November 19, 2019 |  Issue 19-43   Missed Last Week's Washington Report? Click Here to Visit our Archives!
February 13 - 14, 2020
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March 17 - 19, 2020
Omaha, Nebraska
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Community Health Aide Program (CHAP) TAG Vacancies
 In February 2018, with the announcement of CHAP expansion to Tribes beyond Alaska, IHS created a CHAP Tribal Advisory Group.

 Information on CHAP and CHAP TAG, including vacant  positions, is available on the CHAP
website .

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Top Story
NIHB Testifies before House Subcommittee for Indigenous Peoples of the United States on U.S. Commission on Civil Rights Broken Promises Report
NIHB CEO Stacy A. Bohlen testifies before the House Subcommittee for Indigenous Peoples about health care priorities in Indian Country

On Tuesday, November 19, National Indian Health Board (NIHB) Chief Executive Officer, Stacy A. Bohlen, testified before the House Natural Resources Subcommittee for Indigenous Peoples of the United States during an oversight hearing titled: " Reviewing the Broken Promises Report: Examining the Chronic Federal Funding Shortfalls in Indian Country." 

Released in 2018 by the United States Commission on Civil Rights, the Broken Promises report is in follow-up to the 2003 Quiet Crisis report published by the commission documenting the ongoing failures of the federal government to fully live up to its Treaty and Trust obligations to Tribes and American Indian and Alaska Native (AI/AN) Peoples. The report's findings reaffirm what Tribal leaders and citizens have experienced first-hand for centuries - that the federal government's abrogation of its legal obligations continues to adversely impact the health, welfare, livelihood, and economic vitality of Indian Country. 

The Subcommittee hearing provided an opportunity for discussion on the findings of the Broken Promises report, which covers a wide range of federal Indian policy including health care, education, housing, and public safety. 

NIHB's written testimony provides a thorough overview of many of the ongoing challenges within the Indian health system, including chronic underfunding of the Indian Health Service (IHS); barriers in recruitment and retention of quality health providers; lack of dedicated, needs-based and long-term funding for health care and public health infrastructure in Indian Country; and the destructive impacts of constant government shutdowns and endless use of continuing resolutions, among other priorities. NIHB discussed in detail how these systemic funding and resource shortages contribute to the disproportionately higher rates of health disparities experienced within AI/AN communities.

The first panel consisted of federal representatives, including:
  • Patricia Timmons Goodson, Vice-Chair, U.S. Commission on Civil Rights
  • Dr. Anna Maria Ortiz, Director of Natural Resources and Environment, Government Accountability Office
  • Rear Admiral Chris Buchanan, Deputy Director, Indian Health Service
  • Jason Freihage, Deputy Assistant Secretary for Management, Bureau of Indian Affairs
The second panel (which included NIHB CEO Stacy Bohlen) consisted of Tribal and urban Indian representatives, including:
  • The Honorable Fawn Sharp, President, National Congress of American Indians
  • The Honorable Marilynn Malerba, Chief, Mohegan Tribe; Secretary, United South and Eastern Tribes Sovereignty Protection Fund
  • The Honorable Jonodev Chaudhuri, Ambassador, Muscogee Creek Nation
  • Francys Crevier, Executive Director, National Council of Urban Indian Health
To access a recording of the hearing, click here
To access a copy of NIHB's written testimony, click here
House Passes Second Continuing Resolution to keep Federal Government Open through December 20, Includes SDPI
On Tuesday, November 19, by a final vote of 231-192, the House of Representatives passed another short-term Continuing Resolution (CR) that would keep the federal government open through December 20, 2019. The bill will now be sent to the Senate for a vote later this week, where it is likely to pass before being sent to the President for final consideration. The President has also indicated support for the stop-gap measure.

The current CR, titled H.R. 4378, is set to expire this Thursday, November 21.  The new CR, titled H.R. 3055, would be the second stop-gap bill of Fiscal Year (FY) 2020, which began on October 1.  H.R. 3055 would fund the entire federal government through December 20, including the Indian Health Service (IHS).

Importantly, the new CR also extends funding for many expiring health programs, including the Special Diabetes Program for Indians (SDPI). Funding for SDPI would last through the expiration of the new CR on December 20. NIHB continues to advocate for long-term reauthorization of SDPI so that grantees have the necessary assurances of funding to engage in long-term planning. 

It remains unclear if Congress will enact a full-year appropriations package by December 20, or if yet another CR will be necessary to avoid a second government shutdown this calendar year alone. House and Senate appropriators have yet to agree on FY 2020 funding levels for any of the twelve discretionary appropriations bills, creating a logjam that maintains the threat of another shutdown. In addition, partisan differences on spending priorities remain unresolved, without clear indication on when consensus may be reached.

As reported previously , NIHB has sent letters to House and Senate leaders demanding that Congress pass a full-year Interior Appropriations package, which would include IHS, to ensure continuity of care and availability of funding within the Indian health system. In addition, NIHB continues to advocate for passage of advance appropriations for Indian programs, which would protect IHS and the Bureau of Indian Affairs from the harmful impacts of government shutdowns and CRs, both of which disproportionately impact Indian Country.

To access NIHB's letter to the House regarding FY 2020 IHS appropriations,
To access a template letter for the House in support of advance appropriations,
To access a template letter for the Senate in support of advance appropriations,
Senator Udall and Senator Murkowski Introduce the Indian Health Service Health Professions Tax Fairness Act
On November 15, 2019, Senator Tom Udall (D-NM) and Senator Lisa Murkowski (R-AK) introduced S. 2871 - Indian Health Service Health Professions Tax Fairness Act - to help address chronic health care provider shortages throughout the Indian health system. The legislation would exempt the IHS Loan Repayment Program and scholarship funding from federal income tax requirements.  

IHS scholarships and the loan repayment program provide IHS with much-needed funding to recruit and retain necessary health care providers. Currently, up to 25% of funding under the IHS Loan Repayment Program is consumed by federal taxes. Thus, exempting the program from tax obligations ensures that every dollar is maximized for recruitment and retention of providers within the Indian health system.

NIHB submitted a support letter for the legislation in recognition of imminent needs around IHS and Tribal health care provider shortages. Making the IHS Loan Repayment Program tax exempt could lead to nearly 200 additional loan repayment and scholarship awards each year, which can help reduce the over 1,550 vacancies currently documented across IHS, Tribal, and urban Indian facilities.

To access a copy of the bill, click here
To access a copy of NIHB's support letter, click here
NIHB Joins with Several National Indian Organizations in Joint Letter to the House Veterans Affairs Health Subcommittee Regarding Native Veteran Health Priorities
On Friday, November 15, 2019, the National Indian Health Board (NIHB), the National Congress of American Indians (NCAI), the National Council of Urban Indian Health, the Indian Health Service (IHS) Tribal Self-Governance Advisory Committee (TSGAC), and the Alaska Native Health Board (ANHB) sent a joint letter to Chairwoman Julia Brownley (D-CA) and Ranking Member Neal Dunn (R-FL) of the House Veterans Affairs Health Subcommittee with recommendations for improving American Indian and Alaska Native (AI/AN) Veterans' health care.

The joint letter is in follow-up to the Health Subcommittee's oversight hearing, titled "Native Veterans' Access to Healthcare" that took place on October 30, 2019.  Within the letter, NIHB and sister organizations reaffirmed the federal government's trust responsibility to provide health care to AI/ANs and provided recommendations that will serve to improve the health status of Native Veterans. Specific recommendations provided in the letter offer solutions to address the unique barriers faced by Native Veterans including the need to improve care coordination between the Department of Veterans Affairs (VA) and IHS.

The joint letter also asked the Health Subcommittee to support for three important bills: 
  • The Department of Veterans Affairs Tribal Advisory Committee (VATAC) Act of 2019 (H.R. 2791), which would create a Tribal Advisory Committee at VA; 
  • The Native American Veteran Parity in Access to Care Today Act (H.R. 4908), which would exempt Native Veterans from copays when accessing VA services and require the VA to absorb those costs; and, 
  • The Health Care Access for Urban Native Veterans Act (H.R. 4153), which would authorize Urban Indian Organizations (UIOs) and VA to enter into agreements for the sharing of medical services and facilities and other purposes.
To access a copy of the letter, click here
IHS Issues Dear Tribal Leader Letter (DTTL), Announcing Release of Health IT Reports
On Friday, November 15, 2019, Principal Deputy Director of the Indian Health Service (IHS), RADM Michael Weahkee, announced updates in regards to modernizing the agency's health information technology (IT). First, the Department of Health and Human Services (HHS) Office of the Chief Technology Officer has released two reports: Strategic Options for the Modernization of the Indian Health Service Technology Final Report and Strategic Options for the Modernization of the Indian Health Service Information Technology Roadmap Executive SummarySecond, the IHS will be hosting a series of webinars on the two recently released reports on:
* Wednesday, November 20, 2019, at 3:00 p.m. - 4:30 p.m. (Eastern Time)
* Tuesday, December 3, 2019, at 1:00 p.m. - 2:30 p.m. (Eastern Time)
* Wednesday, December 4, 2019, at 3:00 p.m. - 4:30 p.m. (Eastern Time).

Webinar Details
Weblink (Adobe Connect): | Room Passcode: ihs123
Webinar Dial-in: (800) 832-0736 | Dial-in Passcode: 3014886

Also, Tribal Consultation remains open on the Resource and Patient Management System (RPMS) Electronic Health Record (EHR). Tribes and Tribal Organizations may submit recommendations on how to best modernize and improve the EHR to, (Subject line: RPMS Consultation).
IHS Contact Info for: Mr. Randall Hughes,
     Phone: (301) 348-3402
     E-mail at
CMS Issues Proposed Rule on Medicaid Fiscal Responsibility
A Proposed Rule from the Centers for Medicare and Medicaid Services creating new reporting requirements for states to provide CMS with certain information on supplemental payments to Medicaid providers, including supplemental payments approved under either Medicaid state plan or demonstration authority, and applicable upper payment limits (UPL).  The Proposed Rule focuses on four topic areas: Medicaid fee-for-service (FFS) provider payments; Disproportionate share hospital (DSH) payments; Medicaid program financing; Supplemental payments; and Health care-related taxes and provider-related donations.
This proposed rule would promote transparency by establishing new reporting requirements for states to provide CMS with certain information on supplemental payments to Medicaid providers, including supplemental payments approved under either Medicaid state plan or demonstration authority, and applicable upper payment limits. Additionally, the proposed rule would establish requirements to ensure that state plan amendments proposing new supplemental payments are consistent with the proper and efficient operation of the state plan and with efficiency, economy, and quality of care. This proposed rule addresses the financing of supplemental and base Medicaid payments through the non-federal share, including states' uses of health care-related taxes and bona fide provider-related donations, as well as the requirements on the non-federal share of any Medicaid payment.
CMS plans to release a rule related to Medicaid eligibility requirements soon. This is following a hearing that took place in October on Capitol Hill and a recent GAO report. The GAO report covered improvements needed to ensure accurate eligibility determinations and focuses on (1) CMS's oversight of Medicaid eligibility and related expenditures; (2) CMS's efforts to improve Medicaid data; and (3) other opportunities to improve oversight and ensure appropriate enrollment.
Save the Date! National Indian Health Board's 11th Annual National Tribal Public Health Summit  
March 17-19, 2020
Chi Health Center, Omaha, NE

Please join the National Indian Health Board (NIHB) for the 11th Annual National Tribal Public Health Summit (TPHS) March 17-19, 2020 in Omaha, Nebraska at the CHI Health Center Omaha (Arena & Conference Center). The National Tribal Public Health Summit attracts over 500 Tribal public health professionals, elected leaders, advocates, researchers, and community-based service providers from across Indian Country. This conference offers unparalleled opportunities to network, learn about promising Tribal approaches, and get the latest data and information to support work in your community.

Click here for more information.
Upcoming CMS ITU Trainings
Don't miss the National Indian Health Board's (NIHB) presentation at the Centers for Medicare and Medicaid Services' (CMS), Indian Health Service (IHS), Tribal Health Programs, and Urban Indian Programs (CMS I/T/U) regional training sessions!  CMS is committed to helping the I/T/U facilities to maximize their ability to access third party resources.  To meet this objective, CMS, in partnership with the States, the Department of Veteran Affairs, the Social Security Administration, the DHHS Office of the Inspector General, IHS and NIHB provide training to patient benefits advocates on the programs and benefits available through Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. 
The target audience for CMS ITU Trainings includes:
  • Business Office staff
  • Benefits Coordinators
  • Patient Registration staff
  • Medical Records staff
  • Purchased/Referred Care staff
Upcoming Regional Training:
CMS ITU Training - Rapid City
December 17-18, 2019
1333 N Elk Vale Road
Rapid City, SD 55703
Click here to register and for more information.

New CMS Tribal Outreach Materials Available

Two New Videos - Public Service Announcements (PSA)
National Indian Health Board (NIHB) and Centers for Medicare and Medicaid Services (CMS) developed PSAs to use in Indian Country that depicts the best ways to use the outreach and education materials that CMS has created for Tribal communities.
This video  demonstrates tips for using CMS Tribal outreach materials at an information booth at a health fair or community pow-wow.
This video  demonstrates tips for using CMS Tribal outreach materials in a patient home visit with a community health educator like a Community Health Representative, Public Health Nurse or a Community Health Care Provider.
If you have any questions, please email Kristen Bitsuie at .

ACA Open Enrollment Period began November 1, 2019

Open Enrollment for the Exchange (Marketplace) plans begin November 1, 2019. The Health Insurance Exchange (also referred to as the Marketplace) benefits American Indians and Alaska Natives (AI/ANs) by providing opportunities for health coverage through Marketplace health insurance plans. AI/ANs can enroll in the marketplace any time during the year.
Special provisions for AI/ANs through the Affordable Care Act (ACA), include:
  • Special monthly enrollment status;
  • Zero cost-sharing plan option for household incomes at or below 300% of the Federal Poverty Level;
  • Limited cost-sharing plan option for household incomes above 300% of the Federal Poverty Level;
  • No copays, deductibles, coinsurance for zero and limited cost-sharing plans when receiving care from Indian health care providers.
For additional information, visit
Technical Assistance Opportunity: 2020 Cross-jurisdictional Systems Improvement Partnership
Application Deadline: December 6, 2019

Public health and systems issues often span jurisdictional boundaries. To improve public health systems and infrastructure, the Centers for Disease Control and Prevention (CDC) has partnered with the Association of State and Territorial Health Officials (ASTHO), the National Association of City and County Health Officials (NACCHO), and the National Indian Health Board (NIHB) to support a collaborative technical assistance opportunity, the Cross-jurisdictional Systems Improvement Partnership (CJSIP) program, as part of its Strong Systems, Stronger Communities (SSSC) initiative.

This opportunity aims to improve performance improvement practice and increase innovation in response to systems challenges, and to support progress toward meeting national public health standards among Tribal, local, and state health departments. This project is designed to strengthen cross-jurisdictional partnerships among Tribal, local and state health entities to develop and implement a shared action plan toward public health systems improvement. This opportunity requires a shared commitment from at least one Tribal, one local, and one state health department to collaborate on a joint public health systems improvement project.

Partners are to submit a joint letter of interest no later than December 6, 2019. The selected partnership will receive in-person and remote performance improvement capacity-building technical assistance provided by ASTHO, NACCHO, and NIHB from January to July 2020, including through a 2-day in-person workshop. This opportunity does not include direct funding.

HRSA Funding Opportunity: State Offices of Rural Health Coordination and Development Program
Application Deadline: December 20, 2019

The purpose of this program is to develop and maintain activities that will build the capacity of the 50 State Offices of Rural Health (SORH) and rural stakeholders nationwide through strengthening leadership, increasing opportunities for collaboration, offering education on policy and emerging health issues, and supporting the core functions of the SORH. The goals of the SORH Coordination and Development Plan (CDP) are to support the 50 SORH and rural stakeholders nationwide to better coordinate and improve rural health services by: 

1. Providing leadership development at national, regional, state, and local levels to increase the impact of SORH; 
2. Facilitating partnerships and collaboration at the national, regional, state and local levels to improve the exchange of information and best practices that support rural health; 
3. Assisting in the coordination of rural health care through education on policy and emerging health issues; and 
4. Providing capacity development for SORH core functions to improve SORH efficiency. The cooperative agreement will involve an ongoing partnership with the Health Resources and Services Administration (HRSA) in the final development and implementation of the submitted work plan.

Click here for more information.
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