Senators Smith and Murkowski Re-introduced Tribal Health Data Improvement Act

On April 27, Sen. Tina Smith and Sen. Lisa Murkowski re-introduced NCUIH endorsed legislation to improve tribal health data surveillance. The bill intends to address challenges faced by tribes and tribal epidemiology centers when trying to access federal healthcare and public health surveillance data systems. NCUIH worked closely on the development of this bill to ensure urban Indians are adequately counted. If passed, the bill would require:

  • The Department of Health and Human Services to give tribes, tribal epidemiology centers, and the Indian Health Service access to public health surveillance programs and services.
  • The Centers for Disease Control (CDC) to give technical assistance to tribes and tribal epidemiology centers and to engage in tribal consultations on American Indian/Alaska Native (AI/AN) birth and death records
  • CDC to enter cooperative agreements with tribes, tribal organizations, urban Indian organizations, and tribal epidemiology centers to address misclassification of AI/AN birth and death records and public health surveillance information

Encourage states to enter into data sharing agreements with tribes and tribal epidemiology centers.

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IHS Releases FAQs Document Regarding FTCA Extension to UIOs

On April 23, the Indian Health Service (IHS) released a Frequently Asked Questions (FAQ) document regarding Federal Tort Claims Act (FTCA) Coverage for Urban Indian Organizations (UIOs). This FAQ document follows Congress’ amendment to 25 U.S.C. § 5321(d) on January 3, 2021 to extend FTCA coverage to UIOs and their employees to the same extent and in the same manner as to Tribes and Tribal Organizations.

Why Does this Matter to UIOs?:

FTCA coverage for UIO allows for funding that would have been spent on the purchase of medical malpractice insurance to be used on programs and services that benefit their clients.

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NCUIH Partners with Native American Lifelines to Provide COVID-19 Vaccine

After months of tireless advocacy, the National Council of Urban Indian Health (NCUIH) has partnered with Native American Lifelines (NAL), the University of Maryland, Baltimore, and the Indian Health Service (IHS) to bring the COVID-19 vaccine to urban Indians in the Washington, DC, Maryland, and Virginia metropolitan area. Vaccine appointments are being held at the University of Maryland, Baltimore, can be scheduled online, and are open to DMV metropolitan Natives (ages 16+) as well as non-Native individuals who work in organizations serving the Native community.

 

Read more about this new development from local news outlets:

University of Maryland, Baltimore opens COVID vaccine clinic for Indigenous peoples

UMB opens first regional COVID-19 clinic exclusively for Native Americans

COVID-19 Vaccine Available for Native Americans at UMB

UMB News: COVID-19 Vaccine Available for Native Americans at UMB

Vaccine clinic for Native Americans opens in Baltimore

Local clinic aims to get vaccinations to Native American community

NEW STATE OPIOID RESPONSE GRANT REAUTHORIZATION LEGISLATION NOW INCLUDES UIOS

On April 8, 2021, Rep. David Trone introduced a bill titled “State Opioid Response Grant Authorization Act of 2021” to amend the 21st Century Cures Act to reauthorize and expand a grant program for State response to the opioid use disorders crisis, and for other purposes. This bill authorizes funding at $1.75 billion for each of fiscal years 2022 through 2027, to remain available until expended.

This bill includes a 5% set aside of the funds made available for each fiscal year for Indian Tribes, Tribal organizations, and Urban Indian Organizations (UIOs) to address substance abuse disorders through public health-related activities such as implementing prevention activities, establishing or improving prescription drug monitoring programs, training for health care practitioners, supporting access to health care services, recovery support services, and other activities related to addressing substance use disorders.

NCUIH has long advocated for UIOs to be added to the SOR grants given the extent of the impact of the opioid epidemic on urban Indians. NCUIH supports Rep. Trone’s legislation to reauthorize the 21st Century Cures Act grant program for State response to the opioid crisis and its inclusion of UIOs.

 

BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

On April 12, 2021 President Biden released his discretionary budget request for Fiscal Year (FY) 2022, pending a more detailed version in the coming months, which will include the funding recommendations for urban Indian health. This request includes $131.7 billion for the Department of Health and Human Services (HHS), a 23.5% increase from the 2021 enacted level, and $8.5 billion in discretionary funding for the Indian Health Service (IHS), a $2.2 billion increase from FY21. The additional $2.2 billion requested for IHS will go towards promoting health equity for American Indians/Alaska Natives (AI/ANs) and include Urban Indian Organization (UIO) consultation to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

In a press release on the budget, IHS Acting Director Elizabeth Fowler stated, “The budget request for the IHS is developed in close partnership with tribes, tribal organizations, urban Indian organizations, and other key stakeholders to ensure it reflects the evolving health needs of American Indian and Alaska Native people and communities.”

Background and Next Steps

NCUIH has long advocated for advance appropriations for IHS to begin closing the funding disparities that have long hindered AI/AN communities. NCUIH has also requested inclusion of UIOs for urban confer with a philosophy of “no policies about us without us”.

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY23. NCUIH has requested $200.5 million forFY23 for urban Indian health with at least $12.759 billion for the Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY22.

Overview of Budget Request

The budget request includes the following for health:

Department of Health and Human Services

  • $131.7 billion for HHS, a $25 billion or 23.5% increase from the 2021 enacted level

Indian Health Service

Centers for Disease Control and Prevention

  • $8.7 billion in discretionary funding, an increase of $1.6 billion over the 2021 enacted level
    • Promotes Health Equity by Addressing Racial Disparities
      • $153 million for CDC’s Social Determinants of Health program, an increase of $150 million over the 2021 enacted level, to support all States and Territories in improving health equity and data collection for racial and ethnic populations.
    • Advances the Goal of Ending the Opioid Crisis
      • $10.7 billion, an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
    • Commits to End the HIV/AIDS Epidemic
      • $670 million, an increase of $267 million over the 2021 enacted level, to support the critical effort to end the HIV/AIDS epidemic in the United States. Investments in CDC, the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and NIH aim to reduce new HIV cases aggressively while increasing access to treatment, expanding use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.
    • Provides Funding to Reduce the Maternal Mortality Rate and End Race-Based Disparities in Maternal Mortality
      • $200 million to reduce maternal mortality and morbidity rates for Black and American Indian/Alaska Native women nationwide, bolster Maternal Mortality Review Committees, expand the Rural Maternity and Obstetrics Management Strategies program, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients, implement implicit bias training for healthcare providers, and create State pregnancy medical home programs.
    • Addresses the Public Health Epidemic of Gun Violence in America
      • $100 million for CDC to start a new Community Based Violence Intervention initiative—in collaboration with Department of Justice—to implement evidence-based community violence interventions locally in communities of color, as Black men make up six percent of the population but over 50 percent of gun homicide victims, and American Indians/Alaska Natives and Latinos are also disproportionately impacted.

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IHS Pauses Johnson & Johnson COVID-19 Vaccine

On Tuesday, April 14, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) announced that they are recommending a pause on the Johnson & Johnson/Janssen (J&J) COVID-19 vaccine while they review data involving six reported U.S. cases of a rare and severe type of blood clot in individuals receiving the vaccine product. Per this recommendation, the Indian Health Service (IHS) has paused all J&J vaccine administration.

IHS has three vaccine safety monitoring systems in place. To date, there have been no reported cases of the rare and severe type of blood clot seen in some individuals who have received this vaccine. The J&J vaccine makes up approximately 1.5% percent of IHS’s recorded shots in arms to, and IHS does not expect this pause to affect the agency’s goal of fully vaccinating 44% of its active adult patients by the end of April.

IHS employees have been advised to offer Pfizer and Moderna vaccines when available to patients that are scheduled to receive the J&J vaccine and will work to ensure that all vaccination sites have adequate stock of these vaccine products.

For more information, you may also visit the FDA YouTube site to hear the FDA and CDC press conference held this morning to answer questions about this pause in Johnson & Johnson/Janssen vaccine administration.

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Sixth Amendment to HHS Declaration on COVID-19 Vaccine Efforts Adds Flexibility

On February 16, the HHS issued its latest amendment to its Declaration that provides immunity from liability for COVID-19 vaccine administration and other countermeasures during this Public Health Emergency (PHE). Since the pandemic emergency started back in late January 2020, HHS has issued the declaration and six amendments to it.

The Public Emergency and Emergency Preparedness Act (PREP Act) authorizes HHS Secretary to issue such a declaration to insulate from liability, except for willful misconduct. The flexibility inherent in the PREP Act and in the HHS agency actions, has afforded expanded protections for UIOs, as well as increase the number of interventions and categories of people able to administer vaccines.

On April 10, 2020, the former Secretary Alex M. Azar II, amended the Declaration under the PREP Act to extend liability immunity to countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the former Secretary further amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm “COVID–19 might otherwise cause” securing further liability from tort claims. (85 FR 35100, June 8, 2020). On August 19, the next amendment approved additional categories of Qualified Persons authorized to prescribe and dispense the covered countermeasures.

The last amendment posted February 10, 2021, authorizes any health care provider authorized or licensed in any state to administer vaccines in any other state or territory (physician, registered nurse, practical nurse whose license expired in last 5 years and was in good standing to administer in any state or territory). The health care provider is required to complete CDC vaccine training.

In another turn of great advocacy by NCUIH staff in Congressional Relations, all the difficulties experienced by IOUs wanting to test for COVID-19, and interaction with the various federal agencies during the course of the COVID-19 emergency, served to lay the ground work and arguments for introducing the Congressional bill that for the first time extended protections in the Federal Torts Claim Act to urban Indian health providers, becoming Public Law 116-313 on January 5, 2021! See our FTCA bill, H.R. 6535, 116th Congress (2019-2020), deeming an urban Indian organization and its employees to be part of the Public Health Service for purposes of certain claims of personal injury.

Biden Administration Resumes White House Council on Native American Affairs

The first White House Council on Native American Affairs (WHCNAA) meeting of the Biden-Harris administration will be held by Secretary of the Interior Deb Haaland and Domestic Policy Advisor Susan Rice on April 23, 2021. Secretary Haaland will serve as the Council’s Chair.

In a press release from the U.S. Department of Interior, Secretary Haaland stated, “Addressing the systemic inequities that impact Indigenous peoples is the responsibility of every federal agency that will require an all-of-government approach across the Administration.”

President Obama signed an executive order on June 26, 2013, establishing the WHCNAA to bring together federal leaders and Indian Country. The convening of the WCHNAA comes as the Biden-Harris administration has prioritized getting resources out to Tribal communities to address the impacts of climate change, racial equity, economic recovery, and COVID-19 response.

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NATIONAL NATIVE ORGANIZATIONS CALL FOR BOLD ACTION, INCLUSION OF URBAN INDIANS IN INFRASTRUCTURE PACKAGE

On April 13, 2021, the National Council of Urban Indian Health (NCUIH) and several other American Indian and Alaska Native (AI/AN) organizations signed a joint letter urging Congress to address Indian Country’s infrastructure priorities in the upcoming legislative package. The letter includes several requests for infrastructure investments into Urban Indian Organizations (UIOs).

There are 41 UIOs operating in 77 health facilities across 22 states that provide high-quality, culturally competent care to urban Indian populations. Tribal leaders advocated to Congress for the creation of UIOs after the Relocation Era in recognition that the trust obligation for healthcare follows Indians off reservations. Unfortunately, there are significant parity issues experienced by UIOs as compared to other federally funded healthcare systems, which greatly impact their services and operations. For example, the IHCIA prohibits UIOs from making even minor renovations to their facilities using their annual appropriations. This provision was intended to help UIOs maintain or attain accreditation with grants, but instead has hamstrung UIOs from using their already limited funding for any infrastructure needs.

Further, unlike other parts of the Indian health system, UIOs do not receive any funding for facilities infrastructure, which has made repairs, renovations, and remediation extremely difficult. The pandemic has made it even harder for UIOs as they now must make updates for no-contact services, socially distanced waiting rooms, and increased security to adhere to COVID-19 safety guidelines. The time is long overdue for investment into UIO infrastructure for this vital prong of the Indian health system.

The letter includes the following priorities for UIO infrastructure:

Infrastructure for UIOs

  • Amend the IHCIA to remove restrictions on using UIO funds for making facility renovations.
  • At least $100 million for Urban Indian Health IT (25 U.S.C. § 1660h).
  • At least $749.3 million for Urban Indian Health.
  • At least $3 million for Urban Indian Health Community Health Representatives (25 U.S.C. § 1660f).
  • Extend Full (100 percent) Federal Medical Assistance Percentage (FMAP) to services provided at UIOs permanently.
  • Establish an Urban Confer Policy for HHS.

Health Care Facilities Construction

  • At least $21 billion for Healthcare Facilities Construction, including but not be limited to, support for new and current planned projects, the Small Ambulatory Health Center Program, UIOs, the Joint Venture Construction Program, and innovative approaches to addressing unmet construction needs for health facilities as described in 25 U.S.C. §1631(f).

Public Health Infrastructure

  • Allow I/T/U providers to be reimbursed for services provided outside of the four walls of their clinic, just as they would if they were provided in the clinic.
  • Establish a Native Behavioral Health Program for I/T/U and fund through FY26 at $200 million annually with annual increases for medical inflation, and funding available through contracts/compacts for Title I and Title V Tribes.

Tribal Health Workforce Development

  • Fully fund the Community Health Aide Program for implementation in all states and for UIOs.

READ THE LETTER

NCUIH Submits Written Testimony to House Interior Appropriations with FY22 Budget Requests for UIOs

On April 14, the National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes less than 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In the testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

NEXT STEPS:

The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022.

Read the Full Testimony