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May 13, 2020

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 In February 2018, with the announcement of CHAP expansion to Tribes beyond Alaska, IHS created a CHAP Tribal Advisory Group.

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Top Story
WeahkeeConfirmSenate Confirms Rear Admiral Michael Weahkee as Director of the Indian Health Service

The  National Indian Health Board extends congratulations to  Rear Admiral (Rear Adm.) Michael Weahkee who was confirmed on April 21, 2020 by the U.S. Senate as the Director of the  Indian Health Service (IHS) for a four-year term. In this capacity, Rear Adm. Weahkee will continue the responsibility for administering health care to American Indians and Alaska Natives nationwide in IHS, Tribal and urban (ITU) health settings. Director Weahkee has served as the interim head of the agency for the past three years and has proven to be an effective leader of IHS through consistent, responsive and collaborative management in times of grave challenges and limited resources.

"The National Indian Health Board congratulates Director Weahkee on officially becoming head of the Indian Health Service. Director Weahkee continues to show up for Tribes during turbulent and trying times like during the 33-day government shutdown in 2019 and now in the era of Coronavirus," said NIHB Chairperson Victoria Kitcheyan who is also a Tribal Council Member of the Winnebago Tribe of Nebraska. "Rear Admiral Weahkee has proven to be an adept and inclusive leader who has earned the trust and confidence of Tribal Nations. NIHB supports his steady leadership and pledges to continue to work closely with the Indian Health Service to advance and expand health services across the Indian health system."

For the last three years, Rear Adm. Weahkee has traveled extensively throughout Indian Country to meet one-on-one with Tribal leaders in their home communities to understand the unique obstacles Tribes face in the health care and public health arenas - and to facilitate ways to honor the government's trust responsibility for Indian Country's health. Director Weahkee's approach informs IHS's strategic priorities in a way that keeps Tribal voices in the forefront of decision-making. Under his leadership, the quality of IHS-led consultations and listening sessions has improved as Rear Adm. Weahkee has displayed a great willingness to integrate Tribal feedback and priorities into IHS's policy development. IHS has led Tribal consultation teleconferences around the $1.032 billion in IHS funding in the CARES Act. He has also participated in numerous national Tribal calls sponsored by NIHB.

"Rear Admiral Weahkee has been instrumental in getting Coronavirus relief funding to Tribes as quickly as possible and is in regular communications with Tribal leaders," said Kitcheyan. "As a Tribal leader, I appreciate Director Weahkee's thoughtful and collaborative approach in his leadership."
In This Issue:


SenateActCongress Passes Paycheck Protection Program and Health Care Enhancement Act
After passing the U.S. Senate on April 21, earlier today, April 23, the House of Representatives passed an interim coronavirus relief bill, titled the " Paycheck Protection Program and Health Care Enhancement Act ". The bill amends the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) to increase the amounts authorized for the Paycheck Protection Program (PPP), the economic injury disaster loans, and emergency grants under the CARES Act, and authorize additional funding for hospital and provider recovery and coronavirus testing. 

The bill provides an additional $75 billion  for the Public Health and Social Services Emergency Fund of the Department of Health and Human Services for reimbursement to eligible health care providers for health care-related expenses or lost revenues that are attributable to the coronavirus. 

The definition of "eligible health care providers" is identical to the $100 billion provided to health care providers under the CARES Act: public entities, Medicare- or Medicaid-enrolled suppliers and providers, and other for-profit and nonprofit entities that provide diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. IHS and Tribal health care providers have received portions of the provider relief funds under CARES, and NIHB will continue to advocate that IHS and Tribal providers receive portions of the $75 billion provided under this bill. 

The Act gives the Secretary of the Department of Health and Human Services broad discretion in reviewing applications from providers to determine which providers will receive payments from the Relief Fund. The Act would specifically focus on providing additional funding to hospitals and does not establish priorities among different categories of eligible health care providers.

The bill appropriates $25 billion to the Relief Fund for necessary expenses to research, develop, validate, manufacture, purchase, administer, and expand capacity for COVID-19 tests. This includes a minimm baseline $750 million set aside for Tribes, Tribal organizations, and urban Indian organizations for testing and related needs. While the funds are not appropriated directly to IHS, NIHB was able to add language requiring that funds be distributed "in coordination" with IHS to provide additional leverage to request an interagency transfer of the funds to IHS. 

The funding can be used for tests for both active infections and prior exposure, as well as for the manufacturing, procurement, and distribution of tests, testing equipment, and testing supplies (including personal protective equipment needed for administering tests). This funding includes specific allocations to states and various governmental agencies (such as the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration, as well as tribal health organizations) to support activities necessary to accelerate the research, development, manufacturing, and production of COVID-19 tests.

The President is likely to sign the bill later today or on Friday April 24. 
ExtendDeadlineNIHB Requests Deadline Extension for Data Submission Regarding CARES Act Provider Relief Fund

On Thursday April 23, the National Indian Health Board (NIHB) wrote to the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar expressing concern about the lack of notice given to Tribal leaders about the eminent distribution of $10 billion through the Department of Health and Human Services (HHS) from the CARES Act Provider Relief Fund. 

This $10 billion portion, also being referred to as the Targeted Relief Funding, is intended to help alleviate the financial burdens faced by hospitals and other providers around the country in areas highly impacted by COVID 19. The expedited data collection process that HHS is requiring for providers to be considered for a funding allocation. Many Tribes and Tribal providers were only made aware of the distribution and data portal on Wednesday, April 22. Many more Tribes and Tribal providers remain unaware of this pending distribution and data requirement. As such, NIHB has urged HHS to grant an extension to submit facility data to the designated HHS portal so that Indian Country can have adequate opportunity to respond.

The HHS Tribal Consultation Policy (TCP),9 calls on the HHS operating staff and divisions, to have an accountable process to ensure meaningful and timely input by Indian Tribes in the development of policies that have Tribal implications. According to the policy, true and effective consultation shall result in "information exchange, mutual understanding, and informed decision-making on behalf of the Tribal governments involved and the federal government." In practice, this means that once Tribes identify a "critical event," HHS must communicate clear and explicit information on the means and time frames for Tribal Nations to engage in consultation.

Given the amount of resources at stake, NIHB has determined the amount of notice provided as insufficient. With such a substantial amount of funding at issue, which may determine whether or not hospitals and providers can continue to operate in Indian Country, a full complement of notices must go out. 

T o read the full letter submitted by NIHB, please click  here. 

OpenAgainNew Center for Medicare and Medicaid (CMS) Guidelines on President Trump's Opening Up America Again
On April 20, 2020 CMS issued new recommendations for communities that are in Phase 1 of President Trump's Opening Up America Again Guidelines. These recommendations update earlier guidance from CMS on limiting non-essential surgeries and medical procedures. CMS recommends a slow transition for health care professionals to coordinate with local and state public health officials. Similarly, they encourage individuals, if making the decision to increase in-person care, to review personal protective equipment and protocols, and ensure workforce availability, facility readiness, testing capacity and that other supply needs are met.

If you are in a state or community that is part of the Phase 1 reopening guidelines, we urge you to exercise caution. This may mean continuing to practice social distancing and taking other preventative measures to protect your health.

InpatientWaiversUnder Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS Implements New Hospital Payment and Inpatient Rehabilitation Facility Waivers
On April 15, CMS implemented new waivers for increases in payment of Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) inpatient hospital care for those affected from the COVID-19 pandemic. This guidance is for IPPS hospitals and LTCH's on code claims that can now be used to receive the higher payment. Pursuant to the CARES Act, CMS will waive the requirement that Medicare Part A fee-for-service patients treated in inpatient rehabilitation facilities receive at least 15 hours per week of therapy. A complete list of coronavirus waivers and flexibilities can be found HERE.

CMSCallCMS Weekly COVID-19 Updates Call
On April 7, CMS held a COVID-19 update call on recent actions the agency has taken to respond to the COVID-19 pandemic. The call was held for all Medicare fee-for-service providers and interested stakeholders. Some items on the agenda included 1135 waivers, consent contracts and other flexibilities for state Medicaid agencies. A transcript of the call can be found HERE. CMS also maintains a web page of all recent stakeholder calls, "office hours" calls, in addition to Medicare Learning Network Calls. Transcripts and recordings are available HERE.

TelehealthFundingFunding Opportunity through the Federal Communications Commission's (FCC) COVID-19 Telehealth Program
On April 16, the FCC approved the first set of $200 million in funds, under the CARES Act, for the agency's COVID-19 telehealth program. FCC began accepting applications on April 13 as authorized under the CARES Act. The FCC authorized $3.23 million in funding to help six eligible health care organizations to buy telecommunications, such as broadband connectivity, and to cover other needs during the COVID-19 pandemic. FCC will continue to evaluate applications on a rolling basis. "Telehealth has emerged as a critical service for health care providers and patients alike during the coronavirus pandemic," said FCC Chairman Pai. "It promotes social distancing, protects the safety of health care professionals and patients, and frees up space in health care facilities for those who now need it most."

TelementoringHRSA Rural Telementoring Training Center Applications available for FY 2020
On April 20, HRSA published a funding opportunity for which Tribes are eligible on Rural Telementoring Training Centers for fiscal year 2020. The purpose of the program is to train academic medical centers to authorize telementoring learning programs in their communities. The purpose of these programs are to spread awareness of best practices in specialty care for primary care providers, as well as care teams, in rural areas across the country. These centers will improve models of professional education and support that can be adaptable to American Indians and Alaska Natives, and rural minority communities. Grants for the rural telehealth programs for which Tribes are eligible, as well as other HRSA funding opportunities can be located HERE.

HRSATACHRSA Establishes Tribal Advisory Council; Seeking Delegates
The Health Resources and Services Administration (HRSA) is requesting comments on the establishment of its Tribal Advisory Council and is seeking nominations of 12 qualified Tribal officials, from the 12 Indian Health Service (IHS) areas, for consideration for appointment as voluntary delegate members of the HRSA Tribal Advisory Council (TAC). There should be one designated alternate for each TAC member. HRSA TAC members will have the opportunity to engage in meaningful consultation with agency officials, and to share a broad range of views determining the impact of HRSA programs on the American Indian/Alaska Native (AI/AN) health systems and the population. HRSA also seeks Tribes guidance in crafting innovative approaches to deliver health care and assisting with effective consultations.  Nominations are due 05/07/2020.

CMSRatesIndian Health Service Announces Calendar Year 2020 Medicare and Medicaid Rates
The Principal Deputy Director of the Indian Health Service (IHS), under authority of the Public Health Service Act, and the Indian Health Care Improvement Act, has approved Calendar Year (CY) 2020 rates for inpatient and outpatient medical care provided by IHS facilities for Medicare and Medicaid beneficiaries. The revised 2020 Medicare and Medicaid rates are based on fiscal year (FY) 2018 Medicare cost reports and include rate increases for Medicaid inpatient and outpatient, as well as Medicare outpatient and ancillary visits in the lower 48 states and in Alaska. Per Indian Health Service (IHS) guidance, the Federal Register notice should be provided to Medicaid agencies so that an agreement for billing at the CY 2020 rates for services provided on or after January 1, 2020can be reached. IHS will initiate efforts with the Centers for Medicare and Medicaid Services (CMS) to notify Novitas, the Medicare Administrative Contractor, to begin using the CY 2020 rates to make payments for services on or after January 1, 2020. For now, the CY 2019 Medicare rates for billing services should continue to be used until CMS or Novitas provide additional guidance. If you wish to view Medicare and Medicaid rates from 1998 to present, click here. For more information, you may directly contact Mr. Sam Brewster by e-mail at Samuel.Brewster@ihs.gov or by telephone at (301) 443-2041.

IHS COVID-19 All Tribes CAll
Please see below for call information to the  IHS' All Tribes Call on Thursday, April 23rd at 4:00 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 30th 
Time:  4 :00 PM - 5:30 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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