February 22, 2022 | Issue 22-03 |
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The Indian Health Service Releases a Dear Tribal Leader Letter In Response to the Cook Inlet Decision |
On January 24, 2022, the National Indian Health Board (NIHB) took formal action to support a legislative fix for contract support cost (CSC) administration to correct a troubling decision in a recent court case. On August 24, 2021, the D.C. Circuit Court of Appeals in Cook Inlet Tribal Council, Inc. v. Dotomain, held that, if the Indian Health Service (IHS) had “normally” paid for certain costs, those costs could not be eligible for reimbursement as a CSC. On January 12, 2022, the Tribe’s petition for rehearing was denied.
This case means that, if the secretary normally paid for rent, utilities, or other overhead, those costs could not qualify as CSC. Tribes would then have to pay for those costs from health care service and program dollars.
The Cook Inlet decision sets a troubling and potentially far-reaching precedent for future federal-tribal contract negotiations. It has been cited to govern the agency’s decision in December 2021, when approximately 90 percent of one Tribe’s request for FY 2022 CSC funding was declined.
Congress authorized CSC to support Tribal administration of the federal health care programs. Tribes have fought hard to secure full funding of CSC. However, the recent Cook Inlet decision has the potential to reverse that progress for Indian health care.
On February 17, 2022 the IHS released a ‘Dear Tribal Leader’ letter to clarify its CSC policy and position after the Cook Inlet decision. NIHB and Tribes are working with Congress to clarify the CSC administration. To read the letter, see here.
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NIHB Pushes For Native Behavioral Legislation |
The National Indian Health Board (NIHB) has been engaged on two key behavioral health bills pending in Congress. S.2226, introduced by Senator Tina Smith (D-MN), and H.R.4251, introduced by Rep. Frank Pallone (D-NJ-06). The Native Behavioral Health Access Improvement Act are similar bills which would amend the Indian Health Care Improvement Act by establishing behavioral health programs for Tribes to develop culturally-appropriate solutions for prevention, treatment, and recovery.
The bills would provide grants to the Indian Health Service (IHS), Tribes and Urban Indian health programs at $200 million for each fiscal year from 2022 - 2026 according to a formula developed through consultation with Tribes. The grantees would agree to submit data and reports consistent with the submission requirements established through consultation.
H.R.4251 adds a section which would expand the definition of “Indian” for purposes of health insurance reform, exchanges, and subsidies under the Affordable Care Act to include individuals of Indian descent who are members of an Indian community served by the IHS and individuals considered by the Department of Health and Human Services (DHSS) to be Indian for purposes of eligibility for Indian health care services. Individuals included in the definition are eligible for special monthly enrollment periods on health insurance exchanges and elimination of cost sharing under individual health coverage for those whose income is not more than 300% of the poverty line. Under current law, only members of Indian tribes are eligible for these benefits.
NIHB supports the Native Behavioral Health Access Improvement Act and is monitoring the bill closely. For questions further questions, contact Interim Director of Congressional Relations at rharjo@nihb.org.
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UPCOMING EVENTS AND OPPORTUNITIES |
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National Tribal Public Health Summit: Call for Presenter Abstracts! |
Abstract Submission Extended Deadline: February 28, 2022
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Visit the NIHB COVID-19 Tribal Resource Center at:
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