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FY2021Senate Releases All Twelve Appropriations Bills for Fiscal Year 2021
On Tuesday, November 10, 2020, the Senate Appropriations Committee released all twelve appropriations bills for Fiscal Year (FY) 2021. Release of the spending bills follows months of gridlock on FY 2021 appropriations, forcing Congress to pass a
continuing resoution (CR) keeping the federal government open through December 11, 2020.

Senate-Interior-Environment Appropriations Bill
Given the extremely tight timeline for action on appropriations, the Senate is unlikely to hold any committee markups of the spending bills. Instead, Senate and House appropriators are likely to immediately kick off negotiations to resolve differences between the two chambers' respective spending bills for FY 2021. Both House and Senate leadership - including Speaker Nancy Pelosi (D-CA) and Senator Majority Leader Mitch McConnell (R-KY) - have signaled that they are aiming for an omnibus appropriations package to avert both a government shutdown and the need for another CR. If passed, the omnibus package would fund the entire federal government through September 30, 2021.

The Interior, Environment, and Related Agencies Appropriations bill has jurisdiction over funding for the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA). The Senate package proposes roughly $6.21 billion for IHS for FY 2021, an increase of roughly $163 million overall above FY 2020 enacted levels.

The Senate mark for IHS falls roughly $281 million below the House-passed Interior Appropriations bill - a significant gap that will have to be reconciled as appropriators begin conference negotiations. As NIHB previously reported, the House package proposed funding IHS at $6.49 billion overall for FY 2021. The House package also included a separate and additional $1.5 billion in emergency appropriations to construct and renovate IHS and Tribal health facilities. However, the Senate Interior appropriations package does not include the emergency infrastructure appropriations outlined for IHS in the House bill. The Senate package also outlines an indefinite appropriation for 105(l) lease contact agreements, which would treat 105(l) leases similar to Contract Support Costs (CSCs). While the Senate package would increase funding for IHS overall by roughly $163 million, just under 62% of that increase is for the indefinite appropriation for 105(l) leases alone. In addition, the overall spending cap for the entire Interior Appropriations package is at $35.805 billion - only slightly higher than the Interior spending cap from FY 2020. 

The Hospitals & Health Clinics line item is the only one slated for a reduction in the Senate mark for IHS. However, NIHB is extremely concerned about this reduction and is working with appropriations staff to try and reinstate that crucial funding. Within the Hospitals & Health Clinics line item, the Senate package earmarks $2 million for dental health therapy education programs, and $5 million for a new maternal health initiative - equal to the request in the President's budget. The Senate Interior package proposes increasing the Mental Health line item and the Alcohol & Substance Abuse line item is by roughly $2.8 million and $3.42 million, respectively, above their FY 2020 enacted levels.

The Senate mark also maintains $5 million for nationalization of the Community Health Aide Program (CHAP), which is equal to the FY 2020 enacted level. Relatedly, the Senate mark rejects the proposal from the President's Budget to consolidate funding for CHAP, Health Education, and Community Health Representatives (CHRs), instead opting to keep these funding line items separate, as the Tribes prefer.

To read the full text of the Senate Interior bill, click here. 
To read the explanatory statement for the Senate bill, click here.
 
Funding for Important Tribal Programs Outside IHS
NIHB continues to strongly advocate for important Indian health programs funded under the Labor-HHS budget by agencies such as the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Generally the majority of Tribally-specific programs remain level funded at their FY 2020 enacted levels. These include the $15 million set-aside in National Health Service Corps placements within IHS, Tribal and urban Indian facilities.

Centers for Disease Control and Prevention
Under CDC, the Senate mark maintains funding for the Good Health and Wellness in Indian Country program at $21 million for FY 2021. However, unlike the House bill, the Senate LHHS mark for CDC does not include a separate $150 million in Tribal funds for public health infrastructure and program development. Given the significant challenges and gaps in Tribal public health infrastructure nationwide, NIHB is very disappointed that the Senate bill omits this crucial Tribal set-aside and is working to ensure these funds are included in the final negotiated package.

Substance Abuse and Mental Health Services Administration
The Senate mark for SAMHSA largely maintains Tribal funds at FY 2020 enacted levels. For instance, the Tribal Behavioral Health Grants are maintained at $40 million overall ($20 million for mental health and $20 million for substance abuse). Similarly, Congress retains the $50 million Tribal set-aside in opioid response grants, and the $10 million Tribal set-aside for medication-assisted treatment (MAT). 

Similarly, the American Indian/Alaska Native (AI/AN) set-aside in Zero Suicide grants are maintained at $2.2 million, and the AI/AN Suicide Prevention Initiative is retained at $2.9 million.
 
Office of the Secretary
While no Tribally-specific funds are outlined in the total amount for the Office of the Secretary - which administers the Minority AIDS Initiative - report language accompanying the bill states that "The Committee recommends that the Secretary examine current public health initiatives within the Department that address public health crises such as viral hepatitis, HIV/AIDS, and opioids that impact Indian Country."

Administration for Children and Families
Within the Administration for Children and Families (ACF), the Senate mark proposes funding the Native American Caregiver Support Program at $10.3 million, and the Aging Grants to Indian Tribes and Native Hawaiian Organizations at $34.7 million.

For copy of bill text, click here
For copy of the Committee Report, click here


For any questions regarding FY 2021 appropriations, contact NIHB Director of Congressional Relations, Shervin Aazami, at saazami@nihb.org
CAPITOL HILL UPDATES
FY2021Senate Releases All Twelve Appropriations Bills for Fiscal Year 2021
On Tuesday, November 10, 2020, the Senate Appropriations Committee released all twelve appropriations bills for Fiscal Year (FY) 2021. Release of the spending bills follows months of gridlock on FY 2021 appropriations, forcing Congress to pass a
continuing resoution (CR) keeping the federal government open through December 11, 2020.

Senate-Interior-Environment Appropriations Bill
Given the extremely tight timeline for action on appropriations, the Senate is unlikely to hold any committee markups of the spending bills. Instead, Senate and House appropriators are likely to immediately kick off negotiations to resolve differences between the two chambers' respective spending bills for FY 2021. Both House and Senate leadership - including Speaker Nancy Pelosi (D-CA) and Senator Majority Leader Mitch McConnell (R-KY) - have signaled that they are aiming for an omnibus appropriations package to avert both a government shutdown and the need for another CR. If passed, the omnibus package would fund the entire federal government through September 30, 2021.

The Interior, Environment, and Related Agencies Appropriations bill has jurisdiction over funding for the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA). The Senate package proposes roughly $6.21 billion for IHS for FY 2021, an increase of roughly $163 million overall above FY 2020 enacted levels.

The Senate mark for IHS falls roughly $281 million below the House-passed Interior Appropriations bill - a significant gap that will have to be reconciled as appropriators begin conference negotiations. As NIHB previously reported, the House package proposed funding IHS at $6.49 billion overall for FY 2021. The House package also included a separate and additional $1.5 billion in emergency appropriations to construct and renovate IHS and Tribal health facilities. However, the Senate Interior appropriations package does not include the emergency infrastructure appropriations outlined for IHS in the House bill. The Senate package also outlines an indefinite appropriation for 105(l) lease contact agreements, which would treat 105(l) leases similar to Contract Support Costs (CSCs). While the Senate package would increase funding for IHS overall by roughly $163 million, just under 62% of that increase is for the indefinite appropriation for 105(l) leases alone. In addition, the overall spending cap for the entire Interior Appropriations package is at $35.805 billion - only slightly higher than the Interior spending cap from FY 2020. 

The Hospitals & Health Clinics line item is the only one slated for a reduction in the Senate mark for IHS. However, NIHB is extremely concerned about this reduction and is working with appropriations staff to try and reinstate that crucial funding. Within the Hospitals & Health Clinics line item, the Senate package earmarks $2 million for dental health therapy education programs, and $5 million for a new maternal health initiative - equal to the request in the President's budget. The Senate Interior package proposes increasing the Mental Health line item and the Alcohol & Substance Abuse line item is by roughly $2.8 million and $3.42 million, respectively, above their FY 2020 enacted levels.

The Senate mark also maintains $5 million for nationalization of the Community Health Aide Program (CHAP), which is equal to the FY 2020 enacted level. Relatedly, the Senate mark rejects the proposal from the President's Budget to consolidate funding for CHAP, Health Education, and Community Health Representatives (CHRs), instead opting to keep these funding line items separate, as the Tribes prefer.

To read the full text of the Senate Interior bill, click here. 
To read the explanatory statement for the Senate bill, click here.
 
Funding for Important Tribal Programs Outside IHS
NIHB continues to strongly advocate for important Indian health programs funded under the Labor-HHS budget by agencies such as the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Generally the majority of Tribally-specific programs remain level funded at their FY 2020 enacted levels. These include the $15 million set-aside in National Health Service Corps placements within IHS, Tribal and urban Indian facilities.

Centers for Disease Control and Prevention
Under CDC, the Senate mark maintains funding for the Good Health and Wellness in Indian Country program at $21 million for FY 2021. However, unlike the House bill, the Senate LHHS mark for CDC does not include a separate $150 million in Tribal funds for public health infrastructure and program development. Given the significant challenges and gaps in Tribal public health infrastructure nationwide, NIHB is very disappointed that the Senate bill omits this crucial Tribal set-aside and is working to ensure these funds are included in the final negotiated package.

Substance Abuse and Mental Health Services Administration
The Senate mark for SAMHSA largely maintains Tribal funds at FY 2020 enacted levels. For instance, the Tribal Behavioral Health Grants are maintained at $40 million overall ($20 million for mental health and $20 million for substance abuse). Similarly, Congress retains the $50 million Tribal set-aside in opioid response grants, and the $10 million Tribal set-aside for medication-assisted treatment (MAT). 

Similarly, the American Indian/Alaska Native (AI/AN) set-aside in Zero Suicide grants are maintained at $2.2 million, and the AI/AN Suicide Prevention Initiative is retained at $2.9 million.
 
Office of the Secretary
While no Tribally-specific funds are outlined in the total amount for the Office of the Secretary - which administers the Minority AIDS Initiative - report language accompanying the bill states that "The Committee recommends that the Secretary examine current public health initiatives within the Department that address public health crises such as viral hepatitis, HIV/AIDS, and opioids that impact Indian Country."

Administration for Children and Families
Within the Administration for Children and Families (ACF), the Senate mark proposes funding the Native American Caregiver Support Program at $10.3 million, and the Aging Grants to Indian Tribes and Native Hawaiian Organizations at $34.7 million.

For copy of bill text, click here
For copy of the Committee Report, click here


For any questions regarding FY 2021 appropriations, contact NIHB Director of Congressional Relations, Shervin Aazami, at saazami@nihb.org
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES
AmbulatoryA Final Notice on the Ambulatory Surgical Center Accreditation Program from CMS
On October 21, CMS published a final notice on the approval of the Joint Commission for continued recognition as a National Accrediting Organization for Ambulatory Surgical Centers (ASC). An Ambulatory Surgical Center is designed to operate for the purpose of furnishing outpatient surgical services to patients. In order to enter into an agreement, an ASC must first be certified and comply with the conditions set forth in the Medicare regulations. The ASC is then surveyed regularly by the State survey agency to confirm that they continue to meet the requirements. This approval is effective December 20, 2020 until December 20, 2024.
Comment Request from CMS on the Limitations on Provider Related Donations and Health Care Related TaxesComment
On October 23, CMS released a notice of a request for comment on the "Limitations on Provider Related Donations and Health Care Related Taxes, Medicaid and Supporting Regulations." Through this notice, States may use a waiver, submitted to CMS, for broad based and uniformity requirements for health care tax programs which do not already conform to the broad based and uniformity requirements. The State must submit this waiver to demonstrate that their tax programs do not violate the hold harmless provision needed to correctly determine if the Federal financial participation is payable to a State. 

Comments are due December 22, 2020.
InfoRequestsFour Information Collection Requests from CMS
On October 21, CMS released an information collection requests for the "Submissions of 1135 Waiver Request Automated Process," which allows CMS to automate States submissions of their 1135 waiver to relax certain requirements for CHIP, Medicare and Medicaid in order to provide sufficient health care services to individuals enrolled in Social Security Act programs in emergency areas and time periods. The other collection request is the "Solicitation for Applications for Medicare Prescription Drug Plan 2022 Contracts". This request is a revision to a currently approved collection that details the application organizations wishing to provide services under the prescription drug benefit program must complete. The third collection is for the "CMS Plan Benefit Package and Formulary CY 2022", which details the plan benefit package for all Medicare beneficiaries residing in their service area. Medicare Advantage and Prescription Drug Plan organizations are required to submit this package. The final information collection request is titled, "The Generic Clearance: Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey," which determines data collection protocols and a mechanism for conducting methodological experiments. This request asks for input on the revision of the current clearance for this survey to expand the methods and allow specific field tests. 

Comments on these requests are due December 21, 2020.
VaxAccessThe Trump Administration's Announcement on Expanding Access to Vaccines and COVID-19 Tests and an Interim Final Rule from CMS
On October 21, HHS released an announcement of the current administration's act to further expand access to vaccines and COVID-19 tests. On October 28, CMS then released a detailed plan to remove regulatory barriers and ensure consistent coverage for the potential release of a vaccine. Along with this plan, CMS also released a set of toolkits intended to aid the dissemination of a vaccine once it is available. Specifically, this set of guidance documents and toolkits are intended to increase the number of providers eligible to administer a vaccine as well as aid in the reimbursement clarifications in Medicare that the vaccine will come at no charge to the beneficiary. The plan also outlines increased reimbursement for COVID-19 treatments. In addition to this plan, CMS also published a draft of an interim final rule with a comment period of 30 days after its publication to the Federal Register. This rule specifies that any vaccine cleared the FDA will be covered under Medicare as a preventative vaccine at no cost to beneficiaries. The rule will also allow coverage, through the CARES Act, of COVID-19 vaccines by most private health insurances without cost sharing during the course of the public health emergency.
UPCOMING EVENTS, CALLS, AND WEBINARS
Health101Indian Health 101 Webinar

DATE: Tuesday, November 17, 2020
TIME: 3:00 pm ET
JOIN: https://bit.ly/IndianHealth101
Meeting ID: 344 996 1556
Passcode: 2025074070

Join NIHB in celebrating AI/AN Heritage Month with a learning webinar. Indian Health 101 covers the basics of the Indian health system and provides context for understanding the complex legislative and regulatory framework that underpin it. Presenters discuss the federal government's trust and treaty obligations to Tribes and how that is manifested through the Indian health system. Webinar is open to anyone 
who wants to learn.
Election2020 Election Results: What Does It Mean for Tribal Health Policy? Webinar

DATE: Wednesday, November 18, 2020
TIME: 1:45 pm ET
JOIN: https://us02web.zoom.us/webinar/register/WN_w90QGKw6QHSOJbivxZiP6A 
Meeting ID: 852 4172 1783
Passcode: 744132

Join the National Indian Health Board (NIHB) for a discussion reviewing results of the Presidential, House, and Senate elections across the United States. As we look to a new administration in January 2021, this webinar will discuss the potential changes and evolving landscape of Tribal Health Policy and larger public health issues that affect Indian Country.

For any questions regarding the webinar, please contact Congressional Relations Associate Erin Morris at emorris@nihb.org
GRANTS & RESOURCES
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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