NPAIHB Legislative & Policy Update
Tuesday January 26, 2021

Executive Orders

President Biden has issued 30 Executive Orders (EO's) or Memorandum since taking office on Jan 20, 2021. These actions reversmany EO's of the previous administration. Included among these is a Memorandum that freezes all regulatory rules and guidance that have not yet taken effect. The Regulatory Freeze Pending Review will give federal department and agency leadership appointed by or designated by President Biden 60 days to review, and possibly open comments periods for the last minute rules put forward by the previous administration. Your Health Policy team will continue to follow the impact of this EO. 

NPAIHB Regulations Tracker: An on-going list of regulations and status with analysis of potential impact on Indian Country. 

President Biden issued an EO addressing a Unified and Effective Response to Combat COVID-19, creating a COVID-19 Response Coordinator position within the White House, and returning the U.S. to its role as a leader in global health and security. He also issued an EO Advancing Racial Equity and Support for Underserved Communities that utilizes the White House Domestic Policy Council to coordinate the implementation of his domestic policies, embedding "equity principles, policies, and approaches across the Federal Government".

Acting Leadership at Health and Human Services

Norris Cochran has been named Acting Secretary of the Department of Health and Human ServicesMr. Cochran is the HHS Assistant Secretary of Budget, and will serve in the role of Acting Secretary until Xavier Becerra is confirmed by the Senate.

Elizabeth Fowler has been named Acting Director of the Indian Health ServiceMs. Fowler is a member of the Comanche Nation. She has worked for the Indian Health Service (IHS) since 1990, working in many different leadership roles, most recently she has been the Executive Officer for the IHS Oklahoma City Area.

Indian Health Service and 
Veterans Administration Memorandum of Understanding

 A joint Dear Tribal Leader Letter (DTLL) was issued on Dec 02, 2020 regarding an upcoming joint consultation on the DRAFT revised Memorandum of Understanding (MOU) between the two agencies. 
Health Resource and Services Administration

Health Resource and Services Administration (HRSA) received an additional $1 billion through the Coronavirus Response and Relief Supplemental Appropriations Act, 2021, and issued updated  Post-Payment Reporting Requirements on Jan 15, 2021. The Provider Relief Fund Reporting Portal is open for registration. There are no known reporting deadlines at this time. Additional information can be found:
Indian Health Service

Purchased and Referred Care Workgroup Recommendations. The Purchased/Referred Care Workgroup (Workgroup) sent a letter to RADM Weahkee on Jan 19, 2021 outlining the following recommendations:
  • State Medicaid Programs and Work Requirements
    • IHS needs to provide guidance re State Medicaid Work Requirements and PRC
  • Catastrophic Health Emergency Fund (CHEF) Online Tool
    • Online Tool must continue to be a priority 
  • Publishing CHEF Regulations and lower the CHEF Threshold
    • Recommend new CHEF regulations be developed, using recommendations made by the Workgroup regarding CHEF Regulations published in the Federal Register on Jan 16, 2021
Buy Indian Act Tribal Consultation. RADM Weahkee issued a Dear Tribal Leader Letter (DTLL) on Jan 19, 2021 stating that the comment period for the Buy Indian Act Tribal Consultation will be re-opened for an additional 60 days, and that a notification will be published in the Federal Register.  If you have any questions regarding this Consultation, please contact Mr. Santiago Almaraz, Acting Director of the Office of Management Services at the IHS at
IHS Director's Letter. RADM Weahkee also sent a Jan 15, 2021 DTLL offering his thanks for the opportunity to serve in IHS leadership, and as the Director of Indian Health Service of the last four years. 
Coronavirus Response and Relief Supplemental Appropriations Act. IHS issued a Jan 15, 2021 DTLL announcing the allocation of $790 million from the Coronavirus Response and Relief Supplemental Appropriations Act, with 
  • 50 million to Urban Indian Organizations
  • 190 million for the purchase of COVID-19 tests, test kits, testing supplies, therapeutics and personal protective equipment
  • 550 million in program increases to the Hospitals/Clinics, Purchased Referred Care, Alcohol and Substance Use Disorder, Mental Health, Community Health Representative, and Public Health Nursing sub accounts. 
We anticipate another letter in the near future announcing the disbursal of the remaining $210 million dollars that was addressed in the Jan 04, 2021 Tribal
Consultation. The NPAIHB Comment Letter  was submitted on Jan 08, 2021. 
Health IT Modernization. NPAIHB submitted a comment letter to the IHS on Jan 23, 2021 regarding the IHS Dec 10, 2021 DTLL regarding Health Information Technology Modernization. 
Legislative Updates

President Biden introduced his plan for COVID-19 Relief, the 
American Rescue Plan, on Jan 14, 2021. This is a 1.9 trillion-dollar legislative package that provides economic relief and pandemic support. The Biden Plan recognizes that American Indian/Alaska Native people living on reservations are 4x as likely to have COVID-19, and 2x as likely to die from COVID-19 than white Americans, and includes a 20 billion-dollar investment in Indian Country. The Biden Plan also includes $1,400 per-person checks, and raises the minimum wage to $15/hour nationally. Both of these provisions are meeting with opposition on Capitol Hill. With the former president's impeachment hearings beginning on Feb 09, 2021, and the new Senate still negotiating its rules for governance with 50 Democrats and 50 Republicans, it is unclear if a COVID-19 relief package will happen before March.1, 2  
  1. Krawzak, Paul. Impeachment Trial Could Knock Biden Virus Aid Plan Off Course. Roll Call. Jan 22, 2021.
  2. Mascaro, Lisa; Jalonick, Mary Clare. Schumer:  Trump Impeachment Trial to Begin Week of Feb. 08. The Washington Post. Jan 22, 2021.
For more information
 Laura Platero, Executive Director
Veronica Smith, Health Policy Consultant