits. Employees participating in the program are paid a portion of their unemployment benefits based on the percentage of reduced hours. This program provides employers an alternative to laying off employees. All employees are can be in the work share program, or employees from a particular unit can be in the program.
For employers to be eligible to take advantage of this program, they must have a positive percent of excess. This means an employer must have paid as much in premiums as the state has paid former employees in benefits. Percent excess was mailed to employers last November. Employers will be charged for any unemployment benefits paid; however, this charge will be less than if an employer completely laid off an employee.
Additional Eligibility Requirements:
- You are applying to be in the Program instead of laying off your employees.
- You are reducing the hours of at least 2 employees in a certain unit. You would have laid off at least that many employees.
- You are reducing the work hours of that group by at least 10% but no more than 40%.
- You will not hire or have other employees work in that group.
- Your employees’ collective-bargaining agent (union), if any, must agree to the plan.
- You cannot get rid of or reduce employees’ benefits that you currently provide. These include health insurance, retirement/pension benefits, vacation pay and holidays, sick leave, and any other similar benefits you normally provide.
How to Apply:
Fill out the Request for Approval of Work Share Plan, linked here. Submit your completed form via email or send it to the address located at the bottom of the form. The application will be reviewed, and a letter will be mailed to let you know whether your plan is approved. Each work-share plan is effective on the date of approval and runs for 12-months or 52-weeks from that date.
It is CCHN’s understanding at this time that if CHCs want to take advantage of this program that they do need to apply. According to the website, once you apply your application will be processed within a week.
Per this program, employees work can be reduced by at least 10 percent but no more than 40 percent and receive unemployment to cover the amount their work is reduced (additional details below). The handout, linked here, provides additional information on requirements, advantages and disadvantages of the program. The handout, linked here, provides information to employees regarding the program.
The state can pay your employees part of the unemployment benefits they could get for that week. They look at the percentage of how much you reduced their hours and pay them the percentage of the unemployment benefits the state can pay them. You can use the calculator, linked here, to estimate weekly amounts staff would receive under this program.
COVID-19 HR and People Operations Prep Document from LifeLabs Learning: LifeLabs Learning has gathered 650+ HR Leaders from different companies to share ideas, policies, and templates. We co-created this shared doc (which continues to be a work in progress). Access the page here.
Responding to COVID-19 in the Workplace – HUB International: HUB International has developed the following FAQs to help HR leaders and business owners respond to the many employee relations issues resulting from the coronavirus crisis. These FAQs address many of the complex challenges facing our clients. Some content has been taken from federal publications, such as EEOC and DOL FAQs. For information on business insurance and risk management issues, visit the HUB coronavirus resource center here.
Stay At Home Order Resources for Employers: On Wednesday, March 25, Governor Polis issued Executive Order D2020-017 ordering Coloradans to stay in place due to the presence of coronavirus disease 2019 (COVID-19) in the state. Colorado Department of Public Health and Environment’s (CDPHE) issued a public health order defining critical emergency personnel, infrastructure, government functions, and other activities that are exempt from the directives in this Executive Order. Click here for more information on what this means for your staff. Additional resources are provided below.
- A letter stating that your employees are essential staff and can travel freely is linked here. Resource provided by Mountain Family.
- Here is another letter template stating that employee is authorized to travel during the stay at home order.
- Here is another letter template regarding essential business.
While the state is not requiring it, our Department of Public Safety has added a Critical Business Self-Certification form to their website in response to requests from employees and private sector members for a document to carry that certifies that they are traveling for work for a critical business. The form is voluntary. It is not required. Link to the document can be found here.
- Notes from March 23, 2020, Employers Council COVID-19 Q&A
- This resource from Benefit Comply, covers benefits eligibility during sick leave, furloughs, and terminations.
- This article from SHRM provides considerations surrounding benefits before furloughing or terminating employees.
- Here is an article from SHRM regarding tax rules for leave-sharing programs.