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Top Story
CongressLawmakers Release Framework for Fourth COVID Stimulus Package, Passes Continuing Resolution until December 18
On Wednesday, December 9, 2020, a centrist group of lawmakers released a framework for an Emergency COVID Relief legislative package. This emergency relief is slated to be voted on along with the remaining appropriations bills to fully fund the budget for Fiscal Year 2021. Release of the framework follows months of gridlock on not only FY 21 appropriations but also a fourth COVID-19 emergency relief package. The last COVID-19 follows months of gridlock on FY 2021 appropriations, forcing Congress to pass a continuing resolution (CR) keeping the federal government open through December 18, 2020.

The proposal is worth about $908 billion, aiming to break a months-long partisan impasse over emergency federal relief for the U.S. economy amid the ongoing pandemic. The group released a framework summary of the core components of the legislation. It includes an "agreement in principle" to provide $160 billion to state, local, and Tribal governments as the basis for good faith negotiations. It also extends pandemic unemployment insurance programs by 16 weeks, puts more funding into PPP, and includes new funding for testing, tracing, and vaccine deployment and distribution. Indian health providers would also receive supplemental funding under this framework. 

Among the framework, the Tribal health provisions included are: 
  • $1 billion set-aside from the Provider Relief Fund (PRF) for Tribes, tribal organizations, urban Indian health organizations, and health service providers to Tribes 
  • $129 million set-aside for Tribes for development and distribution of COVID-19 vaccines
  • $350 million Tribal set-aside for COVID-19 testing and tracing
  • $300 million for Health Workforce programs, including the National Health Service Corps and Nurse Corps, to support loan repayment to recruit clinicians for underserved areas
  • Authorizes states, Tribes and territories to enter into interstate compacts or agreements, for the purposes of procuring COVID-19 tests and supplies for such tests
  • Extends telehealth flexibilities through December 31, 2021
  • $3.15B to SAMHSA programs for the Substance Abuse Prevention and Treatment Block Grant, the Community Mental Health Services Block Grant, Tribal programs, emergency relief, and peer recovery programs
  • $150M to the Certified Community Behavioral Health Centers (CCBHCs) Program
Lawmakers have hoped that elements of a bipartisan deal could be added to the spending bill required to avoid a government shutdown.  This legislative framework allows the bipartisan group to show that there is a path forward on mutually agreed upon priorities, which could help move McConnell, Schumer, the White House, and Speaker Pelosi closer to a final deal. NIHB will continue to advocate for Tribal health priorities through the next COVID-19 emergency relief package and the reconciliation and passage of remaining Fiscal Year 2021 appropriations bills. 

For any questions, contact NIHB Director of Congressional Relations, Shervin Aazami, at saazami@nihb.org
In This Issue:

TOP STORY
GRANTS AND RESOURCES
CAPITOL HILL UPDATES
CongressLawmakers Release Framework for Fourth COVID Stimulus Package, Passes Continuing Resolution until December 18
On Wednesday, December 9, 2020, a centrist group of lawmakers released a framework for an Emergency COVID Relief legislative package. This emergency relief is slated to be voted on along with the remaining appropriations bills to fully fund the budget for Fiscal Year 2021. Release of the framework follows months of gridlock on not only FY 21 appropriations but also a fourth COVID-19 emergency relief package. The last COVID-19 follows months of gridlock on FY 2021 appropriations, forcing Congress to pass a continuing resolution (CR) keeping the federal government open through December 18, 2020.

The proposal is worth about $908 billion, aiming to break a months-long partisan impasse over emergency federal relief for the U.S. economy amid the ongoing pandemic. The group released a framework summary of the core components of the legislation. It includes an "agreement in principle" to provide $160 billion to state, local, and Tribal governments as the basis for good faith negotiations. It also extends pandemic unemployment insurance programs by 16 weeks, puts more funding into PPP, and includes new funding for testing, tracing, and vaccine deployment and distribution. Indian health providers would also receive supplemental funding under this framework. 

Among the framework, the Tribal health provisions included are: 
  • $1 billion set-aside from the Provider Relief Fund (PRF) for Tribes, tribal organizations, urban Indian health organizations, and health service providers to Tribes 
  • $129 million set-aside for Tribes for development and distribution of COVID-19 vaccines
  • $350 million Tribal set-aside for COVID-19 testing and tracing
  • $300 million for Health Workforce programs, including the National Health Service Corps and Nurse Corps, to support loan repayment to recruit clinicians for underserved areas
  • Authorizes states, Tribes and territories to enter into interstate compacts or agreements, for the purposes of procuring COVID-19 tests and supplies for such tests
  • Extends telehealth flexibilities through December 31, 2021
  • $3.15B to SAMHSA programs for the Substance Abuse Prevention and Treatment Block Grant, the Community Mental Health Services Block Grant, Tribal programs, emergency relief, and peer recovery programs
  • $150M to the Certified Community Behavioral Health Centers (CCBHCs) Program
Lawmakers have hoped that elements of a bipartisan deal could be added to the spending bill required to avoid a government shutdown.  This legislative framework allows the bipartisan group to show that there is a path forward on mutually agreed upon priorities, which could help move McConnell, Schumer, the White House, and Speaker Pelosi closer to a final deal. NIHB will continue to advocate for Tribal health priorities through the next COVID-19 emergency relief package and the reconciliation and passage of remaining Fiscal Year 2021 appropriations bills. 

For any questions, contact NIHB Director of Congressional Relations, Shervin Aazami, at saazami@nihb.org
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES
Biden
President-elect Joe Biden Announces Key Members of Health Team
On December 8, 2020, President-elect Joe Biden announced key nominations and appointments of his health team, that includes Dr. Anthony Fauci who will continue his role as Chief Medical Adviser to the President on COVID-19. The team are leaders with deep experience in public health, government, and crisis management. 
  • Xavier Becerra, Secretary of Health and Human Services - Attorney General of California, long-time champion of expanding access to healthcare, and former Congressman who helped pass the Affordable Care Act.
  • Dr. Vivek Murthy, Surgeon General - A physician, research scientist, and former Vice Admiral in the Public Health Service Commissioned Corps. He currently serves as co-chair of the President-elect's COVID-19 transition Advisory Board.
  • Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention - An expert on virus testing, prevention, and treatment. She is the Chief of Infectious Diseases at Massachusetts General Hospital and a Professor of Medicine at Harvard Medical School.
  • Dr. Marcella Nunez-Smith, COVID-19 Equity Task Force Chair - An expert on health care disparities. She is the founding director of Yale's Equity Research and Innovation Center and co-chair of the President-elect's COVID-19 Transition Advisory Board. Dr. Nunez-Smith will advise the President-elect on a whole-of-government effort to reduce COVID-19 disparities in response, care, and treatment, including racial and ethnic disparities.
  • Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases - The nation's preeminent expert on infectious diseases. Dr. Fauci will remain an essential voice both in informing the public about health risks and safety measures and in helping the scientific community, the Biden-Harris administration, and local officials overcome the COVID-19 pandemic.
  • Jeff Zients, Coordinator of the COVID-19 Response and Counselor to the President - An accomplished public servant, Mr. Zients will advise the president-elect on the implementation of the federal government's COVID response, including managing safe and equitable vaccine distribution, the pandemic supply chain, and coordination across federal agencies and state and local governments.
  • Natalie Quillian, Deputy Coordinator of the COVID-19 Response - A national security expert and former White House and Pentagon senior advisor who played an instrumental role in coordinating the Obama-Biden administration's interagency response to the opioid epidemic.

CoordinationInformation Collection Request from HRSA on the Rural Health Care Coordination Program
On November 30, HRSA published a notice on an information collection request for the reinstatement with changes of the Rural Health Care Coordination Program and the performance measures drawn for the principle topics of interest to the Federal Office of Rural Health Policy, such as access to care, population demographics, staffing consortium network, project specific domains and sustainability. Specifically, this reinstatement includes the addition of the Clinical Measures Section which now expands to focus on Type 2 Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease. This program will aid in the agency's goal to provide an inclusive list of the patient's overall health as well as help the organizations enrolled in the program to improve outcomes throughout the course of the project. Individuals who have received funding for the Rural Health Care Coordination Program are encouraged to comment. Comments on this notice are due January 29, 2021.
CHIPNotice from HHS on the Federal Medical Assistance Percentages and Other Related Updated Percentages for Medicaid and CHIP
On November 30, HHS published a notice on the Federal Medical Assistance Percentages (FMAP), Enhanced FMAP and the disaster recovery FMAP adjustments for 2022. This notice also includes a reminder that adjustments are available for states meeting requirements for disproportionate employer pensions or insurance fund contributions as well as for disaster recovery. However, no states currently qualify for those adjustments. This notice also describes how the fiscal year 2022 FMAP rates do not include the 6.2 percentage point increase to the FMAP already added under the Families First Coronavirus Response Act (FFCRA). These percentages will be in effect from October 1, 2021 until September 30, 2022 for each of the four quarter-year periods.
SafeHarborHHS Final Rule on Safe Harbor Changes
On November 30, HHS released a final rule on the removal of safe harbor protections for specific rebates involving prescription pharmaceuticals and the creation of safe harbors for point of sale reductions and pharmacy benefit manager service fees. Specifically, this rule details discounts for prescription drugs and the amendment of contingent safe harbor regulations which will ultimately change the definition of certain conduct that is protected from liability under the Federal anti-kickback statue. This final rule is effective January 29, 2021.
CommitteeNominations for the HHS Minority Health Advisory Committee
On December 4, HHS released a notice from the Office of Minority Health seeking nomination to appoint a member to their Advisory Committee on Minority Health. The committee focuses on improving the health and healthcare of minorities to reduce racial and ethnic health disparities. There will be 6 openings for nomination to the Committee for calendar year 2021. Individuals interested in applying must not be officers or employees of the federal government and must have expertise in issues regarding minority health. The ethnic minority groups equally represented in the Committee include Hispanic/Latinos, African Americans, American Indians/Alaska Natives, Asian Americans and Pacific Islanders. Three vacancies represent AI/ANs, one vacancy represents the Hispanic and Latino population and then two vacancies representing the Asian Americans and Pacific Islanders. Nominations are due March 4, 2021.
PharmacyProposed Rule from CMS on Payment Parameters for 2022 Pharmacy Benefit Manager Standards
On December 4, HHS and CMS released a proposed rule on payment parameters related to the risk adjustment program. Specifically, these parameters include cost sharing and cost sharing reductions with user fees for federally facilitated exchanges and state-based exchanges on the federal platform. Along with other changes, this rule also proposes changes to special enrollment periods as well as changes to the requirement of reporting certain prescription drug information by qualified health plans or their pharmacy benefit managers. Comments on this proposed rule are due December 30, 2020.
RenewalCMS Guidance on the Renewal Requirements for CHIP
On December 4, CMS released an informational bulletin on the Medicaid and CHIP Renewal Requirements. This bulletin is designed to inform states of current federal requirements and exemptions for their beneficiaries. Along with specific guidance on renewal requirements, this bulletin also covers the 2020 Payment Error Rate Measurement (PERM) program error payment rates and concerns that have arisen due to federal and state audits. The goal of this guidance is to help states, especially in the wake of the COVID-19 public health emergency, make efficient use of federal and state dollars through continued supervision of individuals who remain enrolled and meet Medicaid and CHIP standards.
DTLLIHS Dear Tribal Leader Letter on a Memorandum of Understanding with the VA
On December 2, IHS released a Dear Tribal Leader Letter on the announcement for joint Tribal consultation on a revised draft of a Memorandum of Understanding (MOU) with the Veterans Health Administration. The MOU details the mutual goals, mutual objectives, operational planning and other considerations. The agency is interested in hearing ways to improve the MOU and improve collaboration between both agencies. In addition to Tribal Consultation, IHS also details their plan to hold a series of listening session webinars to gather additional input on the MOU. Comments on the MOU are due February 12, 2021.
UPCOMING EVENTS, CALLS, AND WEBINARS
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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