January 29, 2020 |  Issue 20-3   Missed Last Week's Washington Report? Click Here to Visit our Archives!

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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Top Story
Consideration of RADM Weahkee as Director of Indian Health Service on Hold until Conclusion of Impeachment Trial

The Senate Committee on Indian Affairs (SCIA), which has jurisdiction over the nomination of Rear Admiral (RADM) Michael D. Weahkee as the next Director of Indian Health Service (IHS), will not be holding a vote on the nomination until the conclusion of the Senate impeachment trial. 

Per Senate Rules of Procedure and Practice related to impeachment, consideration of all legislative and executive business are suspended until the trial concludes. This includes consideration of all judicial and executive branch nominations. 

It remains unclear how long the trial will continue. The House of Representatives formally transmitted the articles of impeachment to the Senate on January 16, and the trial officially commenced on January 21. With oral arguments from the House Managers and White House defense counsel having concluded, the next phase will be rounds of questioning from Senators. Later this week, the Senate is likely to vote on whether to call witnesses and subpoena documents related to the charges in the impeachment articles. A simple majority of 51 Senators would need to vote in favor of calling witnesses.  If this were to happen, the trial could potentially carry on for several more weeks.

NIHB will provide more updates as they become available regarding next steps on RADM Weahkee's nomination to be the next IHS Director.

To view NIHB's support letter for RADM Weahkee, click here
Senate Veterans Affairs Committee to hold Markup of VA Tribal Advisory Committee Bill
On Wednesday, January 29, the Senate Veterans Affairs Committee will be holding a markup of eleven bills, including the bipartisan S. 524 - Department of Veterans Affairs Tribal Advisory Committee Act of 2019 introduced by Senator Tester (D-MT). Last May, S. 524 was discussed favorably during a legislative hearing in committee. No changes are anticipated to the bill in today's markup; h owever, committee votes will not be scheduled until the conclusion of the impeachment trial. 

More information about today's markup can be found here.
Trump Administration Guidance on Medicaid Block Grants Forthcoming
On Thursday January 30, 2020 the Center for Medicare and Medicaid Services is expected to issue guidance that will assist states with applying to convert their Medicaid system from a fee for service system into a block grant system. Under a block grant system, states would ask CMS for their funds at the beginning of the year, based on anticipated need. One state, Tennessee, has already applied to CMS for permission to do this. NIHB submitted comments on the Tennessee waiver request, which you can find here.  NIHB will continue to monitor this issue and keep Tribes and Tribal Organizations informed. 

For more information, please contact Carolyn Hornbuckle ( chornbuckle@nihb.org ). 
CMS Seeks Information on Cooperative Agreement to Support Navigators in Federally-Facilitated Exchanges
On January 24, 2020 the Centers for Medicare & Medicaid Services released a notice
on a collection activity on their cooperative grant agreement to support Navigators in federally-facilitated exchanges. The Navigator program applies to those in federally-facilitated exchanges who assist consumers through education and facilitation of qualified health plans, also known as Marketplace plans. The Affordable Care Act requires Marketplaces to establish this program for the help of consumers. Organizations in the Navigator program must receive federal cooperative agreement funding, as well as, cooperate with all federal evaluations with sporadic reports prescribed by CMS. Comments on the cooperative agreement are due to the OMB desk office by February 24, 2020.
IHS Reprograms Fiscal Year 2019 Funding for 105(l) Leases
On January 22, RADM Weahkee issued a Dear Tribal Leader Letter (DTLL), to discuss IHS' proposal to reprogram FY 2019 funds to support 105( l ) leases. IHS is required to fund 105( l ) lease cost agreements from congressional appropriations, but the agency does not have adequate funding to do so. In March 2019, IHS announced Tribal Consultation and Urban Confer and provided an enclosure  summarizing the 18 comments it received on the issue from Tribes and Tribal Organizations. (In FY 19, the requests for 105( l ) leases totaled $101 million, which was four times the amount of lease cost agreements over the previous fiscal year.
IHS recently decided to reprogram $72 million from its FY 2019 Services appropriation to pay for the 105(l) lease cost agreements. IHS is working to establish a technical subgroup, which will be part of IHS' National Tribal Budget Formulation Workgroup, to determine a long term solution for this funding shortfall.
Medicaid Coverage Among American Indians and Alaska Natives in 2018
In 2018 the Medicaid Coverage of American Indians and Alaska Native (AI/AN) declined for the first time since the passage of the Affordable Care Act (ACA) in 2010. Despite a 2018 Uninsured Rate of 14.4%, down from 23.7% in 2010, Medicaid Coverage for AI/ANs declined from 2017 to 2018, the first such decline since 2010. 425,000 more AI/ANs have Medicaid in 2018 compared to 2010 and the percentage with Medicaid has increased from 25.6% to 33.5%. 2018, however is the first with a decline in the number and percentage of AI/ANs with Medicaid coverage.

These findings are based on an NIHB analysis of the r ecently released American Community Survey estimates for 2018 and a review of previous years' estimates. The reasons for the decline are unclear as some states continued with their enrollment gains due to recent Medicaid expansion others saw coverage decline due to changes in the number eligible for Medicaid due to increased incomes and new eligibility requirements that increased the administrative burden for enrollment. States have begun a number of new requirements that threaten to further restrict coverage including: Work requirements, ending retroactive enrollment, presumptive enrollment and by eliminating annual enrollment and proposing changes in the reporting of income and assets for Medicaid coverage.

In 2010 1.36 million AI/ANs had Medicaid and this increased to 1.799 in 2017 only to decline in 2018 to 1.793 million in 2018. Note, however that the decline of 6,000 is within the margin of error. If one examines individual states there is further evidence of decline with the majority of states in decline and a few, those with recent adoption of Medicaid (e.g. Montana and Alaska) increasing enrollment. One can only conclude that Medicaid enrollment for AI/ANs has peaked in 2017 and declines are likely the rule in the coming years. This is particularly true with the new requirements that restrict eligibility as noted above.
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!
MMPC IHS-Tribal Workgroup Call
Date: Thursday, January 30
MMPC IHS-Tribal Workgroup Meeting
3:00-4:00pm ET
Call in: 800-220-9875 | Passcode: 60951640
Date: Thursday, January 30th
TTAG ACA Policy Subcommittee meeting
4:00-5:00pm ET
Call in: 1-877-267-1577| Meeting Number:998 479 752
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: 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)

The 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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