Northwest Portland Area Indian Health Board

Legislative and Policy Update

September 19, 2023

Important Dates

Sep. 18-21, 2023

Affiliated Tribes of Northwest Indians (ATNI) Annual Convention

Great Wolf Lodge, Centralia, WA

Registration Link

Sep. 19, 2023 (10:00 AM PT)

National Health Service Corps. Program Webinar for Tribal Communities 

Registration Link

Sep. 19-20, 2023

IHS Director’s Workgroup on Improving Purchased/Referred Care

Denver, CO; hybrid

Sep. 19-20, 2023

Tribal Leaders Diabetes Committee (TLDC) Meeting

Washington, DC; hybrid

Sep. 20, 2023 (3:00 PM PT)

HRSA Virtual Job Fair for Health Care Professionals 

Registration Link

Sep. 25-26, 2023 

NIHB Tribal Health Equity Data Symposium

Washington, DC

Registration Link

Sep. 27, 2023 (10:00 AM PT)

Office of Management & Budget Consultation on FY 2025 Budget

Zoom Link

Sep. 28, 2023 (10:00 AM PT)

National Institutes of Health All of Us Research Program Tribal Consultation

Registration Link

Oct. 5, 2023 (11:00 AM PT)

FDA Tribal Listening Session on the Safe Disposal of Opioid Analgesics 

Zoom Link

Oct. 5, 2023

Tribal & Urban Indian Organizations Call

TBD

Oct. 6, 2023 (11:00 AM PT)

HHS Tribal Consultation on Section 504 of the Rehabilitation Act Proposed Rulemaking

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

Virtual

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

Virtual

Nov. 12-17, 2023 

National Congress of American Indians Annual Convention & Marketplace

New Orleans, LA

Registration Link

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.

We are now 3 weeks out from the Summit: a Thank You letter and major 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 full Summit Report. You will find all of these materials as well as ongoing resources, 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 to bring to the Affiliated Tribes of the Northwest Indians (ATNI)’s Annual Conference later this month and then to the National Congress of American Indians (NCAI)’s Annual Convention in November;
• 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.

Health News & Notes

Legislation & Appropriation Updates

Contract Support Costs (CSC) Litigation Update. Law360 recently released an article by Geoff Strommer and Steve Osborne discussing the current circuit split regarding IHS’ obligation to pay CSC for a tribe’s entire healthcare program, including the portion funded by third-party revenues.  The U.S. has filed petitions to the Supreme Court requesting a review of decisions awarding contract support costs to tribal health clinics for income collected from third parties.  

• See Law360 Article Here.
• Becerra v. Northern Arapaho Tribe petition
• Becerra v. San Carlos Apache Tribe petition

Special Diabetes Program for Indians (SDPI). SDPI will expire on Sep. 30 unless Congress passes legislation extending SDPI beyond the end of the month.  Call your delegation today to urge Congressional leadership to reauthorize SDPI before Sep. 30.  NIHB has prepared a sample letter on SDPI renewal here and sample talking points here.

Bipartisan Primary Care and Health Workforce Act.  On Sep. 21, 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

Office of Management & Budget (OMB) is hosting a virtual tribal consultation on the President’s FY 2025 Budget on Sep. 27, 2023, at 10 AM PT. The consultation aims to share your funding needs for services, programs, and activities serving and benefiting Tribal governments, organizations, and communities. Written comments are due Sep. 29, 2023, to tribalconsultation@omb.eop.gov. 

• Dear Tribal Leader Letter is Available Here 
• Registration Link for Sep. 27 Consultation

NIH All of Us Research Program Tribal Consultation. NIH will host a virtual tribal consultation on Sep. 28, 2023, from 10-12:00 PM PT on the All of Us Research Program. The Tribal consultation will include 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. 

• See Dear Tribal Leader Letter Announcing Tribal Consultation
• See Federal Register Notice Announcing Tribal Consultation
• Zoom Registration Link

Food and Drug Administration (FDA) Tribal Listening Session on the Safe Disposal of Opioid Analgesics. FDA will be hosting a Tribal listening session on Oct. 5 at 11 AM PT to discuss the new requirement that opioid analgesics manufacturers make pre-paid shipping envelopes available to dispensaries for safe disposals by patients.  

• Registration Link for Oct. 5 Listening Session
• Dear Tribal Leader Letter Available Here.

HHS Tribal Consultation on Section 504 of the Rehabilitation Act Proposed Rulemaking. HHS Office for Civil Rights will be hosting a virtual tribal consultation on Oct. 6 at 11 AM PT on proposed rulemaking implementing Section 504 of the Rehabilitation Act, which prohibits discrimination on the basis of disability in programs and activities that receive Federal financial assistance.  Written comments are due Nov. 13, 2023, through the Federal Rulemaking Portal.  

• Registration Link for Oct. 6 consultation
• See Dear Tribal Leader Letter dated Sep. 14, 2023

IHS Tribal Consultation on Designating North Dakota and South Dakota as Purchased/Referred Care Delivery Areas (PRCDA). IHS will be hosting 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 perform a study of PRC implications and feasibility of creating statewide PRCDAs in North Dakota and South Dakota.  Written comments will be accepted until Nov. 15, 2023.  

• See Dear Tribal Leader Letter dated Sept. 11, 2023
• Zoom Link for Oct. 18 consultation
• Zoom Link for Oct. 26 consultation

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 info@minorityhealth.hhs.gov.  

• Registration Link for Listening Session
• See Dear Tribal Leader Letter dated Sep. 13, 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 requests comments on the FY 2016 and 2017 Report to Congress on the Administration of the Indian Health Service (IHS) Tribal Self-Governance Program. The Indian Self Determination and Education Assistance Act at 25 U.S.C. § 5394 (previously codified at 25 U.S.C. § 458aaa-13) requires that, prior to submitting the report to Congress, the IHS must seek your comments and view. Comments are due Sep. 29, 2023 consultation@ihs.gov.  

• Dear Tribal Leader Letter Available here. 

Administrative and Regulatory Updates

Updated HHS Tribal Consultation Policy. On Sep. 12, 2023, Secretary Becerra signed the updated HHS Tribal Consultation Policy after two years of collaboration with Tribal leaders and the Secretary’s Tribal Advisory Committee Members.  The revised policy is available here. 

IHS Announces FY 2023 Allocation Decision for $700 million under the Bipartisan Infrastructure Legislation (BIL). In the BIL, IHS was appropriated $700 million in 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.  

• See Dear Tribal Leader Letter dated Sep. 7, 2023, for more details on funding allocation.

IHS FY 2024 Loan Repayment Program Update. IHS will begin accepting applications on Oct. 1, 2023, for the 2024 Loan Repayment Program for eligible health care professions 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.  

• See Full List of Eligible Health Professions
• See Dear Tribal Leader Letter dated Aug. 29.

Advisory Committee on Immunization Practices (ACIP) Approves RSV Vaccine for Infants. Last month, the CDC ACIP approved an RSV vaccine for infants aged less than 8 months who are born during or entering their first RSV season and for infants and children aged 8-19 months who are at increased risk for severe RSV disease.  

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 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 clinic services furnished outside of the “four walls” of the facility.  

• See CMCS Informational Bulletin dated Sep. 8, 2023.

Improving the Collection of Social Determinants of Health Data with ICD-10-CM Z Codes Resource. CMS Office of Minority Health has released a new infographic to help providers understand how to utilize ICD-10-CM Z codes to document social determinants of health data. During the National Tribal Opioid Summit, the increased use of z-codes was discussed as a policy recommendation for data collection on social determinants of health in tribal communities.  

• See Z-Code Resource HERE.

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 come into compliance with Medicaid eligibility determination requirements. Since unwinding has commenced, there has been a dramatic loss in Medicaid coverage across the country. 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. 

• NEW CMS Frequently Asked Questions related to End of Medicaid Continuous Enrollment
• TSGAC Briefing Paper on How the End of the PHE Affects Medicare and Medicaid Flexibilities
• NIHB Resources Page on Medicaid Unwinding

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. 

HRSA Provider Relief Funds Reporting Portal Open for Period 5. 

Just a reminder that the PRF Reporting Portal is open, and Reporting Period 5 is due Sep. 30, 2023.  

Tribal Health-related Funding Opportunities

NIHB Climate Ready Tribes Emergency Mitigation Planning Grants – Sep. 29, 2023. The National Indian Health Board (NIHB) provides funding for developing tribal emergency mitigation plans related to extreme weather, coastal erosion, or other impacts of climate change.

IHS released a Dear Tribal Leader Letter announcing 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.

For more information:

Laura Platero, Executive Director 

Karol Dixon, Senior Policy Advisor

Candice Jimenez, Health Policy Analyst

Northwest Portland Area Indian Health Board | Website