What could be better than making Tribal Consultation required of all federal agencies? Getting it right. On May 28 of last year, Congressman Raúl M. Grijalva (D-Ariz.) introduced H.R 3587 legislation for the “Requirements, Expectations, and Standard Procedures for Effective Consultation with Tribes” (RESPECT) Act. Grijalva, who also Chairs the House Natural Resources Committee, is a strong advocate for Tribal sovereignty, self-governance and fulfillment of the federal government’s Trust responsibility to Tribes.  

Initially, H.R 3587 did not gain a lot of traction in the House, though it has the support of numerous Tribes and Tribal organizations. Chairman Grijalva hosted a press conference on March 22, 2022, and announced that the bill would be marked up in the House Natural Resources Committee. Due to this additional attention and the enormous importance of the bill’s objectives, the National Indian Health Board (NIHB) is taking a closer look at the legislation.  

Tribal consultation is currently required by law within the Indian Self Determination and Education Assistance Act (ISDEAA) at 25 U.S. Code § 5325(i) which states: “On an annual basis, the Secretary shall consult with, and solicit the participation of, Indian Tribes and Tribal organizations in the development of the budget for the Indian Health Service and the Bureau of Indian Affairs (including participation of Indian Tribes and Tribal organizations in formulating annual budget requests that the Secretary submits to the President for submission to Congress pursuant to sec. 1105 of title 31).” 

ISDEAA also requires annual Tribal Consultation with both the US Department of Health and Human Services and the Department of Interior for annual budget development. Further, the Indian Health Care Improvement Act, at 25 U.S. Code § 1661 delegates these authorities and duties to the IHS, including ISDEAA where the requirement to consult on the IHS budget is found. 

NIHB Member organizations will meet on Monday, May 2 at 4:00 PM ET to discuss the bill. We will provide an analysis of the bill during the briefing and provide a report to our readers in a coming edition of Washington Report. For more information contact Stacy A. Bohlen, NIHB CEO, at sbohlen@nihb.org. 

On April 7^th, 2022, Representative Tom Cole (R-OK-4) introduced a bill to amend the Indian Self-Determination and Education Assistance Act (ISDEAA) to secure existing Tribal contract support cost reimbursements. The bill titled Indian Health Service (IHS) Contract Support Cost (CSC) Amendment Act, H.R 7455, amends the ISDEAA so that amounts needed to ensure compliance with the contract, under self-governance contracts and compacts, are eligible for reimbursement.

On August 24, 2021, the D.C. Circuit Court of Appeals in Cook Inlet Tribal Council, Inc. v. Dotomain, held that if the Indian Health Service (IHS) had “normally” paid for certain costs, those costs could not be eligible for reimbursement as a CSC. The Cook Inlet decision set a troubling and potentially far-reaching precedent for future federal-tribal contract negotiations. 

In response to the Cook Inlet decision, the National Indian Health Board (NIHB) took formal action to support a legislative fix for contract support cost administration to correct the decision. NIHB and Tribal organizations wrote to Congressional leadership to urge the adoption of an amendment to ISDEAA. 

NIHB applauds the work of Representative Cole and his work for Tribal nations to continue providing healthcare without disruptions and is committed to overseeing the passage of this bill. To read the letter NIHB sent to Cole's office on April 26th sharing our support for H.R 7455, see here.

Senator Bennet is serving his third term in the U.S Senate and is up for re-election in the 2022 elections. His issue areas cover climate change, immigration reform including pathway to citizenship, and ways to instate renewable energy for job and economic growth. Bennet is the Chairman of the Subcommittee on Conservation, Forestry, and Natural Resources of the Committee on Agriculture, Nutrition, and Forestry and Chairman to the Subcommittee on Energy, Natural Resources, and Infrastructure of the Committee on Finance. 

Senator Bennet introduced the Tribal Access to Clean Water Act, S. 2369, on July 15, 2021 along with Senators Martin Heinrich (D-NM), John Hickenlooper (D-CO), and Elizabeth Warren (D-MA).This bill was passed in part of the Infrastructure Investment and Jobs Act (IIJA). The provisions of S. 2369 are similar to and helped shape the IIJA tribal provisions for clean drinking water. The act provided $3.4 billion to Indian Health Service (IHS) for the Sanitation Facilities Construction program whereas IIJA provided $3.5 billion. Similarity, the act increased funding for the Environmental Protection Agency’s Clean Water Act and Safe Drinking Water Act State Revolving Funds which is consistent to provisions within the IIJA. 

He cosponsored Truth and Healing Commission on Indian Boarding School Policies Act, S. 2907 / H.R 5444. This bill establishes a Truth and Healing Commission on Indian Boarding School Policies to investigate the boarding school era policies. It then would make recommendations on ways to protect unmarked graves, identify Tribal nations in which children were forcibly removed, and protect and shield Native families and children from separation. See National Indian Health Board's Resolution No. 22-01 here.

Senator Hickenlooper is currently serving his first term in the U.S Senate and is not up for re-election until 2026. With a background in geology and previously work for an oil and gas company, Senator Hickenlooper’s legislation priorities are energy development, environmental stewardship, and healthcare. He is the Chairman of the Subcommittee on Employment and Workplace Safety of the Committee on Health, Education, Labor, and Pensions. He is also the Chairman of the Subcommittee on Space and Science of the Committee on Commerce, Science, and Transportation. 

Although Hickenlooper’s sponsored legislation is not Indian healthcare-related, his sponsored legislation focused on Tribal small business and entrepreneurship titled Native American Entrepreneurial and Opportunity Act, S. 1735. 

He cosponsored S. 2907 the Truth and Healing Commission on Indian Boarding School Policies Act along with the other Colorado Senator Bennet.

Senator Hickenlooper introduced and cosponsored Senator Bennet’s legislation Tribal Access to Clean Water Act.

Representative Neguse serves Colorado’s second congressional district and is running for re-election in this 2022 election year. He is the first African-American member of Congress in Colorado’s history. Neguse’s legislation priorities focus on securing affordable higher education, consumer protection, and protection of public lands. He is the Chairman of the Subcommittee on National Parks, Forests, and Public Lands of the Committee on Natural Resources. He also sits on the Subcommittee on Antitrust, Commercial, and Administrative Law of the Committee on the Judiciary. 

Neguse cosponsored H.R 6406 Stronger Engagement for Indian Health Needs Act of 2022 introduced by Representative Greg Stanton (D-AZ-9). This bill would make parity and elevate the position the Indian Health Service Area Director to Assistant Secretary within the Department of Health and Human Services (HHS). Making the position Senate-confirmed would allow the Assistant Secretary to provide a higher level of authority and would then be able to bring greater attention and resources to Indian healthcare. 

Securing advance appropriations for the Indian Health Service, Neguse cosponsored Indian Programs Advance Appropriations, H.R 5567, and Indian Health Service Advance Appropriations Act, H.R 5549. Both bills would secure advance appropriations for the Indian Health Service.

He also cosponsored H.R 1888 titled Improving Access to Indian Health Services Act. This bill would require a Federal medical assistance percentage of 100 percent for Indian health care providers. 

Representative Neguse cosponsored H.R 5444 Truth and Healing Commission on Indian Boarding School Policies Act. Introduced by Representative Sharice Davids (D-KS-3), this bill would establish a formal commission to investigate, document, and acknowledge the past injustices of the government’s Indian Boarding School Policies. 

On April 27, 2021, Senator Tina Smith (D-MN) introduced S.1397 the Tribal Health Data Improvement Act of 2021. This bill will be featured in the legislative hearing held by the Senate Committee on Indian Affairs on Wednesday, March 23, 2022. On June 24, 2021, Representative Markwayne Mullin (R-OK-2) introduced the House companion bill H.R. 3841. Representative Tom O’Halleran (D-AZ-1) co-sponsored the bill.

Both bills are intended to improve Tribal access to important public health data and information – a key priority for Tribal nations and the National Indian Health Board (NIHB) that is reflected throughout the NIHB Legislative and Policy Agenda and in Resolution No. 21-05. Data helps Tribal health officials determine trends in health care improvements or disparities, where the health care services are having positive impacts, or where resources are most needed. Without data, Congress, Tribal leaders, and health department officials may lack the information necessary to make informed decisions on resources and priorities.

Data has been critical in implementing and reauthorizing the Special Diabetes Program for Indians as well as increasing Medicaid and Medicare participation and reimbursement. For example, the NIHB Legislative and Policy Agenda highlighted data on Medicaid and Medicare reimbursements contained in a 2019 Government Accountability Office Report.

Most notably, the NIHB Legislative and Policy Agenda recommended that the Centers for Disease Control and Prevention work with states, Indian Health Service, and other stakeholders to ensure that complete and accurate data is captured and shared with Tribes to effectively respond and recover from COVID-19 and other similar public health emergencies. This legislation is an important step in achieving this priority. 

Register for the National Tribal Public Health Summit 2022

Do not miss Dr. Anthony Fauci, Abby Roque, Olympic Silver Medalist, First Indigenous Woman on the USA Olympics Hockey Team, and Dr. Jill Jim of the Navajo Nation Department of Health will speak the National Tribal Public Health Summit (TPHS) 2022! Register now for the National Indian Health Board's (NIHB) invites you to register for the virtual premiere Indian public health event that attracts over 700 Tribal public health professionals, elected leaders, advocates, researchers, and community-based service providers. 

This year’s summit theme is Tribal Health is Public Health and will feature dynamic national speakers, interactive workshops and roundtable discussions, a welcome reception, a fitness event, as well as the presentation of the Native Public Health Innovation Awards. 

Register here.