NCUIH FACILITATES FIRST FEMA UIO LEADERS CALL

MAY 29, 2020

On May 29, for the first time, the Federal Emergency Management Agency (FEMA) met exclusively with a group of Urban Indian Organization (UIO) leaders. The call took place via Zoom video conference. The purpose of the call was to provide UIOs an opportunity to learn about programs open to nonprofits, get questions answered, and open the lines of communication with FEMA officials. FEMA is one of the major operational components that make up the Department of Homeland Security, which is facilitating a whole-of-government response in confronting COVID-19, keeping Americans safe, and helping detect and slow the spread of the virus.

The following officials from FEMA participated in the call: Acting Director Public Assistance Division Tod Wells; Attorney-Advisor, Federal Indian Law Subject Matter Expert Dorn Lawin; Tribal Affairs Specialist Margeau Valteau; and Tribal Integration Advisor Jessica Specht. Dr. Rose Weahkee, Director of the Office of Urban Indian Health Programs at the Indian Health Service, was also in attendance. FEMA sent NCUIH responses to the questions UIO leaders asked in a document that can be found here.

House and Senate Leaders Send Letters of Support for Emergency Third-Party Reimbursement Fund for Indian Health Care Providers, Including UIOs

On May 5, 2020, Senators Kamala Harris (D-CA), Dianne Feinstein (D-CA), and Tom Udall (D-NM) and Representatives Markwayne Mullin (R-OK), Raul Ruiz (D-CA) led 55 of their colleagues in letters to Senate and House leadership requesting additional funding for third-party reimbursement losses for Indian Health Service facilities, Tribal Health Programs, and UIOs.

The letters highlight that third-party reimbursement is essential for the I/T/U system and losses in those funds are only exacerbating funding gaps and other issues facilities face during the pandemic.  The letters were finalized before the most recent phase of COVID-19 legislation, which was released on May 12 by the House of Representatives.

House Letter
Senate Letter

Sen. Harris Announces Legislation to Establish COVID-19 Racial and Ethnic Disparities Task Force with a UIO Representative

On April 30, 2020 Senator Kamala Harris announced she will introduce new legislation to combat racial and ethnic disparities during the COVID-19 pandemic. The COVID-19 Racial and Ethnic Disparities Task Force Act would create a task force designed to provide Congress and the Federal Emergency Management Agency (FEMA) with weekly recommendations on COVID-19 resource allocations according to racially disaggregated data, provide oversight and recommendations for federal agencies on COVID-19 relief funds, and report on structural inequalities before and in-response to COVID-19. The task force, following the COVID-19 public health crisis, would then become an Infectious Disease Racial Disparities Task Force.

The task force legislation is in response to many accounts of major racial disparities during this pandemic, including the health disparities American Indians and Alaska Natives (AI/ANs) are facing. To this end, the task force is set to include one representative on behalf of Urban Indian Organizations (UIOs) and Urban Indians. On May 8, 2020 Representative Robin Kelly (D-IL) introduced companion legislation in the House, H.R. 6763.

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Centers for Disease Control Releases Guidance on Reopening

On Thursday, May 14, 2020, the Centers for Disease Control (CDC) released guidance on reopening businesses, communities, schools, camps, daycares and mass transit. Previous guidelines were withheld by the Trump administration because they were deemed “too prescriptive” and restricted states that desired to reopen. The unreleased document was created by the nation’s top disease investigators with step-by-step advice to local authorities on how and when to reopen public places during the coronavirus outbreak. This report, titled Guidance for Implementing the Opening Up America Again Framework, was researched and written to help faith leaders, business owners, educators and state and local officials as they begin to reopen. This report was not released by the administration but was obtained by the Associated Press.

The new CDC released report provides a series of one page checklists which are designed to provide guidance to communities as they reopen. These checklists do not provide specific advice on when to reopen, rather they present a series of questions for employers to ask before they reopen. The checklists encourage social distancing, cleaning, monitoring of employee symptoms, flexible sick leave policies, the use of masks, as well as other suggestions. The guidance defers to state timelines on reopening. The more relaxed CDC guidelines were released amidst Dr. Anthony Fauci’s warnings that reopening the country too early could yield “really serious” consequences if states don’t have the capacity to respond to new infections.

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Senator Warren and Representative Levin Introduce Legislation That Would Establish a National Contact Tracing Program including UIOs

On Thursday, May 14, 2020, Senator Elizabeth Warren (D-Mass) and Representative Andy Levin (D-Mich) introduced the Coronavirus Containment Corps Act. The Coronavirus Containment Corps Act was co-sponsored by Sens. Tina Smith (D-Minn.) and Jeff Merkley (D-Ore.).The legislation would establish a federal coronavirus contact tracing program.  Sen. Warren and Rep. Levin would like the legislation to be incorporated into any future coronavirus relief packages.

The bill would require the Center for Disease Control (CDC) to develop a national strategy for coronavirus contact tracing within 21 days after coordinating with state, local, and Tribal health officials. The bill would require the Director of the CDC to coordinate with the Director of the Indian Health Service (IHS) to ensure the contact tracing needs of Indian Tribes are met. The legislation would provide states and Tribes with $10 billion for hiring contact tracers and other staff. It would also provide states and Tribes with $500 million to find those who have lost their jobs during the coronavirus and prioritize their hiring as contact tracers. In addition, the legislation will ensure patient privacy by requiring the CDC to anonymize data, automatically delete patient data, and prohibit data-sharing within the federal government except within the CDC and IHS. Tribal health data sovereignty would also be protected by the proposed legislation.

The bill also provides grants to Indian Tribes, Tribal organizations, Alaska Native entities, Indian controlled organizations serving Indians, Urban Indian organizations, or Native Hawaiian organizations. The purpose of these grants will bethe recruitment, placement, and training of individuals seeking employment in contact tracing and related positions.

Contact tracing will help mitigate the transmission of COVID-19 by identifying all individuals who have been in contact with someone who tested positive with coronavirus. These potentially infected individuals are then tested for coronavirus and encouraged to quarantine if they test positive.

The Coronavirus Containment Corps Act would be a significant step forward in ensuring the health of the American Indian/Alaska Native (AI/AN) Population during this pandemic. The legislation also helpsUrban Indian Organizationsby making them eligible for grants to promote job opportunities for Urban Indians as contact tracers.

CMS Issues Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency

This interim final rule with comment period (IFC) instituted by the Centers for Medicare & Medicaid Services (CMS) has instated several Medicare policies on an interim basis. These policies have authorized COVID-19 serology tests, to allow any healthcare professional authorized under State law to order COVID-19 diagnostic laboratory tests and provides new specimen collection fees for COVID-19 testing under the Physician Fee Schedule and Outpatient Prospective Payment System, during the public health emergency (PHE) for the COVID-19 pandemic.  CMS also adopted a relocation exception policy for on-campus and excepted off-campus provider-based departments of hospitals that relocate in response to the PHE.

In addition, CMS updated the Extraordinary Circumstances Exceptions policy under the Hospital Value-based Purchasing (VBP) Program to grant an exception to hospitals affected by an extraordinary circumstance without a request form, and granted exceptions under the updated policy to all hospitals participating in the Hospital VBP Program with respect to certain 4th quarter 2019 measure data that hospitals would otherwise be required to report in April or May of 2020, and measure data that hospitals would otherwise be required to collect during the 1st and 2nd quarters of 2020. Additionally, in response to the PHE, CMS is incorporating changes for Accountable Care Organizations participating in the Medicare Shared Savings Program by delaying 1 year the implementation of certain qualified clinical data registry measure approval criteria under the Quality Payment Program’s Merit-based Incentive Payment System.

This IFC also allows states operating a Basic Health Program (BHP) to seek certification of a revised BHP Blueprint for temporary, significant changes that are directly tied to the COVID-19 pandemic. CMS has also issued a waiver of the “3-hour rule” required by section 3711(a) of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), as well as modifying the coverage and classification requirements for freestanding hospitals to exclude patients admitted solely to relieve acute care hospital capacity in a state that is experiencing a surge during the PHE.  In addition, CMS is making changes to the Medicare regulations to revise payment rates for certain durable medical equipment and enteral nutrients, supplies, and equipment as part of implementation of section 3712 of the CARES Act.   The policies in this IFC are applicable beginning on March 1, 2020 or January 27, 2020, depending on the policy.

Tribal Budget Formulation Workgroup Releases FY22 IHS Funding Recommendations with $200.5 Million for UIOs

Tribal Budget Formulation Workgroup Releases FY22 IHS Funding Recommendations with $200.5 Million for UIOs

On February 13-14, 2020, the Tribal Budget Formulation Workgroup (TBFWG) convened in Arlington, Virginia to develop the National Tribal Budget Recommendation for fiscal year (FY) 2022. On May 4, 2020, a summary of the TBFWG’s Budget Recommendation was released in a document called Reclaiming Tribal Health: A National Budget Plan to Rise Above Failed Policies and Fulfill Trust Obligations to Tribal Nations. The FY 2022 National Tribal Budget Recommendation is $12.759 billion, representing a 30% increase above the FY 2021 National Tribal Budget Recommendation.

The TBFWG recommended a $90.94 million increase for the urban Indian health line item, bringing the funding for Urban Indian Organizations (UIOs) to a total of $200.5 million.

Other UIO priorities the TBFWG included were:

  • 100% Federal Medical Assistance Percentage (FMAP) for UIOs
  • Reimbursement from the Department of Veterans Affairs for services provided to dually eligible American Indians and Alaska Natives (AI/ANs) for UIOs
  • Eligibility for malpractice insurance through the Federal Tort Claims Act (FTCA) for UIOs
  • Eligibility for UIOs to participate in more IHS grant programs.

In addition, the TBFWG highlighted § 105(l) leases by requesting mandatory funding for § 105(l) leases of $337 million, permanent reauthorization for the Special Diabetes Program for Indians (SDPI) with an increase of funding to $200 million per year, advance appropriations for IHS, and renewal of the Indian Health Care Improvement Act.

VIEW HISTORICAL BUDGET FORMULATION RECOMMENDATIONS

PRESS RELEASE: House Passes Latest COVID-19 Bill with $64 Million for UIOs, 100% FMAP for UIOs for 1 Year, VA-IHS Fix for UIOs, and Third Party Relief Fund

FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

NCUIH also testified before the House Natural Resources Committee today on the HEROES Act.

Washington, DC (May 15, 2020) – Today, the House of Representatives passed the latest iteration of COVID-19 legislation, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. This new stimulus bill totals over $3 trillion and includes additional state and local government funding, additional health care funding including $2.1 billion for IHS with $1 billion for reduced third party billing collections and $64 million for Urban Indian Organizations (UIOs), 100% FMAP for UIOs for 1 year, and VA reimbursement parity for UIOs. NCUIH’s President and CEO of NATIVE HEALTH Walter Murillo also testified before the House Committee on Natural Resources Subcommittee on Indigenous Peoples on the HEROES Act today.

walter “The COVID-19 pandemic significantly affects densely populated areas and UIOs are seeing high positive-testing rates. As our health workers are risking their lives every day, we need the federal government to ensure our frontline heroes receive the same protections as all other public health employees. There is more work to be done and we look forward to working with our elected federal representatives in Congress on ensuring the HEROES Act and future legislation provides urban Indian organizations the resources to address this crisis,” said Walter Murillo in his testimony before the House Committee on Natural Resources.

“NCUIH applauds the work of the House of Representatives to introduce this bill with a focus on helping Indian Country address this pandemic which is causing devastation in our communities every day. As NCUIH has been tirelessly advocating for Urban Indian Health in each package, we are appreciative of the inclusion of $64 million for Urban Indian Organizations (UIOs), at least $1 billion in funds to recoup the third-party dollars lost by UIOs and Indian Health Care Providers, 100% FMAP for UIOs through June 30, 2021, and a permanent fix for UIO services provided to Native Veterans. We look forward to working with our Senate champions to ensure these provisions are included in the final package and are hopeful for the addition of the essential parity fix of FTCA for UIOs,” said Francys Crevier, Executive Director.

In his opening remarks for today’s roundtable, Chair of the Subcommittee of Indigenous Peoples, Rep. Ruben Gallego stated, “Inequities are felt beyond the borders of our reservation. For example, urban Indians in places like Phoenix face their own unique challenges in getting access to care. Indian Country has suffered more than any other Americans during the H1N1 pandemic and Spanish flu pandemic a century ago – also because of federal government failures.”

“Unmet needs have been estimated to be close to 32 billion dollars. Accordingly we strongly support increased funding for the system that includes emergency third party reimbursement relief fund and technical Medicaid and Medicare fixes such as the authorization of Medicaid reimbursements for Qualified Indian Provider Services,” said Kevin Allis, CEO of NCAI in his testimony today.

Bill Highlights

  • $2.1 billion for IHS “to prevent, prepare for, respond to, and provide health services related to coronavirus”
    • $1 billion to supplement reduced third party billing collections
    • Not less than $64 million for Urban Indian Organizations (UIOs)
  • $2.1 billion for CDC “to prevent, prepare for, and respond to coronavirus, domestically or internationally”
    • $1 billion for “necessary expenses for grants for core public health infrastructure for State, local, Territorial, or Tribal health departments”
    • Not less than $100 million to “be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes”
  • $3 billion for SAMHSA “to prevent, prepare for, and respond to coronavirus”
    • Not less than $150 million to “be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes”
  • 100% FMAP for services provided through urban Indian organizations “from July 1, 2020 – June 30, 2021”
    • Note: this is only a temporary authorization of 100% FMAP for UIOs
  • Health inequities research: IHS “in coordination with Tribal Epidemiology Centers and other Federal agencies, shall conduct or support research and field studies for the purposes of improved understanding of Tribal health inequities among AI/ANs”
  • VA reimbursement parity for UIOs serving dually eligible AI/AN Veterans

Next Steps

The Senate is still working to develop its own iteration of the next coronavirus package, but Senate Republicans have yet to reach an agreement with Senate Democrats on its timing or content. NCUIH will continue to advocate for the inclusion of UIOs in the final package including the addition of the FTCA parity bill that was introduced in the Senate and House, permanent 100% FMAP for UIOs, VA-IHS parity for UIOs, and the $1.7 billion relief fund advocated for by NCAI, NIHB, and NCUIH.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

NCUIH President to Participate in Roundtable on Heroes Act Benefits for Indian Country

On Friday, May 15, NCUIH President and CEO of NATIVE HEALTH in Phoenix, Walter Murillo will participate in a Roundtable on Coronavirus in Indian Country: Tribal and Urban Organizations.

More Information

May 13, 2020

Media Contact: Adam Sarvana

(202) 225-6065 or (202) 578-6626 mobile

Friday Livestream: Chair Grijalva, Subcommittee Chair Gallego Lead Roundtable on Heroes Act Benefits for Indian Country, Still Unmet Tribal Needs

Washington, D.C. – Chair Raúl M. Grijalva (D-Ariz.) and Rep. Ruben Gallego (D-Ariz.) are hosting a livestreamed roundtable discussion on Friday, May 15, at 1:00 p.m. Eastern time with three national tribal organizations to discuss the House of Representatives’ newly introduced Heroes Act, the ongoing implementation of the CARES Act, and the pressing need for additional federal support in Native American communities across the country to combat the coronavirus.

Gallego is chair of the Subcommittee for Indigenous Peoples of the United States. The event is the second in an ongoing series on coronavirus impacts in Indian Country, which has remained in the national headlines as the virus continues to spread while the Trump administration fails to respond.

Title: Coronavirus in Indian Country: Tribal and Urban Organizations

When: 1:00 p.m. Eastern time on Friday, May 15

Watch Live: https://bit.ly/2zxImiJ (Facebook) or https://youtu.be/ly9iQe8BM4M (YouTube)

Speakers

  • Raúl M. Grijalva, Chair, House Committee on Natural Resources 
  • Ruben Gallego, Chair, Subcommittee for Indigenous Peoples of the United States
  • Kevin J. Allis, Chief Executive Officer, National Congress of American Indians
  • Dante Desiderio, Executive Director, Native American Finance Officers Association
  • Walter Murillo, President, National Council of Urban Indian Health

PRESS RELEASE: Senators Smith, Lankford, McSally and Udall Introduce Bill to Expand Resources for Urban Indian Organizations amid Pandemic

FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

The long-needed fix would allow urban Indian organizations to direct funds back to the patients who need it most.

Washington, DC (May 8, 2020) – Yesterday, Senators Tina Smith (D-MN) and James Lankford (R-OK) introduced bipartisan legislation with Senators Tom Udall (D-NM) and Martha McSally (R-AZ) to expand Federal Tort Claims Act (FTCA) coverage to urban Indian organizations, giving them a desperately needed boost in resources as many suffer critical supply shortages, closures, and financial hardship as a result of the COVID-19 pandemic. The Coverage for Urban Indian Health Providers Act (S.3650), would amend the Indian Health Care Improvement Act to create parity within the Indian Health System. This is a companion bill to H.R. 6535, introduced on April 17, 2020 by Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK).

Urban Indian organizations (UIOs) are doing everything they can to keep their doors open during this pandemic while still dealing with paying for costly medical malpractice insurance. Unfortunately, urban Indian organizations may be forced to make extremely difficult choices – facing competing priorities and expenses like increased PPE prices, trying to pay for testing and supplies, in addition to very costly malpractice insurance. S. 3650 would create parity within the Indian Health Service health system by extending FTCA coverage to urban Indian organizations, who currently are forced to divert resources away from health care in order to foot exorbitant liability costs themselves.

“We are extremely grateful for the leadership of Senator Smith, Lankford, McSally and Udall in introducing this bipartisan legislation for a long-needed fix to the medical malpractice liability protection, which ensures parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, funds that could be spent on PPE and testing kits for the American Indians and Alaska Natives they serve – made even more essential as our communities are hit by this pandemic. As all other Indian Health Care Providers are covered by FTCA and Community Health Centers employees as well as volunteers are also covered, this legislative fix is critical to ensure continuity of health care in a time when it’s needed most,” said Francys Crevier, Executive Director of the National Council of Urban Indian Health (NCUIH).

“Minnesota’s urban Indigenous community has been hit hard by the coronavirus pandemic, yet many urban Indian health organizations are often forced to spend hundreds of thousands of dollars on costly liability protection instead of being able to use those resources to provide health care to Native community members,” said Sen. Smith. “This is unacceptable. We need to make sure that urban Indian organizations can use every dollar they have to give urban Indigenous individuals the care they need. I’m glad to work in a bipartisan way to bring financial relief to these vital organizations.”

“There are two prominent UIOs in Oklahoma that faithfully serve our Tribal communities’ healthcare needs in addition to the other important Tribal health facilities around the state. I am glad our bill addresses this disparity in the law to help ensure equal access to medical malpractice liability coverage for the services they offer,” said Sen. Lankford. “Federal tort law currently omits coverage for UIOs, and especially during the coronavirus pandemic, UIOs, like other already covered Tribal health facilities, need to have the peace of mind that they can utilize their funds for care, not court cases.”

“Urban Indian health programs funded by the IHS are facing revenue shortfalls while ramping up services to combat the COVID-19 pandemic. And, as a result, many of these critical health care programs are struggling to keep the lights on and their doors open. They shouldn’t be the only branch of the IHS that has to divert resources away from health care services to cover exorbitant liability costs,” said Sen. Udall. “The federal government’s trust and treaty responsibilities to Native Americans do not stop at reservation boundaries. Nearly 70 percent of American Indians and Alaska Natives live in urban areas and Congress must ensure they have access to quality health care — especially during this public health crisis. This legislation is a common-sense measure to provide Urban Indian Health Programs with the same federal protections given to all other Indian Health Care Providers.”

“Arizona is home to four Urban Indian Organizations, all of which are forced to spend hundreds of thousands of dollars annually on liability insurance that could otherwise be spent on patients,” said Sen. McSally. “Our legislation will fix this inequity by extending federal liability coverage to our urban Indian health groups, dramatically decreasing the cost of malpractice insurance while freeing up more money for patient care. Bringing parity to Urban Indian Health is an important step to improving Native American health care across the board.”

“On behalf of the NCUIH and NATIVE Health in Phoenix, we appreciate the strong commitment from Arizona Senator McSally in ensuring parity for urban Indian health care providers. In addition to stretching already limited resources more thin, especially during this time of crisis, we are unable to share providers across our clinics. We are hopeful that Congress will act quickly to enact this bipartisan fix to allow our programs to have more resources to put directly back into patient care during this this pandemic,” said Walter Murillo, President of NCUIH, CEO of NATIVE Health.

“Oklahoma City Indian Clinic has been operating on the front lines of this crisis with limited resources. We spend hundreds of thousands of dollars each year on liability insurance for our providers. With parity in FTCA, we would put every cent back into services which will allow us to fulfill our mission of providing excellent health care to American Indians.  Increasing access to quality health care and preventive wellness services and producing positive health outcomes for urban American Indians living in central Oklahoma is the business we are in.  We applaud the leadership of Senator Smith and Senator Lankford on helping redirect resources back to patients and families who rely on our services,” said Robyn Sunday Allen, NCUIH Vice-President and CEO of Oklahoma City Indian Clinic.

“We are grateful to our Senator Tina Smith as well as Senators Udall, McSally and Lankford for introducing this important legislation to help Urban Indian Organizations like Indian Health Board of Minneapolis. Despite the coronavirus pandemic and its implication and impact that is has on our clinic as well as our community, IHB continues to provide health care services that are vital to the ongoing needs of the community we serve. We are hopeful for FTCA coverage to allow us to redirect those resources back to our patients during this pandemic,” said Dr. Patrick Rock, CEO of the Indian Health Board of Minneapolis.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.