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UPCOMING EVENTS
 

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
sdpiLetterNIHB Submits Letter to Congress Alongside 17 Signatories Urging 5-Year Extension of SDPI, all Health Extenders
On Friday September 11, NIHB submitted a letter to Speaker Pelosi, Senate Majority Leader McConnell, House Minority Leader McCarthy, and Senate Minority Leader Schumer, urging immediate action in support of a 5-year extension of the Special Diabetes Program for Indians (SDPI) and other expiring health extenders. These include the National Health Service Corps, Community Health Center Fund, and Teaching Health Centers Graduate Medical Education. NIHB was joined by seventeen signatories including but not limited to JDRF, Endocrine Society, National Association of Community Health Centers, American Diabetes Association, Families USA, and the American College of Obstetricians and Gynecologists. 

SDPI, along with the other health extenders, are currently reauthorized through November 30. NIHB continues to actively work towards securing long-term renewal of SDPI, increased funding for program operations matched to medical inflation, and structural changes to permit Tribes and Tribal organizations to receive awards through self-determination and self-governance contracts and compacts. 

To access a copy of the letter, click here.

For any questions about NIHB's legislative advocacy, contact Shervin Aazami at saazami@nihb.org
In This Issue:

TOP STORY
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES 
UPCOMING EVENTS, CALLS, AND WEBINARS
CAPITOL HILL UPDATES
nihbncaincuihNIHB Submits Letter to Congressional Leadership Alongside NCAI and NCUIH Urging Passage of Emergency COVID-19 Funds for the Indian Health System
On Tuesday September 8, NIHB submitted a letter to congressional leadership alongside the National Congress of American Indians (NIHB) and the National Council of Urban Indian Health (NCUIH) urging Congress to pass emergency appropriations for the Indian Health Service (IHS), Tribal health programs, and urban Indian organizations (I/T/U) to address the COVID-19 pandemic.

To access the full letter, click here.

In the letter, NIHB and partners stressed the significant increases in the number of COVID-19 case infections, hospitalizations, and deaths among American Indians and Alaska Natives over the past two months. Congress has not sent a COVID-19 stimulus package to the President's desk since mid-April. In the interim, Tribal communities continue to be disproportionately impacted by the pandemic without the availability of additional federal relief dollars and resources. 

In addition, Congress is poised to pass a continuing resolution (CR) funding the entire federal government, including IHS, at Fiscal Year (FY) 2020 levels for at least a portion of FY 2021. While an expiration date for the FY 2021 CR is still being negotiated, it will more than likely extend past the November 3 presidential election until sometime in December or early in the following calendar year, after a new Congress is sworn in. 

Earlier this week, Senate Republicans scheduled a floor vote on a "skinny" COVID-19 relief package equaling roughly $500 billion overall - nearly $3 trillion under the House-passed HEROES Act from May. The slimmed version did not include any emergency funds for IHS, and very few Tribal set-asides for public health services such as testing, PPE, and other needs. The truncated bill did not meet the 60-vote threshold to pass the Senate, as all Democrats stood unified in opposition. Speaker Pelosi and Leader Schumer have called for significantly more stimulus funding, including for the Indian health system, that is more aligned with the gravity of the pandemic and the nationwide need for federal relief.

Given the failed Senate vote,  it is unlikely that Congress will successfully broker a stimulus deal before the November election.
sdpiTANIHB Submits Letter to Indian Health Service Urging the Agency to Retract its Technical Assistance to Congress on SDPI, and Issue new Guidance that Aligns with Tribal Leader Recommendations
On Wednesday September 9, NIHB submitted a letter to IHS Director Rear Admiral (RADM) Michael D. Weahkee, urging the agency to immediately rescind its technical assistance (TA) to Congress on the Special Diabetes Program for Indians (SDPI) Reauthorization Act of 2020, and re-issue TA that aligns with Tribal guidance, positions, and recommendations on the future of SDPI.

To access a copy of that letter, click here.

In July, IHS submitted TA in response to a request from Congress on SDPI legislation that included a provision that would authorize Tribes and Tribal organizations to receive SDPI awards through "638" contracting and compacting agreements - a long sought goal of Tribal Nations. Instead of aligning their TA with the Tribal position in support of such a structural change to SDPI, the TA from IHS undercut this top Tribal priority, and potentially dissuade Congress from moving forward on a 638 change to SDPI. NIHB immediately engaged with Congress upon learning of this disturbing TA that ran afoul of Tribal support for self-determination and self-governance. With the assistance of NIHB's member organizations, NIHB submitted a letter to RADM Weahkee detailing the Tribes' strong concerns with the accuracy and appropriateness of the claims made by IHS in their TA to Congress against the proposed change to SDPI's structure. 

Unfortunately, the timing and content of the agency's TA has greatly hampered the prospect of securing a 638 change to SDPI during this congressional term. It remains unclear if IHS will indeed follow Tribal requests to re-engage and correct its TA to match the Tribal position.
tribalhealthdataBipartisan Senate Coalition Releases Tribal Health Data Improvement Act as House Energy and Commerce Committee Clears the Bill 
On Thursday September 10, U.S. Senators Tina Smith (D-MN) and Lisa Murkowski (R-AK) released companion legislation to the Tribal Health Data Improvement Act, originally introduced by U.S. Representatives Greg Gianforte (R-MT) and Ben Ray Lujan (D-NM). The Senators were joined by Sens. Steve Daines (R-MT), Elizabeth Warren (D-MA), Kevin Cramer (R-ND), and Jon Tester (D-MT). The House legislation is supported by Representatives Markwayne Mullin (R-OK), Cathy McMorris Rodgers (R-WA), Raul Ruiz (D-CA), Tom O'Halleran (D-AZ), and Kelly Armstrong (R-ND).

NIHB helped craft both the House and Senate legislation, and strongly supports its passage. Similar to the House bill, the Senate version would 

  • Require the Department of Health and Human Services to give direct access to public health data to Tribes, the Indian Health Service, and Tribal Epidemiology Centers;
  • Require the Centers for Disease Control and Prevention (CDC) to develop guidance for States and local health agencies to improve the quality and accuracy of birth and death record data for American Indians/Alaska Natives;
  • Require the CDC to enter into cooperative agreements with Tribes, Tribal organizations, urban Indian organizations, and Tribal Epidemiology Centers to address misclassification and undersampling of American Indians/Alaska Natives on birth/death records and in health care/public health surveillance systems; and,
  • Encourage states to enter into data sharing agreements with Tribes and Tribal Epidemiology Centers to improve access to public health data
One day prior to introducing of the Senate bill, the House Energy and Commerce Committee held a markup of pending legislation, including H.R. 7948 - the Tribal Health Data Improvement Act. After accepting an amendment from Congressman Mullin to align the language in the House bill with the Senate version, the Energy and Commerce Committee successfully passed the bill and referred it to the full House for consideration. NIHB continues to advocate for swift passage of this critical legislation, and will provide updates as they become available. 

To watch the Energy and Commerce Committee markup, click here.
To access a press release on the Senate bill, click here.
To access the Senate bill, click here.
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES
finalruleFinal Rule from CMS on the Medicare Program, Correction of Amendments
On August 31, CMS published a final rule correcting an amendment titled "FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (HQRP)." The corrections include errors in the preamble including revisions to the finalized proposal for the HQRP, errors in the regulations text including adding exemption requirements for the HQRP, and errors in the agenda on the CMS website. These corrections are effective August 31, 2020. 
NominateHRSANominate a Tribal Official to New HRSA Tribal Advisory Council - Deadline is Sept. 30
The Health Resources and Services Administration (HRSA) has extended the nomination deadline for a seat on the newly established Tribal Advisory Council. Tribes and Tribal organizations now have until September 30, 2020 to nominate qualified tribal officials, particularly from the areas of Alaska, Albuquerque, Billings, Navajo, Phoenix, and Tucson. 
For questions, please contact Dr. Elijah K. Martin, Jr., Tribal Health Affairs, HRSA Office of Health Equity at Emartin@hrsa.gov.
ASPRwebinarASPR Webinar on COVID-19: Optimizing Healthcare Personal Protective Equipment and Supplies
There has been a large increase in the need for healthcare personal protective equipment (PPE) and specialty supplies due to the COVID-19 pandemic. This increase in demand has led to shortages in PPE and changes in how PPE is used and optimized. ASPR TRACIE, in collaboration with the COVID-19 Healthcare Resilience Working Group, is hosting this webinar to highlight PPE preservation strategies, trends, challenges, and lessons learned/promising practices.

Presenters from the public and private sectors will discuss strategies to optimize the healthcare supply of respirators and PPE, such as implementing crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. The webinar will take place from 2:30-4:00 PM (ET) on Thursday, September 24, 2020. 

medicareRuleMedicare Program Proposed Rule on the Medicare Coverage of Innovative Technology with the Definition of "Reasonable and Necessary"
On September 1, CMS released a proposed rule on the Medicare coverage pathway designed to establish a faster and more efficient way for beneficiaries to obtain innovative medical devices designated as breakthrough by the FDA. This rule will ultimately allow for the Medicare Coverage of Innovative Technology pathway to begin national coverage of Medicare after the authorizing date of FDA marketing. This rule also proposes standards to for decisions related to services furnished under Part A and Part B. Comments are due November 2, 2020. 
hrsaaaaHRSA Collection Request for an Extension of the Coronavirus 2019 Data Report
On September 1, HRSA released an information collection request on the "Coronavirus 2019 Data Report." HRSA requests that service providers who used CARES Act funding report information on the number of patients and household members tested for COVID-19 and others effected by COVID-19 in specific ways, such as the number of patients newly diagnosed or the types of services provided using telehealth technology in the COVID-19 Data Report. Comments are due November 2, 2020. 
cmsClinicCMS Clinical Laboratory Improvement Amendments and Patient Protection with Additional Policies to the Affordable Care ActCommissionMeeting
On September 2, 2020 CMS released an interim final rule with comment period. This rule details and enforces Medicare and Medicaid long term care facility requirements for information related to COVID-19. This rule also covers new updates to the "Conditions of Participation" for hospitals and critical access hospitals which also establishes requirements for all Clinical Laboratory Improvement Amendment (CLIA) laboratories to report COVID-19 testing results to the secretary of HHS. This interim final rule is effective on September 2, 2020 and comments are due November 2, 2020.  
HHSchangeHHS change to Statement of Organization, Functions and Delegations of Authority
On September 2, 2020 HHS released a revision to the statement of organization, functions and delegations of authority for HHS' General Counsel, originally written August 4, 2020. This document is intended to replace the previous one. This version includes changes to formatting, changes in law, and incorporates all amendments from the last issuance of the statement of organization.
NoticeHHSA Notice from HHS on the Improved Agency Guidance Documents
On September 4, 2020 HHS released a notice on a supporting document to a previously published executive order that required all federal agencies to create an on-line guidance portal and to revoke guidance documents that are no longer relevant. Specifically, HHS is allowing CMS to fully populate all their guidance documents by July 31, 2020 as their document size is much more substantial than the other federal agencies inventory.
BroadbandNoticeA Notice and Request for Comment on Broadband Services Testing and Measurement from the FCC
On September 4, 2020 CMS released guidance to states on improving care for infants with NAS and their families. This specific guidance details best practices for evidence based payment models for prevention, screening and treatment for discharge services. Other details include technical assistant guidance, financing opportunities through Medicaid and CHIP.  
Millionssss$79 Million from HHS to Support Health Center Response to Emergencies
On September 8, HHS released an announcement on the release of 79 million in funding through HRSA for construction and other means to 165 HRSA funded health centers impacted by Hurricanes and other natural disasters extending from 2018-2019. For a list of award recipients click here
UPCOMING EVENTS, CALLS, AND WEBINARS
NTHCRegister Now for NIHB's National Tribal Health Conference
In response to COVID-19, and in respect to the health of our communities, the National Indian Health Board (NIHB) decided to host its annual National Tribal Health Conference on a virtual platform.
NIHB is committed to providing the same world-class information to support Tribal health systems and opportunities for attendees to network with colleagues from across Indian Country. Tribal consultation and listening consultation sessions with our government partners, hosted by NIHB, will remain free and open to the public during specific, designated times.
NIHB believes this year's virtual conference brings a real opportunity to add new stakeholders to the conversation, especially those who may not have been able to join us in previous years due to travel costs or scheduling conflicts. NIHB is excited to have you join this year's virtual National Tribal Health Conference!

Call for Abstracts - Due TODAY September 11! Learn more.
Register for the Conference! Early Bird Rate through September 18!
hrsaconsultHRSA Tribal Consultation Scheduled During NIHB Virtual Conference: October 13, 2020
The National Indian Health Board is offering a platform during its upcoming virtual conference for the Health Resources and Services Administration (HRSA) to host its annual Tribal Consultation. The HRSA consultation, which is in support of the agency's ongoing commitment to partner with Tribes, is free and open to the public and will take place on Tuesday, October 13, 2020 from 1:00 PM to 3:00 PM (EDT). Tribals official may submit written comments to aianhealth@hrsa.gov by September 28, 2020. 
 
 
To participate in this HRSA Tribal Consultation, please dial in at least 10 minutes before the appointed time to:
Conference number: 800-779-7169; Participant passcode: 6122629
ServiceAwards2020 National Indian Health Board Outstanding Service Awards
Nominations for the National Indian Health Board 2020 Outstanding Service Awards: Recognizing Resiliency in Indian Country are now open! 

Nominate a hero in Indian Health between now and September 8, 2020 to recognize their work at the Local, Regional, and National Levels!

EldercareWebinarNIHB Webinar: Eldercare in the Time of COVID-19, Wednesday, September 9
The National Indian Health Board (NIHB) is hosting a webinar on eldercare during the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC) the risk for severe illness from coronavirus infection increase with age. For example, people in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, at higher risk for severe illness than people in their 50s. The greatest risk for severe illness from COVID-19 is among those aged 85 or older. This webinar will present ways we can help to prevent illness, and care for our elders during these unprecedented times. 

Join us to hear presenters will discuss topics ranging from caring for elders during the pandemic, preventing infection among this vulnerable population and tips for caregivers. Learn more about helping and protecting elders in your community.
**Submit questions in advance to Courtney Wheeler at

Wednesday, September 9, 2020
3:00 PM - 4:00 PM Eastern Time
Register for the Webinar
TelehealthWebiarTelehealth - Understanding our use of Telehealth in the IHS Electronic Health Record, Friday, September 11
In this webinar, the Indian Health Service (IHS) will discuss the need to capture information on the amount and type of telehealth services being provided across the system. It will discuss the importance of this data and provide recommendations for documenting telehealth visits. This will ensure that critical information is available for planning and improvement across the system. Time will be allotted for questions and answers. The webinar is intended for Leaders, directors, healthcare providers, billers, Informaticists, Health Information Management Consultant and Health Information Technology staff in IHS facilities. No credit offered for this webinar.

For questions & technical assistance, contact IHSTele-Education@ihs.gov.

Friday, September 11, 2020
12:00 pm Eastern Time
GRANTS & RESOURCES
HRSATACSolicitation of Nominations for Membership To Serve on Tribal Advisory Council
The Health Resources and Services Administration (HRSA) is seeking additional nominations of qualified Tribal officials as candidates for consideration for appointment as voluntary delegate members of the HRSA Tribal Advisory Council (TAC), which is being established. Specifically, HRSA requests submissions of nominations of qualified Tribal officials from the Indian Health Service (IHS) geographic areas of: Alaska; Albuquerque; Billings; Navajo; Phoenix; and Tucson. 

Nominations for membership must be received on or before September 30, 2020. Read more here.
OpioidMisuseFunding Opportunity: Building Tribal Provider and Patient Capacity for Addressing Opioid Misuse Prevention and Treatment
The National Indian Health Board (NIHB) is pleased to announce Building Tribal Provider and Patient Capacity for Addressing Opioid Misuse Prevention and Treatment made possible through the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control. The funding will provide an opportunity to increase the level of programming, research, policy development, coordination, and/or communication between Tribal programs, leadership, community, and key partners involved in addressing the health consequences of the opioid epidemic. 

Deadline: Applications accepted on a rolling basis until filled. Opportunity closes September 14, 2020.
Read more. 
COVIDResourcesCall for Tribal COVID-19 Resources
The National Indian Health Board (NIHB) is seeking to create a pool of resources which Tribes can access when planning or implementing their own COVID-19 response. To this end, NIHB is asking Tribes to share with us any tools, operational plans, guides, policies, communication products, etc. that has helped your Tribe combat this pandemic. The materials can be de-identified, if needed. These resources will be placed online within NIHB's COVID-19 Tribal Response Center alongside other community health materials. We hope this aids Tribes to build on successes and support each other in the collective effort to mitigate the impact of the pandemic on Indian Country.

To submit any materials or resources, please email Courtney Wheeler (cwheeler@nihb.org). If you have any questions, please contact Courtney Wheeler.

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