HEROES Act Passes House, Includes Significant Tribal Health Provisions


Contact: Shervin Aazami at saazami@nihb.org or 202-507-4088
HEROES Act Passes House of Representatives
Includes $2.1 Billion for IHS alongside other Tribal Health Provisions
WASHINGTON, DC—May 15, 2020—Today, the House of Representatives passed a massive $3 trillion COVID-19 relief package on a largely party line vote of 208-199. The behemoth package includes a number of significant Tribal healthcare and public health provisions to strengthen response efforts across Indian Country. Overall, the package includes billions in relief funding for Tribal, state, and territorial governments including $20 billion in economic relief funding for Tribal Nations.

In addition to funding for federal agencies, Tribal and other government entities, the HEROES Act includes significant investment in election security, education, nutrition, banking measures, housing, and another round of $1,200 direct cash payments to individuals.

While the full HEROES Act is unlikely to pass the U.S. Senate, it is intended to initiate bipartisan negotiations to deliver another round of relief in response to the devastating COVID-19 pandemic.

NIHB has a detailed breakdown of the Tribal health provisions available here , while a full section by section analysis of the entire 1,815 page bill is available here.

Apart from the Tribally-specific health provisions, the HEROES Act would inject another $100 billion into the healthcare provider relief fund administered by the U.S. Department of Health and Human Services (HHS), on top of the $100 billion appropriated under the CARES Act, and the $75 billion under the Paycheck Protection and Health Care Enhancement Act.

However, if enacted, the HEROES Act would make significant technical changes to how HHS administers the provider relief fund, including by emphasizing a focus on reimbursing incurred expenses as opposed to lost revenue, and also directing a greater portion of funds towards providers and health facilities treating a significant number of COVID-19 patients. These changes would also retroactively impact any unobligated balances of provider relief funds from the CARES Act and Paycheck Protection and Health Care Enhancement Act. As NIHB has previously reported, HHS has carved out $400 million out of the CARES Act provider relief fund for direct payments to Indian Health Care Providers across the Indian health system.

Overall, HEROES would provide over $2 billion for the Centers for Disease Control and Prevention (CDC), and $3 billion to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Funding and legislative victories related to Tribal public health in the HEROES Act include:  
Indian Health Service (IHS):
$2.1 Billion overall
  • $1 Billion – to replenish shortfalls in third party healthcare revenue collection lost
  • $500 Million – for healthcare services, telehealth services, personal protective equipment (PPE)
  • $140 Million – for broadband infrastructure and information technology (IT) to support and expand telehealth services and electronic health record (EHR) operations
  • $20 Million – to address the needs of domestic violence victims, as well as homeless individuals and families
  • $64 Million – for urban Indian organizations
  • $10 Million – for safe drinking water and sanitation infrastructure development o
  • $366 Million – to the IHS Facilities Account for the construction of new isolation and quarantine facilities, construction of shelters of opportunity, purchasing of updated equipment, and maintenance and improvement of existing facilities

Bureau of Indian Affairs (BIA)
  • $900 Million overall to prevent, prepare and response to COVID-19
  • $100 Million – for housing construction and improvement
  • $780 Million – for Tribal government services, salaries to maintain operations, cleaning and sanitizing of Tribally-operated facilities
  • $20 Million – for safe drinking water and sanitation development

Centers for Disease Control and Prevention (CDC)
  • At least $100 Million – Tribal set-aside for COVID-19 public health response

Substance Abuse and Mental Health Service Administration (SAMHSA)
  • At least $150 Million – Tribal set-aside for mental health and substance abuse prevention and treatment

Additional Tribal Public Health Provisions
  • $25 million – to create a Tribal advisory panel to conduct research and surveillance into American Indian and Alaska Native health inequities with regard to COVID-19, and to address unmet needs of public health surveillance and infrastructure
  • Guarantees direct IHS and Tribal access to the Strategic National Stockpile
  • Directs the CDC to coordinate with Tribes as they work to implement a nationwide contract tracing, surveillance, containment and mitigation system.
  • Guarantees Tribal access to the CDC’s Public Health Emergency Preparedness (PHEP) program

Tribal Legislative Priorities
  • Authorizes payment of Indian Health Care Providers outside of the “four walls of an IHS or Tribal facility” at 100% Federal Medical Assistance Percentage through June 30, 2021
  • Amends the Indian Health Care Improvement Act (IHCIA) to clarify the requirement that the Veterans Administration (VA) fully reimburse IHS and Tribes for all services authorized under the Purchased and Referred Care (PRC) program
  • Eliminates the cost-sharing requirement for Tribes for the Food Distribution Program on Indian Reservations (FDPIR) and temporarily waives the restriction on dual enrollment in FDPIR and the Supplemental Nutrition Assistance Program (SNAP)
Next Steps
While the full HEROES Act is largely expected to fail in the Senate, many of the significant healthcare and public health provisions are likely to garner bipartisan support. NIHB will continue to advocate to build on the Tribal health provisions for the final relief package. In the meantime, the Senate majority is crafting its own relief package to counter the HEROES Act.
NIHB continues to push forward significant Tribal healthcare and public health provisions to ensure Indian Country is fully equipped with the necessary resources to protect and preserve the health of all American Indian and Alaska Native communities.

To access the full list of Tribal priorities outlined in NIHB's letters to Congress, click here
National Indian Health Board Mission Statement

Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.
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April Hale at ahale@nihb.org