NPAIHB COVID-19 Legislative & Policy  Update
Friday, April 24, 2020
President Trump signed into law the fourth installment of coronavirus relief. The $484 billion coronavirus-relief package for the small business loan program, health care providers, and COVID-19 testing. The Paycheck Protection Program and Health Care Enhancement Act (H.R. 266) provides an additional $100 billion to the Department of Health and Human Services (HHS). Of this total, $75 billion is for reimbursement to health care providers for health health care related expenses or lost revenues. $25 billion of the total is for necessary expenses to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 tests. Of the $25 billion, $750 million is provided to tribes, tribal organizations, and urban Indian health organizations in coordination with IHS. 

NPAIHB has developed this COVID-19 legislative and policy update to keep you apprised of national and state actions in response to the novel coronavirus 2019. These updates will be posted to the NPAIHB COVID-19 website located here: 
IHS DTLL: Announcement of final allocation of the remaining $367 million in CARES Act resources
Published 4/23/20
Announces the IHS decision on the remainder of the $367 million appropriated to the Agency in the CARES Act from the IHS allocated $1.032 billion. The $367 million will be distributed accordingly: $125 million transferred from the services account to facilities including $74 million for medical equipment needs; $41 million for maintenance and improvement needs; and $10 million for sanitation and potable water needs. IHS and Tribal health programs will be provided $50 million for program increases in Community Health Representatives and Public Health Nursing. $20 million will be provided to support Urban Indian Organizations. $172 million of the funds will remain at IHS headquarters including: $5 million to provide additional COVID-19 test kits and materials; $26 million to support Tribal Epidemiology Centers and national surveillance coordination activities; $95 million to support the expansion of telehealth activities across I/T/U programs; $6 million for public health support activities; $10 million for non-clinical Federal staff support; and $30 million to address unanticipated needs in the near future. 

Senate confirms Rear Admiral Michal Weahkee as Director of the Indian Health Service
Confirmed 4/21/20
Approved unanimously by the U.S. Senate the nomination of Rear Adm. Weahkee as the Director of the IHS  for a four-year term. Rear Adm. Weahkee will continue the responsibility of administering health care to AI/ANs nationwide throughout the I/T/U system.Weahkee has served as the interim head of the agency for the past three years and has proven to be an effective leader and partner of federally-recognized tribes and urban Indian organizations. 

CMS releases guidelines on President Trump's Opening Up America Again
Issued 4/20/20
Recommends updates to earlier guidance from CMS on limiting non-essential surgeries and medical procedures. CMS recommends a slow transition for health care professionals to coordinate with local and state public health officials. Recommends reviewing PPE and protocols and ensure workforce availability, facility readiness, testing capacity and supply needs to be met.  

IHS CY 2020 Reimbursement Rates Released
Released 4/17/20
Provides the approved reimbursement rates for inpatient and outpatient medical care provided by IHS and Tribal facilities for CY 2020 for Medicare and Medicaid beneficiaries, beneficiaries of other federal programs, and for recoveries under the federal Medicare Care Recovery Act. For CY 2020, includes $479 per visit rate (excluding Medicare); $427 per visit rate for Medicare; $838 for Medicare Part B inpatient ancillary per diem rate; and $3,675 for inpatient hospital per diem rate (excludes physician/practitioner services).

President Trump is beginning the next phase in our fight against Coronavirus: guidelines for opening up America again
Issued 4/16/20
Release of new guidelines to enable individual states to reopen in phases using a deliberate, data-driven approach. Governors can begin phase openings at the statewide or county-by-count level. The guidelines set benchmarks on new cases, testing, and hospital resources for states to meet to proceed toward a phase reopening. The criteria includes a downward trajectory in cases presenting coronavirus-like symptoms or a downward trajectory in positive tests. Hospitals must have the resources to treat all patients without crisis care and a robust testing program for healthcare workers. 

Health Resources and Services Administration (HRSA) Tribal Advisory Council Nominations (DUE May 7)
Published 2/6/20
Requests nominations from the 12 IHS Areas on the establishment of the HRSA Tribal Advisory Council. There should be one designated alternate for each TAC member. HRSA TAC members will have the opportunity to engage in meaningful consultation with agency officials, and to share a range of views determining the impact of HRSA programs on the I/T/U healthcare system and the AI/AN patient population. Additionally, HRSA seeks tribal guidance in crafting innovative approaches to deliver health care and assisting with effective consultations. 

Idaho rebounds: Governor Little outlines new plans in path to prosperity
Published 4/23/20
Announces new plans to reopen the state's economy in four stages, consistent with direction from the President. The plan sets forth specific criteria for Idaho to meet before moving into each of the four stages. Additionally, the Governor created an Economic Rebound Advisory Committee to provide recommendations that work to support and drive the success of a safe reopening of the economy. Governor Little will make an announcement next week whether Idaho has met the criteria to enter into the next stage of reopening. Every two weeks a re-evaluation will be conducted against criteria to determine feasibility to move from one stage to the next.

Governor Little charts path to prosperity, extends statewide stay-home order to April 30 with exceptions
Published 4/15/20
Announces an extension of the statewide stay-home order to April 30, with exceptions for operations of formerly "non-essential" businesses, facilities, and services and new restrictions related to nonresidential travel into the state. Formerly, "non-essential" businesses may offer curbside and delivery services. The Order was originally  effective on March 25 and will continue to be in effect until April 30 or until it is extended, rescinded, superseded, or amended. 


Governor Brown issues framework for lifting order on non-urgent procedures
Announced 4/23/20
Lifts Governor Brown's order delaying non-urgent procedures for health care providers, as long as they can meet new requirements for COVID-19 safety and preparedness. Hospitals, surgical centers, medical offices, and dental offices that meet those requirements can resume non-urgent procedures on May 1. Medical providers will need to demonstrate the ability to: minimize the risk of coronavirus transmission to patients and healthcare workers; maintain adequate hospital capacity; and support health care workforce in safely resuming activities. Medical providers must also demonstrate that they have an adequate amount of PPE. Facilities ready to resume non-urgent procedures will be required to do so gradually and criteria will be reassessed biweekly. 

Governor Brown introduces framework for reopening Oregon
Introduced 4/14/20
Releases framework for Reopening Oregon, a plan to restart public life and business while maintaining healthy Oregon communities. In order to being reopening, Oregon must first slow the growth of COVID-19 and acquire adequate PPE to protect health care workers and first responders. Once the prerequisites are met, Oregon can begin to reopen by: ramping up testing capacity in every region; developing robust contact tracing systems to track and contacting COVID-19 cases; and establishing a quarantine and isolation program for new cases. 

California, Oregon & Washington announce Western States Pact
Published 4/13/20
Announces an agreement between California Governor Newsom, Oregon Governor Brown, and Washington Governor Inslee on a shared vision for reopening their economies and controlling COVID-19. The Western Pact have agreed to the following principles while building out the West Coast framework:  residents' health comes first; health outcomes and science will guide these decisions; and the states will only be effective by working together. Four goals will be focused on for controlling the virus: (1) protecting vulnerable populations; (2) ensuring an ability to care for those who may become sick with COVID-19; (3) mitigate the non-direct COVID-19 health impacts, particularly disadvantaged communities; and (4) protect the general public by ensuring any successful lifting of interventions including development of a system for testing, tracking and isolating. 


Governor Inslee extends 20 proclamations relating to COVID-19
Announced 4/23/20
Extends 20 proclamations including 5 proclamations related to long term care, given the vulnerability of the population in long term care. The proclamations were extended until the COVID-19 State of Emergency of Emergency or May 9, 2020, whichever occurs first. On April 15, an additional 5 proclamations are extended including Department of Licensing eye exams, Department of Revenue relief from penalties, fees, interest, due dates, unemployment insurance waiver, and ratepayer  assistance and preservation of essential services. An April 22 letter approved the extension of 10 proclamations including: telemedicine and health care parity, rules for unemployment insurance, child care and background checks requirement waivers, and healthcare workers licensing requirement waivers. 

Governor Inslee announces Washington's COVID-19 recovery plan
Published 4/21/20
Releases a plan to lay out a vision for an eventual safe return to public life amid the COVID-19 outbreak. The plan is intended to be a framework for loosening of restrictions contingent on a steady decrease of the spread of COVID-19. The recovery plan begins with widely available testing for individuals who may have contracted COVID-19, tracing for those who have come into close contact with COVID-19 positive individuals, and isolation or quarantine for individuals who could transmit the virus. For the contact-tracing plan to work, the state needs to be processing between 20,000 and 30,000 tests per day, while accessing the necessary supplies has been a barrier. 
For more information
  Laura Platero, Executive Director
Sarah Sullivan, Health Policy Analyst
(503) 228-4185