NPAIHB Legislative & Policy  Update
Thursday, October 31, 2019

November 7
12:30pm PST:  IHS All Tribal and Urban Indian Organization Leaders Call
Dial in: 800-857-5577; Passcode:  670929
Webinar: ; Passcode: ihs123

November 13
11:30am PST: Tribal Budget Consultation and Area Instructions Webinar #3
Webinar:; Passcode: ihs123
Dial in:  800-832-0736; Passcode:  4242095

November 14
8:30am-4:00pm: FY 2022 Portland Area Budget Formulation Meeting
Embassy Suites Portland Airport, Portland, OR

November 15
9:00am-12pm PST:  Portland Area SDPI Tribal Consultation #2
Embassy Suites Portland Airport, Portland, OR

10:00AM PST: CMS and TSGAC Medicare Enrollment and Payment Options for Free-standing Tribal Clinics

November 22
12:00pm PST: IHS Direct Service Tribal Advisory Committee (DSTAC) Monthly Call
Dial-In: 866-751-7820; Passcode: 9269951#

Trump nominates RADM Michael Weahkee as IHS Director
Issued 10/22/19
Announces intention of President Donald J. Trump to nominate Rear Admiral (RADM) Michael D.  Weahkee to serve as Director of IHS, RADM Weahkee has served as Acting Director of the IHS since July of 2017 and is a member of the Zuni Tribe.   RADM Weahkee began his health career as a public health specialist in the United States Air Force and has received two Masters degrees from Arizona State University; a Master of Health Services Administration (MHSA) and a Master of Business Administration (MBA).
  White House Announcement

HRSA Shortage Designation Modernization Project (SDMP) (Data Due 11/1)
HRSA is continuing to modernize the shortage designation and scoring processes. In response to several concerns from IHS, tribal, and urban Indian facilities (I/T/U), HRSA uploaded additional data from IHS and disseminated updated scores to I/T/Us. I/T/U with low scores may also upload supplemental data to the Auto-HPSA Portal. Tribes must submit facility and supplemental data through the portal by November 1, 2019 to guarantee a preview prior to the 2020 Health Professional Shortage Area (HPSA). Webinar training on the Auto-HPSA Portal is available on the SDMP website. 

IHS DTLL: IHS initiates tribal consultation on the fiscal year (FY) 2021 funding distribution for the IHS Special Diabetes Program for Indians (SDPI) (Portland Area Tribal Consultation 11/15; Comments Due 12/1)
10/2/19 Issued
Invites Tribal Leaders to provide input on Consultation questions, as well as on any other issues related to the SDPI funding distribution and formula. Congress has reauthorized the SDPI for 1-3 year periods from 2002-2019. SDPI funding has been at $150 million since 2004 and does not include medical inflation. The Portland Area has held one area consultation on October 23 and will hold another consultation on November 15 from 9:00am-12:00pm PST at the Embassy Suites Portland Airport, Portland, OR.

HHS proposes Stark law and anti-kickback statute reforms to support value-based and coordinated care (Comments Due 12/31)
Issued 10/9/19
Announces proposed changes to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the "Stark Law") and the Federal Anti-Kickback Statute. 
The proposed rules provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposals would ease the compliance burden for healthcare providers across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse. Tribes are requesting a safe harbor similar to the safe harbor for Federally Qualified Health Centers (FQHCs).                                                                                                 HHS OIG Proposed Rule                                                                                                CMS Proposed Rule                                                                                                        HHS Announcement
CMS Final Rule on Medicare, Medicaid, and Children's Health Insurance Programs: Program Integrity Enhancements to the Provider Enrollment Process  (Comments Due 11/4, 5pm EST)
Issued 9/10/19; Effective 11/4/19
Implements statutory provisions that require Medicare, Medicaid, and Children's Health Insurance Program (CHIP) providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers. In addition, it provides the agency with additional authority to deny or revoke a provider's or supplier's Medicare enrollment in certain specified circumstances.

GAO Report: Facilities reported expanding services following increases in health insurance coverage and collections
Released 10/1/19
Looks at health care coverage at IHS facilities from 2013 to 2018.  Federal facility data shows that the proportion of patients with insurance grew from 64% to 78% from fiscal years 2013 through 2018. Facilities in states that expanded access to Medicaid saw the largest increases.  Officials  interviewed from 17 facilities told GAO the increased coverage helped federally and tribally operated facilities expand services.

HHS announces guide for appropriate tapering or discontinuation of long-term opioid use                                                                                      
Issued 10/10/19                                                                                           
Provides advice to clinicians who are contemplating or initiating a change in opioid dosage. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the Guide covers important issues to consider when changing a patient's chronic pain therapy. It lists issues to consider prior to making a change, which include shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient's dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support.                      

Federal Health Insurance Exchange 2020 Open Enrollment
Issued 10/25
Announces the 2020 Federal Health Insurance Exchange's open enrollment period which begins on November 1, 2019. The Health Insurance Exchange (the Marketplace) benefits American Indians and Alaska Natives (AI/ANs) by providing opportunities for health coverage through Marketplace health insurance plans. AI/ANs can enroll in the marketplace any time during the year. Consumers can visit to preview 2020 health plans. 
Senate passes FY 2020 minibus which includes Interior spending bill
Passed 10/31/19
Today the Senate passed (84-9) a bipartisan package of 4 bills that will fund Interior, Agriculture, Transportation and Commerce. Senate Interior spending bill for IHS is only $237m above FY 2019 enacted level, which is $300m less than House spending bill for IHS. House spending bill for IHS was $537m above FY 2019 level. Senate and House must still go to conference to come up with a final spending bill for IHS. 

House Veterans Affairs Committee hearing on healthcare needs for Native Veterans
This hearing represents the first time in decades that  Congress  has held a hearing specifically to examine issues related to health care  accessor  AI/AN veteran issues within both the VA and IHS. On behalf of NIHB, Andrew Joseph, Jr. testified on the need for regular  consultation  with tribes, expansion on access to culturally competent care, increase the scope of mental health services, reimbursement for PRC services, and clarify the referral process between VA and IHS. 

Native American Health Savings Improvement Act (H.R. 4530)
Introduced 9/26/19
Rep. John Moolenaar (R-MI) introduced legislation to amend the Internal Revenue Code to 1986 to permit individuals eligible for Indian Health Service assistance to qualify for health savings accounts. 

Nursing Home Care for Native Veterans Act (H.R. 4532/S. 2558)
Introduced 9/26/19
Rep. Tom O'Halleran (D-AZ) and Sen. Kyrsten Sinema (D-AZ) introduced companion bills to amend Title 38 of U.S.C. to authorize the Secretary of Veteran Affairs to make certain grants to assist nursing homes for veterans located on tribal lands. 

Native Health Access Improvement Act (H.R. 4533)
Introduced 9/26/19
Rep. Frank Pallone (D-NJ) introduced legislation to amend the Public Health Service Act to improve behavioral health outcomes for American Indians and Alaska Natives.

Native Health and Wellness Act (H.R. 4534)
Introduced 9/26/19
Rep. Raul Ruiz (D-CA) introduced legislation to amends the Public Health Service Act to improve the public health system in tribal communities and increase the number of American Indians and Alaska Native pursuing careers and for other purposes. 

All Other Pending Indian Health Bills
10/31  Senate succeeds - then stumbles - on spending bills amid border wall fight

10/31 Indiana halts its Medicaid work requirement

10/28 Rep.Greg Walden, top Republican on powerful House panel, says he will retire

10/25 FDA working 'as quickly as possible' on e-cigarette flavor ban

10/24 Vaping-related lung injuries rise to 1,604 cases nationwide, CDC says

10/22 Idaho submits Medicaid expansion waiver for family planning

10/22 Medicare diabetes prevention helps a few hundred instead of hundreds of thousands

9/30 Idaho submits work requirement waiver for Medicaid expansion
For more information
  Laura Platero, Director of Government Affairs/Health Policy 
Sarah Sullivan, Health Policy Analyst
(503) 228-4185