January 22, 2021 |  Issue 21-1 Missed our previous Washington Report? Click Here to Visit our Archives!

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Top Story
Joseph R. Biden Jr. and Kamala Harris Inaugurated as President and Vice President

This week on Wednesday, January 20th, the United States celebrated a transfer of power and the inauguration of President Joe Biden and Vice President Kamala Harris. Despite the recent attack on the Capitol building, the Inauguration ceremony proceeded without any interruption. NIHB would like to congratulate President Biden and Vice President Harris on assuming office. Their Administration has set forth a clear health agenda in response to the COVID-19 pandemic. NIHB will continue to work with the Biden-Harris Administration in strengthening the government-to-government relationship with the Tribes as well as advocating for the Administration to uphold Trust and Treaty responsibilities for Indian health.

In This Issue:

VernaDemocratic Leadership Expresses Disappointment with CMS Administrator Seema Verna
On January 19th, House Energy and Commerce Chairman Frank Pallone and Senate Committee on Finance Ranking Member Ron Wyden submitted a letter to then-CMS Administrator Seema Verma expressing their disappointment at the end of Administration changes to Medicaid. Specifically, the Chairman and Ranking Member were critical of the changes to Medicaid's 1115 demonstration waivers. Then-CMS Administrator Verma sent a letter to states currently operating Medicaid section 1115 demonstrations outlining a new approach by which CMS rescinds Medicaid 1115 demonstrations, requiring a minimum of nine months notice to allow states to appeal the decision. In Chairman Pallone and Ranking Member Wyden's eyes, the new process is an unnecessary burden on the federal government to impede the incoming Biden Administration's priorities for CMS.
DeartriballeaderIHS Dear Tribal Leader Letter on Resources from the Public Health Emergency Fund
On January 15, IHS released a Dear Tribal Leader Letter and Urban Indian Organization Letter on the specific distribution of $790 million in new resources from the Public Health and Social Services Emergency Fund to the IHS in support of COVID-10 testing, mitigation and other activities related to the pandemic for American Indians and Alaska Natives. This allocation was distributed through the Coronavirus Response and Relief Supplemental Appropriations Act. The funds from this allocation are intended to be a one-time, nonrecurring amount and can also be used to upscale testing of public health, academic, commercial, hospital laboratories, community-based testing sites, mobile testing units, healthcare facilities and other entities testing individuals for COVID-19
Executive Order on Protecting the Federal Workforce and Requiring Mask-Wearing
On January 20, the Biden administration released one of his first
executive orders which requires the federal workforce to wear masks, maintain social distances and other precautions recommended by the CDC. Specifically, any on duty or on-site federal employees, contractors and other workforce individuals in federal buildings should adhere to all public health measures recommended from the CDC. This executive order also encourages wearing masks across America, the establishment of a "Safer Federal Workforce Task Force", the development of a COVID-19 testing plan for the Federal workforce, and lastly, the development of federal research grants to study best practices in relation mitigating the spread of COVID-19.
RacialequityExecutive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government
On his first day in office, President Biden issued an executive order advancing racial equity.  This order acknowledges disparities in under-represented groups and calls for the Domestic Policy Council (DPC) and the Office of Management and Budget (OMB) to lead an inter-agency study on the areas within federal government where significant racial disparities exist.


In addition to engaging directly with underserved communities, the EO calls to stand up an "Equitable Data Working Group," which seeks improve data collection on marginalized and underserved population.  As the EO says, "[m]any Federal datasets are not disaggregated by race, ethnicity, gender, disability, income, veteran status, or other key demographic variables.  This lack of data has cascading effects and impedes efforts to measure and advance equity.  A first step to promoting equity in Government action is to gather the data necessary to inform that effort."

fourwallsCMS extension of the "Four Walls" Requirement
On January 15, CMS released an information bulletin on the extension of grace period related to the "Four Walls" Requirement for Indian Health Service and Tribal Facilities. Currently, CMS has approved nine Tribal FQHC State Plan Amendments to pay the IHS all-inclusive rate as an alternate payment methodology. Due to the public health emergency, it has been difficult for Tribes and Tribally operated FQHCs to complete state plan amendments. This grace period allows for Tribal healthcare facilities to continue to claim Medicaid reimbursement for services provided outside of the "four walls" of a facility through October 31, 2021. Additionally, this extension will allow states and tribal facilities to submit a state plan amendment by December 31, 2021, so that the amendment will take effect November 1, 2021.
ruralareaHHS Revised the Definition of "Rural Area"
On January 12, HHS released a revision of definition for the term "rural area", as well as a response to comments. In collaboration with HRSA, HHS has changed the definition of rural for defining a geographic region eligible to apply for services funded by the Federal Office of Rural Health Policy (FORHP) grants. The comments that this notice responds to are those dealing with proposed modifications to how the FORHP assigns areas to be considered as eligible for rural health grant programs. Specifically, the FORHP is allowing Metropolitan Statistical Area counties that do not contain an Urban Area population to the areas eligible for rural health grant programs. These changes will be in effect for the grant year 2022.
PartDPart D Information Collection Request from CMS
On January 14, CMS published a notice on an extension of a currently approved information collection request titled "Medicare Prescription Drug Coverage and Your Rights." This collection details regulations that require Part D plan sponsors' and network pharmacies to provide Part D enrollees access to a printed copy of the standard pharmacy notice "Medicare Prescription Drug Coverage and Your Rights". This notice is necessary if the individual enrolled' s prescription cannot be filled. Overall, this notice is designed to provide enrollees with accurate information on Part D plans and who to contact when requesting a coverage determination. Comments are due March 15, 2021.
twoinformationTwo Information Collection Requests from CMS on Regulatory Applications and Forms for Medicare
On January 14, CMS released a notice on two other information collection requests. The first collection details the "Application for Health Insurance Benefits Under Medicare for Individuals with Chronic Renal Disease and Supporting Regulations in 42 Code of Federal Regulations" to be used as a form to establish entitlement to Medicare Part A and eligible enrollment in Medicare Part B for those who are diagnosed with End-Stage Renal Disease. The second information collection request details the "Identification of Extension Units of Medicare Approved Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) Providers and Supporting Regulations." This collection details the requirement that an OPT or OSP extension location must be reported to State Survey Agencies through the CMS-381 Form. Comments on the Form with regulations and the Application are due February 16, 2021.
FinalRuleFinal Rule from CMS on the Medicare Coverage Innovative Technology Pathway
January 14, CMS published a final rule on a Medicare coverage pathway to allow Medicare beneficiaries faster access to recently improved medical devices. Specifically, the "Medicare Coverage Innovative Technology (MCIT) pathway" is a program that will span the course of 4 years of national Medicare coverage dependent upon the manufacturer and FDA market authorization date for medical devices. This final rule also details regulatory standards for determinations related to services that are furnished under Part A and Part B. Overall this final rule is designed to give Medicare beneficiaries access to the newest innovations on the market. This final rule is effective March 15, 2021. 
CMSGuidanceCMS Guidance on new Requirements for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act

On January 19, the CMS released guidance to state Medicaid agencies on the "implementation of requirements in section 1001 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act)." This act is designed to inform states that they are not allowed to terminate the Medicaid eligibility of incarcerated youth. This act also allows for Medicaid protections for at-risk youth who are inmates of public institutions as well as provide implementation options related to processing applications for incarcerated youth, redetermination before release, and restoration of benefits when released. These regulations are effective for individuals who become inmates of public institutions on or after October 24, 2019. 

NationalstrategyPresident Biden Issues National Strategy for Combatting the COVID-19 Pandemic
On January 21, 2021, President Joe Biden issued a National Strategy for combatting the on-going COVID-19 pandemic. The new Strategy, which provides seven goals and steps for how to achieve them, is meant to provide the framework for a cohesive national strategy for combatting the pandemic. The steps outline executive actions and Congressional requests that the Administration will take in order to achieve the goals included in the plan. The Strategy commonly cites the need for a data and science driven approach to addressing the pandemic. It also notes the need to ensure a COVID-19 testing, treatment, and distribution plan that targets communities and individuals most at risk for COVID-19."
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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