NPAIHB Legislative & Policy  Update
Wednesday July 1, 2020
FY 2021 Congressional Appropriations Schedule
July 7: House Labor-HHS-Education Subcommittee Markup
July 7: House Interior Subcommittee Markup
July 10: Interior Full Committee Markup
No dates set by Senate for Markups.  NPAIHB submitted IHS and HHS House and Senate testimony

Prior NPAIHB COVID-19 Legislative and Policy Updates are available at: 
H.R. 2:  INVEST in America Act
Passed House on 7/1 (233-188); introduced by Rep. DeFazio on 6/11
S ection 34104 of   the bill provides  $5 billion in total funding for FY 2021 through 2025 for the planning, design, construction, modernization, and renovation of hospitals and outpatient health care facilities within the Indian Health Service.  In addition, section 81611 authorizes  $2.7 billion for each FY 2020 through FY 2024 for construction, modernization, improvement, and renovation of water, sewer, and solid waste sanitation facilities located on tribal land that are listed on the IHS Sanitation Facilities Deficiency List.  This language is the same as stand-alone legislation introduced by Representatives O'Halleran (D-AZ) and Young (R-AK) to fund the IHS  Sanitation Facilities Construction Program  (H.R. 7056).

S.3937: Special Diabetes Program Reauthorization Act of 2020
Introduced on 6/10 by Senator McSally and Senators Sinema and Murkowski. 
Would provide  5 years of funding for the Special Diabetes Program for Indians (SDPI); i ncrease SDPI funding to $200 million annually; and a uthorize tribes and tribal organizations to receive SDPI awards through P.L. 93-638 self-determination and self-governance contracts and compacts. There is a technical issue with the language so a template letter for tribes to submit to their Senator is provided. 

HRSA DTLL: Health Professional Shortage Area (HPSA) scoring criteria and Maternity Care Health Professional Target Area criteria request for information (RFIs)  (DUE 9/18)
Released 6/18/20
Seeks input and feedback through an RFI to inform policy considerations related to changes in scoring criteria for Health Professional Shortage Areas (HPSAs) and solicits additional ideas and suggestions, such as new factors, components, or point weighting. The second RFI seeks input and feedback to inform policy considerations related to the establishment of criteria for Maternity Care Health Professional Target Areas and solicits additional ideas and suggestions. NPAIHB will be holding a policy call to discuss recommendations and gather feedback from Portland Area tribes.

IHS Proposed Rule: Removal of obsolete portion of regulation relating to care and treatment of ineligible individuals (COMMENTS DUE 8/12)
Published 6/15/20
Proposes to remove obsolete language appearing in the Code of Federal Regulations regarding the rates charged for the provision of IHS services to ineligible individuals. The Assistant Secretary of Health and the Surgeon General no longer approve or publish such rates. As proposed it would allow in an emergency for individuals not eligible, "may be provided temporary care and treatment in Service facilities; (b) charging ineligible individuals." 

CDC Notice: CDC Diabetes Prevention Recognition Program (DPRP) Information Collection (COMMENTS DUE 8/14)
Published 6/15/20
Invites the public to comment on the CDC Diabetes Prevention Recognition Program (DPRP) continuing information collection as part of the continuing effort to reduce public burden and maximize the utility of government information. The Office of Management and Budget (OMB) is interested in comments: (1) evaluate whether the proposed collection information is necessary; (2) evaluate the accuracy of the estimate of burden of the proposed collection of information; (3) enhance the quality, utility, and clarity of information collected; (4) minimize the burden of the collection of information; and (5) assess the information collection costs. 

CMS Informational Bulletin: Medicaid managed care frequently asked questions (FAQs) - medical loss ratio (MLR) 
Released 6/5/20
Provides guidance related to the newly adopted Medicaid and Children's Health Insurance Plan (CHIP) Managed Care Final Rule standards for the calculation and reporting of a medical loss ration (MLR) applicable to Medicaid and CHIP managed care contracts. The Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) modified statute to temporarily allow states to keep a larger percentage of remittance from managed care plans when they do not meet MLR requirements. Section 4001 of the SUPPORT Act permits states to keep a larger percentage of the remittances collected specific to the Expansion group, an amount consistent with the federal matching rate applicable to the state's traditional Medicaid population (Federal medical assistance percentage) for a limited period of time. The FAQ includes responses for some of the following topics: requirements for state compliance; requirements for collection of remittance from managed care plans if remittance is minimum MLR is not met; required information for MLR reporting from managed care plans each year; and how managed care plans should calculate the MLR if they cover both Medicare and Medicaid enrollees under and integrated product. 

CDC releases consolidated COVID-19 testing recommendations
Issued 6/13/20
Releases consolidated recommendations for COVID-19 testing, including interim testing guidelines for healthcare personnel, testing strategy options for high-density critical infrastructure workplaces after a case is identified. 

HRSA Tribal Advisory Council (TAC) nominations (Due July 6)
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 narrowly meets criteria to enter final stage of rebound plan, Idahoans strongly urged to continue following safe practices
Released 6/11/20
Declares that the state narrowly met criteria to enter the final stage of the Idaho Rebounds plan to safely and responsibly open the economy in stages, highlighting the importance of individuals strengthening their personal actions to slow the spread.  Idaho did meet the criteria to advance to the final stage, but there was a bump in case reported in early June, including several healthcare workers who contracted COVID-19, and the number of people seen in the emergency room with COVID-19-like symptoms barely declined. 100% of businesses will be able to open their doors as the state enters Stage 4. Visits to senior living facilities and other congregate facilities can resume, under strict protocols and employers can resume unrestricted staffing of worksites. Entering Stage 4 still means that the transmission of the virus needs to be mitigated. As of June 25, Idaho will transition to a regional response to COVID-19, and the state did not meet metrics to move out of the final stage of the Idaho Rebounds plan. 

Idahoans reminded to continue safe practices as Idaho enters Stage 3 of reopening
Published 5/28/20
Announces movement to Stage 3 on May 30. Within Stage 3 the following can occur: bars can open their doors as long as protocols to protect workers and the public are followed; opening of movie theaters; gatherings of up to 50 people; and non-essential travel can resume. Every Idahoan is urged to continue practicing measures to prevent the spread of COVID-19 and all open businesses must follow protocols for opening. 

Governor Brown extends COVID-19 State of Emergency for Sixty Days
Released 6/30/20
Declares an extension of the declaration of a state of emergency regarding COVID-19 for an additional 60 days, until September 4. The state of emergency declaration is the legal underpinning for the executive orders the Governor has issued, including orders on reopening Oregon while maintaining essential health and safety protections, as well as orders around childcare, schools, and higher education operations. Extending the state of emergency declaration allows those orders to stay in effect. Review and reevaluation of each of the emergency orders will take place every 60 days to determine if the orders should be continued, modified, or rescinded. 

Governor Brown extends face coverings requirement statewide
Announced 6/29/20
Requires Oregonians to wear face coverings in indoor public spaces, beginning Wednesday July 1. The guidance applies to businesses and members of the public visiting indoor public spaces. Face covering requirements are already mandated in eight counties. Governor Brown stated that "if we all wear face coverings, practice six feet of physical distancing in public, wash our hands regularly, and stay home when we are sick, then we can avoid the worst-case scenarios that are now playing out in other states." 

Governor Brown announces plans for face covering requirement, outlines next steps in county reopening
Published 6/17/20
Institutes a requirement to wear face coverings while in indoor public spaces, such as grocery stores and other businesses, for the following counties: Multnomah, Washington, Clackamas, Hood River, Marion, Polk, and Lincoln. the mandate is effecting beginning June 24. Marion, Polk, and Hood River counties were granted to move to Phase 2 beginning June 19. Multnomah County was allowed to move to Phase 1 beginning June 19. The entire tori-county region will remain in Phase 1 for at least 21 days after June 19 before the three counties together will become eligible for Phase 2. 

Governor Inslee announces funding for rent assistance, tribal recovery efforts, small businesses and nonprofits
Announced 6/30/20
Provides information on the distribution of nearly $365 million in federal funds to help with the COVID-19 response and relief efforts across Washington. $163 million was provided to the Washington Department of Commerce to provide aid to many of those hardest hit by the economic fallout from the pandemic. This week's distribution includes: $100 million to provide rent assistance to low-income renters at risk of homelessness; $20 million to provide grants to help small businesses; $20 million to provide operating grants to support nonprofits working to address disparities and inequities exacerbated by COVID-19; and $20 million to assist tribes with their pandemic recovery related efforts. 

Governor Inslee announces statewide mask mandate
Published 6/23/20
Announces a statewide mandatory face covering order that will take effect on June 26. Every Washingtonian must wear a facial covering when in a public space, as mandated by the public health order signed by Secretary of Health John Wiesman. The order comes after an announcement of a mandatory mask proclamation for Yakima County. The order was in response to reports of increasing case counts and a potential overwhelming of the county's health care system. 

Governor Inslee issues three proclamations related to COVID-19
Issued 6/19/20
Releases two new and one updated proclamation in response to the continuing COVID-19 pandemic. First is the Shared Work proclamation (20-58) which waives/suspends the statute that requires shared work benefits to be paid by employers, allowing federal CARES Act funding to be used to pay for the employer portion of shared work benefits (expires July 19). Second is the Temporary Licensing for Dental and Pharmacy Graduates (20-59), which allows dental hygiene and pharmacy graduates to obtain a temporary license if certain conditions are met (expires July 19). The final proclamation is for the Department of Licensing for License and Permit Renewal Extension (20-41.5), which allows the Department of Licensing to do an online attestation and not have to meet in-person (expires July 1).

Governor Inslee extends 23 proclamations relating to COVID-19
Published 6/18/20
Provides extension of 23 proclamations in response to the continuing COVID-19 pandemic that were approved by the legislature. Of importance include extensions for the following proclamations: Telemedicine (20-29.3), Department of Health - Health Care Workers (20-32.4), Department of Social & Health Services - NAR Waiver (20-37.3), Department of Social & Health Services - Facilities (20-38.3), and Statewide Orders relating to Long-Term Care (20-52.2)

Governor Inslee announces cancellation of some state employee raises and need for furloughs
Announced 6/17/20
Directs state agencies to cancel a scheduled 3% general wage increase for many of the state's highest-paid general government employees and to begin furloughs for most state employees. The canceled pay raise will affect nearly 5,600 general government employees. Starting no later than June 28, more than 40,000 state employees will be required to take one furlough day per week through July 25. After July, employees will be required to take one furlough day per month at least through the fall. Employees will also be allowed to take voluntary unpaid furloughs. 

Governor Inslee issues safety plan template for businesses in Phase 3
Issued 6/5/20
Released a template for businesses in phase 3 of the Washington "Safe Start" plan. Each business or entity operating in Phase 3 must develop a written safety plan outlining how its workplace will prevent the spread of COVID-19. A business may fill out this template to fulfill the requirement or may develop its own safety plan. Businesses are still required to follow the state's industry-specific guidance. 
For more information
  Laura Platero, Executive Director
Sarah Sullivan, Health Policy Analyst
(503) 228-4185