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Northwest Portland Area Indian Health Board
Legislative and Policy Update
May 2, 2024
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May 1-3, 2024
HHS Region X Tribal Consultation
Silver Reef Casino Resort, WA / Virtual
May 7-8, 2024
HHS Secretary's Tribal Advisory Committee (STAC)
Washington, DC
May 16, 2024
IHS NTAC Quarterly Meeting
Meeting Link
May 19-23, 2024
2024 National Tribal Health Conference
Rapid City, SD
Register Here
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 Open)
Jun 5-6, 2024
DSTAC 3rd Quarter Meeting
Albuquerque, NM
June 11-12, 2024
Tribal Leaders Diabetes Committee (TLDC)
Phoenix, AZ / Virtual
Zoom Link
Jun 11-12, 2024
Facilities Appropriation Advisory Board Meeting (FAAB)
Anchorage, AK
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Appropriations and Funding Opportunities | |
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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 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.
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.
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The Explanatory statement from the House on the second set of bills is located here.
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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.
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Legislative Updates - Senate | |
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S. 3022 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.
S. 3797 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.
02/12/2024 Read twice and referred to the Committee on Indian Affairs
See also H.R. 7516 down below
S. 3768 Supporting Rural Veterans Access to Healthcare Services Act. 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.
S. 2840 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.
- 11/08/23 placed on Senate Legislative Calendar under General Orders No. 242
S. 3130 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.
The Senate Committee on Indian Affairs (SCIA) held two oversight hearings on the fentanyl crisis impacting Native communities on November 8th.
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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.
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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.
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Legislative Updates - House | |
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H.R 7516 Purchased and Referred Care Improvement Act. This is a House Companion bill introduced on 3/1/2024 by Representatives Johnson (R-SD), Schrier, McMorris Rodgers, Newhouse and others, which would amend the “Indian Health Care Improvement Act” to required IHS to develop procedures to reimburse beneficiaries for the provision of approved purchased/referred care services within 30 days, in cases where the patient paid out of pocket.
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Hearing held on 4/30/2024
H.R. 7515 Protecting Native Americans’ Credit Act of 2024. Representatives Kim Schrier and Dusty Johnson and 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.
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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.
03/01/2024 Referred to the House Committee on Financial Services
HR 7227 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.
- 02/09/2024 Referred to the Subcommittee on Health
H.R. 4821 House Passes FY 2024 Interior and Environment Appropriations Bill. 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.
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Tribal Consultation, Listening Session & Written Comments | |
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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 8:45am -10:45am PST at The Monument in Rapid City, SD. Register Here.
Budget Hearing – Fiscal Year 2025 Request for the Indian Health Service on May 1, 7 am PST. House Appropriations Committee’s Subcommittee on Interior and Environment will hold a hearing on the FY 2025 budget request for the Indian Health Service. This is the first time in approximately four years that the IHS has testified to this Committee on its budget proposal. Link to watch/listen Here.
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Next week, the Subcommittee will hold its American Indian/Alaska Native Public Witness Days on May 7 and 8.
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.
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 consultation@ihs.gov, SUBJECT LINE: Health IT Modernization.
- Deployment and Cohort Planning (virtual event)
Date: May 9th, 2024
Time: 10:30 a.m. - 12:00 p.m. PST
Registration
- Multi-Tenant Domain Considerations (virtual event)
Date: August 8th, 2024
Time: 10:30 a.m. - 12:00 p.m. PST
Registration
- Site Readiness and Training (hybrid event)
Date: November 7th, 2024
Time: 10:30 a.m. - 12:00 p.m. PST
Location: TBD
Registration
Call for Consultation: Draft Traditional Medicine Strategy 2025-2034. WHO Traditional Medicine Strategy 2025-2034 (draft) is ready for this online consultation which aimed at gathering valuable technical inputs and insights from Indian Country. The deadline to provide your comments and feedback is May 6, 2024.
CMS All Tribes Consultation Webinar on Traditional Health Care Practices Medicaid Coverage. On April 3, 2024, 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: May 3, 2024.
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Administrative and Regulatory Updates | |
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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, 2024. Marketplace-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 HealthCare.gov.
CHAP TAG Submits Formal Recommendations to IHS. 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. (3/2024)
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.”
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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 provides protection for IHS beneficiaries with authorized referrals. Vendors are prohibited against 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.
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. (2/2024)
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 approval by CMS.
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 Agreement. On 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.
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.
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.
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.
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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.
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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.
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2024 Legislative and Administrative Priorities | |
2023 National Tribal Opioid Summit | |
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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).
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NPAIHB would like to wish Karol Dixon, Director of Government Affairs/Health Policy, a farewell. We thank you for your dedication and service to the Northwest Tribes for the last 20 years. Good luck in your future endeavors!
Please forward any/all correspondence to Rebecca Descombes, Health Policy Assistant, rdescombes@npaihb.org.
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Northwest Portland Area Indian Health Board | Website | | | | |
