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House Passes Short-Term Stopgap to Fund Federal Government through December 11, Funding Indian Health Service and Special Diabetes Program for Indians
On Tuesday, September 22, by a final vote of 359-57, the House of Representatives passed a short-term continuing resolution (CR) for Fiscal Year (FY) 2021 under H.R. 8319, to avoid a government shutdown and fund the federal government at current levels through December 11, 2020. The Senate is set to easily clear the CR early next week, in time for it to reach the President's desk before midnight on Wednesday September 30 when the current fiscal year officially ends. The CR includes an extension of multiple expiring health programs including the Special Diabetes Program for Indians (SDPI) through December 11, the expiration date for the CR itself. This would equal the fifth short-term extension of SDPI in just the past year alone. With SDPI's current reauthorization set to expire on November 30, this extension under H.R. 8319 would last eleven days.

As NIHB reported previously, the House of Representatives passed a full-year appropriations package for Indian Health Service (IHS) and the vast majority of the federal government back in July of this year. The House bill outlined a roughly $445 million increase to the IHS budget above FY 2020 enacted levels to a total of $6.5 billion. The House CR does not include additional relief funds to address the COVID-19 pandemic, keeping funding and policy "anomalies" to a minimum in an effort to achieve swift passage.

On September 8, NIHB was joined by the National Congress of American Indians (NCAI) and the National Council of Urban Indian Health (NCUIH) in a letter to congressional leadership urging emergency appropriations for the Indian health system alongside the CR in furtherance of federal Treaty obligations and to address the devastating impact of COVID-19 in Indian Country. Unlike other federal healthcare entities like the Veterans Health Administration and the Medicaid program, IHS remains subject to the destabilizing impacts of CRs and government shutdowns. 

Tribes and NIHB have repeatedly voiced strong concerns with the impact that a short-term CR without emergency appropriations would have on the Indian health system, which is already chronically underfunded and has lost billions in 3rd party reimbursements due to COVID-19 related shutdowns. It remains unclear if Congress will be able to coalesce behind a full-year appropriations package come December, or if another stopgap measure will be necessary. 

For months, congressional leaders have failed to achieve a bipartisan and bicameral agreement, and the acrimony likely to ensue over the battle to replace Justice Ginsburg only further raises tensions and calls into question whether a stimulus deal can be reached. NIHB's September 8 letter alongside NCAI and NCUIH outlined the top COVID-19 health priorities communicated by Tribes, including:
  • Minimum $2 billion for the Indian health system for services and facilities
  • Minimum $1 billion to replenish lost 3rd party reimbursements
  • Minimum $1 billion for water and sanitation infrastructure
  • Long-term reauthorization for the Special Diabetes Program for Indians
For any questions about NIHB's legislative advocacy, contact Shervin Aazami at
In This Issue:

House Releases Short-Term Stopgap to Fund Federal Government through December 11, Funding Indian Health Service and Special Diabetes Program for Indians

SDPIHearingUnited States Senate Committee on Indian Affairs Holds Legislative Hearing on Several Bills including Special Diabetes Program for Indians
On Wednesday, September 23, the United States Senate Committee on Indian Affairs held a legislative hearing opening discussion on several bills including S. 3937, Special Diabetes Programs for Indians (SDPI) Reauthorization Act of 2020. Members heard testimony from several Tribal leaders including Marcellus Osceola Jr., Chairman of Hopi Nation; and Michael Chavarria, Chairman of the All Pueblo Council of Governors. The Committee also heard testimony from the Director of Indian Health Service (IHS), Rear Admiral (RADM) Michael D. Weahkee about the reauthorization of SDPI and other important legislation. 

Despite significant bipartisan, and bicameral support for SDPI and the other expiring health extenders - which include the National Health Service Corps, funding for community health centers, and the Teaching Health Center Graduate Medical Education program - each are currently slated to only be reauthorized for the extent of the CR, through December 11. This would be the fifth short-term extension of all of these programs since September 2019, and the third during the devastating COVID-19 pandemic.

Earlier this year, NIHB conducted a survey of all SDPI grantees to get a better sense of how the short-term extensions combined with the pandemic have harmed program operations. 1 in 5 SDPI programs reported having to furlough staff, including healthcare providers, due to funding uncertainty, while a quarter of all programs announced delays in purchasing medical equipment to monitor diabetes - all in the backdrop of a pandemic that has severely harmed Indian Country. On September 11, NIHB was joined by 17 organizational signatories in a letter to congressional leadership demanding a long-term 5-year reauthorization of SDPI and other expiring health programs.

Back in the summer, Senator Martha McSally (R-AZ) introduced S. 3937 alongside Senator Murkowski (R-AK) and Senator Sinema (D-AZ), which would have reauthorized SDPI for 5-years at an increase to $200 million annually for the program, and the authority for Tribal governments and Tribal organizations to receive SDPI awards through "638" self-determination and self-governance contracts and compacts. Since then, IHS provided technical assistance (TA) to Congress on the option for Tribes to receive SDPI awards through the 638 process; however, the IHS TA strongly diverged from the recommendations and guidance of Tribal leaders and officials and attempted to deter Congress from moving forward with this change.

The controversial TA added to the procedural delays impacting the timeline for reauthorization of SDPI, further making it vulnerable to another short-term extension. On September 10, NIHB submitted a letter to Rear Admiral (RADM) Weahkee firmly rebuking the IHS TA and demanding that the agency immediately re-engage with Congress to correct and clarify their TA to align with Tribal positions and guidance. Congressional leadership have also outlined support for such a move; however, it remains possible that SDPI and the other health programs will again be used as leverage to build consensus on unrelated proposals, which could again lead to a short-term fix.

NIHB will continue strongly advocating for a long-term reauthorization of SDPI to include an increase to $200 million overall, with the option for Tribes and Tribal organizations to receive awards through 638 contracts and compacts, and will continue to provide updates as they become available.

For any questions on SDPI, COVID-19 stimulus funding, or FY 2021 appropriations, please contact NIHB Director of Congressional Relations, Shervin Aazami, at 
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
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.  
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!

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 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
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.
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 ( If you have any questions, please contact Courtney Wheeler.

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