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TestimonyNIHB Testifies Before House Interior Appropriations Subcommittee Providing an Update on COVID-19 in Indian Country
On Wednesday September 30, Carolyn Angus-Hornbuckle, Chief Operating Officer and Policy Center Director of the National Indian Health Board (NIHB), testified before the House Appropriations Subcommittee on the Interior, Environment, and Related Agencies. Testifying along with NIHB was Kevin J. Allis, CEO of the National Congress of American Indians (NCAI) and Francys Crevier, CEO of the National Council of Urban Indian Health (NCUIH)Committee Chair Rep. Betty McCollum (D-MN) and Ranking Member David Joyce (R-OH) emphasized the bipartisan commitment of the subcommittee to uphold Trust and Treaty Responsibilities to Indian Country.

In her opening remarks, Chairwoman McCollum said, "The need to examine and address the ongoing situation in Indian Country is apparent. Congress needs to understand the full impact of the pandemic on Native Americans, and how to better meet the needs of your communities in future relief packages. Since the beginning of the pandemic, I've advocated for personal protective equipment, or PPE, complete test kits, and other supplies to be made available to Indian health facilities and Tribal governments. Without these items, Native Americans are unable to ensure their safety while receiving essential government services, such as health care, welfare checks, law enforcement services, and domestic violence assistance."

Ms. Hornbuckle provided testimony updating the subcommittee effect of the COVID-19 pandemic on Indian, while urging Tribal COVID-19 priorities: 
  • Minimum $2 billion in emergency funds to IHS for immediate distribution to I/T/U system
  • $1.7 billion to replenish lost 3rd party reimbursements across the I/T/U system
  • Prioritize equitable distribution of a safe and effective COVID-19 vaccine across Indian Country,
  • including a minimum 5% set-aside in vaccine funds for the I/T/U system
  • Minimum $1 billion for water and sanitation systems across IHS and Tribal communities
  • Long-term reauthorization (5 years), higher funding, and expansion of self-determination and self-governance for the Special Diabetes Program for Indians
NIHB reminded the subcommittee that federal Treaty obligations for healthcare to Tribal Nations and AI/AN Peoples exist in perpetuity and must be fully honored, especially in light of the current pandemic. 

To read NIHB's written testimony, click here
To view a recording of the hearing, click here

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

ShortTermCRCongress Sends Short-Term FY 2021 Continuing Resolution to President's Desk
On Wednesday, September 30, 2020, the U.S. Senate passed the short-term continuing resolution (CR) that cleared the U.S. House of Representatives last week. The final vote was 84-10.

As NIHB reported, this CR, filed under H.R. 8319, would flat fund the federal government at FY 2020 enacted levels through December 11, 2020. It would also extend the Special Diabetes Program for Indians (SDPI) through December 11 - equaling the fifth short-term extension of the program in just the past year. The President is set to sign the CR before midnight, when the next fiscal year officially begins.

It remains unclear if Congress will successfully clear a full-year appropriations bill in December, especially given the uncertainty surrounding the presidential election. While leaders from both the House and Senate appropriations committees have publicly voiced a desire to pass a final FY 2021 spending bill in the lame-duck, there remain significant hurdles towards achieving this goal. For one, the Senate has yet to even release any of its twelve appropriations bills, while the House has cleared all of them. Depending on the outcome of the election, there may be little bipartisan good will to work on a full appropriations package in December.
BackgroundChecksIHS Preliminary Findings - Audit on Background Checks
On August 28, 2020, IHS published a Dear Tribal Leader Letter (DTLL) announcing preliminary findings of an Office of Inspector General (OIG) audit. OIG found that two programs in New England conducted state background checks, but did not require employees to complete a federal background check as a condition of employment. Without a federal background check, one program was unaware that it hired an employee who was convicted of a felony in another state. This employee's job involved working with Indian children, and given this information about past criminal history, placed the children in a higher risk of abuse. The audit also revealed that two other Tribal health programs in the New England area did not include FBI federal background checks for employees whose jobs interact with children.
IHS requested a written response from the Tribal health programs who it found in violation of this requirement within 30 days of its notice. The programs are expected to respond with their plans to correct this action. The DTLL notes that OIG's audit is ongoing, and that a final report will be forthcoming. 

To read the DTLL, click here
To read its enclosure, click here
ProviderReliefHHS Opens Additional Tranche of Provider Relief Funding
On Thursday, the US Department of Health and Human Services (HHS) announced their decision to allocate an additional $20 billion dollars in funding from the Provider Relief Fund. This new Phase 3 General Distribution will be open to providers who have already received general distribution funding, including those who have already received 2% of annual revenue that they get from patient care. Providers who have already received 2% of annual revenue are invited to submit additional information to become eligible for an additional payment. HHS will begin accepting applications on Monday, October 5th and the due date for submission is November 6, 2020. For more information, please visit this link.
CommentRequestA comment request from HRSA on a Revision of their Geographic Eligibility for Federal Office of Rural Health Policy Grants
On September 23, HRSA released a request for public comment on the revised geographic eligibility for the Federal Office of Rural Health Policy grants. The Federal Office of Rural Health Policy is requesting changes to the current way of determining eligibility of rural counties based on whether or not they are classified as a Metropolitan Statistical Area (MSA). Specifically, this change will allow for community organizations serving rural populations inside of MSAs to obtain services using grant funding. Comments on this change in methodology are due October 23, 2020. 
FQHCSHHS Delegation of Authority to Pay Federally Qualified Health Centers and Rural Health Clinics
On September 24, HHS released a delegation of authority for the HRSA administrator to pay Federally Qualified Health Center and Rural Health Clinics for the training costs of eligible physicians and practitioners involved with Drug Addiction Treatment Act waivers for opioid use disorder treatment services.
InfoRequestsFive Information Collection Requests from CMS
On September 24, CMS released five separate information collection requests
The first detailed a reinstatement of their 1915(c) Home and Community Based Services Waiver Application. This application is designed to review individual waivers and can be used by states to submit or revise waiver requests. 
The second notice details the Qualified Independent Contractor Demonstration Evaluation Contractor: Analyze Medicare Appeals to conduct formal discussions and reopening's with durable medical equipment suppliers and Part A providers. Specifically, this notice asks for comments on the primary and secondary data needed to understand the claims denial during Level 2 of the appeals process for more accurate claim submissions overtime. 
The third notice details the Medicare program; conditions for payment of power mobility devices. This includes the continuation of the face-to-face examination of the beneficiary by the physician for the durable medical equipment suppliers to keep in their records. 
The fourth information collection request details the state Medicaid eligibility quality control sample selection lists, to provide states with opportunities to improve the accuracy of their CHIP eligibility decisions. 
The final request details the quality improvement strategy implementation plan, progress report form and modification summary supplement, necessary for the required periodic reporting of a qualified health plan and their incentive for improving health outcomes of plan enrollees.  
Comments on these notices are due October 26, 2020. 
MedicaidReviewA CMS Information Collection Request the Medicaid Drug Use Review Program
On September 25, CMS released an information collection request for the Medicaid Drug Use Review (DUR) Program for states to provide a review of their drug therapy before all prescriptions are filled or delivered to a Medicaid patient. This request also details the need for pharmacists to keep records of Medicaid patient profiles, as well as require states to conduct RetroDUR which will keep examinations of claims data ongoing to identify patterns of fraud, or inappropriate care. Comments on this request are due October 26, 2020.
TrumpPlanHHS' Announcement on President Trump's Healthcare Plan
On September 24, HHS announced its role in the president's proposed Healthcare Plan. On September 22, President Trump signed an executive order for better care, lower costs and more choices for patients. This healthcare plan is titled the "America First Healthcare Plan" and is designed to give Americans "lower drug costs, lower insurance premiums, real access to prices of healthcare services and to their medical records." HHS' final rule can be found hereas well as specific guidance from the Food and Drug Administration.
TelehealthNominations for a Rural Telehealth and Healthcare System Readiness Committee
On September 25, 2020, the National Quality Forum announced the need for nominations of members of the new Rural Telehealth and Healthcare System Readiness Committee. This committee is designed to create methodologies for linking quality of care delivered by telehealth, healthcare system readiness and health outcomes in a disaster. Nominations for this committee are due October 26, 2020.
MATMedicaid Programs Now Required to Provide Coverage of Medication Assisted Treatment (MAT) services and drugs
On October 1, 2020 CMS announced that state Medicaid programs are now required to provide coverage of MAT services and drugs under a new mandatory benefit. Specifically this benefit is designed to increase treatment of opioid use disorder for Medicaid beneficiaries. To do this states must include all forms of drugs and biologicals that the Food and Drug administration has approved or licensed MAT to treat opioid use disorder. Through this, states will now be able to apply drug manufacture rebates, drug utilization management mechanisms and drug price reporting and payment of rebates. For more information on Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) please click here. 
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 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
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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