January 24, 2020 |  Issue 20-2   Missed Last Week's Washington Report? Click Here to Visit our Archives!

January 23 - 24, 2020
Washington, DC

Secretary's Tribal Advisory Committee Meeting
February 6 - 7, 2020
Washington, DC

February 11 - 12, 2020
Arlington, VA

February 11 - 12, 2020
Washington, DC

February 13 - 14, 2020
Arlington, VA

February 25 - 26, 2020
Washington, DC

Tribal Leaders Diabetes Committee Meeting
March 11-12, 2020
Washington, DC

March 17 - 19, 2020
Omaha, Nebraska
Register for the Summit HERE

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 .

Join the National Partnership for Dental Therapy!
Click HERE for more information!

Stay Current: Health Alerts from the CDC!
Don't wait for the emergency to arrive before signing up for emergency alerts from the Centers for Disease Control & Prevention!

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IHS Issues Dear Tribal Leader Letter about Funding 105 (l) Lease Costs 
On January 22, the Principal Deputy Director of the Indian Health Service (IHS), RADM Mike Weahkee, issued a Dear Tribal Leader Letter (DTLL) regarding the decision to reprogram fiscal year 2019 (FY 19)  funds from the IHS Services Account to help pay for 105(l) lease cost agreements . By law, IHS is required to pay for these contractual agreements through the IHS Services account; however, the agency does not have a dedicated line item to pay for 105(l) lease expenditures. In addition, IHS had only identified roughly $30 million in FY 2019 funds to pay for these agreements. Nevertheless, in FY 2019 alone, IHS received 205 unique proposals for 105(l) lease agreements totaling nearly $101 million. As a result, IHS had a roughly $70 million shortfall that required funds to be reprogrammed to pay for the lease agreements. T his reprogramming decision applies to FY 19 only.    
The DTLL also assures Tribes that IHS will continue to consult with them regarding longer-term solutions to meet 105 (l) funding requirements. Additionally, the IHS is implementing a technical subworkgroup that will work with the National Tribal Budget Formulation Workgroup and assist in identifying and projecting future costs related to section 105(l).  Tribes and NIHB continue to advocate to IHS and Congress to establish an indefinite appropriation for 105(l) lease agreement, similar to Contract Support Costs.

On March 12, 2019, the IHS initiated Tribal Consultation regarding funding for FY 2019 of 105 (l). Along with their DTLL release, the IHS has included additional documents, a summary of letters received and copies of the written responses received in response to Tribal Consultation:

Read the Dear Tribal Leader Letter: Click Here
Written Responses from Tribes and Urban Indian Organizations on 105 (l): Click Here
Summary of Responses re 105 (l) in FY 19: Click Here

*The January 22, 2020, DTLL states that  of the $72 million to be reprogrammed, $25 million will come from across multiple budget lines and similar to FY 18's reprogramming allocation to fund 105 (l). The detail of FY 18's funding changes can be found here.  

CMS Guidance on Medicaid Block Grants Expected Soon
According to recent media reports such as the Wall Street Journal, the Centers for Medicare and Medicaid Services (CMS) is working to release guidance by the end of January 2020 that will reform the Medicaid program. It is expected that the reforms will allow states to finance their Medicaid programs by implementing block grants.   States in support of block grants seem to be in favor the approach as a way to reduce costs.

The National Indian Health Board (NIHB) continues to hear from Tribes regarding the expected impacts of a potential Medicaid block grant in their state. Tribes and Tribal advocates have been unified in their support of increasing meaningful Tribal consultation, a more direct funding stream to the IHS/Tribal/Urban (I/T/U) health system, and efforts to increase support of Indian Health Care Providers to participate in CMS health reform (payment) programs. While a block grant approach is not considered ideal for many Tribal communities, it is important that any approach meets its obligation to Tribes in fulfillment of the federal Trust responsibility. Therefore, any funding mechanisms that will "cap" funding for healthcare provided to American Indians and Alaska Natives (AI/ANs) will not work for Indian Country. 

NIHB will continue to monitor this issue and keep Tribes and Tribal Organizations informed.  For more information, please contact Carolyn Hornbuckle ( chornbuckle@nihb.org). 

Affordable Care Act Update
On January 21, 2020, the Supreme Court announced that it would not expedite its decision over whether the Affordable Care Act (ACA) is constitutional.  A group of Congressional Democrats and Attorneys General called for the court to rule on the ACA's constitutionality before the presidential election, in hopes that the court would rule for the law to remain in place.

In December 2019, the Fifth Circuit Court ruled that the individual mandate within the ACA was unconstitutional.  This action is causing a partisan stir over whether other parts of the ACA are severable, i.e. whether they can be removed from the law.  Currently, the ACA remains in place, and the Tribal specific provisions of the ACA have not been called to question. To read more about this issue, click here.
IHS Tribal Budget Formulation Workgroup Meeting
The I HS National Tribal Budget Formulation Workgroup (TBFWG) for FY 2022 will meet on February 13 - 14, 2020, in Arlington, VA. The TBFWG meets annually over 2 days and is comprised of two Tribal representatives from each area. The TBFWG collectively reviews and consolidates each IHS area's budget recommendation for the formulation year into a set of Tribal health priorities and budget recommendations to be used nationwide.

Tribes are encouraged to attend T ribal Caucus on Thursday, February 13, 2020 at 8:30 am (Eastern) . The Tribal Co-chairs of the Budget Formulation Workgroup will also be selected during the caucus session.

Meeting Information:
DoubleTree by Hilton Washington DC Crystal City
300 Army Navy Drive
Arlington VA 22202
Phone: 703-416-4100 
Meeting Room: TBA

IHS Contact: Stanley Mitchum, (301) 443-1003 or stanley.mitchum@ihs.gov
CMS Comment Request: Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits
Through this  collection the process for organizations wishing to provide healthcare services under Medicare Advantage (MA) plans will be addressed. Generally these organizations, when applicable, must now complete an application annually, file a bid, and receive final approval from CMS. The MA application process has two options for applicants; requesting a new MA product or requesting an expansion for the service area of an already existing product. This information will ultimately allow for a more thorough review by CMS to determine if applicants are compliant with current requirements for participation in the MA program and eligible for the contract award. This application is open to all health plans that want to participate in the MA program, however it is not the same as the bid process. Comments on this collection are due to the Office of Management and Budget (OMB) by February 5, 2020.
CMS Advance Notice: Part I of the 2021 Methodical Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies
This Advanced Notice identifies key information on proposed updates to the Medicare Part C CMS-Hierarchical Condition Categories (HCC) risk adjustment model and the use of encounter data. These HCC risk adjustment models are used to calculate risk scores that change capitated payments made for aged and disabled beneficiaries enrolled in MA plans. This risk score represents a beneficiaries expected medical costs relative to the average expected medical costs of individuals already entitled to Part A and enrolled in Part B. Comments on the proposals should be submitted via  https://www.regulations.gov by March 6, 2020. 
Medicare Card Reminder
For those enrolled in Medicare, the Centers for Medicare  and Medicaid S ervices (CMS) announced that beginning January 1 st  2020, new Medicare Cards must be presented when receiving services from Tribal hospitals and clinics. If the hospitals and clinics do not receive the new Medicare Beneficiary Identifier (MBI), from those that are enrolled into Medicare, their claim will be automatically rejected.  In order to ensure that claims are paid, it is critically important that Tribal Medicare beneficiaries are aware of this change. 
In the event that an enrolled beneficiary does not have a card yet, or fails to bring it to the appointment, CMS also provides additional i nformation   on how to obtain the new Medicare card.

Registration Open for National Indian Health Board's 11th Annual National Tribal Public Health Summit!
March 17-19, 2020
Chi Health Center, Omaha, NE

The National Indian Health Board invites you to submit a proposalfor the National Tribal Public Health Summit (TPHS). TPHS is a premiere Indian public health event that attracts over 500 Tribal public health professionals, elected leaders, advocates, researchers, and community-based service providers. This year's Summit will feature dynamic national speakers, interactive workshops and roundtable discussions, a welcome reception, a morning fitness event, as well as the presentation of the 2020 Native Public Health Innovation awards.
This year's tracks are:
  • Health Promotion and Disease Prevention
  • Public Health Policy, Infrastructure, Workforce and Systems
  • Substance Misuse, Opioids, and Behavioral Health
  • Environmental Health and Climate Change
  • Traditional Public Health Practice
Click here   to register for the Summit by February 14, 2020 for Early Bird Rates!
February 19-21: Sixth International Meeting on Indigenous Women's Health
The American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynecologists of Canada (SOGC) will host the 6th International Meeting on Indigenous Women's Health, February 19-21, 2020, in Albuquerque, New Mexico. The conference will focus on innovative clinical care models and community-based approaches to health for women and their families in First Nations, Inuit, Metis, American Indian and Alaska Native and other Indigenous communities. During the meeting, participants will strengthen their knowledge about prevalent health 
challenges  facing Indigenous women and acquire practical skills. Topics include: rural maternity safety, trauma-informed care, maternal substance use and cultural safety. Optional hands-on sessions are available for clinical skills building and safety planning.

The preliminary program is available here.
MMPC IHS-Tribal Workgroup Call
Date: Thursday, January 30, 2020
Time: 3:00 PM Eastern
Dial-in: 800-220-9875 | Passcode: 60951640
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 Trainings:
CMS ITU Training - San Diego, CA
February 5-6, 2020
Four Points by Sheraton
8110 Aero Drive
San Diego, CA 92123
CMS ITU Training - Denver, CO
March 18-19, 2020
Embassy Suites by Hilton
Denver Tech Center North
7525 East Hampden Avenue
Denver, CO 80231
CMS ITU Training - Galllup, NM (Navajo)
March 24-25. 2020
Navajo Tribal Utility Authority
Fort Defiance, AZ
Click here to register and for more information.
Upcoming CMS Meetings, Calls, and Webinars
CMS Webinar: Understanding Medicare [CEU], Module 2
Wednesday, January 22, 2020
1:00- 3:00pm ET
Create an account and register here.

CMS Webinar: Long Term Services and Supports: Money Follows the Person - Tribal Initiative, Part 1
Wednesday, January 22, 2020
2:00pm - 3:00pm ET
For more information, and to register, click here

CMS Webinar: From Coverage to Care - How to Use Health Coverage
Thursday, January 30, 2020
1:00 - 2:00pm ET
For more information, and to register, click here.
How to use CMS Tribal Outreach Materials
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  kbitsuie@nihb.org .

Udall Foundation Announces Next Round of Applications for 
Native American Congressional Internship Program
Application Deadline: January 31, 2020

This program for Native American and Alaska Native undergraduate (juniors/seniors), graduate, and law students offers a unique opportunity to gain professional leadership experience in Washington, D.C. Udall Foundation's fully-funded, ten-week summer internship in Washington, D.C., offers distinctive opportunities for Native American and Alaska Native students who are interested in learning more about the Federal legislative process while gaining an insider's view of the government's unique trust relationship with Tribes. Interns work in congressional and agency offices where they have opportunities to research legislative issues important to Tribal communities, hone their legal research and writing skills, and network with public and Tribal officials and Tribal advocacy groups.
The Foundation seeks candidates who demonstrate academic excellence, leadership qualities, and an interest in working with Native American issues and policy. Interns are provided round-trip airfare, lodging, per diem, and an educational stipend. Download the application from the Udall Foundation website and submit it by the January 31  deadline.
IHS 2020-2021 Scholarship Program Now Open!
Application Deadline: February 28, 2020, 7:00 PM Eastern

The Indian Health Service (IHS) Scholarship Program is now accepting applications for scholarship support for the 2020-2021 academic year.

Pre Nursing, Pre Medicine, Pre Dentistry, Nursing BS, Nurse Anesthetist MS, Nurse Midwife MS, Physician Assistant MS, Clinical Social Work MS, Nurse Practitioner MS, DNP, Clinical Psychology D, Counseling Psychology D, Dentistry D, Optometry D, Pharmacy D, Physician (Allopathy/Osteopathy), Physical Therapy D, Podiatry D.

For specific eligibility requirements with degree programs, please view the IHS Scholarship Comparison Chart.

HRSA Funding Opportunity: Rural Health Care Coordination Program
Application Deadline: March 12, 2020

HRSA is accepting applications for fiscal year (FY) 2020 Rural Health Care Coordination Program. The purpose of this program is to support rural health consortiums aiming to improve access and quality of care through application of care coordination strategies with the focus areas of collaboration, leadership and workforce, improved outcomes, and sustainability in rural communities.

The FY 2020 President's Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. You should note that this program may be cancelled prior to award.

The Health Resources and Services Administration (HRSA) is the primary federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  

Click here to view the funding opportunities in Grants.gov .
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