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On Tuesday, February 2nd, 2021, the National Indian Health Board joined the National Congress of American IndiansNational Council of Urban Indian Health and fifteen Tribal organizations in a letter to Congress to ensure that Indian Country's COVID-19 concerns and priorities are comprehensively addressed in the next relief package.

The Tribal health priorities outlined in the letter are as follows:
  • Minimum $8 billion directly related to the COVID-19 public health response to the Indian/Tribal/Urban (I/T/U) system including:
  • Minimum $1 billion vaccination distribution and implementation
  • Minimum $250 million in COVID-19 testing
  • Minimum $200 million for Personal Protective Equipment (PPE), medical supplies, and the deployment of supplement medical personnel
  • Minimum $1 billion for Native veterans' health through the Veterans Health Administration
  • Minimum $200 million tribal set aside for support of mental and behavioral health programs
  • Minimum $40 million tribal set aside for programs that serve as response to domestic abuse
  • Minimum $3 billion in funds to replenish third party revenue loss in the I/T/U system
  • Minimum $2.67 billion for the construction and improvement of water and sanitation infrastructure for the I/T/U system and Tribal communities
  • Extend full (100 percent) Federal Medical Assistance Percentage to Urban Indian Organizations
  • Permanently extend waivers under Medicare for the use of telehealth
If you have any questions regarding the next legislative package in response to the COVID-19 pandemic, please contact Erin Morris at emorris@nihb.org.
In This Issue:

CR4 NIHB sends Letters to Congressional Leadership Outlining Tribal Priorities
With the release of President Biden's American Rescue Plan proposal to combat the COVID-19 Pandemic, the National Indian Health Board has sent a letter to Senate Majority Leader Schumer and House Speaker Pelosi outlining legislative priorities to address the dire public health concerns that face Indian Country during this time.

Read NIHB's Letter to the Senate.
Read NIHB's Letter to the House.
CR1House Energy and Commerce Health Subcommittee Hearing on COVID-19 Vaccines, Testing and the Medical Supply Chain
On Wednesday, February 4th, 2021, the House Energy and Commerce Sub-Committee on Health held a hearing on the current state of the U.S. response to COVID-19. Witnesses included Vice President of In-Q-Tel, Luciana Borio, M.D., former Director of the U.S. Strategic National Stockpile, Greg Burel, former Secretary of HHS, and Governor of Utah, the Honorable Michael Leavitt, and Executive VP of the Robert Wood Johnson Foundation, Julia Morita, M.D. 
Committee members on both sides of the aisle focused on bolstering the medical supply chain and leveraging local resources to ensure those who need the vaccine are receiving it, especially in traditionally underserved communities. Witnesses advised that Congress invest heavily in the medical supply chain, health care information technology for tracing vaccine distribution, and the medical workforce in the same vein that Congress funds the Defense Department, adjusted for inflation and mandatory. Witnesses also recommended leveraging Federally Qualified Health Centers (FQHCs) for vaccine distribution. FQHCs are uniquely tied to the communities they serve, and using them for vaccine distribution would help fight the ongoing hesitancy around the vaccine. 
CR2House of Representatives passes $1.9 Trillion Budget Resolution
On Wednesday, February 3, the U.S. House of Representatives passed a budget resolution along party lines outlining the $1.9 trillion package President Biden promised for addressing the ongoing COVID-19 pandemic. The resolution outlines preliminary spending goals for the $1.9 trillion package and now heads to the U.S. Senate for approval. The use of the reconciliation process means that this resolution, and the eventual budget outlined in the resolution, only need a simple majority in the Senate to pass and cannot be filibustered.
President Biden and Democratic Congressional leaders are hopeful that the budget process can still be bipartisan but implore that they cannot wait to measure Republican support to move forward. Congressional leaders hope to have a budget to the President by March 14, when enhanced unemployment benefits run out.
CR3New Senate Committee Assignments Announced
After passing the organizing resolution with agreement from both Majority Leader Schumer and Minority Leader McConnel, the Senate has now assigned committee membership and freshman Senators have been assigned to committees critical to Tribal public health priorities:
For help in connecting with your Congressional delegation, please contact Erin Morris at emorris@nihb.org.
FASG1Final Rule Extension from HHS on the Access to Affordable Life-Saving Medications
On January 26, HHS published a final rule with a delay of an effective date for the "Implementation of Executive Order on Access to Affordable Life-Saving Medications." The new effective date for this final rule is March 22, 2021. This rule applies to health centers that participate in the 340B Drug Pricing Program and receive grant funding through that program. This rule will require health centers to make insulin or injectable epinephrine available to their patients who identify as low income and to make the price of these drugs less than the facility paid through its 340B Program. This final rule is a part of the "Regulatory Freeze Pending Review" memorandum from the new administration, that details the delay of the effective date for rules published in the federal register that have not yet taken effect.
On January 29, IHS released a Dear Tribal Leader Letter on a Notice of Proposed Rule Making for the Catastrophic Health Emergency Fund (CHEF) originally published on January 26, 2016. This proposed rulemaking describes five different changes including defining the governance of the CHEF, ensuring that a Service Unit will not be eligible for reimbursement until the episode of care's cost has reached a certain threshold, create a payment methodology for the CHEF, and establish a methodology that will allow for no payments to be made to a Service unit from the CHEF in the event that the provider of said services is eligible to receive payment from any other source where a patient is eligible for reimbursement. This DTLL also sets a threshold beginning with the amount of $19,000 for fiscal year 2016 and then increasing annually based on the Consumer Price Index as well as announces the development of a new CHEF Notice of Proposed Rule Making in response to Tribes and Tribal Organizations' previous concerns. 
On January 29, the Executive Office of the President released a memorandum titled "Tribal Consultation and Strengthening Nation-to-Nation Relationships." This memorandum encourages executive departments and agencies to incorporate Tribal consultation and Tribal sovereignty with a detailed plan of actions the head of each agency and the Office of Management and Budget (OMB) director will take to implement such policies, asses said plan periodically, and report back with a progress report of updates to said plan or changes. The memorandum details this administration's commitment to upholding the promises made to Tribal nations. 
FASG4Final Rule Extension from HHS on Fraud and Abuse
On February 2, HHS released a final rule on a memorandum that delays the effective date of a previously published rule titled "Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees." Certain portions of the Safe Harbor regulation detailing discounts for prescription pharmaceutical products are delayed through this memorandum put forth by the new administration titled "Regulatory Freeze Pending Review". This memorandum intends to freeze specific regulations that have not yet gone into effect for a duration of 60 days in order to investigate if additional actions are appropriate. This rule also corrects technical errors found in the previously published final rule. The new effective date is March 22, 2021.

On February 2, 2021, the Indian Health Service (IHS) Acting Director sent a letter to Tribal Leaders and Urban Indian Organizations to announce the allocation decisions for $210 million in new resources transferred from the Centers for Disease Control and Prevention (CDC) to the IHS. The funds are to support COVID-19 vaccine-related activities in American Indian and Alaska Native communities. They were authorized by the Coronavirus Response and Relief Supplemental Appropriations Act, signed into law on December 27, 2020. These funds are one-time, non-recurring, and can only be used for the purposes specified in the statute.

Of the $210 million transferred from the CDC to the IHS for vaccine-related activities,
  • $190 million to IHS Federal health programs and Tribal Health Programs (THPs), using existing distribution methodologies for program increases in Hospitals and Health Clinics, Purchased/Referred Care, Community Health Representatives, and Public Health Nursing. All THPs will receive these one-time, non-recurring funds through unilateral modifications and/or amendments to their existing ISDEAA agreements.
  • $10 million to support Urban Indian Organizations.
  • $10 million for additional public health support activities, including additional resources for Tribal Epidemiology Centers, the development and production of culturally appropriate education materials, partnerships with national AI/AN organizations and academic institutions, and other critical support activities.
Read the full letter.
FASG5The USAC Announced a Series of 2021 Webinars for Tribal Partners
The Universal Service Administrative Company (USAC) has recently announced four webinars targeted specifically for Tribal members and partners to participate in for calendar year 2021. These webinars will detail important information about USAC's Lifeline program that can be used by individuals who live on federally recognized Tribal lands. The Lifeline program provides discounted broadband and phone services for consumers who meet eligibility requirements. For more information on these webinars and on the Lifeline program in general, contact the Tribal liaison for USAC, Kraynal Alfred at TribalLiaison@usac.org.
FASG6ACF Releases Nearly $10 Billion in COVID-19 Relief Funds to State, Territory, and Tribal CCDF Programs
On February 3, the Administration for Children and Families (ACF) awarded nearly $10 billion in supplemental Child Care and Development Fund (CCDF) program funding to states, territories, and Tribes to address the needs of child care providers and families resulting from the coronavirus disease 2019 (COVID-19) pandemic. These funds were made available under the recently enacted Consolidated Appropriations Act of 2021 and Coronavirus Response and Relief Supplemental Appropriations Act of 2021 (P.L. 116-260). 

Funds can be used for a range of activities, including continuing payments and assistance to help child care providers in the case of decreased enrollment or closures and to ensure that providers are able to remain open or reopen; providing child care assistance to essential workers without regard to income eligibility requirements; providing relief from copayments and tuition payments for families; delivering technical assistance to help child care providers implement practices in line with guidance from state, territory, and local health departments and from the Centers for Disease Control and Prevention regarding the safe provision of child care services; and supporting other allowable CCDF program activities. The Office of Child Care (OCC) will provide further guidance to states, territories, and Tribes, including information on reporting requirements for these funds, through the OCC COVID-19 Resources page.
GR1Upcoming IHS, Tribal and Urban Indian (ITU) Trainings from CMS
Throughout the years NIHB has collaborated with the Centers for Medicare and Medicaid Services (CMS) to provide trainings on health insurance and the marketplace to individuals involved in the ITU healthcare system. These trainings specify how the Indian Health Service, Tribal Health Programs, and Urban Indian Programs can maximize their third-party revenue through patient's enrollment in CMS health insurance programs. Individuals who are encouraged to attend are business office staff, benefit coordinators, patient registration staff, medical records staff and purchased referred care services staff. In addition to valuable information surrounding third-party revenue, billing and other healthcare insurance activities, this training can also be counted towards one Continuing Education Credit from the American Academy of Professional Coders. The next training will be held from March 22-29, 2021 for individuals located in the IHS Navajo area.
GR2U.S. Department of Commerce Announces Consultation Series on Tribal Broadband Connectivity Grants
On Tuesday, February 2nd, the U.S. Department of Commerce released a Dear Tribal Leader letter announcing a consultation series on the Tribal Broadband Connectivity Program (TBCP). TBCP is funded at $1 billion for developing broadband infrastructure and creating affordable broadband programs, such as free or reduced-cost broadband service, preventing disconnection of broadband services, remote learning, and telehealth. The three scheduled consultation sessions are:
  • Friday, February 5, 2021, from 1:00 PM EST to 5:00 PM EST, Dial in information: +1 (213) 929-4212 Attendee code: 651-925-190, Webinar registration link here
  • Wednesday, February 10, 2021 from 1:00 PM EST to 5:00 PM EST, Dial in information: +1 (562) 247-8321 Attendee code: 470-923-858, Webinar registration link here
  • Friday, February 12, 2021, from 1:00 PM EST to 5:00 PM EST, Dial in information: +1 (562) 247-8422 Attendee code: 564-371-049, Webinar registration link here
Join the Tribal Self Governance Education Consortium (SGCETC) for a webinar with Dr. Stephanie Russo Carroll, Dr. Desi Rodriguez-Lonebear, and Dr. Randy Akee from the US Indigenous Data Sovereignty Network to discuss Indigenous data sovereignty, the CARE Principles for Indigenous Data Governance, and the role of Tribal governments in developing data sovereignty protocols and procedures. This webinar will provide an opportunity for Tribal leaders and officials to discuss a potential framework and a starting point for identifying common strategies for Indigenous data sovereignty.
Indigenous data sovereignty asserts the rights of Tribal Nations and Indigenous Peoples to govern the collection, ownership, and application of their own data. Indigenous data sovereignty derives from Tribes' inherent right to govern their peoples, lands, and resources. Defi­ning a strategy for enhancing Indigenous data sovereignty for Tribes is needed to support Tribal rights and interests in data.

Tuesday, February 9, 2021
2:00 - 3:00 pm Eastern Time
Join the Tribal Self Governance Education Consortium (SGCETC) for a webinar to learn more about the Provider Relief Fund (PRF), reporting requirements, and eligible use of funds. Susan Marsiglia Gray, Director of the Health Resources and Services Administration (HRSA) Office of Provider Support's Division of Policy and Program Operations, will provide an overview and will seek to answer your questions related to the PRF.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136), the Paycheck Protection Program and Health Care Enhancement (PPPHCE) Act (P.L. 116-139), and the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act (P.L. 116-123) appropriated funds to reimburse eligible healthcare providers for healthcare related expenses or lost revenues attributable to coronavirus. These funds were distributed by HRSA through the PRF program.

February 10, 2021
2:00 - 3:00 pm Eastern Time
GR3COVID-19 in Indian Country, Thursday, February 11
COVID-19 has had a disproportionate impact on Native communities throughout the US. Join experts for a conversation about combating this devastating pandemic in Indian Country.

Featuring Rear Admiral Michael Toedt, MD, Chief Medical Officer, Indian Health Service; Dr. Loretta Christensen (Diné [Navajo]), Chief Medical Officer, Navajo Area Office Indian Health Service; and Phyllis Davis, Tribal Council member, Gun Lake Band Pottawatomi and Chair of the Great Lakes Area Tribal Health Board.
This online program will be moderated by Dr. Charles Grim (Cherokee), Chickasaw Nation Secretary of Health.
Presented by the Smithsonian National Museum of the American Indian in partnership with the Indian Health Service.
Thursday, February 11, 2021
2:00 PM - 3:30 PM Eastern Time
GR4Centers for Disease Control and Prevention recruiting delegates for Tribal Advisory Committee
The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry's (ATSDR) Tribal Advisory Committee (TAC) is currently recruiting delegates for the Nashville Area, Phoenix Area, and Tucson Area to increase Tribal health, wellness, and inclusion by providing recommendations to inform CDC policies, programs, and priorities. The deadline to submit nomination letters has been extended to February 12, 2021. To access the Dear Tribal Leader Letter, TAC eligibility criteria, and a nomination letter sample, read more here.
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