C-SPAN Clip: NIHB Chair Victoria Kitcheyan Discusses Indian Health Priorities for COVID-19

APRIL 9, 2020 | CLIP OF VICTORIA KITCHEYAN ON NATIVE AMERICAN COMMUNITIES AND CORONAVIRUS

Clip Transcript

Call from: Michigan

Thank you so much for taking my call. I run an urban agency an urban indian center just south of Detroit called the American indian Services. We’re a mental health provider as well as a food provider. My question is, what is being done for the 75% of American Indians who live in cities? We’ve had a hard enough time just surviving because the State of Michigan has cut our budget repeatedly for the last 5 years. We’re trying to hang on and serve the American Indians in the cities. If people went home, the tribes would not be able to accommodate them. They would be bankrupt in weeks, so what’s going to be done for the Indian people living in the cities?

Victoria Kitcheyan

Thank you Faith for that question. The urban Indian organization, NCUIH, has been a champion in advocating for urban organizations and they were also included in the first funding package and, in fact, the urban indian priorities are something that cannot be forgotten because many of our tribal members live in urban areas and most recently the National Congress of American Indians and the National Indian Health Board signed on to a letter today advocating for the needs of the fourth funding package and in there the urban needs have also been advocated for. So, I understand your frustration and often the urbans are left out and so the federal agencies have to consult with the federally recognized tribes and they only have to concur with the urban organizations, but we cannot forget our relatives that are living in some of these most highly populated areas that need the resources just as much as we do on the reservation.

Udall, Senate Democrats Unveil COVID-19 “Heroes Fund,” $25,000 Proposed Pay Increase to Essential Workers and, Urban Indian Organizations and Tribal Workers on Frontlines of Pandemic Response

https://www.indian.senate.gov/news/press-release/audio-udall-senate-democrats-unveil-covid-19-heroes-fund-25000-proposed-pay

AUDIO: Udall, Senate Democrats Unveil COVID-19 “Heroes Fund,” $25,000 Proposed Pay Increase to Essential Workers and Tribal Workers on Frontlines of Pandemic Response

COVID-19 “Heroes Fund” would give Tribal frontline workers equal access to proposed $25,000 premium for essential workers, implement $15,000 Essential Worker Recruitment Incentive to attract and secure frontline workforce needed to fight public health crisis

Udall’s remarks on the COVID-19 Heroes Fund begin at 11:38 here.

WASHINGTON—Today, U.S. Senator Tom Udall (D-N.M.) joined Senate Democratic Leader Chuck Schumer (D-N.Y.) and Senators Patty Murray (D-Wash.), Sherrod Brown (D-Ohio), Bob Casey (D-Penn.), and Gary Peters (D-Mich.) to unveil the COVID-19 “Heroes Fund,” Senate Democrats’ proposal to establish a pandemic premium pay to reward, retain, and recruit essential workers. Senate Democrats’ proposed “Heroes Fund” consists of two major components: a $25,000 premium pay increase for essential workers—including Tribal workers—equivalent to a raise of $13 per hour from the start of the public health emergency until December 31, 2020, and a $15,000 essential worker recruitment incentive to attract and secure the workforce needed to fight the public health crisis.

A summary of Senate Democrats’ COVID-19 “Heroes Fund” proposal can be found here.

“Essential frontline workers in New Mexico, Indian Country, and across America are risking their own health to protect ours, to care for our loved ones, and to keep our communities safe and running. We owe these heroes – the health care workers, first responders, law enforcement, grocery clerks, delivery workers, and many others – more than just words of gratitude: we must make sure they are paid what they deserve,” Udall said.

“Importantly, this proposal will give Tribal frontline workers equal access to these benefits, and includes the necessary flexibility to meet the unique needs of Native communities,” Udall continued. ”Because this crisis is hitting Indian Country especially hard: frontline workers in Native communities are stretched thin, and, due to severe federal underfunding, Indian Country has long struggled to recruit and retain workers in fields like health care and law enforcement. So this proposal is absolutely necessary for Indian Country and for all communities — to support the frontline workers who are doing incredible, life-saving work, and to secure the workforce that we need to keep our nation healthy and strong.”

Across New Mexico, Indian Country, and America, essential frontline workers—doctors, nurses, grocery store workers, transit workers, public safety personnel, and many more—continue to put themselves at risk on the front lines of the COVID-19 pandemic. Udall and Senate Democrats’ proposal would compensate these workers for their great personal sacrifices and tireless dedication while increasing the recruitment of additional workers for the front lines that will be needed in the months ahead.

Udall and Senate Democrats fought for workers-first provisions in the recently-passed CARES Act, the $2 trillion package includes key provisions to support New Mexico, including: direct payments to individual New Mexicans and a major expansion of unemployment benefits, badly-needed direct relief for small businesses, an emergency infusion of resources into hospitals and to support health care workers, and reimbursement for state and Tribal governments that have stepped up to address the crisis.

Udall and Senate Democrats also fought to ensure Tribes had equitable access to federal resources in the recently-passed CARES Act. They secured over $10 billion in resources for Tribes and Native communities to address their unique needs, including providing over $1 billion to the Indian Health Service and establishing an $8 billion Tribal Government Relief Fund.

Portions of the first wave of grants from the package have recently been released to New Mexico, while the Indian Health Service announced disbursement of $600 million of the over $1 billion in funds Udall helped secure from the CARES Act.

“Thousands of workers report to the frontlines of our nation’s pandemic response each and every day, placing themselves squarely in harm’s way to serve the needs of others,” said Leader Schumer. “Senate Democrats’ proposed ‘Heroes Fund’ would provide premium pay to these essential workers—the doctors and nurses, grocery store workers, transit workers, and more who are central to fighting this crisis—and would establish an incentive system to retain and recruit the workforce needed for the long months to come. Essential frontline workers sacrifice daily for our collective health and well-being, and Senate Democrats are fully committed to supplying these heroes the financial support they deserve.”

Listen to the audio of Udall’s remarks, beginning at minute 11:38, here.

A summary of Senate Democrats’ COVID-19 “Heroes Fund” proposal can be found here and below:

The COVID-19 “Heroes Fund” Summary

Senate Democrats’ Proposal for Pandemic Premium Pay to Reward, Retain, & Recruit Essential Workers

Essential frontline workers are the true heroes of America’s COVID-19 pandemic response.  Senate Democrats believe in providing premium pay to frontline workers during this pandemic to reward essential frontline workers, ensure the retention of essential workers who are working grueling hours on the frontlines of this crisis, and promote the recruitment of additional workers who will be needed in the months ahead.

As the Congress looks at a potential fourth COVID-19 bill, the following proposal is meant for consideration by Members of Congress, key stakeholders, and the American people. Senate Democrats’ proposal consists of two major components:

1. A $25,000 pandemic premium pay increase for essential frontline workers, equivalent to a raise of an additional $13 per hour from the start of the public health emergency until December 31, 2020.

2. A $15,000 recruitment incentive for health and home care workers and first responders to attract and secure the workforce needed to fight the public health crisis.

Structure of the Pandemic Premium Pay

To meet the goals of reward, retention, and recruitment, Senate Democrats propose a set dollar amount per hour with a maximum amount for the year, for a definite duration, and with an additional bonus for workers who sign up to do such essential work during this crisis.

Amount of Pay Premium. The proposal—

  • Uses a flat-dollar amount per hour premium model in order to ensure it is clear, simple, and lifts up particularly those workers making lower wages.
  • Would give each essential frontline worker $13/hour premium pay on top of regular wages for all hours worked in essential industries through the end of 2020.
  • Would cap the total maximum premium pay at $25,000 for each essential frontline worker earning less than $200,000 per year and $5,000 for each essential worker earning $200,000 or more per year.

Duration of Premium. The premium pay period—

  • Must be for a specified and clear duration of time to ensure workers can rely on it for their economic security and plan for needs like additional child care.
  • Should cover all hours worked by each essential frontline worker through December 31, 2020, or until the worker’s salary-based maximum premium pay is reached.

Premium Pay as a Recruitment and Retention Incentive.  In order to recruit the additional health care workers, home care workers, and first responders needed over the coming months, thef proposal—

  • Would provide a one-time $15,000 premium for signing on to do essential work.
  • Would limit eligibility for this incentive premium to essential health and home care workers and first responders that are experiencing severe staffing shortages impeding the ability to provide care during the COVID-19 pandemic.[1]

Premium Pay and Worker Incentives Delivery Mechanism

The proposal would fully federally-fund the premium pay and recruitment and retention incentive. We will continue to seek input on the specific mechanism for delivering the pay to workers, as well as the universe of “essential workers” to be covered. The new federal fund would partner with entities designated as an “eligible employer” – states, localities, tribes, and certain private sector employers – to issue the funds premium payments to eligible workers. Frontline federal employees would also be granted the new benefit of up to $25,000.

COVID-19 Heroes Fund. The new COVID-19 Heroes Fund would provide funds directly to eligible employer-partners so that they could distribute the premium payments.

  • Employers in industries engaged in “essential work” would apply to the Heroes Fund for funds to be used to add line-item premium pay to employees’ or independent contractors’ paychecks. The eligible employer would track these payments, provide payroll records demonstrating premium payments, and return any unspent funds to the agency.
  • No employer would be required to participate, but all would be strongly encouraged to and the program would be widely advertised.
  • An entity that contracts directly with the state, locality, Tribe, or the federal government (e.g., to provide care to people with Medicare and Medicaid coverage) would be considered a private sector employer, and employees of this entity who are designated as “essential” would be eligible for premium pay. Similarly, an eligible employer is also an individual who hires someone designated as “essential” through programs established through the State (e.g., self-directed care arrangements). This would help ensure coverage of the 2.2 million home health aides, direct service providers, and personal care workers who provide services to more than 12 million Americans.
  • Eligible employers would submit applications for the recruitment and retention incentive premium on a rolling basis.

Federal Workforce. The proposal would ensure all federal government essential frontline employees receive the same $25,000 premium pay benefit provided to other essential workers.[2]

  • Coverage should be expansive to capture all federal employees with public-facing positions.  This includes Title 5 employees and employees of all other federal personnel systems (e.g., employees of the Postal Service, TSA, VA, FAA, District of Columbia, and federally-funded Indian programs[3]).
  • The benefit would be limited to frontline and public-facing positions – employees who are not teleworking from their homes.

Additional Background and Commentary

Precedents. Disasters require exceptional flexibility in standard work schedules and assignments and often put first responders and other essential workers in dangerous situations. To ensure this critical workforce is compensated appropriately, there are precedents for funding hazard premium pay and worker incentives through a federal program.

FEMA, through the Robert T. Stafford Disaster Response and Emergency Assistance Act and the Disaster Relief Fund, is currently authorized to reimburse state, local, and tribal governments for straight-time and premium pay associated with disaster response. Extraordinary costs (such as call-back pay, night-time or weekend differential pay, and hazardous duty pay) for essential employees who are called back to duty during administrative leave to perform eligible Emergency Work are eligible for reimbursement in certain circumstances.

This authority has been used many times over the last few years to pay for personnel costs associated with enforcing curfews, facilitating evacuation routes, and restoring critical infrastructure. Past usage illustrates precedent for federal funding of critical state, local, and tribal employees performing essential response functions that keep our communities safe in times of disaster.

Essential Frontline Worker definitions. As mentioned above, the definition of essential frontline workers for purposes of both the premium pay increase and the recruitment-retention incentive will be the subject of debate. This proposal is not meant to exclude any worker from this conversation. Rather, we hope this proposal will encourage a discussion about how large and diverse this universe of workers truly is. Our goal is to make federal, state, tribal, local and private sector essential workers that are at risk eligible for this benefit.

Retroactive Pay. Workers who have been on the frontlines since the initial declaration of the Public Health Emergency on January 27, 2020, could receive a lump sum of backpay of $13 per hour for work before enactment. These workers would continue to receive the $13 per hour premium pay on top of regular wages moving forward, but these workers would still be subject to the maximum premium pay cap outlined above.

Additional Benefits for Essential Health and Home Care Workers and First Responders. The employers of frontline health and home care workers and first responders should be eligible to apply for a second round of premium pay funds of up to $10,000 as those workers continue to combat the virus.

Death Benefits. It is a deeply disturbing but unfortunate reality that some of our frontline workers are making the ultimate sacrifice to the nation through their work fighting COVID-19. Their families rightfully deserve to receive the full amount of the premium pay as a lump sum in addition to all other forms of death benefits.

Protections from Corporate Expense Shifting. Certain large corporations engaged in the provision of essential services and goods employ essential frontline workers who are deserving of premium pay. However, massive corporations should make investments in providing premium pay of their own accord before trying to participate in this program.

Protecting Workers and PPE. Senate Democrats have been fighting to give essential workers the protections and equipment they need to stay safe. The CARES Act provided billions of dollars for PPE, and Democrats have pushed the Administration to appoint a czar to handle all manufacturing and distribution of critical PPE. We must do more to ensure all frontline workers have the protective gear they need to perform their jobs safely, and we need a strong emergency temporary standard to protect all workers.


[1] The recruitment and retention incentive might need to cover a broader swathe of workers in Indian Country and other underserved areas that experienced high levels of essential frontline worker vacancies prior to the COVID-19 pandemic.

[2] Certain federal workers are entitled under current law to a maximum 25 percent hazard premium pay for exposure to hazardous substances, including virulent biologicals.  However, President Trump has failed to activate this policy for the federal workforce during the COVID-19 pandemic.

[3] Federally-funded Indian program employees include any employee who works for 1) program operated by an Indian Tribe under an Indian Self-Determination and Education Assistance Act “638” contract or compact; 2) a Tribal Controlled Schools Act “297” grant Bureau of Indian Education school; or, 3) an urban Indian organization operating under an Indian Health Service contract pursuant to Title V of the Indian Health Care Improvement Act.

Legislative Text Example

Example from CARES Act without specified funding amount for UIOs:

The bill provides $1.032 billion to the Indian Health Service (IHS) in critically needed resources to support the Indian Health System during the pandemic, including expanded support for medical services, equipment, supplies and public health education for IHS direct service, tribally operated and Urban Indian Organizations; expanded funding for purchased/referred care; and new investments for telehealth services, electronic health records improvement, and expanded disease surveillance by tribal epidemiology centers. Not less than $450 million shall be distributed through Tribal shares and Urban Indian Organizations.

Example from CARES Act if it had specified funding for UIOs:

The bill provides $1.032 billion to the Indian Health Service (IHS) in critically needed resources to support the Indian Health System during the pandemic, including expanded support for medical services, equipment, supplies and public health education for IHS direct service, tribally operated and Urban Indian Organizations; expanded funding for purchased/referred care; and new investments for telehealth services, electronic health records improvement, and expanded disease surveillance by tribal epidemiology centers. Not less than $450 million shall be distributed through Tribal shares; and not less than $94 million to Urban Indian Organizations.

NCUIH Requests to Congress for COVID-4

NCUIH Letter to House Leadership on COVID-4 (April 10, 2020)

NCUIH Letter to Senate Leadership on COVID-4 (April 10, 2020)

NCUIH Essential UIO Requests for COVID-4 with Legislative Text

UIO Letter to Congress

UIO Survey Data on COVID-19

 

Letter Text:

April 10, 2020

Dear House and Senate Leadership:

On behalf of the National Council of Urban Indian Health (NCUIH) and the urban Indian organizations (UIOs) we represent,[1]we write to thank you for your continued commitment to ensuring American Indians and Alaska Natives in urban areas receive access to critical health care resources during this pandemic. NCUIH acknowledges and appreciates the hard work of our leaders in Congress who ensured that urban Indians were not overlooked in the first three phases of legislation to address COVID-19.

NCUIH writes to respectfully request that Congress honor the United States’ trust obligation for the provision of health care to American Indians and Alaska Natives (AI/ANs).  To this end, it is essential to include in the proposed fourth emergency coronavirus aid package measures necessary to improve access, prevention, mitigation, and treatment at UIOs. As the sole part of the Indian Health Service (IHS) health care system specifically designed to provide health care services to AI/ANs living off reservation, UIOs are a critical component of AI/AN health care, and they are at the frontlines of this pandemic.[2] Many UIOs report severe shortages of Personal Protective Equipment (PPE) – forcing reduced hours and even facility closures. In total, this pandemic has forced three UIOs to close their doors. This has rippling effects throughout the community – causing UIOs to lay off or furlough nearly 100 staff members and leaving families in our communities without essential services. UIOs have immediate needs that require critical funding and technical policy fixes to enable UIOs to continue to provide high quality care to their patients while also managing local outbreaks and minimizing risks to their communities.

A recent survey found that 83 percent of UIO-respondents have been forced to reduce their services, with 48 percent reporting no capacity for medicine delivery, and 28 percent reporting no capacity for triage space. Notably, every UIO respondent reported supply shortages. Added costs due to COVID-19 have reached almost $2 million per month at many UIOs. This creates significant strains on the already chronically underfunded facilities and requires prompt Congressional action. An appropriation of $161 million for Urban Indian Health would cover the remaining budgetary strain and unforeseen costs incurred since February and provide resources to enable UIOs to continue to provide high quality care to their patients while also managing local outbreaks and minimizing risks to their communities in the coming months.

NCUIH requests that the fourth package include the following critical policies, many of which are no cost technical fixes, to help UIOs provide high quality, culturally competent care to their patients during the pandemic.

Appropriations Requests for UIOs:

  1. A minimum of $161 million for UIOs in the IHS as an urban Indian health line item
  2. Establish an $80 million urban Indian facilities line item for expansion, renovation, and enhancements
  3. Establish a $1.7 billion Emergency Third-Party Reimbursement Relief Fund for IHS, Tribal Programs, and include a line item for UIOs at only $200 million

Federal or State Cost Savings Requests:

  1. 100% FMAP for UIOs (Current bills: S.1160/ H.R. 2316) – Bipartisan, bicameral support, which provides parity for Medicaid services
  2. Parity in Medical Malpractice Liability to Stretch Limited Federal Dollars (FTCA) for UIOs and Volunteers of Indian Health Care Providers
  3. Inclusion of UIOs in National Community Health Aide Program

No Cost Technical Fixes:

  1. Confer Policy for HHS
  2. Inclusion of UIOs in Advisory Committees with Focus on Indian Health
  3. Access to the National Stockpile (S. 3514)
  4. IHS-VA MOU fix for UIOs (Current bills: H.R. 4153/ S.2365) – Bipartisan, bicameral with IHS and VA support
  5. Access to the Public Health Emergency Program (Current bills: H.R. 6274/ S.3486)
  6. Amend Facilities Renovation (25 U.S.C. 1659) to include other accreditations

Unfunded Indian Health Provisions in the Indian Health Care Improvement Act (IHCIA):

  1. Establish a Current and Future Facilities Assessment for the urban health line item in IHS and fund at $570,000 (25 U.S.C. 1656)
  2. Establish an Urban Indian Health Community Health Representatives in IHS and fund at $3.05 million (25 U.S.C. 1660f)
  3. Establish UIO Health Information Technology line item in IHS and fund at $20 million (25 U.S.C. 1660h)

It is vital that Congress act expeditiously to provide resources for AI/AN people residing in urban areas. UIOs are on the front lines of this crisis – and we must support them.  These provisions are critical to ensure that the national policy, “in fulfillment of [the U.S.’s] special responsibilities and legal obligations to the American Indian people[,] to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to affect that policy”[3] is upheld. By omitting critical policies fixes from federal efforts to address the novel coronavirus pandemic, Congress would omit some AI/AN people -– simply on the basis of their place of residence.

Thank you for your partnership and please do not hesitate to reach out to a member of our team should you need further information on any of these policy requests.

Sincerely,

Francys Crevier, J.D.

Executive Director

Enclosures: COVID-19 Funding History

COVID-19 Funding History

Phase 1 – H.R. 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

    • $40 million minimum set-aside in CDC funds and $70 million of the HHS Public Health Emergency Fund distributed to IHS
      • CDC allocated $80 million in funds to Indian Country, with $8 million to UIOs
    • Of the $70 million of the Public Health Emergency Fund, IHS did not allocate any to UIOs, but will use $40 million to purchase PPE and medical supplies for the IHS National Supply Service Center

Phase 2 – H.R. 6201: Families First Coronavirus Response Act

    • $64 million for IHS
      • IHS allocated $3 million for urban Indian organizations

Phase 3 – H.R. 748: Coronavirus Aid, Relief, and Economic Security Act

    • $1.032 billion for IHS
      • IHS allocated $30 million for urban Indian health

[1] NCUIH represents 41 urban Indian Organizations UIOs which operate 74 health facilities spanning 22 states.

[2] As of the 2010 census, more than 70% of AI/AN people live in urban or suburban areas.

[3] Indian Health Care Improvement Act, 25 U.S.C. §â€¯1602.

POLITICO: Democrats seek hazard pay for health workers amid pandemic

Democrats seek hazard pay for health workers amid pandemic

By Tucker Doherty, Rachel Roubein

04/08/2020 08:14 PM EDT

Congressional Democrats are trying to add $13 per hour hazard payments for frontline health care workers up to a total of $25,000 in the next coronavirus relief package, along with $15,000 incentives for people who join the medical workforce surge during the pandemic.

Senate Minority Leader Chuck Schumer said a so-called Heroes Fund could compensate nurses, EMTs and other workers for unanticipated risks as they confront a flood of new cases. Some workers have unsuccessfully sought payments from cash-strapped hospitals and other employers experiencing a downturn in business from lockdowns and cancelations of nonessential procedures.

“No proposal will be complete without addressing the needs of our essential workers by giving them hazard pay,” Schumer said on a call this week with reporters.

But no Republican has signed on to the plan, an indication that bipartisan buy-in might be elusive as congressional Republicans race to send billions of dollars more to small businesses hit hard by the crisis. The White House didn’t comment for this story, and Senate Majority Leader Mitch McConnell’s office didn’t respond to a request for comment.

The proposed hazard payments would be limited for health professionals earning above $200,000, but even workers above the cutoff could receive up to $5,000. Schumer also proposed extending the payments to workers in other industries, including grocery store workers, truck drivers, drug store workers and pharmacists.

Some doctors and nurses have described staying in hotels to ensure they don’t inadvertently pass the virus to their families. Others have said they fear they’ll get infected, in part because of a severe shortage of specialized protective equipment.

”If you’re putting your life and your health on the line, or you come home to your family and you’re risking their health, that seems to me like something that should be compensated for,” said a resident physician from Cleveland, who asked to remain anonymous because he wasn’t authorized to speak to the press.

The recently passed CARES Act, H.R. 748 (116) , allows patients to get tested for coronavirus without out-of-pocket costs in most cases, but sick workers could be left with thousands of dollars in medical bills for subsequent treatment. According to the Kaiser Family Health Foundation, an average hospital admission for pneumonia with major complications costs more than $20,000 in total, including $1,300 in out-of-pocket costs.

Some doctors have also expressed frustration that they are ineligible for the law’s $1,200 stimulus checks, which are reduced for workers with incomes above $75,000. The labor market analytics firm Emsi found 41 percent of health practitioners are eligible for the full amount, compared to 83 percent of the labor market overall. In New York, a high wage state that has become the epicenter of the crisis, just 29 percent of health practitioners are fully eligible.

Democratic lawmakers and labor unions have pushed in the last week for hazard pay for health personnel and other essential workers. At an SEIU press event, Sen. Bob Casey (D-Pa.) called for legislation that would treat health workers as “soldiers coming off the battlefield.”

President Donald Trump floated the idea of hazard pay during an appearance of Fox News last week and said his administration was asking hospitals to consider bonuses for their front-line workers. But the $2.2 trillion stimulus bill’s hospital bailout fund is likely going to other needs. Hospitals say they’re desperate for more cash, as they work to buy much-needed equipment and grapple with revenue they’re losing from canceling elective surgeries.

Congress gave HHS wide latitude to determine how to divvy up those funds — and announced the first, $30 billion tranche, based on how providers bill Medicare, would go out to hospitals within days. The next batch will focus on health providers who get very few Medicare dollars, such as nursing homes, pediatricians and children’s hospitals.

Vice President Mike Pence has touted the announcement of a “special pandemic pay program” for the 40,000 employees of HCA Healthcare, one of the country’s largest hospital chains. But the company’s program is focused on maintaining pay for furloughed and quarantined employees.

Labor leaders say they’ve pushed for hazard pay alongside other worker priorities, such as adequate protective equipment. But with traditional revenues in collapse and costs increasing, they say even those employers receptive to the idea haven’t offered much.

“We’re attempting to get, in nursing homes in particular, time-and-a-half pay,” said Rob Baril, an SEIU regional president, “but ultimately, if there’s not additional federal or state money that comes down, it becomes very difficult for employers to meet those needs.”

Baril said essential workers were also being asked to make other sacrifices, such as quitting part-time jobs they rely on to make ends meet. A CDC report on the initial wave of deaths in Washington state nursing homes in March identified shared staff as a major cause of the spread between facilities. In response, some local health departments have banned the practice.

Some hospital operators and physician staffing firms have responded to funding shortfalls by cutting pay, benefits and hours. Envision Healthcare, a major private equity-backed provider scrutinized by Congress last year over surprise billing, is withholding pay and cutting salaries. Alteon Health, a major ER staffing firm, rolled back announced cuts to vacation and retirement benefits following critical media coverage.

Indian Health Service (IHS) Opioid Grant Pilot Program (OGPP)

On April 3, 2020, the Indian Health Service (IHS) in a Dear Tribal Leader and Urban Indian Organization Leaders (DTLL/DUIOLL) announced that they will be creating a new Indian IHS Opioid Grant Pilot Program (OGPP). OGPP is being funded by the $10 million increase for the Alcohol and Substance Abuse Program budget line funding, authorized by The Consolidated Appropriations Act, 2019 (Public Law 116-6).

As an immediate step, IHS will publish a Notice of Funding Opportunity (NOFO) in the Federal Register this spring.  The NOFO will outline details of the eligibility criteria, objectives, and funding methodology.  In general, the IHS anticipates to award up to 18 grants: one grant opportunity open to each of the IHS Areas; three grant opportunities open to Urban Indian Organizations; and three grant opportunities open to highest priority IHS Areas with a targeted focus on Maternal & Child Health.

A component of the OGPP includes national management and administrative activities, including intensive programmatic technical assistance and support to grantees in developing, implementing, and evaluating their pilot program.

The OGPP was formed after considering the input from 26 letters and over 100 comments IHS received during the comment period on OGPP.

JOB OPENING: Missoula Urban Indian Health Center – Wellness Care Coordinator (RN/CDE or RD)

Click to view Job Announcement

ABOUT MUIHC

MUIHC draws from a diverse skill set using an interdisciplinary team led approach to implement a comprehensive suite of healthcare services. We are working towards instituting trauma-informed practices and policies in order to achieve holistic wellness for the Missoula Native community.

MUIHC CLINIC LOCATION

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NCUIH Resource: COVID-19 and Telehealth for Urban Indian Organizations

Download PDF with Links

Contact: Andrew Kalweit, akalweit@NCUIH.org

COVID-19 & Telehealth at Urban Indian Organizations

Reimbursement for Telehealth Services has been expanded. Adopting telehealth may help treat an influx of COVID-19 patients while providing routine care to others.

Key Facts
  • Medicare now allows reimbursement for Urban Facilities
  • Virtual check-ins can use a broad range of devices and phones
  • State Medicaid programs are expanding reimbursement
  • Many private insurers have embraced the platform at parity to in-person services

General Resources & Start-Up Guides

Summary of Updates

Medicare Fee-for-Service

Provide Telehealth Visits, Virtual Check-ins, and E-visits
  • Medicare reimbursement is now allowed in urban areas
  • All services allow patients to initiate encounters from their home
  • Telehealth visits can be with new or established patients
  • E-visits and brief “virtual check-ins” can be reimbursed:
    • for emails, calls, texts, and audio/video streaming
    • with established patients
  • Eligible providers are:
    • Physicians
    • Nurse practitioners
    • Physician assistants
    • Nurse-midwives Clinical nurse specialists
    • Certified registered nurse anesthetists
    • Clinical psychologists (CP)
    • Registered dietitians or nutrition professional
  • See the CMS Fact Sheet for this 1135 waiver, the list of eligible codes, and FAQs.
  • Medicare has Waived licensing requirements that health care professionals hold licenses in the state in which they provide services.*

Medicaid

  • State Waivers have expanded opportunities for reimbursement
  • Policies vary between states, but updates have been collected online.
  • For a good guide for services in your state that were already reimbursable prior to COVID-19, see the 2019 CCHP Report.

Private Insurers

Letters on COVID-19 Response

Letters on COVID-19 Response