February 14, 2020 |  Issue 20-5   Missed Last Week's Washington Report? Click Here to Visit our Archives!
February 13 - 14, 2020
Arlington, VA

February 25 - 26, 2020
Washington, DC

Tribal Leaders Diabetes Committee Meeting
March 11-12, 2020
Washington, DC

March 17 - 19, 2020
Omaha, Nebraska
Register for the Summit HERE

Community Health Aide Program (CHAP) TAG Vacancies
 In February 2018, with the announcement of CHAP expansion to Tribes beyond Alaska, IHS created a CHAP Tribal Advisory Group.

 Information on CHAP and CHAP TAG, including vacant  positions, is available on the CHAP
website .

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Click HERE for more information!

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NIHB Chairwoman Kitcheyan Testifies before House Appropriations Subcommittee on Interior

From left to right: RSBCIH, Inc. Board Vice-President Teresa Sanchez, Southcentral Foundation VP of Behavioral Services April Kyle; and NIHB Board Chair Victoria Kitcheyan.

Earlier this week, on Tuesday, February 11, 2020,  National Indian Health Board (NIHB) Chair and Great Plains Area Representative, Victoria Kitcheyan, testified on behalf of NIHB for the annual American Indian and Alaska Native Public Witness Hearings on the Fiscal Year (FY) 2021 Indian Health Service (IHS) budget before the  House Appropriations Subcommittee on Interior, Environment, and Related Agencies.  To access NIHB's written testimony,   click here .

"The repercussions of continued underfunding of IHS are measurable and quantifiable. An American Indian or Alaska Native born today has a life expectancy that is 5.5 years less than the national average, while in certain states - including in the Great Plains Area where I am from - Our People are dying as much as two decades earlier," said Kitcheyan.

NIHB's recommendations for the FY 2021 IHS budget reflect the recommendations of the IHS Tribal Budget Formulation Workgroup, which calls for $9.1 billion in funding for IHS next year. As part of NIHB's written and oral testimony, Chairwoman Kitcheyan discussed the need for:
  • Establishing a full, needs-based budget for IHS funded under mandatory appropriations
  • Securing advance appropriations for IHS and other critical Indian programs
  • Ensuring Congress enacts an indefinite appropriation and distinct line item for 105(l) lease expenditures
  • Securing meaningful funding increases for all line items in the IHS budget, including the newly established Electronic Health Records (EHR) line item
T o watch a live recording of the hearing, click here
To access a copy of NIHB's written testimony for the record, click here
In This Issue:


Tribes Notified of Possible Public Health Service Corps Officer Deployment in Light of Coronavirus 
HRSA to Consider Asking Loan Repayment Program Applicants for Additional Education Information 
HRSA Establishes Tribal Advisory Council 
CMS Releases Guidance on Medicaid Block Grants
CMS Issues Proposed Rule on Basic Health Program Parameters for 2021
NIHB Joined by 44 Tribes, Tribal organizations, and urban Indian organizations in letter to Congress Demanding 5-year Reauthorization of Expiring Health Extenders, Including the Special Diabetes Program for Indians
The Special Diabetes Program for Indians (SPDI) is among several expiring health programs that are only reauthorized through May 22, 2020. In addition to SDPI, funding for the Special Diabetes Program, teaching health centers, community health centers, and the National Health Service Corps are set to expire on May 22. To that end, NIHB has been partnering with national organizations to demand a 5-year reauthorization of all of these vital programs. 

Earlier this week, NIHB was joined by 44 Tribes, Tribal organizations, and urban Indian organizations; and ten national non-Native organizations that advocate on behalf of the other expiring health programs, in a letter to House and Senate leadership demanding that Congress swiftly pass a 5-year reauthorization of all of these programs.  In total, there were 54 signatories on the letter - demonstrating the extensive and powerful support for these critical health extenders. 

NIHB highly encourages Tribes and Tribal organizations to also share the letter with their Representatives and Senators so that they can continue to advocate before leadership for enactment of 5-year renewal.

To access the House letter, click here
To access the Senate letter, click here
Congress Must Hear from Indian Country NOW on 5-Year Renewal of the Special Diabetes Program for Indians
The National Indian Health Board (NIHB), National Congress of American Indians (NCAI), and National Council of Urban Indian Health (NCUIH) are working closely together to ensure that Congress passes a 5-year renewal of the Special Diabetes Program for Indians (SDPI) before it expires on May 22, 2020. But lawmakers NEED to hear directly from Tribes, Tribal organizations, and urban Indian organizations urging them to swiftly pass a 5-year reauthorization NOW!

SDPI is one of the most successful public health programs ever implemented. Because of SDPI, rates of End Stage Renal Disease among American Indians and Alaska Natives fell by 54% from 1996 to 2013. Meanwhile, rates of diabetic eye disease fell by 50%. Not only does SDPI improve and save lives, it also saves millions of taxpayer dollars. A 2019 federal report found that SDPI is responsible for saving Medicare $52 million per year! These results are unmatched, and speak directly to the value and success of SDPI. Congress must achieve 5-year renewal of SDPI now!

If Congress fails to pass 5-year renewal of SDPI, our People's health will be placed in grave danger. Our communities will lose medical and public health providers. Our facilities will be forced to cut vital diabetes care services. Our youth and adult health education programs would close down. And most importantly, our People's lives will be lost.

In December 2019, key members of Congress including Chairman Pallone (D-NJ) and Ranking Member Walden (R-OR) of the House Energy and Commerce Committee, along with Chairman Alexander (R-TN) of the Senate Health, Education, Labor, and Pensions Committee, announced a bipartisan, bicameral agreement that would fund SDPI, community health centers, teaching medical centers, and other critical health programs for five years!

Congress almost passed 5-year renewal of these programs under the fiscal year 2020 spending package but special interests got in the way. A 5-year renewal would be the longest stretch of guaranteed funding in over a decade. It is long past due for Congress to do its job and pass 5-year renewal of SDPI.

Contact your Member of Congress TODAY to demand that they put our health first and swiftly pass 5-year renewal of SDPI and other critical health programs NOW!
  • Click here for talking points on SDPI
  • Click here for a sample template letter to send to your Representative
  • Click here for a sample template letter to send to your Senators
Your Representative's contact information can be found  here , and your Senators' information can be found  here .

The clock is ticking!
Congress must hear from YOU about SDPI Renewal NOW!

Coronavirus Declared Public Health Emergency

On February 7 2020,  HHS published a notice on the Coronavirus where the Secretary of HHS classified the virus as a public health emergency in that the virus could potentially affect national security or the health and security of United States citizens living abroad. This notice also includes the authorization of emergency use of in vitro diagnostics for diagnosis of the novel coronavirus.
The declaration became effective on February 4th 2020.


Tribes Notified of Possible Public Health Service Corps Officer Deployment in Light of Coronavirus

On February 6, the Indian Health Service (IHS), issued an authorization and notice on the possibility of deployment for Corps officers in the U.S. Public Health Service due to the rapid spread of the 2019 Coronavirus. Corps officers play a vital role in the U.S. Department of Health and Human Services (HHS), particularly as part of the Emergency Support Function (ESF) #8 role in supplementing Tribes, states, and others the resources in response to public health emergencies. This includes incidents with international implications. The HHS Secretary and Assistant Secretary for Health (ASH) have begun to implement Corps participation in ESF #8 activities through outbreak expertise and guidance to health care professionals, conducting passenger screening at U.S. airports and borders, and providing logistical and technical support, as needed. To ensure the availability of the greatest number of assets, the ASH has exercised his authority in Commissioned Corps Directive (CCD) 121.02 "Deployment and Readiness" (https://dcp.psc.gov/ccmis/ccis/documents/CCD_121.02.pdf) to deploy Corps officers assigned to HHS Operating and Staff Divisions without supervisory or agency approval.

Since the deployment of Corps officers at any moment stands to put Tribes in a difficult situation, the IHS commits to working closely with Tribes to assist as much as possible with solutions for backfilling Corps officers who are deployed.
Those with questions or concerns are encouraged to contact CAPT Angela Mtungwa, Director, Division of Commissioned Personnel Support, IHS, by e-mail at angela.mtungwa@ihs.gov, or by telephone at (301) 443-5440.

HRSA to Consider Asking Loan Repayment Program Applicants for Additional Education Information 
On February 3  2020, HRSA sent out a notice requesting public comment on the National Health Service Corps (NHSC) Loan Repayment Program. The program was established to assure an adequate supply of trained primary care health professionals to provide evidence based Substance use disorder (SUD) treatment to health professional shortage areas. Under this notice, information collected will be used to assess a Loan Repayment Program (LRP) applicant's eligibility to obtain information for NHSC site applications.
Comments are due March 4, 2020.
HRSA Establishes Tribal Advisory Council
The Health Resources and Services Administration (HRSA) is requesting comments on the establishment of its Tribal Advisory Council and is seeking nominations of 12 qualified Tribal officials, from the 12 Indian Health Service (IHS) areas, for consideration for appointment as voluntary delegate members of the HRSA Tribal Advisory Council (TAC). There should be one designated alternate for each TAC member. HRSA TAC members will have the opportunity to engage in meaningful consultation with agency officials, and to share a broad range of views determining the impact of HRSA programs on the American Indian/Alaska Native (AI/AN) health systems and the population. HRSA also seeks Tribes' guidance in crafting innovative approaches to deliver health care and assisting with effective consultations. Nominations for the HRSA TAC are due May 7, 2020.

CMS Releases Guidance on Medicaid Block Grants
On January 30, 2020, CMS released its long awaited block grant guidance. The guidance, released under the banner of "Healthy Adult Opportunity" (HAO) lays out a path for, and encourages states to apply to transition  part of their Medicaid program to a capped payment system. While this looks different in some respects from other types of government block grants, states choosing to use this framework will agree to a set payment amount, and will not be able to bill CMS for more than this amount, with some specific exceptions (like a natural disaster). 

The guidance is targeted towards the ACA expansion population. Mandatory populations such as pregnant women, children, and those eligible on the basis of a disability are excluded from the HAO.
The guidance provides states with the ability to apply for certain "flexibilities," essentially a menu of items that they can choose to include in their HAO demonstration. There is no limit on how many they can include, as long as they do not contradict each other. The "flexibilities" that the guidance lists include: imposing work requirements on beneficiaries, waivers of retroactive eligibility, and the ability to make certain changes in benefits, among other flexibilities.
The guidance also specifically mentions AI/ANs, and provides that AI/ANs are to be exempt from premiums and cost-sharing arrangements and that services rendered in IHS and Tribal facilities should not be counted in the calculations used to determine a state's cap. It also provides for the preservation of the 100% FMAP. There is no mention of reimbursements for Urban programs. Despite these protections, we are concerned about the impact of the "flexibilities," such as work requirements and waiver of retroactive eligibility, on AI/ANs and the I/T/U system.
CMS Issues Proposed Rule on Basic Health Program Parameters for 2021 
CMS published a proposed methodology to determine the federal payment amounts for the program year 2021 to states that elect to establish a Basic Health Program under the Affordable Care Act. The Basic Health Program (BHP) makes health benefit coverage affordable to those under age 65 with household incomes between 133 percent and 200 percent of the Federal Poverty Level and to others that qualify. This methodology identifies the specific information required to determine federal payments for the BHP by using previous data and assumptions that reflect ongoing operations, experience of BHPs and the operation of the Exchanges. Rate cells for each state, a unique combination of age range, geographic area and other aspects, will also be used to calculate federal payment amounts and premium tax credit (PTC) for the BHP. Comments on this proposed methodology are due March 11, 2020.

Medicare Card Reminder
For those enrolled in Medicare, the Centers for Medicare  and Medicaid S ervices (CMS) announced that beginning January 1 st  2020, new Medicare Cards must be presented when receiving services from Tribal hospitals and clinics. If the hospitals and clinics do not receive the new Medicare Beneficiary Identifier (MBI), from those that are enrolled into Medicare, their claim will be automatically rejected.  In order to ensure that claims are paid, it is critically important that Tribal Medicare beneficiaries are aware of this change. 
In the event that an enrolled beneficiary does not have a card yet, or fails to bring it to the appointment, CMS also provides additional i nformation   on how to obtain the new Medicare card.

Early Bird Registration Still Open for National Indian Health Board's 11th Annual National Tribal Public Health Summit!
March 17-19, 2020
Chi Health Center, Omaha, NE

The National Indian Health Board invites you to submit a proposalfor the National Tribal Public Health Summit (TPHS). TPHS is a premiere Indian public health event that attracts over 500 Tribal public health professionals, elected leaders, advocates, researchers, and community-based service providers. This year's Summit will feature dynamic national speakers, interactive workshops and roundtable discussions, a welcome reception, a morning fitness event, as well as the presentation of the 2020 Native Public Health Innovation awards.
This year's tracks are:
  • Health Promotion and Disease Prevention
  • Public Health Policy, Infrastructure, Workforce and Systems
  • Substance Misuse, Opioids, and Behavioral Health
  • Environmental Health and Climate Change
  • Traditional Public Health Practice
Click here   to register for the Summit by February 14, 2020 for Early Bird Rates!
Register for the February 12 MIPS Value Pathways Webinar

The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar on
Wednesday, February 12 at 2:30 p.m. ET to provide an overview of the MIPS Value Pathways (also referred to as MVPs) participation framework, which was outlined in the
2020 Quality Payment Program Final Rule . CMS is committed to co-developing the MIPS Value Pathways with stakeholders and the public, and will be using this webinar to answer questions from organizations interested in providing input on MVPs.
During the webinar, CMS subject matter experts will:
  • Recap the MIPS Value Pathways framework
  • Discuss the goals of the MVPs and benefits for clinicians
  • Obtain feedback and answer questions as time allows
Please note that this webinar will only cover existing information about the MIPS Value Pathways, as found within the 2020 Final Rule, MVPs webpage , and accompanying materials such as the MVPs fact sheet and illustrative diagrams . No new information about the MVPs will be presented during this time.
Webinar Details
Title: MIPS Value Pathways Webinar
Date: Wednesday, February 12, 2020
Time: 2:30 - 3:30 p.m. ET
Please note: The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the feedback portion. If you cannot hear audio through your computer speakers, please contact  CMSQualityTeam@ketchum.com
CMS ITU  Trainings
Don't miss the National Indian Health Board's (NIHB) presentation at the Centers for Medicare and Medicaid Services' (CMS), Indian Health Service (IHS), Tribal Health Programs, and Urban Indian Programs (CMS I/T/U) regional training sessions!  CMS is committed to helping the I/T/U facilities to maximize their ability to access third party resources.  To meet this objective, CMS, in partnership with the States, the Department of Veteran Affairs, the Social Security Administration, the DHHS Office of the Inspector General, IHS and NIHB provide training to patient benefits advocates on the programs and benefits available through Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. 
The target audience for CMS ITU Trainings includes:
  • Business Office staff
  • Benefits Coordinators
  • Patient Registration staff
  • Medical Records staff
  • Purchased/Referred Care staff
Upcoming Regional Trainings:
CMS ITU Training - Denver, CO
March 18-19, 2020
Embassy Suites by Hilton
Denver Tech Center North
7525 East Hampden Avenue
Denver, CO 80231
CMS ITU Training - Galllup, NM (Navajo)
March 24-25. 2020
Navajo Tribal Utility Authority
Fort Defiance, AZ
Click here to register and for more information.

Two New Videos - Public Service Announcements (PSA)
National Indian Health Board (NIHB) and Centers for Medicare and Medicaid Services (CMS) developed PSAs to use in Indian Country that depicts the best ways to use the outreach and education materials that CMS has created for Tribal communities.
This video  demonstrates tips for using CMS Tribal outreach materials at an information booth at a health fair or community pow-wow.
This video  demonstrates tips for using CMS Tribal outreach materials in a patient home visit with a community health educator like a Community Health Representative, Public Health Nurse or a Community Health Care Provider.
If you have any questions, please email Kristen Bitsuie at kbitsuie@nihb.org .
IHS 2020-2021 Scholarship Program Now Open!
Application Deadline: February 28, 2020, 7:00 PM Eastern

The Indian Health Service (IHS) Scholarship Program is now accepting applications for scholarship support for the 2020-2021 academic year.

Pre Nursing, Pre Medicine, Pre Dentistry, Nursing BS, Nurse Anesthetist MS, Nurse Midwife MS, Physician Assistant MS, Clinical Social Work MS, Nurse Practitioner MS, DNP, Clinical Psychology D, Counseling Psychology D, Dentistry D, Optometry D, Pharmacy D, Physician (Allopathy/Osteopathy), Physical Therapy D, Podiatry D.

For specific eligibility requirements with degree programs, please view the IHS Scholarship Comparison Chart.

HRSA Funding Opportunity: Rural Health Care Coordination Program
Application Deadline: March 12, 2020

HRSA is accepting applications for fiscal year (FY) 2020 Rural Health Care Coordination Program. The purpose of this program is to support rural health consortiums aiming to improve access and quality of care through application of care coordination strategies with the focus areas of collaboration, leadership and workforce, improved outcomes, and sustainability in rural communities.

The FY 2020 President's Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. You should note that this program may be cancelled prior to award.

The Health Resources and Services Administration (HRSA) is the primary federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  

Click here to view the funding opportunities in Grants.gov .
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