NPAIHB Legislative & Policy Update
Tuesday December 21, 2020

ACTION ALERTS
Continuing Resolution (CR) 

Two CR's have passed since the last Legislative and Policy Update, funding the federal government through Dec 21, 2020. The House and Senate worked over the weekend and reached agreement an additional COVID-19 relief package, which will move forward Dec 21 along with the omnibus appropriations bill for FY 2021.
 
COVID-19 Relief

The House and Senate reached an agreement over the weekend on $900 billion in COVID-19 relief, and are expected to vote on this bill as a part of a $1.4 trillion FY 2021 appropriations package today. Tribal specific provisions include:
  • EXTENSION to Dec 2021 for the use of CARES Act Funding (1)
  • $1b in Provider Relief Funds for tribes, tribal organizations, urban Indian organizations, and health service providers to tribes
  • $3.42b from the Center for Disease Control (CDC) in direct grants to tribal, state, local and territorial governments
  • $129m from the CDC for vaccination distribution and infrastructure for tribes, tribal organizations, urban Indian organizations, and health service providers to tribes
  • $350m in direct grants for tribes, tribal organizations and urban Indian health organizations for COVID-19 testing and tracing
  • $25b in rental assistance to states and local governments, and Native American tribes
  • Funding for the Food Distribution Program on Indian Reservations (FDPIR)
  • $3.15b to SAHMSA block grant programs
  • An additional $300/week in unemployment benefits for 11 weeks (1)
  • $600 direct stimulus payments, with an additional $600/child (1)
1. Duehren, Andrew; Peterson, Kristina. Congress has Reached Agreement on Pandemic Relief, McConnell Says. Wall Street Journal. Dec 20, 2020.
 

This Act was passed by Congress on Dec 18, 2020. This Act amends the Indian Health Care Improvement Act and requires Department of Defense and Department of Veteran's Affairs to reimburse Indian Health Service for services provided through purchased/referred care.
 POLICY UPDATES
Government Accountability Office
 
The Government Accountability Office (GAO) provided a report to Congress containing recommendations to the Indian Health Service regarding improvements needed in the areas of provider misconduct and substandard performance. On the GAO website, it states that "this report was generated because of provider misconduct, including sexual abuse and physical assault. IHS has taken steps to address these concerns but inconsistencies remain in its oversight. IHS lacks
  • A consistent process to review its regional offices' training and policies
  • A standard format to document reviews of information (such as patient complaints) to ensure consistent oversight at facilities"
 
Health & Human Services

On Dec 18, 2020 HHS published proposed changes to the Affordable Care Act that will require state Medicaid, Medicaid Managed Care,  and CHIP programs to improve the prior authorization process and improve Health Information Exchanges. The proposed rule would require payers in Medicaid and CHIP to build electronic interfaces (HL7) for data exchange and prior authorizations.  The proposed rule does not cover Medicare or Medicare Advantage plans at this time.  Comments are due by Jan 04, 2021.
 
Health Resources and Services Administration
 
The FAQ for Provider Relief Funds was updated as of Dec 04, 2020.
 
Indian Health Service
 
Indian Health Services issued a DTLL on Dec 17, 2020 announcing an additional consultation regarding the Buy Indian Act Notice of Proposed Rulemaking in order to review contracting procedures.
 
Indian Health Service issued a DTLL on Dec 10, 2020 to update the I/T/U system on next steps related to Information Technology (IT) modernization. RADM Weahkee's recommendation is a full replacement of the RPMS system. Written consultation comments are due Jan 24, 2021 to consultation@ihs.gov.
IHS is hosting a Health IT Modernization listening session
  • Jan 14, 2021 from 11am - 12:30 pm (Pacific Time) REGISTRATION LINK
  • Meeting ID: 939 813 1199  Passcode: 026367
The IHS and the U.S. Department of Veterans Affairs issued a joint DTLL on Dec 02, 2020 regarding an upcoming joint consultation on the DRAFT revised Memorandum of Understanding (MOU) between the two agencies.
  • DRAFT MOU
  • The first information session was held on Dec 09, 2020 the next session TBD
  • Written comments and recommendations due Feb 12, 2021
    • consultation@ihs.gov or tribalgovernmentconsultation@va.gov
    • Subject Line: VA-IHS MOU Update
 
Office of Civil Rights
 
Department of Health and Human Services (HHS), Office of Civil Rights (OCR) issued guidance Dec 18, 2020 regarding how HIPAA permits covered entities and their business associates may use health information exchanges (HIEs) to disclose protected health information (PHI) for the public health activities of a public health authority.
 
Office of Minority Health
 
Department of Health and Human Services (HHS), Office of Minority Health (OMH) is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Minority Health.
  • Committee and qualification information is found here.
  • Deadline for nominations is Mar 04, 2021.
LEGISLATIVE UPDATES
Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 is headed to the President's desk for signature. This package of bills will improve access to care and reduce costs for all veterans, and includes the following re. American Indian/Alaska Native (AI/AN) veterans:
  • An amendment to statute (38 U.S.C ยง 1730A) that prohibits the collection of co-pays from AI/AN veterans by the Veterans Administration. 
  • The formation of a Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs that will advise the VA Secretary on matters related to Indian tribes, tribal organizations, and Native veterans.
  • A provision that allows IHS to enter into a memorandum of understanding with the Secretary of HHS that will allow IHS case managers to provide case management assistance to veterans who receive housing vouchers under the Tribal Housing and Urban Development-Veterans Affairs Supportive Housing program (Tribal HUD-VASH)
 
H.R. 6535 passed the House on Dec 17, 2020 and the Senate on Dec 20, 2020. This legislation extends federal tort claims protection to Urban Indian Organizations (UIO) and employees of UIOs.

For more information
 Laura Platero, Executive Director
Veronica Smith, Health Policy Consultant
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