April 10, 2020 |  Issue 20-10  Missed Last Week's Washington Report? Click Here to Visit our Archives!

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, Native Organizations Request Over $8 billion for the Indian Health System Ahead of Fourth Congressional COVID-19 Funding Package
In active nationally coordinated effort to ensure Tribes are meaningfully included in COVID-19 relief funding, the National Indian Health Board (NIHB) along with a coalition of 10 national and regional Tribal organizations sent a letter outlining Tribal health care and public health priorities to House Speaker Nancy Pelosi, Senate Majority Leader Mitch McConnell, Senate Minority Leader Chuck Schumer, and House Minority Leader Kevin McCarthy late Wednesday night. The letter includes a robust and comprehensive list of Tribal priorities, including over $8 billion in funding for the Indian health system, in addition to multiple legislative priorities such as maximizing third-party health care revenue streams and ensuring Indian Country has direct access to the Strategic National Stockpile. 

"Tribal leaders and Tribal health directors were instrumental in identifying Tribal and public health priorities and we urge Congress to include them in phase four funding that will address critical, Tribal needs around COVID-19," said NIHB Chairperson Victoria Kitcheyan. "Indian Country had significant wins in the CARES Act, but our systems operate on such limited resources, that the Indian health system needs more support to effectively respond to COVID-19."

The Tribal and public health priorities are broken into four sections: funding, technical Medicaid and Medicare fixes, technical amendments, and legislative fixes and reauthorizations. Notable priorities include:
  • $1.215 billion for hospitals and health clinics
  • Establish a $1.7 billion Emergency Third-Party Reimbursement Relief fund for IHS, Tribes, Tribal organizations and urban Indian organizations
  • $85 million for equipment purchases and replacements
  • Maximize third party-reimbursements by making technical fixes to Medicare and Medicaid
  • Expand telehealth capacity and access in Indian Country by permanently extending waivers under Medicare
  • Provide direct IHS, Tribal and urban Indian organization access to the Strategic National Stockpile
  • Permanently reauthorize the Special Diabetes Program for Indians
The organizations' ask for $1 billion for Purchased/Referred Care (PRC) will ensure Indian Health Service (IHS) and Tribal facilities have the resources needed to pay for outside specialty care related to COVID-19. PRC, also known as contract health, is a program that allows IHS and Tribally operated facilities to contract out essential health care services that are not available within the Indian health care delivery system. Because of Coronavirus, IHS and Tribal facilities are having to refer patients to outside providers for high cost emergency and specialty care which is quickly depleting Purchased/Referred Care resources.

Joining NIHB, the letter was signed by the National Congress of American Indians, Self-Governance Communication and Education Tribal Consortium, Alaska Native Health Board, Rocky Mountain Tribal Leaders' Council, California Rural Indian Health Board, Great Plains Tribal Chairmen's Health Board, United South and Eastern Tribes Sovereignty Protection Fund, Inter-Tribal Association of Arizona and Northwest Portland Area Indian Health Board.

In addition to advocacy efforts, NIHB continues to work with federal agencies that are administering the funding from the first three COVID-19 funding packages to Tribes by hosting listening sessions and consultations for Tribal leaders to engage in dialogue on how the funding should get to the Tribes.

Congressional Native American Caucus Endorses Priorities for Indian Country

On April 10, Rep. Deb Haaland (D-NM) and Rep. Tom Cole (R-OK), co-chairs of the Congressional Native American Caucus, sent a letter to House Appropriations Chairwoman Nita Lowey (D-CA) and Ranking Member Kay Granger (R-TX) expressing support for the letter sent to Congressional leadership by NIHB and Native organizations outlining health care and public health priorities significant to Tribes and Tribal organizations. 

The full letter may be read here. 

Visit the NIHB COVID-19 Tribal Resource Center: www.nihb.org/covid-19.
CSPANNIHB Chairwoman Victoria Kitcheyan appears on C-SPAN's Washington Journal
NIHB Chairwoman Victoria Kitcheyan, who is also a Tribal Councilwoman with the Winnebago Tribe of Nebraska, appeared on C-SPAN's live program Washington Journal to speak about the impact of COVID-19 on Tribal communities. Ms. Kitcheyan highlighted the health disparities that Native people face, spoke about the current situation in Indian Country and gave an outline of the funding for Tribes from COVID-19 legislation passed by Congress.
TelehealthGuidanceCenters for Medicare and Medicaid Rural Health Care and Medicaid Telehealth Flexibilities and Guidance
On April 2, the Centers for Medicaid and Medicaid Services (CMS) released an Informational Bulletin (CIB) on Medicaid Rural Health Care and Telehealth Flexibilities. The guidance provides information to Medicaid agencies and interested stakeholders on options to facilitate access to service through the use of telehealth delivery methods. The CIB also specifies new guidance on Medicaid substance use disorder treatment services via telehealth.

NursingHomesTrump Administration Issues COVID-19 Recommendations to Nursing Homes, State and Local Governments
On April 2, CMS issued new recommendations on how to mitigate the spread of COVID-19. These recommendations include, but are not limited to, the advising of nursing homes to restrict visitors as well as the implementation of inspections from CMS for infection control. The recommendations can be found here.

DiagnosisCodeCMS Introduces Medicaid Diagnosis Code for COVID-19
On April 3, CMS released guidance on a new diagnosis code, U07.1. Due to the national emergency the code has been effective since April 1, 2020. The ICD-10 MS-DRG GROUPER software package has also been updated to accommodate the new code and should be used by providers when appropriate for discharges on or after April 1.

RuralMaternalCMS is Requesting Information on Rural Maternal Health Care
CMS's Office of Minority Health seeks Tribal recommendations regarding rural maternal and infant health care. Responses to this information request (RFI) will be used to inform future work by CMS to develop and refine programs and policies that ensure rural women have access to high quality maternal health care that results in optimal health outcomes. CMS encourages the public to review the RFI at  go.cms.gov/ruralhealth and submit comments to RuralMaternalRFI@cms.hhs.gov. Comments will be collected until Sunday, May 31 at 11:59pm ET.

Update on CMS' Approval of Section 1135 Waivers
Over the past few weeks, CMS has been steadily approving Section 1135 waivers, which are designed to allow states to waive certain regulatory requirements in order to speed up the provision of services. As of April 7, 46 states and the District of Columbia have been approved for this waiver. States are most commonly being approved for changes to provider enrollment, prior authorization requirements, and are being allowed to offer services in alternative settings. NIHB has been uploading one-page summaries of the waivers for states with I/T/U facilities. You can find one-pagers on each state's approved 1135 waiver, as well as information about the 1135 waiver more broadly in our COVID-19 Tribal Resource Center here. NIHB will continue to update the web page as states are approved.

SurveyResponsesNIHB Requesting Responses to 2nd COVID-19  Needs and Priorities Survey

The National Indian Health Board (NIHB) is asking for Tribes' continued assistance in assessing the Coronavirus Disease 2019 (COVID-19) prevention and response capacity in Indian Country. An initial survey was distributed on March 3rd, 2020 and received over 190 responses, providing much needed information in advocating for funding for Indian Country, as was approved by Congress in the Coronavirus Aid, Relief, and Economic Security Act or CARES Act last week. NIHB thanks you all for the response.

As the pandemic continues to expand across the nation and challenges our public health infrastructure and capacity on a daily basis, it is crucial that NIHB continue to hear the needs of Tribes.  This second survey will assess current and expected needs for medical countermeasures, workforce, infrastructure, and communication in response to COVID-19.
We ask that you please consider the questions at the link below and share any information you can with NIHB.
This survey should take about 10-15 minutes to complete. You can access the survey here:  https://survey.az1.qualtrics.com/jfe/form/SV_56WOzrDU1jkmpcF

IHS COVID-19 All Tribes CAll
Please see below for call information to the 
IHS' All Tribes Call on Thursday, April 9th at 3:30 PM Eastern . This call is intended to update Tribes on the Coronavirus Disease 2019 (COVID-19). Tribal Leaders will have an opportunity to provide comments and ask questions to federal officials. IHS has also scheduled a COVID-19 call for the following week at the same time-call info is the same for both calls.

Date:   Thursday, April 16th
Time:   3:30 PM - 5:00 PM (Eastern)
Conference Call:   800-857-5577 | Participant Passcode:  6703929
Webinar Adobe Connect:   https://ihs.cosocloud.com/r4k6jib09mj/ | Participant Password:  ihs123
Rural Communities Opioid Response Program Notice of Funding Opportunity
Application Deadline: April 24, 2020
HRSA recently released the Rural Communities Opioid Response Program (RCORP) notice of funding opportunity (HRSA-20-031). HRSA plans to award approximately 89 grants to rural communities as part of this funding opportunity. Applications are due by Friday, April 24, in Grants.gov .
Successful RCORP-Implementation award recipients will receive $1 million for a three-year period of performance to enhance and expand substance use disorder (SUD), including opioid use disorder (OUD), service delivery in high-risk rural communities. They will implement a set of core SUD/OUD prevention, treatment, and recovery activities that align with HHS' Five-Point Strategy to Combat the Opioid Crisis.
The target audience for CMS ITU Trainings includes:
  • Business Office staff
  • Benefits Coordinators
  • Patient Registration staff
  • Medical Records staff
  • Purchased/Referred Care staff
Please click here to access the schedule of virtual CMS ITU trainings. 
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