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July 22-23, 2020

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.

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Top Story
CivilRightsNational Indian Health Board Cites Federal Government's Failure to Uphold Treaty Obligations to Tribal Nations for Severe COVID-19 Impacts on American Indians and Alaska Natives in Testimony Before U.S. Commission on Civil Rights
The National Indian Health Board (NIHB) Acting Chairman William Smith from the Valdez Native Tribe of Alaska testified before the U.S. Commission on Civil Rights as part of a virtual public briefing, titled:  COVID-19 in Indian Country: The Impact of Federal Broken Promises on Native Americans. In his oral remarks before the Commission, Acting Chairman Smith discussed the federal government's failure to fulfill its treaty obligations to the Tribes for healthcare and public health, made evident by chronic underfunding of Indian Health Service (IHS), paternalistic oversight over Tribal programs and reluctance to expand self-determination and self-governance policies across federal agencies. 
The U.S. healthcare system spends about $9,409 per year for one American's health - but the U.S. only spends just $3,779 per year for one American Indian or Alaska Native person's health. According to the Government Accountability Office (GAO), from 2013 to 2017, the IHS annual spending increased by roughly 18% while spending under Medicare and Medicaid increased by 22% and 31%, respectively. Similarly, during the same period, the Veterans Health Administration (VHA), which is the only other federal healthcare delivery system, increased its spending by 32%. The VHA has a service population that is only three times that of IHS, but the agency's annual appropriations are nearly 13 times higher.
Acting Chairman Smith also offered the Commission recommendations to remedy the systemic barriers and give Tribes a chance to fight COVID-19, which included:
  1. Honor the treaties.
  2. Listen to Tribes and act accordingly.
  3. Implement the Indian Self Determination Act in every agency of the Federal Government.
  4. Immediately invest $1 billion in water and sanitation.
  5. Provide emergency funding directly to Tribes for COVID-19 intervention.
  6. Permanently reauthorize and fully fund the Special Diabetes Program for Indians.
  7. Make technical fixes to federal Medicaid law that would maximize third party revenue for the Indian health system.
  8. Address mental and behavioral health needs that have been exacerbated by the COVID-19 pandemic.
  9. Stop using a competitive grant mechanisms or other paternalistic funding models with Tribes.
  10. Establish the Indian Health Service as an entitlement program that is fully funded.
Learn more about NIHB's advocacy at www.nihb.org or visit the NIHB COVID-19 Tribal Resource Center at www.nihb.org/covid-19/advocacy-tools to read the full testimony.
In This Issue:



EmergencyNIHB Submits Letter Asking for Extension of COVID-19 Public Health Emergency
The  National Indian Health Board (NIHB) submitted a letter to Secretary of Health and Human Services (HHS) Alex Azar asking for an extension of the Public Health Emergency (PHE) beyond its currently scheduled end date of July 25, 2020. The letter highlights that the circumstances that necessitated the public health emergency are not only still present but have only gotten worse, with the United States reaching record highs of new cases on a near daily basis. It also highlights that a lot of the emergency powers, including waivers to Medicare and Medicaid, are conditioned on the existence of the Public Health Emergency.

Read the full letter. 
HumanResearchAnnouncement of a Meeting of the Secretary's Advisory Committee on Human Research Protections
On July 6, 2020 HHS released a notice on a meeting of the Secretary's Advisory Committee on Human Research Protections. The meeting will be held virtually and is scheduled for Wednesday July 22 till Thursday July 23, 2020. The purpose of the meeting is to provide specific advice to the Secretary of Health and Human Services on topics centered on the protection of human research subjects. Other topics covered during this meeting include the interpretation of Public Health Surveillance and Risk to Non-subjects in Human Subject Research. 

For more information on this meeting please follow this link.
ScarceMaterialsCorrection to the Notice of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures
On July 7, 2020 HHS released a notice on a correction to the name of a March 30, 2020 federal register release titled "Notice of Designation of Scar
ce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures". This new notice requests to update the named contact to the "Notice of Designation of Scarce Materials or Threatened Materials." The notice also removes the drugs Chloroquine Phosphate and hydroxychloroquine HCl as they are no longer listed as scarce materials.
PowerMobilityMedicaid Program Collection Request on Conditions for Payment of Power Mobility Devices
On July 8, 2020 CMS released a collection request on their Medicaid Program: conditions for payment of power mobility devices, including power wheelchairs and power operated vehicles. Specifically this request asks for comments on an April 5, 2006 final rule that requires a face-to-face examination of the beneficiary by the physician or treating practitioner, a written prescription, and a receipt of pertinent parts of the medical record by the supplier in order to keep in their records for later review from CMS agents. 

Comments are due September 8, 2020.
PRCA Notice from IHS on Purchased/Referred Care Delivery Area Designation
On July 10, 2020 IHS released a notice on the intent to expand geographic boundaries of the Purchased/Referred Care Delivery Area for the Northwestern Band of the Shoshone Nation. This expansion would include the Utah counties of Box Elder, Davis, Salt Lame and Weber. With this expansion Tribal members would now be eligible to receive Purchased Referred Care services and are now expected to serve an additional 171 individuals.

Comments are due August 10, 2020
HHSFundingHHS Funding to Award Health Centers' COVID-19 Response
On July 9, 2020 HHS awarded $21 million in funding to support health centers and their response to COVID-19 from HHS and HRSA. $17 million of this funding will support 78 health center program look-alikes (LALs) to expand COVID-19 testing capacity. The LAL programs are funded through the Health Center Program and operate to provide services according to HRSA Health Center Program requirements. With the addition of these funds, approximately $2 billion has been awarded to HRSA funded health centers during the coronavirus pandemic. These LALs are critical in their communities as they provide testing to a majority of individuals and will continue to expand their testing and testing related activities to more patients as the pandemic continues. Along with this newly released funding, HRSA also released over $4.5 million in funding for COVID-19 response of Health Center Controlled Networks.
FCCThe Federal Communications Commission (FCC) Approved its Final Set of COVID-19 Telehealth Program Applications
On July 8, 2020 the FCC approved its final set of COVID-19 telehealth program applications. This 25 application set included $10.73 million in funding for urban and rural healthcare providers from all over the country. During the course of the FCC's COVID-19 Telehealth Program the agency has accepted 589 funding applications from 47 states with a total of $200 million in funding.
ReliefPayments$4 billion from HHS in Additional Relief Payments to Healthcare Providers Impacted by COVID-19
On July 9, 2020 HHS through HRSA released $4 billion in additional relief payments to healthcare providers in response to COVID-19. $3 billion of that funding will be used to support hospitals serving vulnerable populations, while the remaining $1 billion will go to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas. These additional payments are also now available for dentists to apply for and will now include dentists in the launch of the Enhanced Provider Relief Fund Payment Portal. 
CMSLetterCMS Dear State Medicaid Director Letter
On July 14, 2020 CMS released a Dear State Medicaid Director Letter that described new guidance for the home and community-based services (HCBS) Settings Rule. Due to the response of the COVID-19 pandemic from states, CMS is now changing their HCBS settings criteria with the understanding that it is now difficult for states to comply. CMS's specific concern is with the elderly where social distancing has made it hard for those individuals to participate in their communities. In addition, other concerns have also been brought to the attention of CMS by states on how the setting criteria cannot easily be achieved due to the pandemic. CMS has decided to extend the deadline for ensuring compliance with the Home and Community-Based Settings Regulation. The new deadline is now for March 17, 2023.
DTLLDear Tribal Leader Letter from the Indian Health Service (IHS)
On July 2, 2020 the IHS released a Dear Tribal Leader letter on initiating Tribal consultation on the use of $30 million in funding from the Special Diabetes Program for Indians (SDPI). This funding is an offset from previous year funds due to an accumulation of prior SDPI grants. Due to an added sixth year to the current grant cycle for SDPI, a new plan is needed for FY 2020 offset funds. Both offset funds and carry over funds could be used for different purposes. These purposes could include "new grant funding for $10 million per year for 3 years for eligible entities that do not currently have a SDPI grant, or one open to all eligible entities to apply to address diabetes related risk factors." This letter concludes with an invitation for all Tribal leaders to provide feedback to IHS on how this $30 million might be spent. 

The deadline to comment is August 28, 2020.
Please see below for call information to the  IHS' All Tribes Call on Thursday, July 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, July 23rd
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
EnrollmentWebinarNIHB Webinar: Health Insurance Enrollment During COVID-19
The National Indian Health Board (NIHB) is hosting a webinar on Health Insurance Enrollment During COVID-19 on Thursday, July 30 from 2:00 - 3:30 pm Eastern Time. This webinar is for enrollment assisters, patient registration and benefits coordinators.  The onset of the COVID-19 pandemic made it critical for enrollment assisters across Indian Country to stay informed on the special protections and benefits that health insurance coverage offers to the safety of American Indians and Alaska Natives (AI/ANs). The webinar is intended to help educate enrollment assisters about available health insurance coverage options, benefits and special federal protections exclusively for AI/ANs. The webinar will cover Special Enrollment Period eligibility for AI/ANs who have experienced lifetime events, such as losing a job or having a baby. Webinar participants will hear from BeWellNM and an Indian Health Service Patient Benefits Coordinator about their outreach and education strategies.

Date: Thursday, July 30, 2020
Time: 2:00 PM - 3:30 PM Eastern Time
DTFundingFunding Opportunity: Dental Therapy in Indian Country
Applications due Monday, July 20, 2020 at 11:59 PM ET
The National Indian Health Board (NIHB) is pleased to announce it is accepting applications for three funding opportunities related to dental therapy in Indian Country. These announcements are part of NIHB's Tribal Oral Health Initiative.
  • Tribal Colleges/Universities to conduct activities to develop dental therapy education programs
  • Tribes and Tribal Organizations to conduct activities to implement dental therapy in health settings
  • Tribes and Tribal Organizations to conduct outreach and education activities in support of dental therapy
Completed applications should be submitted to Brett Weber at bweber@nihb.org and should reference the grant code in the subject line. Read more and download the applications here.  
MinigrantsNIHB Offering Tribal Telehealth Capacity Mini-grants
Applications due Tuesday, July 21, 2020 at 11:59 PM ET
With funding from the Johns Hopkins University Center for American Indian Health, as part of the national Nick Kristof's C-19 Impact Initiative, the National Indian Health Board (NIHB) is offering 18 COVID-19 Tribal Telehealth Mini-grants to Tribes, Tribal organizations or inter-Tribal consortia in amounts up to $10,000 each to assist with building capacity and responding to telehealth services and needs. The project period will run from approximately August 1 through December 31, 2020. To download the application, click here. Download the application here.
Additionally, a preapplication webinar was held Monday, July 13, 2020. The preapplication webinar slides and recording can be found here under the NIHB COVID-19 Tribal Telehealth Mini-Grant banner.
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