Northwest Portland Area Indian Health Board
Legislative and Policy Update
October 26, 2023
Oct. 27, 2023 (11:00 AM PT)
IHS Information Systems Advisory Committee Monthly Meeting
Oct. 30, 2023 (11:00 AM PT)
VA’s Tribal Consultation on Climate Adaptation and Environmental Justice
Nov. 2, 2023 (12:00 PM PT)
IHS November Tribal and Urban Indian Organizations Call
Nov. 8, 2023 (10:30 AM PT)
IHS Tribal Consultation: Health Information Technology Modernization The Path Forward
Nov. 9, 2023 (11:00 AM PT)
SAMHSA Tribal Consultation on Tribal Opioid Response Grant
Nov. 9, 2023 (1:00 PM PT)
SAMHSA Tribal Listening Session on Behavioral Health and Substance Use Disorder Resources for Native Americans
Nov. 12-17, 2023
National Congress of American Indians Annual Convention & Marketplace
New Orleans, LA
Nov. 13, 2023
SAMHSA Tribal Listening Session on the Use of High-Dose Buprenorphine for the Tx of OUD
Nov. 28, 2023 (8:00 AM PT)
Save the New Date!
Portland Area Office FY 2026 Budget Formulation Meeting
Nov. 28-29, 2023 - to be confirmed
HHS Secretary’s Tribal Advisory Committee (STAC) Meeting
Nov. 30, 2023 (10:00 AM PT)
IHS NTAC Quarterly Meeting
Dec. 5-6, 2023
IHS Tribal Leaders Diabetes Committee Meeting
Embassy Suites by Hilton Portland Airport, Portland, OR or Virtual
Dec. 6-7, 2023
Direct Service Tribes Advisory Committee National Meeting
Dec. 13, 2023 (8:00 AM PT)
IHS Health IT Modernization Summit
2023 National Tribal Opioid Summit
Dear Tribal leaders, Colleagues, and Community,
On behalf of the Northwest Portland Area Indian Health Board (NPAIHB), I want to offer my deep appreciation for your participation in the first National Tribal Opioid Summit (NTOS), hosted by the Tulalip Tribes of Washington State. Together, we were over 1,000 Tribal leaders, frontline workers, and federal and state policymakers sharing our knowledge, experiences, and commitment to ending the tribal opioid crisis.
Over our three days together, we heard invaluable feedback from you on how to improve prevention, care and support, law and justice, and data along with the need for increased funding and policy changes to strategically address the opioid crisis as a public health emergency.
The NPAIHB is committed to supporting the power and the leadership of Native communities in developing solutions. As a follow-up to the Summit, we have developed:
1. A set of draft policy recommendations (linked here); we request comments, edits, and suggestions to email@example.com by October 27, 2023.
2. The policy team from the NTOS will be reconvening to determine follow-up and to finalize this document.
3. The NTOS Resource Hub will continue to be your resource for more information—https://www.npaihb.org/national-tribal-opioid-summit/
We have turned the NTOS registration website into a National Tribal Opioid Summit Resource Hub to serve as a central location for post-Summit follow-up.
We heard from those with lived experiences that first and foremost we must save lives and connect those who are ready for treatment with culturally-based services. NPAIHB's Opioid Use Disorder site has information and videos available on Narcan and Medication Assisted Treatment.
The Summit showed that we are stronger together. We continue to heal. By harnessing the strength of our sovereign tribal governments, our partnerships with federal and state agencies, and the collective wisdom of communities—we can end this epidemic.
To healing our Nations together.
Quarterly Health News & Notes
Check out the Injury Prevention edition of the Health News & Notes quarterly journal. This issue features comments from Chairman Nickolaus D. Lewis; vehicular and pedestrian safety; and ending the Syphillis endemic in Indian Country.
Appropriations and Legislative Updates
Continuing Appropriations Act, 2024. Congress passed the Continuing Appropriations Act, which funds the federal government through Nov. 17, 2023, and averted a government shutdown for now. The Act included a temporary extension for the Special Diabetes Program for Indians (SDPI), which will expire after the Nov. 17 deadline.
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. The HELP Senate Committee plans to hold a business hearing on the Bipartisan Primary Care and Health Workforce Act. This legislation 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.
Tribal Consultation, Listening Session & Written Comment Updates
IHS Tribal Consultation on Designating North Dakota and South Dakota as Purchased/Referred Care Delivery Areas (PRCDA). IHS will host two tribal consultations on Oct. 18, 2023, at 12 PM PT and Oct. 26, 2023, at 12 PM PT to discuss the agency’s plans to study PRC implications and the feasibility of creating statewide PRCDAs in North Dakota and South Dakota. Written comments will be accepted until Nov. 15, 2023.
Office of Minority Health (OMH) Listening Session on Healthy People 2030. OMH will be hosting a listening session on Oct. 25 at 1 PM PT to discuss a notice of funding opportunity entitled “Healthy People 2030 Leading Health Indicators Initiative.” Written comments are accepted until Oct. 31, 2023, to firstname.lastname@example.org.
Department of Veterans Affairs (VA) Tribal Consultation on Climate Adaptation and Environmental Justice. The VA will be hosting a virtual consultation on Oct. 30, 2023, at 11 AM PT on the VA’s Climate Adaptation Plan for 2024 and on the VA’s Environmental Justice Strategic Plan development. Written comments are due by Oct. 30, 2023, to email@example.com with the subject line: “VA Climate Adaptation Planning” or “Environmental Justice at VA.”
Substance Abuse and Mental Health Services Administration (SAMHSA) Virtual Tribal Consultation on the Tribal Opioid Response Grant Program. SAMHSA will hold a virtual tribal consultation on the Tribal Opioid Response grant program on Nov. 9, 2023, at 11 AM PT.
SAMHSA Virtual Tribal Listening Session on the Behavioral Health and Substance Use Disorder Resources for Native Americans. SAMHSA will be hosting a second virtual tribal listening session on Nov. 9 at 1 PM PT on the Behavioral Health and Substance Use Disorder Resources for Native Americans grant program that was authorized under Section 1201 of the Consolidated Appropriations Act, 2023.
SAMHSA Virtual Tribal Listening Session on the Use of High-Dose Buprenorphine for the Treatment of Opioid Use Disorder. SAMHSA will be hosting a virtual tribal listening session on Nov. 13 at 11:30 AM PT to hear from providers treating OUD in Tribal clinical settings about the need for, effectiveness and safety of, barriers to, and practical experience with higher dose (24mg+) buprenorphin.
IHS Portland Area Office (PAO) Budget Formulation Tribal Consultation. IHS Portland Area Office (PAO) FY 2026 Budget Formulation Meeting. Please save the date for the IHS PAO FY 2026 Budget Formulation meeting on Nov. 28, 2023, from 8-12:30 PM PT.
- Location information, a Zoom link, and meeting materials will be forthcoming.
CDC Environmental Justice Index Tribal Listening Session. The CDC, the Agency for Toxic Substances and Disease Registry (ATSDR), and the HHS Office of Environmental Justice are hosting a listening session on Oct. 27 at 12 PM PT to hear from Tribal Leaders regarding their input and concerns related to the Environmental Justice Index. The Index provides place-based scores representing the impacts of environmental injustice on local communities across the country to help identify high-risk areas for health impacts. A Zoom registration link will be forthcoming.
IHS Initiates Consultation on the Updated Medical Priority Levels for Purchased/Referred Care (PRC). IHS is seeking written comments by Oct. 27, 2023, to firstname.lastname@example.org on the IHS Medical Priority Levels. Under the new updated levels, PRC services are divided into four general categories: A) Preventative and Rehabilitative; B) Medical, Dental, Vision, and Surgical Services; C) Reproductive & Maternal/Child Health Services; and D) Behavioral Health Services. Each category has three priority levels: Priority 1, Core—Essential Services; Priority 2, Intermediate—Necessary Services; and Priority 3, Elective—Justifiable Services. These priority levels will be implemented no later than Jan. 1, 2024, across the federally-operated units and may be used as a guide for Tribal programs. Albuquerque Area has already implemented these priorities as a pilot as of 2016.
NIH All of Us Research Program Tribal Consultation. NIH hosted a virtual consultation on the All of Us Research Program last week. The Tribal consultation included an update on NIH’s approach to Tribal engagement, a discussion about integrating data from self-identified AI/AN participants in the program’s data platform, the All of Us Research Hub, and program planning. Written comments are due by Oct. 28, 2023, to AOUTribal@nih.gov.
HHS Tribal Consultation on Section 504 of the Rehabilitation Act Proposed Rulemaking. HHS Office for Civil Rights hosted a virtual tribal consultation last week on proposed rulemaking implementing Section 504 of the Rehabilitation Act, which prohibits discrimination based on disability in programs and activities that receive Federal financial assistance. Written comments are due Nov. 13, 2023, through the Federal Rulemaking Portal.
Administration of Community Living (ACL) Tribal Consultation on the Older Americans Act (OAA). ACL hosted a tribal consultation on last week to review proposed changes to the OAA implementing regulations to incorporate a new subpart on Adult Protective Services published in the federal register on Sep. 12, 2023.
Administrative and Regulatory Updates
HHS and Drug Enforcement Agency (DEA) Issues Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription Controlled Substances. On March 1, the DEA released two proposed rules that would restrict telemedicine prescribing of controlled substances unless there had been a prior in-person medical evaluation. The DEA received over 30,000 comments from the NPAIHB in response to this proposed rule. To allow time to review the comments, the DEA continued the telemedicine flexibilities for prescribing controlled medications authorized under the COVID-19 Public Health Emergency until Nov. 11, 2023. The DEA and HHS have issued a second temporary extension through Dec. 31, 2024.
IHS Shares Resources to Address Opioid Epidemic. The IHS has gathered resources and tools to address the opioid crisis, including fentanyl test strips education; screening, brief intervention, and referral to treatment; Naloxone training toolkit; and syringe service resources. The resources and tools are available at www.ihs.gov/opioids/harmreduction.
IHS Released Updated Information on Seasonal Vaccines. See Dear Tribal Leader Letter dated September 22, 2023, with updated information on Influenza, Respiratory Syncytial Virus (RSV), and COVID-19 vaccines.
IHS Announces FY 2023 Allocation Decision for $700 million under the Bipartisan Infrastructure Legislation (BIL). In the BIL, IHS was appropriated $700 million each fiscal year 2022-2026 for the Sanitation Facilities Construction Program. During a consultation in April, IHS informed tribal leaders that there was a funding shortfall to fund all 1,369 projects, totaling $4.4 billion in the Sanitation Deficiency System (SDS) as of December 31, 2022. For FY 2023, IHS has announced that the agency will continue to use current SDS data and not limit funding to projects on the SDS list as of 2021. Additionally, IHS will allocate $584 million to Tier 1 construction costs projects, $29 million for Tier 1 design and construction documents, and $70 million for project shortfalls.
IHS FY 2024 Loan Repayment Program Update. IHS will begin accepting applications on Oct. 1, 2023, for the 2024 Loan Repayment Program for eligible healthcare professionals at www.ihs.gov/loanrepayment/applynow. The awards will provide up to $50,000 total in exchange for a 2-year full-time service obligation.
ACF Announces Proposed Reallotment of FY 2022 Funds for the Low Income Home Energy Assistance Program (LIHEAP). ACF has announced a preliminary determination that funds from FY 2022 LIHEAP are available for reallotment to states, territories, tribes, and tribal organizations that received FY 2023 direct LIHEAP grants. This preliminary redistribution of funds from FY 2022 does not include funds appropriated under the American Rescue Plan Act of 2022, P.L. 117-2.
CDC Recommends 2023-2024 COVID-19 Boosters for Everyone 6 Months and Older. Updated COVID-19 vaccines from Pfizer-BioNTech and Moderna will be made widely available.
CMS Releases Updated Guidance on Medicare Provider Enrollment for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). CMS has released a provider enrollment Frequently Asked Questions (FAQs) addressing details on Medicare enrollment of MFTs and MHCs. The Consolidated Appropriations Act of 2023 expanded Medicare Part B coverage to include reimbursement for behavioral health services furnished by MFTs and MHCs starting in 2024.
CMS Releases New Medicaid Transportation Coverage Guidance. CMS released State Medicaid Director Letter No. 23-006 regarding transportation assurance, including a compilation of Medicaid transportation policy with federal requirements and state flexibilities. Page 16 of the Guide discusses Tribal transportation and references federal regulation that permits Tribes and Tribal organizations to serve as transportation brokers to address the many barriers American Indian and Alaska Native beneficiaries face accessing transportation.
CMS Extends Four Walls Grace Period for an Additional 12 Months. CMS announces an extension for IHS and Tribal facilities enrolled as clinics to continue to claim Medicaid reimbursement for services furnished outside of the “four walls” of the facility.
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.
FDA Announces Additional Tools for States and Tribes Interested in Section 804 Importation Program (SIP). The SIP allows authorized programs to import certain prescription drugs from Canada to reduce the cost of covered drug products. For Tribes and states interested in submitting a SIP proposal, the FDA has created Tips for SIP proposals available HERE. You can contact the agency’s Intergovernmental Affairs staff at IGA@fda.hhs.gov to discuss the SIP program further.
Tribal Health-related Funding Opportunities
IHS released a Dear Tribal Leader Letter to announce that they are accepting applications for the FY 2022 and 2023 Small Ambulatory Program (SAP). The FY 2022 budget includes $25 million, and the FY 2023 budget includes $25 million for a total budget of $50 million available for SAP. Fiscal year 2022 and 2023 SAP projects will be awarded up to $3.5 million, and all 12 IHS Areas that submit an application will have an opportunity to receive an award. Under the SAP, Tribes or Tribal Organizations that are operating an Indian healthcare facility pursuant to a healthcare services contract or compact may competitively apply for funding for the construction, expansion, or modernization of small ambulatory healthcare facilities.
Anticipated Award: Up to $3.5 million. Due date: Nov 10, 2023.
If your Tribe or Tribal Organization is interested in participating in the FY 2022 and FY 2023 SAP, please download and complete the application on the DFPC website at https://www.ihs.gov/dfpc/programs/#sap.
John Hopkins Center for American Indian Health Scholarship. Financial support for American Indian and Alaska Native scholars, health leaders, health professionals, and paraprofessionals serving tribal communities who are interested in attending the Johns Hopkins Center for American Indian Health Summer or Winter Institute courses at the Johns Hopkins School of Public Health. Eligible applicants are American Indian and Alaska Native scholars with a Bachelor’s degree and a minimum grade point average of 2.75.
The application due date is Nov. 17, 2023.
The IHS Division of Diabetes Treatment and Prevention has a new 2024 funding opportunity for federally recognized tribes, tribal organizations, urban Indian organizations, and/or federal healthcare facilities that currently do not have a 2023 Special Diabetes Program for Indians grant. The 2024 Special Diabetes Program for Indians 2.0 (SDPI-2) will be a 4-year program to address diabetes treatment and prevention efforts in American Indian and Alaska Native communities, and applications are due by Nov. 29, 2023.
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