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Top Story
HousePRCHouse Passes Bill to Improve Health Care Access to Native Veterans
On Monday, November 16, 2020, the U.S. House of Representatives, by voice vote, passed the PRC for Native Veterans Act (H.R. 6237). The bill was originally introduced by Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK). The bill requires the Veterans Health Administration (VHA) to reimburse the Indian Health Serivce (IHS) and Tribally-run health facilities for purchased and referred care (PRC) used for Native veterans. VHA would be responsible for reimbursing specialty and contract care provided by a Tribe or IHS along with direct care. In July, the NIHB testified in favor of the legislation before the Subcommittee for Indigenous Peoples of the United States (SCIP) under the House Committee on Natural Resources. 

From NIHB's testimony in July, it states, "The federal government has a dual responsibility to AI/AN Veterans [...] this legislation that will strengthen the government-government relationship, improves access to care for AI/AN Veterans, and raises health outcomes."

The bill will now go to the Senate Committee on Indian Affairs for consideration. 
In This Issue:

TOP STORY
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES 
GRANTS AND RESOURCES
CAPITOL HILL UPDATES
HousePRCHouse Passes Bill to Improve Health Care Access to Native Veterans
On Monday, November 16, 2020, the U.S. House of Representatives, by voice vote, passed the PRC for Native Veterans Act (H.R. 6237). The bill was originally introduced by Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK). The bill requires the Veterans Health Administration (VHA) to reimburse the Indian Health Serivce (IHS) and Tribally-run health facilities for purchased and referred care (PRC) used for Native veterans. VHA would be responsible for reimbursing specialty and contract care provided by a Tribe or IHS along with direct care. In July, the NIHB testified in favor of the legislation before the Subcommittee for Indigenous Peoples of the United States (SCIP) under the House Committee on Natural Resources. 

From NIHB's testimony in July, it states, "The federal government has a dual responsibility to AI/AN Veterans [...] this legislation that will strengthen the government-government relationship, improves access to care for AI/AN Veterans, and raises health outcomes."

The bill will now go to the Senate Committee on Indian Affairs for consideration. 
Senators Introduce Bipartisan Bill Aimed at Eliminating Copays for Native VeteransBipartisan
On Wednesday, November 18, 2020, Senator Jon Tester (D-MT) and Senator Jerry Moran (R-KS) introduced the Native American Veteran Parity in Access to Care Today (PACT) Act, a bipartisan bill aimed at eliminating copays for Native American veterans accessing health care through the Department of Veterans Affairs (VA). 
While American Indian/Alaska Natives (AI/ANs) are not subject to health care copays through the IHS, Native veterans are currently required to pay copays when using the VA for health care services. This disparity directly conflicts with the dual responsibility the federal government has with Tribes and to veterans that serve our country. NIHB supports this legislation to eliminate this significant barrier to care for our Native veterans. 
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES
Two Comment Requests from CMS on the "Results of Your Drug Coverage Request" and "Medicare Advantage Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey."TwoRequests
On November 9, CMS released a notice on two comment requests titled, "Results of Your Drug Coverage Request" and "Medicare Advantage Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey." The Results of Your Drug Coverage is to provide enrollees with information on the Medicare Advantage Prescription Drug Plan and inform beneficiaries when the plan covers a prescription drug under a different Medicare benefit than was originally requested by the enrollee. This collection also replaces the current forms for communicating coverage provided to Medicare Advantage Prescription Drug enrollees for Part B and Part D drug request. The second collection request concerning the CAHPS survey, details the type of data collected from the survey in order to be used in development of a 5-star rating system for Medicare Advantage plans. The survey is needed to provide information to Medicare beneficiaries on more informed choices on health and prescription drug plans available to them. Individuals are asked to comment on how CMS is collecting this information and ways to enhance collection. Comments are due January 8, 2021.
The Medicare Program and End-Stage Renal Disease Prospective Payment SystemProspectivePayment
On November 9, CMS published a final rule on revisions to the End-Stage Renal Disease Prospective Payment System (PPS) for 2021. This final rule also details new changes to the payment rate for renal dialysis services from an End-Stage Renal Disease facility and changes to the requirements to the Quality Incentive Program for End-Stage Renal Disease. Specific topics covered in this rule include an annual update to the wage index, an update for the PPS base rate for 2021, a two-year transition policy, low volume payment adjustment, expansion of the transitional add-on payment adjustment for new and innovative equipment and supplies (TPNIES), updating the outlier policy and changes to the eligibility criteria for TPNIES. This final rule is effective January 1, 2021.
Proposed Rulemaking from IHS on the Procedures for Contracting in the Buy Indian ActBuyIndianAct
On November 10, IHS released a notice of proposed rulemaking on the regulations associated with the Buy Indian Act, that will allow for the IHS to set aside procurement contracts for AI/AN-owned businesses. These regulations will begin the implementation of the Buy Indian Act. This notice details how the rule fits with the IHS and department acquisition regulations, procedures involved, contract requirements, the representation by an Indian Economic Enterprise Offeror and challenges to representation. Comments on this proposed rulemaking are due January 11, 2020.
An Information Collection Request from CMS on the Hospital and Health Care Complex Cost ReportComplexCost
On November 10, CMS published a notice on a collection request for information on the "Hospital and Health Care Complex Cost Report." This request is needed in order for CMS to determine a hospital's reasonable cost incurred in furnishing medical services to Medicare beneficiaries and to calculate the hospital's reimbursement. The hospitals originally paid under a prospective payment system may receive reimbursement in addition to the prospective payment for Medicare reimbursable bad debts, uncompensated care, organ acquisition costs and so on. This hospital cost report data will be used by the Medicare Payment Advisory Commission to calculate Medicare margins and analyze data to create Medicare Program recommendations to Congress. Comments are due January 11, 2021.
The 2021 Inpatient Hospital Deductible and Extended Care Services Coinsurance Amounts from CMSCoinsurance
On November 12, CMS released a notice on 2021 inpatient hospital deductible and the hospital and extended care services coinsurance amounts. These amounts are in relation to the Medicare Hospital Insurance Program for Medicare Part A and this statute specifies the formula used to determine said amounts. From this notice, the inpatient hospital deductible for 2021 will be $1,484 and the daily coinsurance amounts will be $371 for the first 90 days of hospitalization in a benefit period. For lifetime reserve days the coinsurance amount will be $742, and $185.50 for the 21st
through the 100th day in a skilled nursing facility in a benefit period for extended care services. The deductible and coinsurance amounts mentioned in this notice are effective January 1, 2021.
A Notice from CMS on the 2021 Part A Premiums for the Uninsured Aged and Specific Disabled Individuals in the Medicare ProgramDisabledMedicare
On November 12, CMS published a notice on the "Medicare's Hospital Insurance (Part A) premium for uninsured enrollees in calendar year 2021." Specifically, these premiums are tailored to those who are at the uninsured age and for those who have specific disabilities and have exhausted other entitlement. The new monthly Part A premium will be $471 overall, and $259 for others. This notice also details the monthly premium rate calculation, waiver of proposed rulemaking and a regulatory impact analysis. This new premium amount is effective January 1, 2021.
Medicare Part B Monthly Actuarial Rates, Premium Rates and New Annual DeductiblePartB
On November 12, CMS released a notice on the monthly actuarial rates for individuals aged 65 and older or the disabled enrolled in Part B of the Medicare Supplementary Medical Insurance program that begins on January 1, 2021. This notice also updates the monthly premium, the deductible and the income-related monthly adjustment amounts to be paid by beneficiaries that have income above a certain amount for aged and disabled beneficiaries. Specifically, the 2021 actuarial rates are $291 for aged enrollees and $349 for disabled enrollees. The standard monthly Part B premium rate will be $148.50 plus a $3 repayment amount. For the Part B deductible, $203 will be charged to all Part B beneficiaries. For individuals who have to pay an income related monthly adjustment, additional amounts will be charged dependent upon the total cost of the Part B coverage, plus a unique repayment amount. The updated premiums, deductibles and such amounts are effective on January 1, 2021.
TransparencyA Final Rule from HHS on Transparency in Coverage
On November 12, HHS released a final rule on transparency in coverage for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information to the beneficiary or enrollee. This final rule also includes the estimate in relation to the group health plans and health insurance issuers of the beneficiaries cost sharing liability for covered items or services furnished by a specific provider. Plans and issuers are required to make such information available by way of internet and also by paper if requested. Through this final rule plans and issuers are also required to disclose in network provider negotiated rates, drug pricing information and historical out of network allowed amounts. In addition, this rule finalizes amendments to its medical loss ratio program rules. This final rule is effective January 11, 2021.
HRSAHRSA and the Title V Maternal and Child Health Services Block Grant to State Program
On November 12, HRSA released a notice of an information collection request on "Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report." HRSA is updating this guidance originally used annually by all 50 states on applying for Block Grants in preparing for the annual report. These updates will ultimately give states the ability to articulate the description of its Title V program activities. Specifically, HRSA requests comments on the necessity and utility this program, the estimated burden of the request, ways to enhance the information collected and how the use of automated collection can minimize burdens. Comments are due December 14, 2020.
CMS Final Rule on Managed Care for Medicaid and CHIPCHIP
On November 13, CMS released a final rule on "Medicaid and Children's Health Insurance Program (CHIP) Managed Care." This final rule details regulatory framework for manages care regulation changes in order to relieve regulatory burdens for states and to promote transparency in the delivery of care. This rule identifies how states may implement a managed care delivery system through 4 different waiver types. Similarly, states can also implement voluntary managed care programs through contracts with organizations that the state has procured using a competitive procurement process. Overall, the goal of this rule is for states to implement in a cost-effective manner Medicaid and CHIP managed care programs without many administrative burdens. This final rule is effective on December 14, 2020.
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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