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Northwest Portland Area Indian Health Board
Legislative and Policy Update
March 7, 2024
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Mar 12-13, 2024
Facilities Appropriations Advisory Board
Sacramento, CA
Mar 12-14, 2024
IHS Patient Registration and Patient Benefits Coordination Training
Reno, NV
Registration Link
Mar 26-27, 2024
CHAP Tribal Advisory Group Meeting
Rockville, MD – Hybrid
Registration Information
Mar 29, 2024
Information Systems Advisory Committee ISAC Monthly Meeting
Apr 9-10, 2024
HHS Annual Tribal Budget Consultation
Washington, DC
April 15-18, 2024
Tribal Self-Governance Conference
Registration Link
Apr 22-25, 2024
NPAIHB Tribal Health Director Meeting and Quarterly Board Meeting
Sequim, WA
May 1-3, 2024
Region X Tribal Consultation
Silver Reef Casino Resort, WA
More Information TBD
May 7-8, 2024
HHS Secretary's Tribal Advisory Committee
Washington, DC
May 20-23, 2024
2024 National Tribal Health Conference
The Monument, Rapid City, SD
Register Here
June 17-20, 2024
Washington Tribal Opioid Summit
Spokane, WA
July 25-26, 2024
SAMHSA Region X Opioid Summit
Boise, ID / Virtual
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SBIRT Funding. SAMHSA released a Notice of Funding Opportunity (NOFO) for Screening, Brief Intervention, and Referral to Treatment. The purpose of this program is to implement the screening, brief intervention, and referral to treatment public health model for children, adolescents, and/or adults in primary care and community health settings (e.g., health centers, hospital systems, health maintenance organizations (HMOs), preferred-provider organizations (PPOs) health plans, Federally Qualified Health Centers (FQHC), behavioral health centers, pediatric health care providers, children’s hospitals, etc.) and schools with a focus on screening for underage drinking, opioid use, and other substance use. Eligibility includes “Indian tribes, or tribal organizations (as such terms are defined in section 5304 of title 25), health facilities, or programs operated by or in accordance with a contract or award with the Indian Health Service”. Applications are due April 12, 2024. Link to NOFO here. | |
Appropriations and Legislative Updates | |
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Fiscal Year 24 Funding. On Feb 29, the Senate and House extended the FY2024 budget with the fourth continuing resolution for this year. Six bills, including funding for the Departments of Agriculture, Energy, Housing and Urban Development, Transportation, and Veterans Affairs, with a few other related agencies, will be funded through March 8. The remainder of federal government funding will be extended through March 22. The six funding bills are known as the minibus bill. The Special Diabetes Program for Indians included in the minibus is funded for $160,000,000 through December 31, 2024. Minibus text here.
Purchased and Referred Care Improvement Act. Senators Cantwell and Rounds introduced the Purchased and Referred Care Improvement Act, bipartisan legislation to require the Indian Health Service (IHS) to reimburse tribal members for care sought outside of IHS in a timely manner. This would prevent outside providers from burdening tribal members with wrongfully charged medical debt, which is incurred when IHS doesn’t reimburse tribal members for Purchased/Referred Care (PRC) claims in a reasonable timeframe. This act, also introduced on the House side by Representative Dusty Johnson, would:
- Ensure that IHS – not the tribal citizen – is liable for payments for PRC services that are or were authorized by IHS.
- Directs the Secretary to notify PRC providers and patients that the patients are not liable to any provider or debt collector for charges associated with authorized PRC services.
- Permits IHS to establish and implement procedures to allow patients who paid out-of-pocket for IHS-authorized PRC services to be reimbursed by IHS no later than 30 days after a patient submits the necessary documentation.
Protecting Native Americans’ Credit Act of 2024. Representatives Kim Schrier and Dusty Johnson introduced two bills (see PRC Improvement Act above) to hold the Indian Health Service (IHS) accountable for disregarding health care bills owed to providers and to protect Native Americans’ credit from wrongfully charged medical bills owed by IHS through Purchased/Referred Care claims. The Protecting Native Americans’ Credit Act of 2024 would:
- Excludes medical debt attributable to IHS-authorized PRC services received at a non-IHS facility from a Native American’s Consumer Report.
- Provides Native Americans with a dispute process for inclusion of debt for authorized medical services rendered on a consumer report.
- Requires HHS to send a notice to the individual that HHS has assumed liability for part of or all of the medical debt.
- Directs reporting agencies to delete all information related to medical debt from file and notify furnisher and consumer of deletion upon receiving required documentation of HHS’s liability of debt.
Truth and Healing Commission on Indian Boarding School Policies Act of 2024. Representatives Sharice Davids and Tom Cole reintroduced the Truth and Healing Commission on Indian Boarding School Policies Act of 2024 to investigate, document, and report on the histories of Indian boarding schools, Indian boarding school policies, and long-term impacts on Native communities (HR 7227).
The Senate Committee on Indian Affairs (SCIA) held two oversight hearings on the fentanyl crisis impacting Native communities on November 8th.
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The SCIA Oversight Hearing held on Nov. 8th titled, “Fentanyl in Native Communities: Native Perspectives on Addressing the Growing Crisis” is available for viewing HERE.
- The SCIA Oversight Hearing held on Dec. 6th titled, “Fentanyl in Native Communities: Federal Perspectives on Addressing the Growing Crisis” is available for viewing HERE.
House Passes FY 2024 Interior and Environment Appropriations Bill (H.R. 4821). H.R. 4821 includes an increase of $149 million for the Indian Health Service for a total of $7.08 billion in FY 2024 and $5.9 billion in advance appropriations for the IHS in FY 2025. However, the bill does not include the President’s Budget Request to make Contract Support Costs and 105(l) lease mandatory appropriations.
Supporting Rural Veterans Access to Healthcare Services Act (S. 3768). U.S. Senators Kevin Cramer (R-ND) and Angus King (I-ME), members of the Senate Veterans Affairs and Armed Services Committees, introduced the Supporting Rural Veterans Access to Healthcare Services Act. This legislation would provide travel assistance to veterans living in highly rural areas for VA-authorized health care appointments. Specifically, the bill would reauthorize the VA Highly Rural Transportation Grant (HRTG) Program for five years and add Tribal Organizations as entities eligible to apply for the program. The HRTG Program provides transportation services in areas with less than seven people per square mile and is available at no cost for veterans who live in eligible zones.
Restoring Accountability in the Indian Health Service Act of 2023. Sens. Barrasso (R-WY), Thune (R-SD), Lummis (R-WY), Daines (R-MT), and Rounds (R-SD) have reintroduced the Restoring Accountability in the Indian Health Service Act (S. 3130) to amend the Indian Health Care Improvement Act to improve transparency, oversight, and accountability in the IHS and address recruitment and retention.
IHS Workforce Parity Act of 2023. Sens. Cortez Masto (D-NV) and Mullin (R-OK) introduced S. 3022 titled IHS Workforce Parity Act of 2023 that would amend the Indian Health Care Improvement Act to allow IHS scholarship and loan recipients to fulfill service obligations through half-time clinical practice.
Bipartisan Primary Care and Health Workforce Act. The Bipartisan Primary Care and Health Workforce Act was introduced and includes $5.8 billion per year over the next three years in mandatory funding for community health centers and $2.2 billion for each fiscal year in discretionary funding, one-time $3 billion capital investment to support construction and renovation at health centers with priority to dental and behavioral health projects, increasing mandatory funding for National Health Service Corps to $950 million per year for FY 2024 through 2026, $300 million for each FY 2024 through 2028 for the Teaching Health Center Graduate Medical Education program.
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Tribal Consultation, Listening Sessions & Written
Comment Updates | |
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IHS Requirements for IT or physical access to IHS-controlled facilities. On February 29, 2024, the IHS issued a DTLL regarding procedures to comply with the Homeland Security Presidential Directive 12 (HSPD-12): Policy for a Common Identification (ID) Standard for Federal Employees and Contractors. HSPD-12 requires all Federal employees, contractors, volunteers, and affiliates (including Tribal employees and/or contractors), to use standard forms of identification to gain access to federally controlled facilities and Federal Information Technology (IT) systems. IHS is hosting an information session on March 20, 2024, 12:30-2:00 PM Pacific Time.
Reducing Burden When Measuring Performance of SAMHSA Client-Level Grants. SAMHSA hosted two listening session seeking input on burden reduction related to grant performance data collection and reporting. Questions to consider to prepare: What should SAMHSA consider as we prioritize decreased burden and high-quality data? How can collecting and reporting client-level data be streamlined to enhance efficiency? Which questions are most valuable for meeting your data collection requirements? In what ways are you leveraging the data acquired from your SAMHSA grants to enhance and evaluate your programs? If not, what are the constraints preventing its utilization?
Written responses and questions: SAMHSA Office of Tribal Affairs and Policy (OTAP) email mailbox through March 15, 2024, at otap@samhsa.hhs.gov.
IHS HIT Modernization. On January 18, 2024, the Indian Health Service (IHS) issued a Dear Tribal Leader letter, announcing a series of four Tribal and Urban Consultation sessions set to take place throughout the HIT Modernization 2024 calendar. The first session, slated for February 8th, will provide an overview of the Enterprise Collaboration Group. During this session, the IHS requests feedback on system configuration and change management. Written comments are due 30 days following each session by email to consultation@ihs.gov or urbanconfer@ihs.gov - SUBJECT LINE: Health IT Modernization.
Enterprise Collaboration Group
Comments due: March 8, 2024
Deployment and Cohort Planning (virtual event)
Date: May 9th, 2024
Time: 10:30 AM - 12:00 PM PST
Registration
Multi-Tenant Domain Considerations (virtual event)
Date: August 8th, 2024
Time: 10:30 AM - 12:00 PM PST
Registration
Site Readiness and Training (hybrid event)
Date: November 7th, 2024
Time: 10:30 AM - 12:00 PM PST
Location: TBD
Registration
IHS NPRM Abortion Funding. A Dear Tribal Leader Letter dated January 17, 2024, from the IHS Director notified that an NPRM was published in the Federal Register, proposing the removal of outdated regulations on the use of Indian Health Service funds for certain abortions. IHS hosted a consultation on Tuesday, February 27, 2024, and written comments are due by Friday, March 8, 2024.
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Administrative and Regulatory Updates | |
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SAMHSA Medications for the Treatment of Opioid Use Disorder. SAMHSA revised and released the final rule in February 2024, to make COVID-19 flexibilities permanent, and to expand access to care and treatment for opioid-use disorder. These rules will go into effect in October 2024, allowing time for OTPs to prepare and for states to review their regulations that impact how this rule is implemented.
HRSA Announces Nearly $50 Million Initiative to Support Opioid Treatment and Recovery Services in Rural Communities. On Wednesday, March 6, HRSA Administrator Carole Johnson joined White House Domestic Policy Advisor Neera Tanden and more than 900 rural health stakeholders to announce the Rural Opioid Treatment and Response Initiative. The initiative includes the release of the latest Rural Communities Opioid Response Program notice of funding opportunity, RCORP-Impact. This program aims to increase access to life-saving treatment and help rural individuals achieve long-term, sustained recovery.
IHS Encounter Rate. Indian Health Service (IHS) Announces Calendar Year 2024 Reimbursement Rates and Launch of Associated Webpage: IHS Director Roselyn Tso issued a recent Dear Tribal Leader Letter in which she announced the publication of CY 2024 reimbursement rates in the Federal Register. The rates apply for inpatient and outpatient medical care provided at IHS facilities for Medicare (excluding inpatient Medicare Part A) and Medicaid beneficiaries, beneficiaries of other federal programs, and for recoveries under the Federal Medical Care Recovery Act. Director Tso also announced the launch of a new IHS website focused on all-inclusive rate reimbursement information, such as calculation and source documents. The new website is available here.
Outpatient per Visit Rate (Excluding Medicare)
Calendar Year 2024
Lower 48 States: $719
Outpatient per Visit Rate (Medicare)
Calendar Year 2024
Lower 48 States: $667
White House Tribal Nations Summit. On Dec. 6, 2023, President Biden signed a new Executive Order (EO) to reform how the federal government funds and supports Tribal Nations. The EO requires federal agencies to take action to ensure federal funding for Tribes is accessible, flexible, and equitable, creates a Tribal Access to Capital Clearinghouse for Tribes and Native businesses to find federal funding, requires the federal government to measure chronic funding shortfalls and develop recommendations for what additional funding and programming is necessary, and report annually on these recommendations.
Veterans Affairs Reimbursement Agreement. On Dec. 6, 2023, the Indian Health Service (IHS) and the Department of Veterans Affairs (VA) signed a revised reimbursement agreement. VA will reimburse IHS for purchased/referred care and contracted travel for AI/AN Veterans, in addition to direct care provided for AI/AN Veterans. The DTLL is located here, and the updated agreement is located here.
Indian Health Service Scholarships. The IHS Scholarship Program is accepting applications for scholarship support for the 2024-2025 academic year. The IHS Scholarship Comparison Chart shows a list of eligible degree programs.
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Eligible students are encouraged to apply by February 28, 2024.
White House Releases Playbook to Address Social Determinants of Health. This Playbook lays out an initial set of structural actions federal agencies are undertaking to break down silos and to support equitable health outcomes by improving the social circumstances of individuals and communities. To accompany this Playbook, the Department of Health and Human Services also released a Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework.
Health and Human Services (HHS) Region 10 Tribal Quarterly Call. HHS Region 10 hosted a quarterly call on Thursday, February 29, 2024. The Region X Tribal Consultation will be held in May
Indian Health Service (IHS) Announces New Electronic Health Record System. IHS has selected General Dynamics Information Technology, Inc. to build, configure, and maintain a new IHS electronic health record system utilizing the Oracle Cerner technology.
CMS Provides Guidance to States on Coverage of Health-Related Social Needs (HRSNs). The CMS guidance provides opportunities available under Medicaid and Children’s Health Insurance Program (CHIP) to cover services and supports that address health-related social needs.
Tribal Protections in Medicaid and CHIP Managed Care Oversight Toolkit. This new toolkit provides resources for states, managed care plans, and Indian Health Care Providers to maximize the benefits of Medicaid and CHIP managed care for American Indian and Alaska Native enrollees consistent with the statutory and regulatory Indian managed care protections.
State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit. This updated toolkit serves as a consolidated and comprehensive compilation of telehealth policies, including related flexibilities and requirements, for states to consider when using telehealth to deliver Medicaid and CHIP benefits and services.
Mandatory Continuous Enrollment for Children in Medicaid and CHIP. Effective January 1, 2024, states are required to provide 12 months of continuous enrollment for children under 19 in Medicaid and CHIP. States may terminate eligibility for children under 19 for the following limited circumstances for children who reach age 19, cease to be state residents, request a voluntary termination of eligibility, or who are deceased, or the agency determines that eligibility was erroneously granted. States are not limited to providing only a 12-month continuous enrollment period for children. Oregon became the first state to receive approval from CMS to maintain eligibility for children from birth to six. Washington has a similar request waiting for approval by CMS.
Medicaid Unwinding Updates. The Consolidated Appropriations Act 2023 set an end date for the Medicaid continuous enrollment condition to March 31, 2023, which included a fourteen (14) month period for states to comply with Medicaid eligibility determination requirements. Since unwinding has commenced, there has been a dramatic loss in Medicaid coverage nationwide. The Tribal Self-Governance Advisory Committee is coordinating a Tribal-specific data survey to share with the Centers for Medicare and Medicaid Services to show the impact on Tribes and Tribal health programs. The Survey is available HERE.
National Institutes of Health (NIH) announces the establishment of the RADx Tribal Data Repository: Data for Indigenous Implementations, Interventions, and Innovations (D4I). After a competitive review, Stanford University, in partnership with the Native BioData Consortium, has been selected to lead this unique NIH-supported effort. The Native BioData Consortium is the first Indigenous-led 501(c)(3) nonprofit research organization and biodata repository within the geographic borders and legal jurisdiction of a Tribal Nation (Cheyenne River Sioux Tribe).
New Health Resources & Services Administration (HRSA) Director of Tribal Affairs, Juliana Blome, Ph.D. She formerly served as Deputy Director of the Tribal Health Research Office at the National Institutes of Health (NIH), where she worked alongside Dr. David Wilson (Navajo Nation). There, she focused on strengthening collaborations between NIH and American Indian and Alaska Native communities, building partnerships based on trust and transparency, and increasing cultural awareness in research that improves health in Tribal communities.
The Veterans Affairs (VA) Department Finalizes Rulemaking on the Pilot Program on Graduate Medical Education and Residency. Effective Dec. 13, 2023, the VA adopts the proposed rule issued on Feb. 4, 2022, as final, with changes, to amend its regulations to include a new pilot program on graduate medical education and residency. The final rule responds to written comments received, including several comments from Tribes and Tribal organizations.
The U.S. Government Accountability Office (GAO) Releases Report on Indian Health Service Federal Facilities. The Report, released in November 2023, found that many federally operated facilities are not in good condition and their medical equipment is aging. The GAO made three recommendations to IHS: to assess the extent of medical equipment data problems across IHS areas implement a plan to correct any problems, and regularly monitor adherence to IHS medical equipment inventory management policy requirements.
Not Invisible Act Commission Releases Final Report. The Report calls upon the federal government to declare a Decade of Action and Healing to address the crisis of missing, murdered, and trafficked American Indian and Alaska Native people. A summary of Key Findings and Recommendations can be found on page 11 of the Report.
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The Supreme Court Will Hear Contract Support Cost Payments Dispute.
In the past two weeks, the Supreme Court agreed to hear the two federal government petitions consolidated into one case. The petitions request the Court to overturn the orders requiring the IHS to reimburse millions in administrative health care costs to Tribes for third-party income.
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SCOTUSblog articles on “Tribal self-governance at center of dispute over federal health care costs” and “Funding for Native healthcare programs”– article links, one | two.
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2023 National Tribal Opioid Summit | |
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Dear Tribal leaders, Colleagues, and Community –
As ongoing follow-up to the first National Tribal Opioid Summit (NTOS), hosted by the Tulalip Tribes of Washington State we want to remind you of the resource materials available via the National Tribal Opioid Summit Resource Hub. The NTOS Federal Policy Recommendations and Northwest Region Opioid Overdose Mortality Data Brief have been posted on the Resource Hub website, most recently.
- Recent updates include identifying actions items on follow-up to national declaration of an opioid emergency in concert with OR and WA state governor staff and follow-up meetings with congressional staff, including Sen. Tina Smith (MN).
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Northwest Portland Area Indian Health Board | Website | | | | |
