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Northwest Portland Area Indian Health Board
Legislative and Policy Update
Jully 11, 2023
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Jul 13, 2023 (12:00 PM PST)
Indian Health Service Tribal and Urban Indian Organizations Call
Information Link
Jul 19-20, 2023
Region 10 Opioid Summit
— Vancouver, WA
Registration Link
Jul 20, 2023 (12:00 PM PST)
DSTAC Monthly Meeting
Jul 24, 2023 (12:00 PM PST)
Tribal Health Directors Meeting
— Siletz, OR
Jul 25-27, 2023
16th Biennial NPAIHB & CRIHB Joint & Quarterly Board Meeting
— Siletz, OR
Jul 25, 2023
MMPC Face-to-Face Meeting
— Washington, DC
Jul 26, 2023 (11:00 AM PST)
NIH Tribal Advisory Committee Monthly Meeting
— Virtual
Jul 26-27, 2023
TTAG Face-to-Face Meeting
— Washington, DC
Jul 27-29, 2023
MMPC/CMS TTAG Meetings
— Washington, DC; hybrid
Jul 27, 2023 (9:30 AM PST)
CHAP Tribal Advisory Group (TAG) Meeting
— Virtual
Zoom Link
Jul 27, 2023 (11:00 AM PST)
CDC/ATSDR Tribal Advisory Committee Meeting
Jul 27, 2023 (11:00 AM PST)
Northwest Region/Region 10 – Federal/Tribal Coordination Call
— Virtual
Aug 10-11, 2023
HHS Annual Region 10 Tribal Consultation
— Hybrid; Anchorage, AK
Registration Link
Aug 16-17, 2023
NIH Tribal Advisory Committee Meeting
— Bethesda, MD
Aug 22-24, 2023
National Tribal Opioid Summit
— Tulalip, WA
Registration Link
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Acclaimed actor Dallas Goldtooth known for his work on Rez Dogs and Dakota language instructor and writer will be joining NPAIHB for our National Tribal Opioid Summit on Aug. 22-24 hosted by the Tulalip Tribes.
The National Tribal Opioid Summit will address the intersection of COVID-19 and the opioid crisis throughout our communities.
NPAIHB and Tribal leaders recognize the pain and heartbreak of losses in our communities, the anxiety of behavioral health prover shortages and provider burnout, and the lack of culturally specific substance use treatment and recovery programs. The summit program will address the need for increased funding and policy changes to collectively and strategically address this crisis.
(War whoop!)
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Spring Edition
Check out the Behavioral Health edition of the Health News & Notes quarterly journal. This issue features comments from Chairman Nickolaus D. Lewis and information on the upcoming summer youth delegate opportunities.
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Legislation & Appropriation Updates | |
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Indian Child Welfare Act upheld (Brackeen v. Haaland decision). In a major ruling on June 15, the Supreme Court rejected a challenge to the constitutionality of the Indian Child Welfare Act, a 1978 federal law that seeks to keep Native American children with Native American families. By a vote of 7-2, the court ruled that Congress had the power to enact the law, and it rebuffed arguments that the law violates the 10th Amendment’s “anticommandeering” doctrine, which bars the federal government from requiring states to adopt or enforce federal law. The court declined to reach two other claims, including an argument that ICWA discriminates based on race, explaining that neither the individuals challenging the law nor the state of Texas have standing – a legal right to bring the lawsuit in the first place.
Fiscal Responsibility Act, H.R. 3746 Passes House and Senate, Signed into Law by President. President Joe Biden signed the debt ceiling bill, a capstone to months of negotiations to address the limit. H.R. 3746 suspends the debt ceiling limit through January 1, 2025, limits FY 2024 nondefense discretionary funds to FY 2023 levels, allows for a 1% growth in FY 2025 and considers only a 1% increase for FY 2026-2029. Additionally, this deal prevents a first-ever default while reducing the budget deficit, safeguards Social Security, Medicare, and Medicaid, and fulfills obligations to veterans. Raising the nation's debt limit, now at $31.4 trillion, will ensure the government can borrow to pay debts already incurred.
- The legislation includes spending caps on the total amount for non-defense discretionary funding for two years.
- The Indian Health Service (IHS) falls under non-defense discretionary funding; however, how the caps impact the actual IHS budget has yet to be determined.
- The legislation included the budgetary authority to extend advance appropriations for IHS for FY25 and FY26 but limited the advance appropriation amount for each year to the FY 2024 appropriated amount.
- The IHS issued a Dear Tribal Leader Letter on June 30, 2023, detailing the impact of FTRA on COVID-19 funding. Funds transferred from the IHS to Tribes are considered obligated and are not subject to a recession. The IHS estimates the recession will be $419 million, with 4.858 million from the Portland Area.
Special Diabetes Program for Indians (SDPI). On June 15, the Senate Health, Education, Labor, and Pensions Committee held a business meeting to consider several bills. Among the measures the Committee approved, and by a 20 to 1 vote, is legislation introduced on June 7 by Senators Collins (R-ME) and Shaheen (D-NH), the co-chairs of the Senate Diabetes Caucus, which would reauthorize the Special Diabetes Program (S. 1855). The bill would reauthorize the Type 1 Diabetes Research program and the Special Diabetes Program for Indians components at $170 million for FY 2024 and FY 2025. Sixty senators recently sent a letter to Senate leadership in support of the reauthorization of the Special Diabetes Program.
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Reauthorization Act of 2023, H.R. 2547, introduced by Rep. Tom Cole (R-OK-04) and Rep. Raul Ruiz (D-CA-36). This bill would reauthorize SDPI at $150 million annually for five fiscal years.
- House SDPI sign-on letters are still accepting signatures! Urge your representative to join the letter!
- To view the Congressional sign-on letter for the House, click here.
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Special Diabetes Program Reauthorization Act of 2023, S.1855. On June 15, the Special Diabetes Program Reauthorization Act of 2023 was marked up in committee. (Senate Health, Education, Labor, and Pensions Committee). The bill will reauthorize the Type 1 Diabetes Research program and the Special Diabetes Program for Indians at $170 million each for FY 2024 and FY 2025.
Assistant Secretary for Indian Health within HHS, H.R. 2535, reintroduced in the 118th Congress by Rep. Stanton (D-AZ) and Rep. Joyce (R-OH). This bill would elevate the current position of the Director of the Indian Health Service to Assistant Secretary for Indian Health within HHS. This bill was referred to the House Committee on Natural Resources and then to the Committee on Energy and Commerce.
Urban Indian Health Confer Act, H.R. 630. On June 7, the House Natural Resources Committee’s Subcommittee on Indian and Insular Affairs held a legislative hearing on several tribal bills. One of the measures is the bill reintroduced by full Committee Ranking Member Grijalva which would require agencies of the Department of Health and Human Services to confer with urban Indian organizations regarding health care for American Indians and Alaska Natives who live in urban areas (H.R. 630). The House passed similar legislation in the 117th Congress. The NIHB sent a letter on June 12, 2023, to the House NR Committee expressing concerns with H.R. 630, and Ranking Member Grijalva withdrew the bill from markup.
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Tribal Consultation, Listening Session & Written Comment Updates | |
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The Department of Veterans Affairs (VA) hosted a listening session during the Tribal Self-Governance Conference to discuss the draft Tribal Health Program Reimbursement Agreement template. This agreement allows the VA to reimburse the IHS, Tribal Health Programs, and Urban Indian Organizations for health care services provided to eligible AI/AN veterans. Written comments may be submitted to [email protected] by July 20, 2023. For additional information regarding this effort, please contact Kara Hawthorne at [email protected].
National Institutes of Health All of Us Tribal Engagement program hosting Tribal listening sessions. The All of Us Research Program (run by the National Institutes of Health) aims to accelerate health research and medical breakthroughs to enable an era of precision medicine for all. All of Us is committed to ensuring that the program reflects the diversity of the United States. All of Us recognizes that American Indian and Alaska Native (AI/AN) individuals are underrepresented in health research and often are not included in sufficient numbers to arrive at scientifically valid conclusions about the population in national research studies.
Office of Management and Budget (OMB) Tribal Consultation on the President’s Mandatory Funding Proposal for the IHS. OMB held a virtual tribal consultation on the President's mandatory funding proposal for the IHS on Jun. 2, 2023, at 11:00 AM PST.
- Dear Tribal Leader, Letter announcing Tribal Consultation
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NPAIHB submits Written Comments on the President’s IHS Mandatory Proposal. On June 30, the NPAIHB submitted written comments to the Office of Management and Budget (OMB) in response to its May 2, 2023, Dear Tribal Leader Letter seeking input on the President’s legislative proposal for IHS mandatory funding. NPAIHB’s comments were based on the talking points developed during Tribal Caucus on June 1. NPAIHB encouraged the Administration to move 105(l) and Contract Support Cost to mandatory funding and maintain advance appropriations for HIS, fund two additional Regional Referral Centers, fund CHAP implementation, and fully fund PRC at $8 billion, in addition to other Northwest priorities.
Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry (ATSDR), Department of Health and Human Services (HHS) Tribal Consultation on CDC’s Rape Prevention and Education (RPE) Program. CDC and ATSDR are hosting this meeting to consult with federally recognized AI/AN tribes to receive input and guidance to inform sexual violence prevention activities and strategies in developing Notices of Funding Opportunities (NOFOs). Tribal consultation will be held on Jul. 12, 2023, from 11:00 AM to 12:30 PM.
Administration for Children and Families (ACF), Office of Child Care (OCC) will host a virtual Tribal Consultation on Child Care and Development Fund Program. The consultation will consider how components of the Child Care and Development Fund program affect Tribal Nations. During the consultation, OCC leaders will also be available to speak with Tribal leaders to share OCC updates. Tribal consultation will be held on Jul 20, 2023, at 10:00 AM Pacific.
- You can register for the consultation here.
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Administrative and Regulatory Updates | |
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IHS Health IT Modernization. The IHS requests Tribes participate in collaborative planning for the new IHS enterprise electronic health record solution. The IHS invites sites that are considering the new enterprise EHR as a viable option to complete the enclosed Statement of Interest to indicate their interest in participating in shared enterprise solution planning. There is no deadline to submit the statement of interest.
Government Accountability Office (GAO) released a report on July 10, 2023, “Indian Health Service: Actions Needed to Improve Use of Data on Adverse Events. GAO was asked to review IHS's capacity for using its information technology systems to manage patient care and monitor adverse events, defined as events that could have caused or did cause harm, damage, or loss to patients. The report examines how IHS (1) uses its electronic health record system to monitor health care quality at federally operated facilities and (2) monitors adverse events.
The GAO made two recommendations that HHS concurred with:
- The Director of IHS should ensure that the appropriate headquarters officials have access to and regularly review and compare data on trends in adverse events reported in its I-STAR system for—at a minimum—each area. Such data could include, for example, trends in the number of adverse events by category.
- The Director of IHS should ensure that the appropriate headquarters officials take steps, as appropriate, to address any needed improvements or disseminate any best practices identified based on their review of data on trends in adverse events for—at a minimum—each area.
IHS Requesting Priorities on Health Professionals for the Scholarship Program and Loan Repayment Program. IHS invites feedback on a “Priority Categories” list for inclusion in the Scholarship Program and Loan Repayment Program for FY 2024-2025. Health profession priorities are due Aug. 1, 2023, to Jeremy Sheehan at [email protected].
HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health Emergency HIPAA Notifications of Enforcement Discretion. OCR is providing a 90-calendar day transition period for covered health care providers to comply with the HIPAA Rules concerning their provision of telehealth. The transition period will begin on May 12, 2023, and expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occur in connection with the good faith provision of telehealth during the 90-calendar day transition period.
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Learn more about compliance with the OCR announcement here.
IHS Website for Sanitation Facilities Construction Projects. IHS Division of Sanitation Facilities Construction Projects launched a new website that includes the status of all sanitation facilities projects funded with the Bipartisan Infrastructure Law.
CDC Director Rochelle Walensky Announces her Departure from the Agency. The White House announced that Director Walensky will leave the Agency on June 30. She has served as Director of the agency for two years and has guided the Biden Administration on the COVID-19 response since he took office.
- See Press Release from CDC
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A June 16 statement by CDC Director Rochelle P. Walensky released the Appointment of Dr. Mandy Cohen as the 20th CDC Director. Dr. Cohen has held senior positions at the Centers for Medicare and Medicaid Services during the Obama administration, including chief operating officer and chief of staff, and served as acting director of the agency’s Center for Consumer Information and Insurance Oversight.
CDC Launches a New Tribal Public Health Data Site. The CDC has launched an online Tribal Public Health Data site to assist tribal partners and others with information and tools related to tribal data. The site guides accessing CDC tribal data; information on tribal data issues, tools, technical assistance, and training; and tribal data-related resources from public health partners. This site will continue growing as CDC further engages with tribes and tribal organizations to provide the most needed data-related information.
Medicare Prescription Drug Inflation Rebate Program. CMS announces lower coinsurance for individuals with Medicare Part B coverage for 27 certain prescription drugs that will go into effect on Apr. 1, 2023. The list of Part B drugs this rebate applies to is available HERE.
CMS Issues State Health Official Letter Discussing 'Unwinding.' CMS released a State Health Official (SHO) letter outlining new requirements in the Consolidated Appropriations Act, 2023, that impact state activities for the Medicaid and CHIP programs to unwind from the COVID-19 public health emergency. As of April 1, 2023, states are no longer required to maintain continuous Medicaid enrollment to receive the temporary FMAP increase.
Drug Enforcement Agency (DEA) Issues 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 will continue the telemedicine flexibilities for prescribing controlled medications authorized under the COVID-19 Public Health Emergency until Nov. 11, 2023.
Office of Inspector General for Health and Human Services issues Consumer Alert: Fraud Schemes Targeting Native American Communities in Behavioral Health Treatment Centers. A summary of the May 16 Alert is below, and the full Alert can be found here. The Alert identifies two types of fraudulent schemes targeting some of the most vulnerable members of Native American communities:
- A scheme involving phony sober living homes for addiction treatment and support, where the scammers pretend to be healthcare providers offering fake services and treatments while stealing the personal and medical identities of vulnerable community members;
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A scheme involving the recruitment of patients by employees of behavioral health outpatient treatment centers, who often work for fraudulent healthcare providers, and seek to induce patients to undergo an intake process with a licensed Behavioral Health Professional specializing in substance abuse counseling, then fraudulently billing Medicaid for services that do not align with the actual time spent.
Office of Inspector General (OIG) Compliance Program Guidance Documents. OIG announces modernization of Compliance Program Guidance (CPG) that includes: publishing general CPG on federal fraud and abuse laws, compliance program basics, operating effective compliance programs, and OIG processes and resources for all individuals and entities; publishing industry-specific CPGs for providers, suppliers, and other participants in the healthcare industry or other sectors related to Federal health care programs. This updated guidance will no longer be available on the Federal Register but on the OIG website.
SAMHSA Announces Removal of DATA Waiver Requirement to Prescribe Buprenorphine. Clinicians can now prescribe medications for the treatment of opioid use disorder without submitting a Notice of Intent (Waiver) to SAMHSA.
VA Adds Chiropractic Services to Covered Medical Benefits. The VA has amended its regulations to add chiropractic services to its medical benefits package effective May 22, 2023.
VA Released Final Rule on Co-Payment Exemption for Indian Veterans. The VA released the final rule to implement co-payment exemptions for Indian and urban Indian veterans for hospital care or medical services received on or after January 5, 2022.
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Tribal Health-related Funding Opportunities | |
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Upcoming HRSA Grant Application Deadlines in July:
SAMHSA releases notice of funding opportunity for 988 Tribal Response Cooperative Agreement Support. The option provides financial resources to improve response to 988 contacts (calls, chats, and texts) originating in Tribal communities and activated by American Indians/Alaska Natives. This program aims to: (1) ensure access to culturally competent, trained 988 crisis center support 988 Lifeline centers; (2) improve integration and support of 988 crisis centers, Tribal nations, and Tribal organizations to ensure follow-up care; and (3) facilitate collaborations with Tribal/state/territory health providers, UIOs, and first responders in a manner which respects Tribal sovereignty.
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Eligible entities, Award, and Application Information: Federally recognized Indian Tribes, tribal organizations, and Urban Indian Organizations. Anticipated Award: $2,000,000 annually/3 years total. Due date: Jul. 18.
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Northwest Portland Area Indian Health Board | Website | | | | |
