Washington Report

The National Indian Health Board is a dedicated advocate to Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php.

August 23, 2022

In This Week's Washington Report

Action Item: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations, Tribes Share Initial Support

Action Item: Meet Your Members - Montana

Action Item: All Tribes Webinar: Proposed Policy Changes for Medicare Payments

Action Item: NIHB Testifies on the Indian Health Service Advance Appropriations Act

Action Item: Register for the National Tribal Health Conference

News From Capitol Hill

Tribes Share Initial Support: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations

The National Indian Health Board (NHIB) and the National Congress of American Indians (NCAI) are partnering to reach out to Tribes in order to amplify your voice and help save Native lives. We are collecting primary data from Tribes on the impacts of government shutdowns on the delivery of Indian Health Service (IHS) programs.

Endorsing advance appropriations for the IHS, the Biden Administration is aware of the adverse impacts of discretionary funding and has included advance appropriation in the fiscal year (FY) 2023 budget proposal.

While the House did not include advance appropriations in its spending bill and the Senate did include advance appropriations in its spending bill, the securement for advance appropriations for IHS is not secured yet.

Tribes need advance appropriations for IHS funding now. Allies in Congress are asking for your stories to help get their colleagues on board. Members of Congress frequently ask, “Why do Tribes need Advance Appropriations?” and “How do funding disruptions harm Tribal nations and their people?”

Sharing stories with NIHB and NCAI through the survey, Tribal leaders and Tribal health directors have noted federal governmental shutdowns result in loss of patient contact hours, loss of third-party billing opportunity and revenue, and loss of hours of operations of health services.

"Being critically underfunded affects the services we can provide especially in very remote areas, also not having advanced appropriations makes it hard to plan, and also having to supplement from our third-party funds takes away from the additional services we are able to provide to due people due to no access due because of our location."

Testifying in support of advance appropriations, a Tribe noted that "people who actually visit villages, will better understand [their] living conditions, and see how remote [they] are. Transportation is mainly by aircraft; others, if the weather is allowable, travel by boats and during the winter by snowmobiles".

For NIHB and NCAI to effectively better advocate for advance appropriations in Congress, it would be beneficial for your Tribe or Tribal health director to fill out this survey. In addition, you will be routed to a separate link to enter to win a Pendleton for taking this survey.

For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD, at apayment@nihb.org.

All Tribes Webinar: Proposed Policy Changes for Medicare Payments under the 2023 Physician Fee Schedule and other Medicare Part B Issues

The Centers for Medicare & Medicaid Services (CMS) Division of Tribal Affairs (DTA) and the Centers for Medicare (CM) will host an All Tribes Webinar on Thursday, September 1, 2022, at 2:00-3:00 PM ET to provide an overview of proposed policy changes for Medicare payments under the Physician Fee Schedule Proposed Rule (PFS) and other Medicare Part B issues.

Since 1992, Medicare payment has been made under the Physician Fee Schedule for the services of physicians and other billing professionals. Physicians’ services paid under the Physician Fee Schedule are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. Payment is also made to several types of suppliers for technical services, most often in settings for which no institutional payment is made.

The purpose of this All Tribes Webinar is to provide an overview of the proposed policy changes under this year’s Physician Fee Schedule Proposed Rule. On July 7, 2022, CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule, and other Medicare Part B issues, effective on or after January 1, 2023.

The calendar year (CY) 2023 PFS is one of several proposed rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better accessibility, quality, affordability, and innovation.

Comments on the CY 2023 PFS are due by September 6 and can be submitted here.

The fact sheet for the PFS, can be found here.

The fact sheet for the shared savings program provisions can be found here.

All Tribes Webinar

Thursday, September 1, 2022

2:00-3:00 PM Eastern Time

Meet Your Member

Montana

Senator Steve Daines (R-MT)

Senator Steve Daines who is serving his second term in the U.S Senate previously was a member in the U.S House of Representatives from 2013 to 2015. Daines along with the other Montana's senator, JonTester (D-MT), represent the 12 Tribal nations of Montana who both sit on the Senate Committee on Indian Affairs. Daines, protecting the natural resources of Montana, advocates for Montana job growth and resources, managing public lands of Montana, and protecting Montana's veterans' and Tribes.

Daines is the Ranking Member of the Subcommittee on National Parks of the Committee on Natural Resources, is also the Ranking Member of the Subcommittee on Healthcare of the Committee on Finance, and is on the Committee on Baking, Housing, and Urban Affairs.

Supporting a longstanding Tribal request, Daines cosponsor's Senator Tina Smith's Tribal Health Data Improvement bill. It is intended to elevate American Indian/Alaska Native (AI/AN) healthcare. The Tribal Health Data bill would improve Tribal access to important public health data and information. It also reauthorizes through fiscal year (FY) 2026 the National Center for Health Statistics in the Centers for Disease Control and Prevention (CDC). The Department of Health and Human Services (HHS) must (1) establish a strategy for providing data access to Indian Tribes and Tribal epidemiology centers; and (2) make available all requested data related to health care and public health surveillance programs and activities to IHS, Tribes, Tribal organizations, and Tribal epidemiology centers.

Daines cosponsored S. 1512 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. This bill would expand coverage and remove restrictions on telehealth services under Medicare. Specifically, this bill would remove restrictions on health facilities, including Indian Health Service and Native Hawaiian Health Care systems, allowing greater flexibility in receiving telehealth services.

Other News and Events

NIHB Testifies on the Indian Health Service Advance Appropriations Act

On July 28, Jonathan Nez, President of the Navajo Nation and a National Indian Health Board (NIHB) Board Member, testified before the United States House of Representatives Natural Resources Committee Hearing. Introduced by the late Congressman Don Young (AK), the hearing was to receive testimony on HR 5549 Indian Health Services (IHS) Advance Appropriations Act.

The Indian Health Service (IHS) Advance Appropriations Act is a continuation of bipartisan Congressional efforts that increases Tribal and federal government efficiency, reduces federal taxpayer waste, and saves American Indian/Alaska Native (AI/AN) lives by providing stable funding for health care services in Indian Country. NIHB is pleased to see advance appropriations included in President Biden’s fiscal year (FY) 2023 funding request and urges Congress to include advance appropriations for IHS in this FY appropriations bill, which sets overall spending limits by agency.

During the most recent 35-day government shutdown in 2019, IHS was the only federal health care program directly harmed. President Nez explained, “The Navajo Nation’s 27,000 square miles of land and more than 400,000 Tribal citizens were especially hard hit during the worldwide COVID-19 pandemic. While there is no good time for government shutdowns to occur, it will take years following the COVID-19 pandemic before Tribal nations are resilient enough to withstand another government shutdown.”

IHS faces chronic challenges made worse by endless use of continuing resolutions (CRs) and the persistent threat of government shutdowns. IHS is the only one of four federal health delivery programs not protected from government shutdowns and CRs. Medicare/Medicaid receive mandatory appropriations. The Veterans Health Administration (VHA) receive advance appropriations starting a decade ago.

In September 2018, the Government Accountability Office (GOA) issued a report that noted “uncertainty resulting from recurring CRs and from government shutdowns has led to adverse financial effects on Tribes and their health care programs.”If the uncertainly of CR’s continue, so too does the threat to an interruption of the treaty and trust obligation for the only class of Americans with a federal treaty right to health care.

"Advance Appropriations for IHS is a step towards fully honoring the treaty and trust obligation for health. It would constitute a demonstrated commitment that Congress will enact solutions that address the health inequities and ensure the health and wellness of Tribal communities,” said President Nez.

NIHB is dedicated to ensuring funding for IHS and other agencies affecting health care in Indian Country is increased.

Read the full written testimony here.

National Tribal Health Conference and 50th Anniversary Celebration

THE POWER OF IDENTITY: A PATH TO TRIBAL HEALTH EQUITY

Join the National Indian Health Board (NIHB) as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-29, 2022. Learn more and register here.

NIHB has extended the deadline for nominations for the 2022 Outstanding Service Awards until August 26. All awards will be presented at the Annual Heroes in Health Awards Gala, taking place as part of NTHC. The Gala will be held at the National Museum of the American Indian in Washington, DC, on Tuesday, September 27, 2022. Learn more and submit Award Nomination here.

National Indian Health Board | www.nihb.org | 202-507-4070

Congressional Relations Associate Ciara Johnson at cjohnson@nihb.org

Visit the NIHB COVID-19 Tribal Resource Center at www.nihb.org/covid-19

Media inquiries, contact Janee Andrews at JAndrews@nihb.org