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Northwest Portland Area Indian Health Board

Legislative and Policy Update

October 10, 2023

Important Dates

Oct. 12, 2023 (11:30 AM PT)

ACL Tribal Consultation on Adult Protective Services Proposed Rule

Zoom Link

Oct. 16-19, 2023

NPAIHB Tribal Health Director & Quarterly Board Meeting (QBM)

Fort Hall, ID

Oct. 17, 2023 

MMPC Face-to-Face Meeting 

Washington D.C.; hybrid 

Oct. 18, 2023 (12:00 PM PT)

IHS Tribal Consultation on North Dakota and South Dakota PRCDA Expansion

Zoom Link

Oct. 18-19, 2023 

CMS Tribal Technical Advisory Group Face-to-Face Meeting 

Washington D.C.; hybrid

Oct. 19, 2023 (12:00 PM PT)

IHS Direct Service Tribes Advisory Committee Monthly Meeting


Oct. 24, 2023 (1:00 PM PT)

FDA Tribal Listening Session on Nutrition Initiatives 

Zoom Link


Oct. 24-25, 2023

ACF Tribal Advisory Committee Meeting

Washington D.C.

Oct. 25, 2023 (1:00 PM PT)

Office of Minority Health Listening Session on Healthy People 2030

Zoom Link


Oct. 26, 2023 (12:00 PM PT)

IHS Tribal Consultation on North Dakota and South Dakota PRCDA Expansion

Zoom Link

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

Webinar Link


Nov. 2, 2023 (12:00 PM PT) 

IHS November Tribal and Urban Indian Organizations Call

Nov. 3, 2023

Save the Date Portland Area Office Budget Formulation Consultation


Nov. 9, 2023 (11:00 AM PT)

SAMHSA Tribal Consultation on Tribal Opioid Response Grant

Zoom Link


Nov. 9, 2023 (1:00 PM PT)

SAMHSA Tribal Listening Session on Behavioral Health and Substance Use Disorder Resources for Native Americans

Zoom Link

Nov. 12-17, 2023

National Congress of American Indians Annual Convention & Marketplace

New Orleans, LA

Registration Link

Nov. 28-29, 2023

HHS Secretary’s Tribal Advisory Committee (STAC) Meeting

Washington, D.C.


Nov. 30, 2023 (10:00 AM PT)

IHS NTAC Quarterly Meeting



Dec. 5-6, 2023

IHS Tribal Leaders Diabetes Committee Meeting 

Portland, OR


Dec. 6-7, 2023

Direct Service Tribes Advisory Committee National Meeting

Dec. 13, 2023 (8:00 AM PT) 

IHS Health IT Modernization Summit 

Registration Link

2023 National Tribal Opioid Summit

Dear Tribal leaders, Colleagues, and Community –

On behalf of the Northwest Portland Area Indian Health Board (NPAIHB), we want to offer our deep appreciation for your participation in the first National Tribal Opioid Summit (NTOS), hosted by the Tulalip Tribes of Washington State. 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.


Thank You letter and significant press releases have been shared from the NPAIHB and the Office of National Drug Control Policy (ONDCP) via the White House. An Executive Summary is now available as a first step to the entire Summit Report. All these materials and ongoing resources are available via the National Tribal Opioid Summit Resource Hub


We look forward to sharing further in the coming weeks the following: 

  • A set of policy recommendations;
  • A comprehensive update to the Tribal Opioid Response: National Strategic Agenda based on the feedback, recommendations, and best practices of Tribal leaders, health experts, service providers, and community members;
  • A Summit Report.


Announcement on Free Naloxone Available to Tribes. As part of the global settlement of the opioid litigation wit Teva, Teva will provide up to 20,000 Naloxone boxes per year for 10 years for free.  Interested Tribes in receiving these free boxes of Naloxone must fill out the Naloxone Interest Form available at by Oct. 15, 2023.  

Quarterly Health News & Notes

Summer Edition

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.

Read the Publication Here

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.

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

Administration of Community Living (ACL) Tribal Consultation on the Older Americans Act (OAA).  ACL will host a tribal consultation on Oct. 12, 2023, at 11:30 AM PT 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. 

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.  

U.S. Food and Drug Administration (FDA) Tribal Listening Session on Nutrition Initiatives. The FDA will host an all-tribes call on Oct. 24, 2023, at 1 PM PT with the Center for Food Safety and Applied Nutrition for Tribal Leaders to learn about nutrition initiatives.  

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 [email protected].  

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 protected] with the subject line: “VA Climate Adaptation Planning” or “Environmental Justice at VA.” 

IHS Portland Area Office (PAO) Budget Formulation Tribal Consultation.  Please save the date for the IHS PAO Budget Formulation tribal consultation on Nov. 3, 2023. More information will be forthcoming.

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.  

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 [email protected] 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 [email protected].  

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.  

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.     

HHS Makes Available Four Free At-Home COVID-19 Tests. Starting Sep. 25, 2023, every U.S. household can order four free COVID-19 rapid tests delivered to their home.

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

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  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 [email protected] 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

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.  

For more information:

Laura Platero, Executive Director 

Karol Dixon, Director of Government Affairs/Health Policy

Candice Jimenez, Chief of Staff

Northwest Portland Area Indian Health Board | Website