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Northwest Portland Area Indian Health Board

Legislative and Policy Update

April 22, 2024

Important Dates

April 23-24, 2024

IHS Information Systems Advisory Committee (ISAC) Spring Semi-Annual Meeting

Oklahoma City, OK / Virtual

Zoom Link

May 1-3, 2024

HHS Region X Tribal Consultation

Silver Reef Casino Resort, WA

May 7-8, 2024

HHS Secretary's Tribal Advisory Committee

Washington, DC

May 19-23, 2024

2024 National Tribal Health Conference

Rapid City, SD


May 20, 2024

HRSA Annual Tribal Consultation

The Monument, Rapid City, SD

Register Here

Jun 1-6, 2024

National Congress of American Indians Midyear Conference 2024

Cherokee, NC

Agenda-at-a-Glance (Registration Opening Soon)

Jun 5-6, 2024

DSTAC 3rd Quarter Meeting

Albuquerque, NM, (TBD)

Jun 11-12, 2024

Facilities Appropriation Advisory Board Meeting (FAAB)

Anchorage, AK

June 11-12, 2024

Tribal Leaders Diabetes Committee (TLDC)

Phoenix, AZ / Virtual

Zoom Link

Appropriations and Legislative Updates

CHAP TAG Submits Formal Recommendations to IHS.[RD1]  March 26 & 27, the Community Health Aide Program Tribal Advisory Group met to discuss updates on the implementation of the national CHAP to the contiguous 48 states. Tribal representatives articulated eight recommendations in which Director Tso was receptive and the timeline the CHAP TAG proposed. Director Tso requested that the TAG and IHS author a joint letter that memorializes the recommendations and describes the timeline for their implementation.

Fiscal Year 24 Funding. Congress passed the first package of spending bills on Friday, March 8. The six funding bills include funding for the Departments of Agriculture, Energy, Housing and Urban Development, Transportation, and Veterans Affairs, with a few other related agencies. The Indian Health Service was funded at $6.96 billion for FY2024, and the Special Diabetes Program for Indians was funded for $160,000,000 through December 31, 2024. Minibus text here. The second package of bills, including funding for Labor, Health and Human Services, Education, Defense, Homeland Security, Financial Services, State-Foreign Operations, and Legislative Branch was passed and signed into law on March 23, 2024.

  • An explanatory statement from the House on the second set of bills is located here.
  • A list of Congressionally directed spending from the Senate is here.

The FY2024 bills provide advance appropriations to the Indian Health Service for the FY2025 Indian Health Services and Indian Health Facilities accounts totaling $5.2 billion. 

Advance appropriations for FY2025 were not included for all accounts. The Electronic Health Record System, the Indian Health Care Improvement Fund, Contract Support Costs, Payments for 105(l) Tribal Leases, Sanitation Facilities Construction, and Health Care Facilities Construction are subject to normal appropriations next year.  The final bill fully funds and leaves discretionary Contract Support Costs, estimated to be $1.1 billion in FY 2024, and Payments for Tribal Leases, estimated to be $149 million in FY 2024.  Purchased/Referred Care is funded at $996.8 million for FY2024, which is an increase of $27.7 million over FY2023.


Purchased and Referred Care Improvement Act. Senators Cantwell and Rounds introduced the Purchased and Referred Care Improvement Act, bipartisan legislation to require the Indian Health Service (IHS) to reimburse tribal members for care sought outside of IHS in a timely manner. This would prevent outside providers from burdening tribal members with wrongfully charged medical debt, which is incurred when IHS doesn’t reimburse tribal members for Purchased/Referred Care (PRC) claims in a reasonable timeframe. This act, also introduced on the House side by Representative Dusty Johnson, would: 

  • Ensure that IHS – not the tribal citizen – is liable for payments for PRC services that are or were authorized by IHS. 
  • Directs the Secretary to notify PRC providers and patients that the patients are not liable to any provider or debt collector for charges associated with authorized PRC services. 
  • Permits IHS to establish and implement procedures to allow patients who paid out-of-pocket for IHS-authorized PRC services to be reimbursed by IHS no later than 30 days after a patient submits the necessary documentation. 

Protecting Native Americans’ Credit Act of 2024 Representatives Kim Schrier and Dusty Johnson introduced two bills (see PRC Improvement Act above) to hold the Indian Health Service (IHS) accountable for disregarding health care bills owed to providers and to protect Native Americans’ credit from wrongfully charged medical bills owed by IHS through Purchased/Referred Care claims. The Protecting Native Americans’ Credit Act of 2024 would: 

  • Excludes medical debt attributable to IHS-authorized PRC services received at a non-IHS facility from a Native American’s Consumer Report. 
  • Provides Native Americans with a dispute process for inclusion of debt for authorized medical services rendered on a consumer report. 
  • Requires HHS to send a notice to the individual that HHS has assumed liability for part of or all of the medical debt. 
  • Directs reporting agencies to delete all information related to medical debt from file and notify furnisher and consumer of deletion upon receiving required documentation of HHS’s liability of debt. 

Truth and Healing Commission on Indian Boarding School Policies Act of 2024. Representatives Sharice Davids and Tom Cole reintroduced the Truth and Healing Commission on Indian Boarding School Policies Act of 2024 to investigate, document, and report on the histories of Indian boarding schools, Indian boarding school policies, and long-term impacts on Native communities (HR 7227).

The Senate Committee on Indian Affairs (SCIA) held two oversight hearings on the fentanyl crisis impacting Native communities on November 8th. 

  • The SCIA Oversight Hearing held on Nov. 8th titled, “Fentanyl in Native Communities: Native Perspectives on Addressing the Growing Crisis” is available for viewing HERE.  
  • The SCIA Oversight Hearing held on Dec. 6th titled, “Fentanyl in Native Communities: Federal Perspectives on Addressing the Growing Crisis” is available for viewing HERE. 

House Passes FY 2024 Interior and Environment Appropriations Bill (H.R. 4821). H.R. 4821 includes an increase of $149 million for the Indian Health Service for a total of $7.08 billion in FY 2024 and $5.9 billion in advance appropriations for the IHS in FY 2025.  However, the bill does not include the President’s Budget Request to make Contract Support Costs and 105(l) lease mandatory appropriations.  

Supporting Rural Veterans Access to Healthcare Services Act (S. 3768). U.S. Senators Kevin Cramer (R-ND) and Angus King (I-ME), members of the Senate Veterans Affairs and Armed Services Committees, introduced the Supporting Rural Veterans Access to Healthcare Services Act. This legislation would provide travel assistance to veterans living in highly rural areas for VA-authorized health care appointments. Specifically, the bill would reauthorize the VA Highly Rural Transportation Grant (HRTG) Program for five years and add Tribal Organizations as entities eligible to apply for the program. The HRTG Program provides transportation services in areas with less than seven people per square mile and is available at no cost for veterans who live in eligible zones.


Restoring Accountability in the Indian Health Service Act of 2023. Sens. Barrasso (R-WY), Thune (R-SD), Lummis (R-WY), Daines (R-MT), and Rounds (R-SD) have reintroduced the Restoring Accountability in the Indian Health Service Act (S. 3130) to amend the Indian Health Care Improvement Act to improve transparency, oversight, and accountability in the IHS and address recruitment and retention.


IHS Workforce Parity Act of 2023. Sens. Cortez Masto (D-NV) and Mullin (R-OK) introduced S. 3022 titled IHS Workforce Parity Act of 2023 that would amend the Indian Health Care Improvement Act to allow IHS scholarship and loan recipients to fulfill service obligations through half-time clinical practice. 

Bipartisan Primary Care and Health Workforce Act. The Bipartisan Primary Care and Health Workforce Act was introduced and includes $5.8 billion per year over the next three years in mandatory funding for community health centers and $2.2 billion for each fiscal year in discretionary funding, one-time $3 billion capital investment to support construction and renovation at health centers with priority to dental and behavioral health projects, increasing mandatory funding for National Health Service Corps to $950 million per year for FY 2024 through 2026, $300 million for each FY 2024 through 2028 for the Teaching Health Center Graduate Medical Education program.  

Tribal Consultation, Listening Sessions & Written Comment Updates

CMS All Tribes Consultation Webinar on Traditional Health Care Practices Medicaid Coverage. On April 3, 2024, the CMS Division of Tribal Affairs, in collaboration with the CMS State Demonstrations Group, is holding an All Tribes Consultation Webinar to obtain advice and input on pending section 1115(a) demonstration proposals for Medicaid coverage and reimbursement for Traditional Health Care Practices provided by qualifying providers at Indian Health Service (IHS) and Tribal facilities. Register Here.

  • Comment Due date: April 24, 2024.

Equity Action Plan. On February 14, HHS released the 2023 update of its Equity Action Plan in coordination with the Biden-Harris Administration’s whole-of-government equity agenda. The Equity Action Plan is part of the Department’s efforts to implement the President’s Executive Order on “Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government,” HHS values its government-to-government relationship with Indian Tribes and recognizes that robust Tribal Consultation is important to this process. HHS invites you, through the Office of the Assistant Secretary for Planning and Evaluation (ASPE), to a virtual Tribal Consultation to share your feedback on these important priority areas and to hear your thoughts and concerns. 


HRSA Two-Topic Consultation. Health Resources and Services Administration will be conducting a Tribal Consultation on two topics: the Agency’s revised Tribal Consultation Policy and the calculation and use of Health Professional Shortage Area (HPSA) scores. The scores are used by the National Health Service Corps to determine priorities for the assignment of primary care, dental health, and mental health professionals. 

  • Monday, May 20, 2024, from 8:45 AM -10:45 AM PST at The Monument in Rapid City, SD. Register Here.

IHS HIT Modernization. On January 18, 2024, the Indian Health Service (IHS) issued a Dear Tribal Leader letter, announcing a series of four Tribal and Urban Consultation sessions set to take place throughout the HIT Modernization 2024 calendar. The first session, slated for February 8th, will provide an overview of the Enterprise Collaboration Group. During this session, the IHS requests feedback on system configuration and change management. Written comments are due 30 days following each session by email to or - SUBJECT LINE: Health IT Modernization.

Deployment and Cohort Planning (virtual event)

Date: May 9th, 2024

Time: 10:30 AM - 12:00 PM PST


Multi-Tenant Domain Considerations (virtual event)

Date: August 8th, 2024

Time: 10:30 AM - 12:00 PM PST


Site Readiness and Training (hybrid event)

Date: November 7th, 2024

Time: 10:30 AM - 12:00 PM PST

Location: TBD


Administrative and Regulatory Updates

HHS Takes Additional Actions to Help People Stay Covered During Medicaid and CHIP Renewals. On March 28, HHS, through the Centers for Medicare & Medicaid Services, announced the Unwinding SEP end date will be extended to November 30, 2024Marketplace-eligible consumers who are disenrolled from Medicaid, CHIP, or if applicable, the Basic Health Program (BHP) coverage can select a plan under the Unwinding SEP by submitting or updating an application through 

Purchased/Referred Care Delivery Area Expansion website. The IHS announced a new website for PRC with the following:

“It includes a status tracker of submitted PRCDA Expansion requests, the PRCDA Listing, and a summary of PRCDA versus Service Delivery Area. A PRCDA refers to the geographic area within which PRC services will be made available by the IHS to members of an identified Indian community who reside in the area, subject to the provisions of 42 C.F.R. Part 136 Subpart C. Tribes may seek PRCDA re-designation or expansion to increase their geographical coverage to include beneficiaries not covered under their existing PRCDA. The PRCDA Expansion webpage will be updated on a routine basis with updated information as needed.”

The website is located here.

The IHS also noted in the March 12, 2024 announcement that:

Section 222 of the Indian Health Care Improvement Act protects IHS beneficiaries with authorized referrals. Vendors are prohibited from billing beneficiaries of the IHS for care provided under the PRC program. In summary, patients are not liable for services that are authorized by PRC, and vendors are prohibited from collecting any payments for these services from the patient, whether directly or through referral to an agent for collection. Patients experiencing this should promptly contact their service unit’s PRC program to resolve the billing issue. Vendors who continue to bill patients despite notification can be reported to Area PRC leadership and IHS attorneys for further action.

SAMHSA Medications for the Treatment of Opioid Use Disorder. SAMHSA revised and released the final rule in February 2024, to make COVID-19 flexibilities permanent, and to expand access to care and treatment for opioid-use disorder. These rules will go into effect in October 2024, allowing time for OTPs to prepare and for states to review their regulations that impact how this rule is implemented. 


Health and Human Services (HHS) Region 10 Tribal Quarterly Call. HHS Region 10 hosted a quarterly call on Thursday, February 29, 2024.  The Region X Tribal Consultation will be held on May 1-3, 2024 in Ferndale, WA. 

HRSA Announces Nearly $50 Million Initiative to Support Opioid Treatment and Recovery Services in Rural Communities. On Wednesday, March 6, HRSA Administrator Carole Johnson joined White House Domestic Policy Advisor Neera Tanden and more than 900 rural health stakeholders to announce the Rural Opioid Treatment and Response Initiative. The initiative includes the release of the latest Rural Communities Opioid Response Program notice of funding opportunity, RCORP-Impact. This program aims to increase access to life-saving treatment and help rural individuals achieve long-term, sustained recovery. 

IHS Encounter Rate. Indian Health Service (IHS) Announces Calendar Year 2024 Reimbursement Rates and Launch of Associated Webpage: IHS Director Roselyn Tso issued a recent Dear Tribal Leader Letter in which she announced the publication of CY 2024 reimbursement rates in the Federal Register. The rates apply for inpatient and outpatient medical care provided at IHS facilities for Medicare (excluding inpatient Medicare Part A) and Medicaid beneficiaries, beneficiaries of other federal programs, and for recoveries under the Federal Medical Care Recovery Act. Director Tso also announced the launch of a new IHS website focused on all-inclusive rate reimbursement information, such as calculation and source documents. The new website is available here.

Outpatient per Visit Rate (Excluding Medicare) 

Calendar Year 2024 

Lower 48 States: $719 

Outpatient per Visit Rate (Medicare) 

Calendar Year 2024 

Lower 48 States: $667 

White House Tribal Nations Summit. On Dec. 6, 2023, President Biden signed a new Executive Order (EO) to reform how the federal government funds and supports Tribal Nations. The EO requires federal agencies to take action to ensure federal funding for Tribes is accessible, flexible, and equitable, creates a Tribal Access to Capital Clearinghouse for Tribes and Native businesses to find federal funding, requires the federal government to measure chronic funding shortfalls and develop recommendations for what additional funding and programming is necessary, and report annually on these recommendations. 

Veterans Affairs Reimbursement AgreementOn Dec. 6, 2023, the Indian Health Service (IHS) and the Department of Veterans Affairs (VA) signed a revised reimbursement agreement. VA will reimburse IHS for purchased/referred care and contracted travel for AI/AN Veterans, in addition to direct care provided for AI/AN Veterans. The DTLL is located here, and the updated agreement is located here


Indian Health Service Scholarships. The IHS Scholarship Program is accepting applications for scholarship support for the 2024-2025 academic year. The IHS Scholarship Comparison Chart shows a list of eligible degree programs.

  • Eligible students are encouraged to apply by February 28, 2024

White House Releases Playbook to Address Social Determinants of Health.  This Playbook lays out an initial set of structural actions federal agencies are undertaking to break down silos and to support equitable health outcomes by improving the social circumstances of individuals and communities.  To accompany this Playbook, the Department of Health and Human Services also released a Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework.  

Health and Human Services (HHS) Region 10 Tribal Quarterly Call. HHS Region 10 hosted a quarterly call on Thursday, February 29, 2024. The Region X Tribal Consultation will be held in May.

Indian Health Service (IHS) Announces New Electronic Health Record System. IHS has selected General Dynamics Information Technology, Inc. to build, configure, and maintain a new IHS electronic health record system utilizing the Oracle Cerner technology.

CMS Provides Guidance to States on Coverage of Health-Related Social Needs (HRSNs). The CMS guidance provides opportunities available under Medicaid and Children’s Health Insurance Program (CHIP) to cover services and supports that address health-related social needs. 

Tribal Protections in Medicaid and CHIP Managed Care Oversight Toolkit. This new toolkit provides resources for states, managed care plans, and Indian Health Care Providers to maximize the benefits of Medicaid and CHIP managed care for American Indian and Alaska Native enrollees consistent with the statutory and regulatory Indian managed care protections.

State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit. This updated toolkit serves as a consolidated and comprehensive compilation of telehealth policies, including related flexibilities and requirements, for states to consider when using telehealth to deliver Medicaid and CHIP benefits and services. 

Mandatory Continuous Enrollment for Children in Medicaid and CHIP.  Effective January 1, 2024, states are required to provide 12 months of continuous enrollment for children under 19 in Medicaid and CHIP. States may terminate eligibility for children under 19 for the following limited circumstances for children who reach age 19, cease to be state residents, request a voluntary termination of eligibility, or who are deceased, or the agency determines that eligibility was erroneously granted. States are not limited to providing only a 12-month continuous enrollment period for children. Oregon became the first state to receive approval from CMS to maintain eligibility for children from birth to six. Washington has a similar request waiting for approval by CMS.

Medicaid Unwinding Updates. The Consolidated Appropriations Act 2023 set an end date for the Medicaid continuous enrollment condition to March 31, 2023, which included a fourteen (14) month period for states to comply with Medicaid eligibility determination requirements.  Since unwinding has commenced, there has been a dramatic loss in Medicaid coverage nationwide. The Tribal Self-Governance Advisory Committee is coordinating a Tribal-specific data survey to share with the Centers for Medicare and Medicaid Services to show the impact on Tribes and Tribal health programs.  The Survey is available HERE. 

National Institutes of Health (NIH) announces the establishment of the RADx Tribal Data Repository: Data for Indigenous Implementations, Interventions, and Innovations (D4I). After a competitive review, Stanford University, in partnership with the Native BioData Consortium, has been selected to lead this unique NIH-supported effort. The Native BioData Consortium is the first Indigenous-led 501(c)(3) nonprofit research organization and biodata repository within the geographic borders and legal jurisdiction of a Tribal Nation (Cheyenne River Sioux Tribe).

New Health Resources & Services Administration (HRSA) Director of Tribal Affairs, Juliana Blome, Ph.D.  She formerly served as Deputy Director of the Tribal Health Research Office at the National Institutes of Health (NIH), where she worked alongside Dr. David Wilson (Navajo Nation). There, she focused on strengthening collaborations between NIH and American Indian and Alaska Native communities, building partnerships based on trust and transparency, and increasing cultural awareness in research that improves health in Tribal communities.  

The Veterans Affairs (VA) Department Finalizes Rulemaking on the Pilot Program on Graduate Medical Education and Residency.  Effective Dec. 13, 2023, the VA adopts the proposed rule issued on Feb. 4, 2022, as final, with changes, to amend its regulations to include a new pilot program on graduate medical education and residency.  The final rule responds to written comments received, including several comments from Tribes and Tribal organizations.  

The U.S. Government Accountability Office (GAO) Releases Report on Indian Health Service Federal Facilities. The Report, released in November 2023, found that many federally operated facilities are not in good condition and their medical equipment is aging.  The GAO made three recommendations to IHS: to assess the extent of medical equipment data problems across IHS areas implement a plan to correct any problems, and regularly monitor adherence to IHS medical equipment inventory management policy requirements.    

Not Invisible Act Commission Releases Final Report. The Report calls upon the federal government to declare a Decade of Action and Healing to address the crisis of missing, murdered, and trafficked American Indian and Alaska Native people.  A summary of Key Findings and Recommendations can be found on page 11 of the Report.  

Litigation Updates

United States Supreme Court Skeptical of Federal Government’s Argument in Contract Support Cost Cases. SCOTUS heard oral arguments in Becerra v. San Carlos Apache Tribe and Becerra v. Norther Arapaho Tribe on March 25, 2024 (the consolidated case is Becerra v. San Carlos Apache Tribe 23-250). The issue of the case is whether the Indian Health Service (IHS) must pay contract support costs (CSC) not only to support IHS-funded activities but also to support the Tribe’s expenditure of income collected from third parties. The decision in this case could have major impacts on IHS funding.

The Supreme Court Will Hear Contract Support Cost Payments Dispute.

In the past two weeks, the Supreme Court agreed to hear the two federal government petitions consolidated into one case. The petitions request the Court to overturn the orders requiring the IHS to reimburse millions in administrative health care costs to Tribes for third-party income. 

  • SCOTUSblog articles on “Tribal self-governance at center of dispute over federal health care costs” and “Funding for Native healthcare programs”– article links,

one | two.

2023 National Tribal Opioid Summit

Dear Tribal leaders, Colleagues, and Community –

As ongoing follow-up to the first National Tribal Opioid Summit (NTOS), hosted by the Tulalip Tribes of Washington State we want to remind you of the resource materials available via the National Tribal Opioid Summit Resource Hub. The NTOS Federal Policy Recommendations and Northwest Region Opioid Overdose Mortality Data Brief have been posted on the Resource Hub website, most recently.  

  • Recent updates include identifying actions items on follow-up to national declaration of an opioid emergency in concert with OR and WA state governor staff and follow-up meetings with congressional staff, including Sen. Tina Smith (MN).  

For more information:

Laura Platero, Executive Director 

Karol Dixon, Director of Government Affairs/Health Policy

Candice Jimenez, Chief of Staff

Northwest Portland Area Indian Health Board | Website