House Passed NCUIH IHS – VA Bill

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On December 3, the House passed the Health Care Access for Urban Native Veterans Act (H.R. 4153) which would amend the Indian Health Care Improvement Act (IHCIA) to enable the VA to reimburse Urban Indian Organizations (UIOs) for services to VA beneficiaries at urban Indian health centers.

This passage comes after advocacy from NCUIH and other national organizations serving American Indians/Alaska Natives (AI/AN). On July 15, 2019, NCAI passed a resolution calling on the United States Congress to enact legislation requiring the Veterans Affairs Administration to reimburse UIOs for health care provided to AI/AN veterans. Following the resolution, NCUIH testified before Congress on Native Veterans’ access to healthcare, asking the Department of Veterans Affairs to “fully implement the VA and Indian Health Services’ Memorandum of Understanding (VA-IHS MOU) and Reimbursement Agreement for Direct Health Care Services.”

On December 4, the National Council of Urban Indian Health (NCUIH), National Congress of American Indians (NCAI), and National Indian Health Board (NIHB) wrote a letter urging Congress to ensure the passage of this bill before the end of the year.

 

Why does this matter to UIOs?
  • Most AI/AN veterans live in urban areas and would benefit from the culturally competent care provided at UIOs. Reimbursement for these services would allow UIOs to adequately serve Native Veterans.
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PRESS RELEASE: First-Ever Standalone NCUIH Bill Passes Congress to Shore Up Resources for Urban Indians

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FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

December 20, 2020 (Washington, DC) – On December 20, the Senate voted to pass to H.R. 6535 by unanimous consent to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs) instead of having to divert scarce resources away from health care to foot exorbitant insurance costs. On December 17, the United States House of Representatives passed by unanimous consent under suspension of the rules. The passage of this non-controversial bill is a step forward in creating parity within the Indian Health System to ensure that the trust and treaty responsibility is upheld by the US government.

“We applaud Congress and the Administration for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts as we are in the midst of a pandemic. As our frontline workers risk their lives in this pandemic that is devastating Indian Country, this will be critical to saving Native lives and will increase available health care services. We are thankful to Senators Smith, Lankford, Udall, Hoeven and Schumer along with our House leaders, Representatives Gallego, Mullin, Grijalva, Pallone, Young, and Cole” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites. Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now go to the President for his signature.

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House Passes NCUIH Bill to Extend FTCA Coverage to Urban Indian Health Workers

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December 17, 2020

Today, the United States House of Representatives voted to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs), which would put a stop to having to divert scarce resources away from health care to foot exorbitant insurance costs. This bill was passed by unanimous consent under suspension of the rules and will now be referred to the Senate for further consideration.

“We applaud the House, especially Rep. Ruben Gallego and Rep. Markwayne Mullin, for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts. We urge the Senate to move quickly to pass this law before the end of this Congress. As we battle this pandemic that is devastating Indian Country, this will be critical to save Native lives and will increase available health care services,” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites.1 Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now be referred to the Senate for further consideration. On December 4, 2020, NCUIH and the National Congress of American Indians sent a letter to Congress to urge them to pass this bill before the end of the year and will continue to work with the Senate to encourage swift passage.

Background

Contact:

Meredith Raimondi

Director of Congressional Relations

mraimondi@ncuih.org

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NCUIH Statement on President-elect Biden’s Nomination of Urban Indian Health Champion Haaland

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President-elect Joe Biden nominated New Mexico Congresswoman Deb Haaland as Secretary of the Department of the Interior. If confirmed, she would be the first Native person to hold a Cabinet-level position and the first to lead Interior. In addition to public lands, waterways, wildlife, national parks, and natural resources that fall under the purview of Interior, the agency has wielded untold influence over the nation’s federal policy towards tribes and Native people in general throughout its history. As Congresswoman for New Mexico’s Second District and Co-Chair of the Native American Caucus, Congresswoman Haaland been championed priorities for Urban Indian health, including First Nations Community HealthSource in Albuquerque.

“NCUIH is so pleased to learn that Representative Haaland will be tapped to lead the Department of the Interior and will be the first Native in a Cabinet-level position,” said Francys Crevier, Algonquin, CEO of the National Council of Urban Indian Health. “As vice chair of the House Committee for Natural Resources, she has been exceptionally supportive of legislation that upholds tribal sovereignty and improves the quality of life for all Native people, including those residing in urban areas. The selection of a Native woman to oversee this agency holds special significance for us because of the sordid history of federal government policies to dispossess indigenous people of their land and culture with an intent to ‘kill the Indian, save the man.’ Today, Urban Indians participate in many programs under the Department of the Interior, Bureau of Indian Affairs, and Bureau of Indian Education, including social services and adult care assistance. We are confident that Representative Haaland will bring the same level of competence and passion to her role as Secretary and congratulate her for this well-deserved nomination.”

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COVID-19 RELIEF BILLS Include Support for Indian Country Including Urban Indians

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The proposal begins to address the many urgent needs of Indian Country.

On December 14, a bipartisan group of lawmakers released two bills totaling $908 billion that would provide economic relief amid the COVID-19 pandemic, including several Indian Country relief measures. The first bill titled “Emergency Coronavirus Relief Act of 2020,” provides $748 billion in unemployment assistance, COVID-19 vaccine funding, health care funding, and other emergency relief. The second bill, “Bipartisan State and Local Support and Small Business Protections Act,” allocates $160 billion for state, local, and tribal government aid and liability protection for business.

In summary, the first bill provides the following for IHS, tribal organizations and Urban Indian Organizations (UIOs):

  • $1 billion in to IHS in Provider Relief Funds
  • $350 million to IHS for COVID-19 testing and contact tracing purposes
  • $129 million from CDC to IHS to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
  • $185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

On December 4, 2020, NCUIH, NCAI, and NIHB wrote a letter to Congress regarding this COVID-19 package. In the letter, the organizations requested $2 billion in emergency funds to Indian Health Service (IHS) for immediate distribution to Indian Health Service/Tribal Health Program/UIO (I/T/U) system, minimum $1 billion to replenish lost third-party reimbursements across the I/T/U system, a minimum five percent I/T/U funding set-aside for vaccine distribution and administration, and long-term reauthorization of the Special Diabetes Program for Indians (SDPI).

Next Steps

  • Congress is close to an agreement and will continue negotiations to pass a final relief package.
  • NCUIH will continue to monitor developments.

Summary

FUNDING: EMERGENCY CORONAVIRUS RELIEF ACT OF 2020

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

  • This bill provides $1 billion in Provider Relief Funds to IHS to assist IHS directly operated programs, programs operated by tribes and tribal organizations, and urban Indian organizations
    • $700 million shall be used to supplement reduced third-party revenue collections
    • $200 million shall be allocated at the discretion of the Director of IHS for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at IHS and tribal facilities
    • $100 million shall be allocated at the discretion of the Director of the IHS for additional expenditures necessary to the purposes specified within this Act

VACCINE TESTING AND CONTACT TRACING

  • Provides $350 million to IHS, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for COVID-19 testing and contact tracing purposes

 

VACCINE DISTRIBUTION AND ADMINISTRATION

  • Provides $6 billion for CDC-wide activities and program support with $2.58 billion to be made available for vaccine distribution and administration
    • $129 million shall be allocated to IHS to fund IHS directly operated programs, programs operated by tribes and tribal organizations, urban Indian organizations, and health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
    • The remainder of the $2.58 billion allocation can be made available for other activities regarding COVID-19, including grants, contracts, or cooperative agreements to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.

 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

  • $3.15 billion allocated for the Substance Abuse and Mental Health Administration (SAMHSA) program support
    • $1.3 billion shall be for the State Opioid Response Grant
    • $50 million shall be made available to Indian Tribes and Tribal organizations
    • $185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

 

FUNDING: BIPARTISAN STATE AND LOCAL SUPPORT AND SMALL BUSINESS PROTECTIONS ACT

CORONAVIRUS LOCAL COMMUNITY STABILIZATION FUND

  • Provides $160 billion to the Coronavirus Local Community Stabilization Fund for State and Tribal entities
    • Of this amount, $8 billion shall be reserved for Tribal entities and 60 % be allocated based on relative population of each Tribal entity and 40% based on the number of employees for each Tribal entity

 

Topic Funding/Section Language
Public Health and Social Services Emergency Fund $1,000,000,000 “That of the amount made available under this paragraph in this Act, not less than $1,000,000,000 shall be transferred to the Indian Health Service, which may allocate the funds for Indian Health Service directly operated programs, programs operated by tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act (25 U.S.C.5301 et seq.), and contracts or grants with Urban Indian organizations under title V of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.)”
$700,000,000 “$700,000,000 shall be used to supplement reduced third party revenue collections”
$200,000,000 “$200,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at Indian Health Service and tribal facilities”
$100,000,000 “$100,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for additional expenditures necessary to the purposes specified within this Act”
Vaccine Testing and Contact Tracing $350,000,000 “transfer $350,000,000 to the Director of the Indian Health Service, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for such purposes.”
Vaccine Distribution and Administration $6,000,000,000,

 

 “For an additional amount for ‘‘CDC-Wide Activities and Program Support’’, $6,000,000,000 to remain available until expended, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for distribution and administration of and communications about coronavirus vaccines”
$2,580,000,000 “From the $6,000,000,000 appropriated under the heading ‘‘Department of Health and Human Services—Centers for Disease Control and Prevention—CDC-Wide Activities and Program Support’’, the Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall make available— $2,580,000,000 for activities described in paragraph (3) (Vaccine distribution and administration)”
$129,000,000 “$129,000,000 shall be transferred to the Indian Health Service, which may, in consultation with the Director of the Centers for Disease Control and Prevention, allocate the funds for Indian Health Service directly operated programs, for programs operated by tribes and tribal organizations

under the Indian Self-Determination and

Education Assistance Act (25 U.S.C. 5301

10 et seq.), for contracts or grants with urban

Indian organizations under the Indian Health Care Improvement Act (25 U.S.C.

13 1601 et seq.), and for health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications.”
Remainder of $2,580,000,000 “From the amount made available under paragraph (1)(B) and not allocated under subparagraph (A), the Secretary shall make available the remainder of such amount for other activities to prevent, prepare for, and respond to coronavirus, domestically or internationally, including—[…] a contingency fund for additional amounts the Secretary may award, including through grants, contracts, or cooperative agreements, to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.”
Substance Abuse and Mental Health Services $3,150,000,000 “Provided, That in addition to amounts provided herein, for an additional amount, $150,000,000 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93 […] For an additional amount for carrying out titles III and V of the PHS Act, including grant programs under such title V, with respect to substance abuse treatment and prevention, $3,000,000,000”
$1,300,000,000 “Provided, That of such amount, $1,300,000,000 shall be for the State Opioid Response Grants for carrying out activities pertaining to opioids, stimulants, and alcohol undertaken by State agencies responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x–21 et seq)”
$50,000,000 “Provided further, That of such amount, $50,000,000 shall be made available to Indian Tribes and Tribal organizations”
$185,000,000 “For an additional amount for carrying out titles III, V, and XIX of the PHS Act, in coordination with the Indian Health Service, with respect to substance use disorder and behavioral health among Indian tribes, tribal organizations, and urban Indian organizations, $185,000,000: Provided, That such amount is designated by the Congress as being for an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901(b)(2)(A)(i)).”
Coronavirus Local Community Stabilization Fund $160,000,000,000 “Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated for making payments to States and Tribal entities under this section, $160,000,000,000 for fiscal year 2021, to remain available until expended.”
$8,000,000,000 “Of the amount appropriated under paragraph (1), the Secretary shall reserve $8,000,000,000 of such amount for making payments to Tribal entities under subsection (c)(7), subject to subparagraph (B).”

 

 

Why is this important to UIOs?

  • UIOs need additional funding to provide adequate health care for American Indians/Alaska Natives and ensure successful COVID-19 vaccine distribution and administration.
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PRESS RELEASE: Indian Health Service Allocates Vaccines for Urban Indian Organizations

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FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

After being excluded in previous pandemics, this is a step in the right direction for urban Indians.

Washington, D.C. (December 16, 2020) – The Indian Health Service (IHS) began the allocation process for the COVID-19 vaccine to IHS facilities, Tribal-facilities and Urban Indian Organizations (UIOs). As part of the 1A distribution process, initial doses from IHS are for Indian Health Care Providers and residents of long-term health centers. Since the start of the pandemic, the National Council of Urban Indian Health (NCUIH) has advocated for the vaccine distribution to include all of Indian Country, including urban Indian populations.

“As the data continues to show, this pandemic is killing our people at devastating rates as Indian Country bears the brunt of this crisis,” said Francys Crevier (Algonquin), NCUIH CEO. “With the approval of the vaccine, there is a glimmer of hope. As urban Indians were left out of the H1N1 vaccine discussions, we are encouraged to see that Urban Indian Organizations and their staff who are providing life-saving care to our communities were among the first wave to receive vaccines.”

The Gerald Ignace Center in Wisconsin was one of the first UIOs to receive the vaccine for their health care workers. (See the video here.)

Next Steps

  • A full schedule of the organizations receiving the vaccine is not publicly available from the Administration.
  • NCUIH will provide updates as more information becomes available.

Background

###

About the National Council of Urban Indian Health The National Council of Urban Indian Health (NCUIH) is the national organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/ANs) living in urban settings. NCUIH envisions a nation where comprehensive, culturally competent personal and public health services are available and accessible to AI/ANs living in urban communities throughout the United States.  NCUIH is the only organization that represents all 41 Urban Indian Organizations (UIOs) federally funded by the Indian Health Service.

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NCUIH SIGNS THREE JOINT LETTERS URGING CONGRESSIONAL ACTION BEFORE THE END OF THE YEAR

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The National Council of Urban Indian Health (NCUIH) signed three letters urging Congress to act on priority issues in Indian Country: COVID-19 stimulus health funds for Indian Country, extension of Federal Tort Claims Act (FTCA) coverage to Urban Indian Organizations (UIOs), and passage of several tribal Veteran bills.

COVID-19 Stimulus Health Funds for Indian Country

This letter, signed by NCUIH, the National Indian Health Board (NIHB), and the National Congress of American Indians (NCAI), advocates for COVID-19 pandemic relief and includes the following funding priorities:

  • Minimum $2 billion in emergency funds to Indian Health Service (IHS) for immediate distribution to Indian Health Service/Tribal Health Program/UIO (I/T/U) system
  • Minimum $1 billion to replenish lost third-party reimbursements across the I/T/U system
  • Minimum five percent I/T/U funding set-aside for vaccine distribution and administration
  • Long-term reauthorization of the Special Diabetes Program for Indians (SDPI)

Read the letter.

FTCA Coverage for UIOs

The letter, signed by NCUIH and NCAI, advocates for parity in the Indian Health System (IHS) by urging Congress to pass H.R. 6535 / S. 3650. This legislation would extend the same insurance coverage as IHS and Tribal facilities to UIOs. This bill has passed the House Natural Resources Committee and is awaiting action to be added to the House suspension calendar.

Read the letter.

Tribal Veterans Bills

This letter, signed by NCUIH, NCAI, and NIHB, deals with several bills supporting Native Veterans including NCUIH’s H.R. 4153 which was passed in the House on Thursday, December 3 by unanimous consent. It now awaits further consideration by the Senate where NCUIH is advocating for it be hotlined before the end of the year.

Read the letter.

Why is this important to UIOs?

  • Passage of these bills would mean liability coverage for UIOs, improved health care delivery for Native Veterans, and increased funding to respond to the pandemic.

NCUIH Contact: Meredith Raimondi, Director of Congressional Relations, (mraimondi@ncuih.org)

 

LETTERS:

 

December 4, 2020

Re: COVID-19 Stimulus Health Funds for Indian Country

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally-recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to include the following emergency funding and technical resources for Indian Health Service (IHS), Tribal governments, and urban Indian organizations (collectively “I/T/U”) in any year-end COVID-19 stimulus package, omnibus appropriations package, or in a separate legislative vehicle, before the end of the 116th Congress.

  • Minimum $2 billion in emergency funds to IHS for immediate distribution to I/T/U system
  • Minimum $1 billion to replenish lost 3rd party reimbursements across the I/T/U system
  • Minimum 5 percent I/T/U funding set-aside for vaccine distribution and administration
  • Minimum $1 billion for water and sanitation systems across IHS and Tribal communities
  • Long-term reauthorization of the Special Diabetes Program for Indians(SDPI)

Over the course of this pandemic, Tribal Nations, Tribal organizations, and UIOs have submitted countless letters to Congress outlining the devastating toll of COVID-19 across Indian Country. Most recently, on September 8, we wrote to you about the urgent need for Congress to pass the same critical priorities outlined in this letter. Back in July of this year, the bipartisan Congressional Native American Caucus submitted a letter to House Appropriations Committee Chair Lowey and Ranking Member Granger, urging inclusion of the Tribal priorities outlined in our joint letters. But as of this writing, we still await congressional action on these priorities while COVID-19 conditions in Indian Country have only worsened.

Since mid-July,therehasbeena390% increase in COVID-19 case infections among AI/ANsreportedbyIHS1, and a 179% increase in hospitalization rates among AI/ANs.2 According to the Centers for Disease Control and Prevention (CDC), COVID-19 death rates among AI/ANs are 2.6 times the rate for non-Hispanic Whites.3As of November 30, IHS has reported a 7-day rolling average positivity rate of 14.5% nationwide, with some IHS Areas experiencing positivity rates at above 26%.4 In comparison, according to CDC data, the nationwide average 7-day positivity rate has not surpassed 15% since week 19 of the pandemic (ending May 9, 2020). These sobering data points only affirm the fact that Indian Country continues to bear the brunt of this crisis. Just this week, CDC Director Dr. Redfield warned that COVID-19 deaths could reach as high as 450,000 come February – demonstrating that the toll of the virus is far from over. Without sufficient additional congressional relief sent directly to I/T/U systems, these shocking upward trends will likely continue because I/T/U systems have limited resources to mitigate, treat, and respond to the virus.

Meanwhile, the Special Diabetes Program for Indians (SDPI) – a program that is instrumental for COVID-19 response efforts in Indian Country because it is focused on prevention, treatment, and management of diabetes, one of the most significant risk factors for a more serious COVID-19 illness5 – has endured five short-term extensions since last September, placing immense and undue strain on program operations. In fact, a national survey conducted by the National Indian Health Board (NIHB) found that nearly 1 in 5 Tribal SDPI grantees reported employee furloughs, including for healthcare providers, with 81% of SDPI furloughs directly linked to the economic impacts of COVID-19 in Tribal communities. Roughly 1 in 4 programs have reported delaying essential purchases of medical equipment to treat and monitor diabetes due to funding uncertainty, and nearly half of all programs are experiencing or anticipating cutbacks in the availability of diabetes program services – all under the backdrop of a pandemic that continues to overwhelm the Indian health system.

To be clear, we appreciate the over $1 billion to IHS under the CARES Act and the $750 million Tribal testing set-aside under the Paycheck Protection Program and Health Care Enhancement Act; however, these investments have been necessary but insufficient to stem the tide of the pandemic in Tribal and urban AI/AN communities. While were main optimistic that Congress can pass an omnibus appropriations package for Fiscal Year (FY)2021 by December 11, the possibility of another continuing resolution (CR) remains. We remind you that IHS is the only federal healthcare delivery system that is not exempt from CRs and government shutdowns.

If Congress fails to provide sufficient emergency appropriations for the I/T/U, a stopgap measure will force a health care system serving roughly 2.6million AI/ANs to continue operating under a pandemic without an enacted budget or even adjustments for medical and non-medical inflation. In addition, IHS will be forced to coordinate distribution and administration of a COVID-19 vaccine without additional federal resources and funding. In short, that is a recipe for even more disaster, death, and despair. You can prevent that from happening, and we implore you to do so by acting swiftly on the recommendations in this letter.

We thank you for your continued commitment to Indian Country, and as always, stand ready to work with you in a bipartisan fashion to advance the health of all AI/AN people.

Sincerely,

National Indian Health Board

National Congress of American Indians National Council of Urban Indian Health

1 Number of COVID-19 cases reported by IHS increased from 27,233 positive cases on July 19, 2020 to 106,393 cases as of November 30, 2020

2 On July 19, 2020, CDC had reported an age-adjusted cumulative COVID-19 hospitalization rate of 272 per 100,000 among AI/ANs; as of November 21, rates among AI/ANs were at 487.3 per 100,000.

3 Centers for Disease Control and Prevention. COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html#footnote03

4 Indian Health Service. COVID-19 Cases by IHS Area. Retrieved from https://www.ihs.gov/coronavirus/

5The Centers for Disease Control & Prevention includes diabetes in a list of medical conditions that increase the chance of severe illness from COVID-19. Centers for Disease Prevention & Control, People with Certain Medical Conditions (Aug. 14, 2020), https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.

 

December 4, 2020

Re: FTCA Coverage for UIOs

Dear Speaker Pelosi, Leader McConnell, Leader McCarthy, and Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to pass H.R. 6535 / S. 3650 in this Congress to provide parity in the Indian Health System. Specifically, UIOs would be extended the same insurance coverage as Indian Health Service (IHS) and Tribal facilities instead of being forced to divert scarce resources away from health care in order to foot exorbitant insurance costs.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites.1 Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites.2 As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases3” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

As you know, the trust responsibility to provide health care extends to urban Indians, as well as those Indians residing on reservations. Enacting this law before the end of this Congress would undoubtedly save AI/AN lives and increase available health care services. This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

We thank you for your continued commitment to Indian Country and, as always, stand ready to work with you in a bipartisan fashion to advance the health status of all AI/AN people.

Sincerely,

National Congress of American Indians National Council of Urban Indian Health

1 Hatcher SM, Agnew-Brune C, Anderson M, et al. COVID-19 Among American Indian and Alaska Native Persons — 23 States, January 31–July 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1166–1169.

2 Centers for Disease Control and Prevention. COVIDView Weekly Summary.

3 COVID-19 Data – Situation Summary (November 25, 2020)

 

December 4, 2020

Re:  Request Passage of Tribal Veterans Bills this Congress

Dear Speaker Pelosi, Majority Leader McConnell, Minority Leader McCarthy, and Minority Leader Schumer:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally-recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41 urban Indian organizations (UIOs), we write to urge you to ensure the passage of the following tribal veteran bills in any legislative vehicle before the end of the 116th congress:

  • H.R. 4908 / S. 4909 – Native American Veterans PACT Act
  • S. 524 / H.R. 2791 – Veterans Affairs Tribal Advisory Committee Act of 2019
  • S. 2365 / H.R. 4153 – Health Care Access for Urban Native Veterans Act of 2019
  • H.R.6237 – PRC for Native Veterans Act

AI/ANs have a long history of distinguished service to this country. Per capita, AI/ANs serve at a higher rate in the Armed Forces than any other group of Americans and have served in all the nation’s wars since the Revolutionary War. In fact, AI/AN veterans served in several wars before they were even recognized as U.S. citizens. Despite this esteemed service, AI/AN veterans have lower personal incomes, higher unemployment rates, and are more likely to lack health insurance than other veterans.

The United States must honor its commitments to AI/AN veterans. The federal government’s responsibility to provide quality healthcare to AI/AN veterans comes both from their service to this country and the federal government’s treaty and trust obligations to AI/AN people. If enacted, the legislation listed above, and detailed below, moves us closer to fulfilling the federal government’s dual responsibility to AI/AN veterans, regardless of whether they are living on rural reservation lands or in major urban areas.

H.R. 4907 / S. 4909 – Native American Veterans PACT Act

Currently, AI/AN veterans are required to pay a copayment before receiving services at the VA. In the fiscal year 2017, approximately 30 percent of AI/AN veterans were charged copayments, averaging approximately $281.56 per veteran,1 representing a significant barrier to care for AI/AN veterans. The Native American Veterans PACT Act would eliminate copayments for AI/AN veterans accessing VA health care and would bring parity between those AI/AN veterans receiving services at VA and those who receive services through the Department of Health and Human Services (HHS) Indian Health Service (IHS) and under Medicaid.

The House passed H.R. 4907 on September 22, 2020, and S. 4909 was introduced on November 18, 2020, with bipartisan support. We thank Representative Ruben Gallego for introducing H.R. 895, and Senator Jon Tester and Jerry Moran for introducing S. 4909. In 2020, NCAI passed Resolution #PDX-20-008 in support of this legislation.

S. 524 / H.R. 2791 – Veterans Affairs Tribal Advisory Committee Act of 2019

AI/AN veterans, tribal leaders, and GAO have expressed the need for VA to engage with tribal stakeholders when assessing, developing, and implementing AI/AN veterans’ policy. The Veteran Affairs Tribal Advisory Committee Act of 2019 would help fulfill this need by establishing a VA Tribal Advisory Committee (VATAC). A VATAC would advise the Secretary on improving programs and services for AI/AN veterans, identify timely issues related to VA programs, propose solutions to identified issues, provide a forum for discussion, and help facilitate getting useful feedback from Indian Country. Building a strong relationship between the VA and tribal nations will increase awareness and understanding across the VA of the unique issues affecting AI/AN veterans in tribal communities. This awareness paired with more direct interaction with tribal leaders who regularly hear from AI/AN veteran constituents will ultimately produce faster solutions and better services for AI/AN veterans.

The Senate Committee on Veterans Affairs ordered S. 524 out of Committee favorably on January 29, 2020. The House Committee on Veterans’ Affairs ordered H.R. 2791 favorably on July 30, 2020. We thank Senator Jon Tester for introducing S. 524 and Representative Deb Haaland for introducing H.R. 2791. In 2019, NCAI passed Resolution #REN-19-033 in support of this legislation.

S. 2365 / H.R. 4153 – Health Care Access for Urban Native Veterans Act of 2019

UIOs are an essential part of the Indian healthcare delivery system. AI/AN veterans often prefer to use Indian healthcare providers, including UIOs, for reasons such as cultural competency, community and familial relations, and shorter wait times. However, UIOs are currently ineligible to be reimbursed for the services they provide to AI/AN veterans. The Health Care Access for Urban Native Veterans Act of 2019 would amend the Indian Health Care Improvement Act (IHCIA) to enable the VA to reimburse UIOs for services to VA beneficiaries at urban Indian health centers.

The Senate placed S. 2365 on the Senate Legislative Calendar under General Orders on December 18, 2019. The House H.R. 4153 on December 3, 2020. We thank Senator Tom Udall for introducing S. 2365 and Representative Ro Khanna for introducing H.R. 4153. In 2019, NCAI passed Resolution #REN-19-034 in support of this legislation.

H.R. 6237 – PRC for Native Veterans Act

Currently, VA reimburses IHS and tribally-run health programs for costs related to direct care to AI/AN veterans within IHS and tribal facilities. Unfortunately, the VA does not reimburse either entity for the cost of services provided by the Purchased Referred Care (PRC) program, despite IHS being codified under federal law as the payer of last resort. The PRC for Native Veterans Act would amend the IHCIA to clarify that the VA and the Department of Defense are required to reimburse the IHS and tribally-run health programs for healthcare services provided to AI/AN veterans through an authorized referral.

The House passed H.R. 6237 on July 29, 2020. We thank Representative Ruben Gallego for introducing H.R. 6237. In 2020, NCAI passed Resolution #REN-19-054 in support of this legislation.

We thank you for your continued commitment to Indian Country, and as always, stand ready to work with you in a bipartisan fashion to advance the wellbeing of our AI/AN veterans.

Sincerely,

National Indian Health Board

National Congress of American Indians National Council of Urban Indian Health

1 U.S. Gov’t Accountability Office, GAO-19-291, Actions Needed to Strengthen Oversight and Coordination of Health Care for American Indian and Alaska Native Veterans (2019).

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