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Northwest Portland Area Indian Health Board
Legislative and Policy Update
May 29, 2024
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May 29-30, 2024
CMS Health Equity Conference
Bethesda, Maryland/Virtual Option
CMS Health Equity Conference - Register
Jun 1-6, 2024
National Congress of American Indians Midyear Conference 2024
Cherokee, NC
Agenda-at-a-Glance (Registration Open)
June 3, 2024
Second Annual HHS Pride Summit
Washington, DC
Registration & Live Stream
Jun 5-6, 2024
DSTAC 3rd Quarter Meeting
Albuquerque, NM
June 6, 2024
Discrimination as a Social Determinant of Mental Health Disparities
Virtual/Register Here
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
July 16-18, 2024
12th Annual National Native Harm Reduction Summit
Mahnomen, MN
Register Here
July 23 – 25, 2024
2024 Washington State Tribal Opioid Fentynal Summit
Spokane, WA
Registration due date: June 27
July 25, 2024
FY 2026-2027 Tribal Budget Formulation Planning and Evaluation Meeting
Meeting Webpage
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Appropriations and Funding Opportunities | |
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Tribal Opioid Response Grants. On May 2, 2024, SAMHSA announced the Tribal Opioid Response Grant. The purpose of this program is to assist in addressing the opioid overdose crises in Tribal communities by increasing access to FDA-approved medications for the treatment of opioid use disorder (MOUD), and supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder (OUD) and co-occurring substance use disorders. Click Here for Notice of Funding. Deadline: July 1, 2024.
Cooperative Agreements for the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Program. The purpose of this program is to support states and Tribes with implementing youth (up to age 24) suicide prevention and early intervention strategies in schools, educational institutions, juvenile justice systems, substance use and mental health programs, foster care systems, pediatric health programs, and other child-and youth-serving organizations. Award amount: $725,000/year. Deadline: June 3, 2024. Deadline: June 3, 2024.
Application found here.
Emergency Community Water Assistance Grants: This program helps eligible communities prepare, or recover from, an emergency that threatens the availability of safe, reliable drinking water. Applications are accepted on an ongoing basis. What qualifies as an emergency? Drought/flood, earthquake, tornado/hurricane, disease outbreak, chemical spill/leak/seepage, other disasters.
Crisis Counseling Assistance and Training Program (CCP): The CCP is a short-term disaster relief grant for states, U.S. territories, and federally recognized tribes. CCP grants are awarded after a presidential disaster declaration. CCP funding supports community-based outreach, counseling, and other mental health services to survivors of natural and human-caused disasters. Applications are accepted on an ongoing basis. Visit Crisis Counseling Assistance and Training Program (CCP) | SAMHSA
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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Introduced: Native ELDER Act: Senator Murkowski introduced the Enhancing Native Elders’ Longevity, Dignity, Empowerment, and Respect Act (Also known as the Native ELDER Act). Which includes reforms to Title VI of the Older Americans Act to expand training, allow for home modifications for aging in place, and create an Older Americans Tribal Advisory Committee. NIHB provided technical assistance on the bill to support eh advancement of Tribal priorities for our Elders. Bill Text here.
Senate Testimony Opportunity: The Senate Appropriations Subcommittees have announced their Outside Witness Testimony instructions for both the Interior, Environment, and Related Agencies and the Labor, Health and Human Services, Education, and Related Agencies.
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.
On May 1, 2024, the Senate Indian Affairs Committee approved five bills, including a revised version of legislation to allow Indian Health Service scholarship and loan recipients to fulfill service obligations through half-time clinical practice.
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View the text of S. 3022 here. 5/1/24 Committee on Indian Affairs. Ordered to be reported with an amendment in the nature of a substitute favorably. A Summary is in Progress.
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.
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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.
- 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.
- 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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IHS Tribal Consultation and Urban Confer: IHS seeks your guidance and recommendations on funding methodologies for seven (7) IHS behavioral health initiatives, focusing on funds currently distributed through grants.
Tribal Consultation
IHS Tribal Consultation on the Draft IHS Strategic Plan for FY 2024-2028. IHS is seeking your guidance and recommendations on the draft Indian Health Service Strategic Plan for Fiscal Years 2024-2028. The plan will establish the Agency's direction for the next 5 years. Your input will assist us in establishing goals, objectives, strategies, and performance measures to improve Agency operations, strengthen Tribal partnerships, and deliver quality health care to American Indians and Alaska Native in Tribal communities. DTLL here.
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. Comments Due: July 1, 2024
IHS Tribal Consultation on the Draft IHS Strategic Plan for FY 2024-2028. IHS is seeking your guidance and recommendations on the draft Indian Health Service Strategic Plan for Fiscal Years 2024-2028. The plan will establish the Agency's direction for the next 5 years. Your input will assist us in establishing goals, objectives, strategies, and performance measures to improve Agency operations, strengthen Tribal partnerships, and deliver quality health care to American Indians and Alaska Natives in Tribal communities. DTLL 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 consultation@ihs.gov, SUBJECT LINE: Health IT Modernization.
Deployment and Cohort Planning (virtual event)
Date: June 9th, 2024
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
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Administrative and Regulatory Updates | |
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Government Accountability Office (GAO) is Accepting Nominations for Five Tribal and Indigenous Advisory Council Positions. GAO’s Tribal and Indigenous Advisory Council is compsed of 16 Tribal and indigenous leaders who provide advice to GAO in carrying .including those that serve Tribes, their citizens, and descendants. GAO reviews span a broad range of topics of concern to Tribes, including health care, education, economic development, environmental protection, justice, and infrastructure, among others. Nominations must be submitted to TIAC@gao.gov no later than May 31, 2024 (5/2024).
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
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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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Northwest Portland Area Indian Health Board | Website | | | | |
