Tribal Leaders Diabetes Committee Meeting Highlights Portland Urban Indian Organization’s Exemplary Programming

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On December 5-6, 2023, the National Council of Urban Indian Health (NCUIH) represented urban Indian organizations (UIOs) as a technical advisor at the Indian Health Service (IHS) Tribal Leaders Diabetes Committee (TLDC) meeting in Portland, Oregon. During the two-day meeting, committee members discussed the status and future of the Special Diabetes Program for Indians (SDPI), received Portland Area diabetes programming updates and legislative updates, and had a discussion with IHS Deputy Director Benjamin Smith. The SDPI status updates from IHS were crucial as the current continuing resolution (CR) legislation has authorized the program for an additional $25.89 million, for a total of $46 million through January 19, 2024.

TLDC is planning on hosting the next in-person meeting on March 5-6 in Reno, Nevada. Details are forthcoming.

NARA NW, Portland UIO, Recognized for Exemplary Diabetes Programing

Native American Rehabilitation Association of the Northwest, Inc. (NARA)

During the TLDC meeting, the Native American Rehabilitation Association of the Northwest, Inc. (NARA), a Portland area urban Indian organization (UIO), was recognized for its work on diabetes treatment and prevention. NARA gave a presentation on its Saturday Diabetes Clinics, which started in 1999 and has since emerged as a highly successful program. NARA’s Saturday Diabetes Clinics are a multidisciplinary “one-stop-shop” for diabetes care offered once a month. Because this clinic is offered on the weekends, NARA has been able to increase involvement and attendance in the program with an average of 14-16 patients attending each session.

The monthly clinic offers comprehensive diabetes care, presenting a holistic approach to managing the disease. The process involved various healthcare professionals and services, beginning with a pharmacist and medical assistants to facilitate annual labs and vaccines. Patients also consult with an ophthalmologist, podiatrist, medical provider for a thorough review of the disease management and medication use, and a dietitian for personalized coaching lasting 20-30 minutes. Additionally, behavioral health support is provided, recognizing the often co-occurring challenges of diabetes and depression. The clinic integrates a cancer screening indicator and hosts a semi-annual eye exam clinic offered by the local university. Furthermore, dental services are offered, contributing to the overall well-being of the patients. The innovative and comprehensive nature of NARA NW’s Saturday Diabetes Clinics garnered enthusiastic support from TLDC members, who expressed their excitement and interest in replicating the model within their own Tribes.

Special Diabetes Program for Indians Updates and Planning

The current CR legislation has granted authorization for SDPI, allocating $46 million for the fiscal year (FY) 2024 until January 19, 2023. However, the full authorization for SDPI in 2024 remains pending, awaiting further legislative action. In response to the evolving funding landscape, the IHS has made decisions to optimize available resources. A portion of the one-time, unobligated SDPI funding, combined with the allocated $46 million from the FY2024 CR, will be utilized to fund all grant recipients for the first six months of the 2024 grant year, extending until June 20, 2024. The total available funds for this initiative amount to $69.5 million.

IHS has also initiated the implementation of another program, SDPI-2. This new grant program aims to extend SDPI funding to Tribes and UIOs that do not currently have an SDPI grant. Funded using unobligated and prior-year SDPI grant funding, SDPI-2 is structured as a four-year grant program. The application review process for SDPI-2 officially started on December 4, 2023 with the anticipated date for grant awards set for January 13, 2024. IHS noted that 9 applications were selected with one applicant being a UIO.

Members of TLDC discussed the potential funding outcomes for SDPI. These options included the reauthorization of SDPI with an allocation exceeding $150 million for one or more years, reauthorization at $150 million for one or more years, a scenario where SDPI is reauthorized with $147 million (reflecting a 2% reduction due to sequestration) for one or more years, and the possibility that SDPI may not be reauthorized at all.

Background on TLDC

The IHS Director established the TLDC in 1998. The TLDC makes recommendations to the IHS Director on broad-based policy and advocacy priorities for diabetes and related chronic conditions as well as recommends a process for the distribution of SDPI funds.

The TLDC consists of the following members:

  • One elected or duly-appointed Tribal Leader from each of the 12 IHS Areas serves as the primary representative.
  • Each Area also designates an alternate member to serve when the primary member is unavailable to do so.
    • TLDC elects one of its members to serve as the Tribal Co-Chair
  • One federal representative, who serves as the Federal Co-Chair
    • One technical advisor from each of the following American Indian/Alaska Native organizations serves in an advisory (non-voting) capacity to the TLDC: Direct Service Tribes Advisory Committee, National Congress of American Indians, National Council of Urban Indian Health, National Indian Health Board, and Tribal Self-Governance Advisory Committee.

White House 2023 Progress Report for Tribal Nations Highlights Commitment to Supporting Urban Native Communities

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The Biden-Harris Administration released the 2023 Progress Report for Tribal Nations (“Progress Report”) during the December 6-7, 2023, White House Tribal Nations Summit. The Progress Report touches on several areas of concern to urban Indian organizations (UIOs) as discussed in the National Council of Urban Indian Health’s (NCUIH) 2023 Policy Priorities. The Progress Report also highlights work done in partnership with UIOs, such as initiatives addressing Missing and Murdered Indigenous Peoples (MMIP), Native Veteran Health and Homelessness, Mental Health, Health Information Technology (HIT) Modernization, and Reproductive Health Care.

Successes with Urban Native Communities Highlighted MMIP

In January 2023, The Department of Health and Human Services (HHS) submitted the MMIP Prevention, Early Intervention, and Victim and Survivor Services Plan to the White House Domestic Policy Council and to the President. Developed in consultation with the Department of the Interior, Tribal Nations, research and community-based organizations and UIOs, it is a comprehensive plan to support prevention efforts that reduce risk factors for victimization of Native Americans and increase protective factors, including by enhancing the delivery of services for Native American victims and survivors as well as their families and advocates.

Native Veterans

In support of the Native American Veterans Homelessness Initiative, VA and other federal agencies engaged with UIOs to support and offer resources to AI/AN Veterans experiencing homelessness. The Initiative took the following actions in 2023:

  • VA and Indian Health Service (IHS) developed an informational brochure for Native American veterans experiencing homelessness and distributed these brochures to UIOs, IHS facilities, and external partners across the country.
  • VA and IHS developed and launched an interagency interactive map of UIOs and VA healthcare systems with points of contact information in June 2023.
  • VA developed and implemented training webinars for UIOs to raise awareness of VA homeless programs among Native American veterans and to build or increase effective, responsive, and collaborative relationships between UIOs and VA.
  • VA and various UIOs collaborated on Stand Down events in Seattle, Phoenix, Los Angeles, Albuquerque, and soon Alaska. These one-to-three-day events bring VA staff and volunteers together to provide food, clothing, and health screenings to homeless and at-risk veterans and receive referrals for healthcare, housing solutions, employment, substance use treatment, mental health counseling, and other essential services.

The Veterans Health Administration amended its medical regulations to implement a statute exempting eligible Indian and urban Indian veterans from copayment requirements. This change is based on a requirement within the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020. As of October 2023, 2,674 Native veterans have been approved for the copayment exemption, with copayment cancellations totaling just over $1.5 million.

Mental Health

HHS announced a new $35 million grant opportunity, enabled by the Bipartisan Safer Communities Act, to better support the 988 Suicide and Crisis Lifeline services in Tribal communities. One of the aims of the program is to facilitate collaborations between Tribal, state, and territory health providers, UIOs, law enforcement, and other first responders in a manner that respects Tribal sovereignty.

HIT Modernization

Throughout the process for selecting the new Electronic Health Record (EHR) vendor, IHS coordinated with Tribal and urban Indian organization partners through extensive Tribal engagement via Tribal consultations, listening sessions, urban confers, advisory committee meetings, an Industry Day, and the participation of hundreds of Tribal, urban Indian, and IHS system users in vendor product demonstrations. IHS ultimately awarded a 10-year contract to General Dynamics Information Technology to build, configure, and maintain a new enterprise EHR system utilizing Oracle Cerner technology.

Reproductive Health Care

In response to President Biden’s Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services, IHS added new over-the-counter contraception options to the IHS National Core Formulary, which will expand access to high-quality contraception for patients. IHS encouraged Tribally or UIO operated IHS facilities to make the same options available to patients.

VA Responds to Advisory Committee on Tribal and Indian Affairs’ Recommendations to Improve Native Veteran Health

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The Department of Veterans Affairs (VA) released its consolidated responses to VA’s Advisory Committee of Tribal and Indian Affairs’ (ACTIA) November 2022 recommendations to VA Secretary Dennis McDonough regarding improvements to VA’s programs and services to better serve Native American veterans. These recommendations were finalized during the November 8-11, 2022, ACTIA Meeting and included several recommendations to improve the delivery of health services to Native veterans living in urban areas. These included suggestions regarding interagency collaboration under the Veteran Health Administration-Indian Health Service (VHA-IHS) memorandum of understanding (MOU), development of a VA Urban Confer policy, use of traditional healing practice for American Indian and Alaska Native (AI/AN) veterans, data on urban veteran behavioral health, and urban veteran homelessness. VA’s responding is a crucial step toward achieving the goal of supporting AI/AN veterans as whole people and meeting their needs.

Background on the ACTIA

The Committee was established in accordance with section 7002 of Public Law 116- 315 (H.R.7105 – Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020). Pursuant to Public Law 116-315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. The Committee serves in an advisory capacity and, at least once a year, the Committee must submit recommendations to the Secretary of Veterans Affairs and relevant Congressional committees concerning legislative or administrative action to improve programs and services of the Department to better serve Native American Veterans.

Alongside partners from throughout Indian Country, the National Council of Urban Indian Health (NCUIH) played a critical role in getting this legislation passed in 2020. In a December 4, 2020 letter NCUIH signed with other National Native organizations regarding the ACTIA, NCUIH emphasized the importance of establishing the ACTIA to improve programs and services for Native veterans.

NCUIH subsequently nominated NCUIH’s Board President, Ms. Sonya Tetnowski, to the ACTIA, where she serves as the Chair of the Health Subcommittee. Ms. Tetnowski is the CEO of the Indian Health Care Center of Santa Clara Valley and is an Army veteran.

Recommendations and Responses

The ACTIA submitted eleven recommendations to VA to improve the care of AI/AN veterans. NCUIH is highlighting VA’s response to five of those recommendations below. To read the full response, click here.

Recommendation 1C: Interagency Collaboration Under VHA-IHS MOU

VA Office of Tribal Government Relations (OTGR), Veterans Health Administration (VHA) Office of Tribal Health (OTH) and the Office of Rural Health concur in principle with the ACTIA recommendation to require annual partnership between Veterans Integrated Services Network Directors and at least one Indian Health Service (IHS), Tribal, Urban or Native Hawaiian Health program to meet a specific goal or objective as described in the current Veterans Health Administration (VHA) – IHS Memorandum of Understanding (VHA-IHS MOU). ACTIA recommended that this be implemented in FY 2023. OTGR, VHA OTH, and the Office of Rural Health recommend that Network Directors submit an annual report to the Executive Committee of the VHA/IHS MOU Interagency Workgroup documenting compliance with this recommendation. The VHA-IHS MOU Interagency Workgroup will then provide an annual summary report of these efforts to VA’s ACTIA.

Recommendation 1D: Urban Confer Policy

The ACTIA recommended that  VA develop an Urban Confer Policy in order to partner with UIOs more effectively in their provisions of health services of Native Veterans in urban areas.  The ACTIA stated that this recommendation should be implemented by December 2023.

VA will research the processes and authorities used by other federal agencies to create the urban confer policy that ACTIA recommended.

Recommendation 3A: Behavioral Health/Suicide Prevention

The ACTIA recommended that VA provide information on its efforts to collect data on:

(1) Veteran suicides that occur on tribal lands which can be included in the VA/IHS MOU operational plan; and

(2) AI/AN Veteran suicides that occur in urban areas.

The ACTIA stated that data concerning urban city in which Native Veteran suicides occur needs greater specificity to address issues such as how VA defines rural and urban. The ACTIA recommended VA begin collecting data by October 2023, publish its first report by October 2024, then annually publish the results at the beginning of each fiscal year thereafter in October of each calendar year.

VA stated that it supports the goals of this recommendation and requested the opportunity to discuss and coordinate regarding avenues for enhancing available data sources to broaden accurate and reliable reporting on suicides among AI/AN Veterans. VA stated that it is not aware of resources needed to identify whether Veteran suicide deaths occur on tribal lands and that Veteran suicide deaths are identified from joint VA/Department of Defense searches of the Centers for Disease Control and Prevention’s National Death Index (NDI). VA OTGR and VHA OTH will provide a plan of action by the end of the second quarter of FY 2024.

Recommendation 3B: Cultural Healers/Natural Helpers

As part of the ACTIA recommendations regarding cultural healers/natural helpers, the ACTIA recommended VA, incorporating input gathered in tribal consultation and urban confer, amend VA policy and relevant VHA Directives to champion and/or allow the use of traditional healing as a legitimate and evidence-based practice that promotes the wellbeing of American Indian, Alaska Native and Native Hawaiian Veterans. It stated that VA should complete this recommendation by October 2024.

VA responded by stating that VHA looks forward to supporting evidence-based traditional healing in alignment with VHA’s Whole Health System of Care. VA also stated that VHA suggested changes to language in this recommendation.

Recommendation 3C: Homelessness as a Health Disparity

The ACTIA recommended that VHA Homeless Programs Office (HPO) amend its Strategic Plan to target a 5% increase in Stand Downs located on tribal lands, rural communities, Native Hawaiian communities and in urban areas with a high population of AI/ANs.

It also recommended that VA should:

  • Create objectives in the operations plans of each region to ensure the target increase percentage in Stand Downs can be met.
  • Provide quarterly updates with information on progress made or a justification for why the goal was not reached.
  • Gather information on the number of American Indians, Alaska Natives and Native Hawaiians that attend each event, including their tribal affiliation.
  • Complete this recommendation by October 2025.

VA staff will ensure that messaging is provided to the Bureau of Indian Affairs when an event is planned, apply for VA specific purpose funding for local Stand Down events and work collaboratively with local providers to gather information on the number of American Indians, Alaska Natives and Native Hawaiians that attend each event, including their tribal affiliation.

VA stated that it is committed to increasing the number of Stand Downs in targeted areas with high populations of AI/AN. Starting in FY 2023, VA will begin sharing stand down data with the ACTIA.

VHA HUD-VA Supportive Housing agrees with the replacement of BIA with “IHS, Urban Indian Organizations and Tribal Health Programs.”

VHA Homeless Program Office (HPO) will:

  • encourage UIOs, IHS, and where appropriate, tribes to participate in existing stand down development and implementation.
  • collaborate with and support UIOs, IHS and tribes interested in developing Stand Downs.
  • provide an educational and outreach tool (VHA stand down presentation) it has developed to assist UIOs and IHS in developing tribal specific stand downs.

VHA HPO would recommend that Tribes who are interested in tribal specific Stand Downs request the assistance of VA OTGR.

For information on Stand Down events, please click here.

Next Steps

The National Council of Urban Indian Health (NCUIH) welcomes the VA’s response to the ACTIA’s recommendations. The ACTIA recommendations provide tangible programmatic changes that VA can make to better serve Native veterans. NCUIH looks forward to continuing to work with the ACTIA and VA to advance these changes and ensure that Native veterans have access to the benefits and services that the earned through their military services.

HHS Provides Update on Suspected Behavioral Health Treatment Center Fraud Targeting Native Americans in Arizona

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On November 14, 2023, the Department of Health and Human Services (HHS) sent a Dear Tribal Leader and Urban Indian Organization Leader Letter (DTLL/DULL) to provide an update on suspected behavioral health treatment center fraudulent activities in Arizona. The DTLL/DULL provided a list of resources to stay up to date on the matter and described a “whole of government” approach that the Indian Health Service (IHS), Tribal leaders, Urban Indian Health Program leaders, the Arizona Health Care Cost Containment System (AHCCCS), and the State of Arizona are working toward. Specifically, they have established mechanisms to help affected people receive care, transportation, and other needed services. HHS stresses the importance of staying vigilant in addressing this matter.

Background

Suspected fraudulent providers are believed to be targeting vulnerable American Indian and Alaska Native (AI/AN) people who are unsheltered and experiencing the impacts of substance use disorder (SUD) health conditions. Reports indicate the suspected fraudulent providers entice vulnerable individuals with food, money, shelter, and offer treatment and safe housing to lure them into facilities that do not provide treatment. Initially, suspected fraudulent providers focused on recruiting in reservation communities in Arizona and New Mexico, but more recently there are reports of recruitment efforts throughout Indian Country and direct solicitation to the IHS, Tribal Health Programs, and Urban Indian Health Programs in an effort to gain referrals.

On May 16, 2023, Arizona Governor Katie Hobbs and Attorney General Kris Mayes joined the AHCCCS Office of Inspector General (OIG) to announce payment suspensions against registered behavioral health providers of Medicaid services based on credible allegations of fraudulent billing activities. This first of many actions to stop these criminal activities was a coordinated effort by the Arizona Attorney General’s Healthcare Fraud and Abuse Section, the Federal Bureau of Investigation (FBI), HHS, the U.S. Attorney’s Office, and the Internal Revenue Service. The suspected false and fraudulent claims have been associated with unethical treatment practices, patient brokering, unnecessary services, and overcharging. These actions have led to the suspension of more than 100 unique registered behavioral health providers since the May 16 announcement, and the search for additional fraudulent providers continues.

Resources to Stay Up to Date

IHS will provide regular communication, new information, and additional details as they become available. Several resources are immediately available:

Should you have any questions, please contact your IHS Area Office directly.

Bureau of Indian Education Seeks Nominations for Membership on the Advisory Board for Exceptional Children

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On December 4, 2023, the Bureau of Indian Education (BIE) issued a notice seeking nominations of individuals to serve on the Advisory Board for Exceptional Children (Advisory Board). There will be three positions available to specifically serve in the areas of Indian persons with disabilities; or State education officials; or State Interagency Coordinating Councils (for States having Indian reservations). Applications are due Wednesday, January 31, 2024.

Eligibility and Nomination Information

Nominations may come from individuals, organizations, and federally recognized Tribes. Interested individuals may also self-nominate. Nominees should have expertise and knowledge of the issues and/or needs of American Indian children with disabilities. A summary of the candidates’ qualifications (resume or curriculum vitae) must be included with a completed nomination application form. Nominees must have the ability to attend Advisory Board meetings, carry out Advisory Board assignments, participate in teleconference calls, and work in groups.

Please submit nominations to Ms. Jennifer Davis, Designated Federal Officer (DFO), Bureau of Indian Education, Division of Performance and Accountability, 2600 N Central Ave., Suite 800, Phoenix, AZ 85004; email to jennifer.davis@bie.edu; or fax to (602) 265–0293. Please click here for the nomination application on BIE’s website.

Background

The Advisory Board was established under the Individuals with Disabilities Education Act of 2004 (IDEA) in an effort to advise the Secretary of the Interior, through the Assistant Secretary-Indian Affairs, on the needs of Indian children with disabilities. Members of the Advisory Board will provide guidance, advice, and recommendations with respect to special education and related services for children with disabilities in BIE-funded schools in accordance with the requirements of IDEA.

The Advisory Board will also:

(1) Provide advice and recommendations for the coordination of services within the BIE and with other local, State and Federal agencies;

(2) Provide advice and recommendations on a broad range of policy issues dealing with the provision of educational services to American Indian children with disabilities;

(3) Serve as advocates for American Indian students with special education needs by providing advice and recommendations regarding best practices, effective program coordination strategies, and recommendations for improved educational programming;

(4) Provide advice and recommendations for the preparation of information required to be submitted to the Secretary of Education under 20 U.S.C. 1411 (h)(2);

(5) Provide advice and recommend policies concerning effective inter/intra agency collaboration, including modifications to regulations, and the elimination of barriers to inter- and intra-agency programs and activities; and

(6) Report and direct all correspondence to the Assistant Secretary—Indian Affairs through the Director, BIE with a courtesy copy to the Designated Federal Officer (DFO).

Membership

Pursuant to 20 U.S.C. 1411(h)(6), the Advisory Board is composed of up to fifteen individuals involved in or concerned with the education and provision of services to American Indian infants, toddlers, children, and youth with disabilities. The Advisory Board composition reflects a broad range of viewpoints and includes at least one member representing each of the following interests:

  • American Indians with disabilities;
  • teachers of children with disabilities;
  • American Indian parents or guardians of children with disabilities;
  • service providers;
  • State education officials;
  • local education officials;
  • State interagency coordinating councils (for States having Indian reservations);
  • Tribal representatives or Tribal organization representatives; and
  • other members representing the various divisions and entities of BIE.

NCUIH Advocates for HHS Office of Minority Health to Address AI/AN Needs in Healthy People 2030 Leading Health Indicators Initiative

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On October 31, 2023, the National Council of Urban Indian Health (NCUIH) submitted written comments in response to the Department of Health and Human Services (HHS) Office of Minority Health’s (OMH) September 13, 2023, letter regarding the development of a Notice of Funding Opportunity (NOFO) entitled Healthy People 2030 Leading Health Indicators Initiative (LHII). In its comments, NCUIH urges OMH to consider the health needs of American Indian and Alaska Native people living in urban areas when developing the NOFO, in accordance with Congress’ directive in the Indian Health Care Improvement Act “to raise the health status of Indians and urban Indians to at least the levels set forth in the goals contained within the Healthy People 2010 initiative or successor objectives,” like Healthy People 2030. NCUIH highlighted particular leading health indicators (LHIs) which impact American Indians and Alaska Natives living in urban areas, such as maternal deaths, food insecurity, diabetes, behavioral health, substance use disorders, and drug overdose deaths, and also urged OMH to facilitate partnerships between grantees and UIOs to ensure American Indians and Alaska Natives can be served by the LHII no matter where they reside.

Background

Healthy People 2030 identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being. Healthy People 2030, the initiative’s fifth iteration, builds on knowledge gained over the first four decades. The Healthy People 2030 LHII is intended to identify innovative adaptations of evidence based/evidence informed practices that improve health outcomes related to Healthy People 2030 LHIs among racial, ethnic, tribal and other disadvantaged communities.

LHIs are a small subset of high-priority Healthy People 2030 objectives selected to drive action toward improving health and well-being. Most LHIs address important factors that impact major causes of death and disease in the United States, and they help organizations, communities, and states across the nation focus their resources and efforts to improve the health and well-being of all people. Healthy People 2030 includes 23 LHIs that are organized by life stage: Infants, Children and Adolescents, Adults and Older Adults, and All Ages.

Projects funded under the LHII will implement public health improvement models intended to improve health for one to two Healthy People 2030 LHIs in geographic areas targeted by the recipients. OMH also expects the initiative will result in enhanced capacity of public health, community, and government entities to address and reduce health disparities in geographic areas targeted by the recipients.

Next Steps

NCUIH will continue to monitor the development of the Healthy People 2030 Leading Health Indicators Initiative and advocate on the inclusion of issues of importance to American Indians and Alaska Natives living in urban areas and the UIOs that serve them.

December Policy Updates: White House Tribal Nations Summit Updates, 100% FMAP, and More

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Happy New Year!

In This Edition: ….conference season is underway, and many more developments in urban Native health policy.

Have a safe and happy holiday season!

White House Tribal Nations Summit Updates

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Rep. Sharice Davids (D-KS), joins NCUIH CEO Francys Crevier, JD (Algonquin), AIHEC’s VP of Congressional Relations Ahniwake Rose, and Tribal college students during the White House Tribal Nations Summit.

NCUIH CEO Francys Crevier had the opportunity to attend the 2023 White House Tribal Nations Summit on December 6 and 7 in Washington, D.C.

President Biden sign Exec Order

President Joseph Biden joins Tribal Leaders to sign Executive Order 14112.

President Biden Signs Executive Order on Reforming Federal Funding and Support for Tribal Nations to Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination (EO 14112) during the White House Tribal Nations Summit.

The Biden-Harris Administration also released a 2023 Progress Report for Tribal Nations, which outlines historic progress the Administration has made over the past year to address top Indian Country concerns.

  • Initiatives vital to urban Native communities were highlighted, including strategies for access to the Strategic National Stockpile in healthcare, HHS’s Comprehensive Missing and Murdered Indigenous People (MMIP) plan, Veteran’s Health exemptions, the Native American Veterans Homelessness Initiative, 988 Suicide Lifeline focus, Indian Health Service (IHS) Health Information Technology (HIT) Modernization, reproductive healthcare access at IHS, and SSA Native Language accessibility improvements.

MR

NCUIH’s Vice President Policy and Communications presented at the Tribal Leaders Briefing.

On December 5, NCUIH was honored to contribute as a presenter alongside many other Native organizations at the National Congress of American Indians (NCAI) Tribal Leaders Briefing ahead of the 2023 White House Tribal Nations Summit.

Federal Budget Updates
Congress dealing with surprise medical bills

On November 15, 2023, a full government shutdown was averted when Congress passed a two-tiered Continuing Resolution (CR) serving as a stopgap spending measure. The CR was signed into law by President Biden on November 16, 2023.

What is included: The CR includes two funding deadlines for the twelve appropriations accounts, January 19 and February 2.

The bottom line: Last year, Congress authorized $5.13 billion in advanced appropriations for IHS, insulating the majority of IHS programs from the worst effects of a government shutdown.

Go deeper: The CR re-authorized the Special Diabetes Program for Indians (SDPI) until January 19th at $25.89 million, and funds IHS accounts not receiving advanced appropriations at FY23 levels through February 2nd.

Did you know?: President Biden requested $250 million for IHS in emergency supplemental funding in response to the current opioid epidemic. Congress has not included this funding in this CR.

Urban Indian Health Priority Updates: SDPI Reauthorization & 100% FMAP for UIOs

Illustration of Congress with empty speech bubbles

Special Diabetes Program for Indians​ (SDPI):

The Lower Cost, More Transparency Act of 2023 (H.R. 5378) includes language reauthorizing SDPI for FY2025 and raises funding to $170 million. The bill passed the House on Monday, December 11, 2023.

  • What’s next: The bill will now be considered by the Senate with a vote expected in the New Year.

  • Why it matters: The bill’s reauthorization of SDPI would allow for UIOs to continue to use grant funding to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. The FY2024 Continuing Resolution (CR) re-authorized SDPI at $25.89 million and is set to expire on January 19, 2024, making this legislation even more crucial to avoid lapses in critical diabetes research and care funding.

100% Federal Medical Assistance Percentage (FMAP) for UIOs:

On Nov. 30, Representative Bacon (R-NE-2) and Representative Ruiz (D-CA-25) reintroduced the bipartisan Urban Indian Health Parity Act (H.R. 6553) which would amend the Social Security Act to set the FMAP at 100% for services provided to Medicaid beneficiaries at UIOs.

“We applaud Representatives Ruiz and Bacon for this bipartisan effort to ensure that the federal government honors its trust responsibility to Native people and improves health outcomes that are desperately needed. With broad support from Indian Country, we are hopeful that Congress will move forward with ending this inequity to expand resources for communities that benefit from the necessary services provided by urban Indian organizations and all Indian Health Care Providers,” said Francys Crevier, CEO of NCUIH.

  • What’s next: NCUIH is currently working to secure more cosponsors for the bill.

American Medical Association Adopts NCUIH-Supported Resolution on IHS Improvements, Includes 100% FMAP for UIOs:

  • On November 3, 2023, NCUIH submitted written testimony to the 2023 Interim Meeting of the American Medical Association (AMA) House of Delegates, held on November 10-14, 2023, regarding the proposed resolution “Federal Medical Assistance Percentage Extension for Urban Indian Organizations” as part of  a larger resolution, Resolution 812 (I-23), “Indian Health Service Improvements.”

  • What they’re saying: The Reference Committee noted that 100% FMAP would “lead to enhanced and directed advocacy of priorities as identified by American Indian/Alaska Native-serving health organizations and other important stakeholders.”

  • The bottom line: The AMA adopted the entire resolution, including the language in support of 100% FMAP for UIOs.

“RESOLVED, that our American Medical Association supports an increase to the Federal Medical Assistance Percentage (FMAP) to 100% for medical services which are received at or through an Urban Indian Organization that has a grant or contract with the Indian Health Service (IHS) and encourage state and federal governments to reinvest Medicaid savings from 100% FMAP into tribally-driven health improvement programs.”

  • Why it matters: Adoption of this resolution means that 100% FMAP will now be a priority of the AMA moving forward. Having the support of the largest physician advocacy organization is an additional advocacy tool NCUIH and other organizations can utilize, and it shows Congress the necessity of passing 100% FMAP legislation.

Screenshot of FMAP infographic title

NCUIH Infographic on 100% FMAP for UIOs

Our thought bubble: NCUIH recently released an infographic on the importance of setting the FMAP at 100% for services provided to Medicaid beneficiaries at urban Indian organizations.

NCUIH Releases Report on Recent Trends in Third-Party Billing at UIOs

NCUIH

On November 29, 2023, NCUIH published its report on the experience of UIOs enrolled in Medicaid and the Children’s Health Insurance Program as a primary care case manager (PCCM) or Indian Managed Care Entity (IMCE).  ​

Go deeper:

  • Overall UIOs reported a positive experience when operating as a PCCM and felt that it improved patient care​.

  • The sole UIO operating as an IMCE (providing PCCM services) also felt that it improved patient care.

  • Read the full report.

What else?:

  • This is one of two reports funded by NORC at the University of Chicago focusing on third-party billing that NCUIH released this year​.

  • Our second report concerning Traditional Healing will be published early in 2024​.

NCUIH Requests Updates on IHS Health IT Modernization & AI/AN Engagement in HHS Healthy People Initiative

IHS

On November 20, NCUIH submitted comments to the Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP) regarding Healthy People (HP) Objectives​.

  • The bottom line: NCUIH recommended that the agency conduct Tribal Consultation and Urban Confer when developing new objectives, ensure ODPHP is engaging with the HHS Secretary’s Tribal Advisory Committee on HP 2030 additional Objectives, and ensure that an IHS representative is on each of the objective workgroups.​

On December 8, NCUIH submitted comments to IHS regarding HIT Modernization: The Path Forward​.

  • The bottom line: NCUIH requested that the agency clarify the HIT Modernization implementation process, provide an update to the timeline for HIT Modernization implementation, provide frequent and regular updates to the IHS HIT Modernization webpage, and communicate the status of the Enterprise Collaboration Group.

Upcoming Events and Important Dates

Calendar with events on it

Upcoming Events & Important Dates:

  • January 9, 11 & 17​, 2024 – IHS Tribal Consultation – Updating the IHS Tribal Consultation Policy on the definition of “Indian Tribe.”

  • January 16-18​, 2024 – U.S. Patent and Trademark Office, Department of Commerce Tribal Consultation: Genetic Resources, Traditional Knowledge, and Traditional Cultural Expressions​.

  • January 18, 2024 ​- Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call​.

Upcoming Federal Agency Comments:

  • January 18 – HHS Office of Civil Rights (OCR) – Proposed Rule on HHS Grants Regulation​:

    – Provisions in the HHS grant regulations that would require grant recipients to comply with applicable federal statutory nondiscrimination provisions, require HHS compliance with applicable Supreme Court decisions in administering grants, and provide a religious exemption from certain provisions. ​

  • January 23 – Department of Veterans Affairs (VA)/IHS – Revised Reimbursement Agreement Program​:

    – VA and IHS have executed a revised agreement to facilitate reimbursement by VA to IHS for health care and related services provided by the IHS to eligible AI/AN Veterans. ​

  • February 2 – Centers for Medicare and Medicaid Services (CMS) – Enforcement of State Compliance with Reporting and Federal Medicaid Renewal​:

    – This interim final rule implements reporting requirements and enforcement authorities in the Social Security Act that were added by the Consolidated Appropriations Act, 2023. ​

    – New enforcement authorities include requiring States to submit a corrective action plan, suspending disenrollments from Medicaid for procedural reasons​, imposing civil money penalties (CMPs), & applying a reduction to the State-specific FMAP for failure to meet reporting requirements.

ICYMI:

  • On December 5-6, NCUIH attended the Tribal Leaders Diabetes Committee (TLDC) meeting in Portland, Oregon as a technical advisor.

    – Much of the discussion was around SDPI and the current CR reauthorizing SDPI through January 19, 2024. Full SDPI reauthorization is still pending.

    – The Native American Rehabilitation Association of the Northwest, Inc. presented on their UIO’s diabetes programing including their Saturday Diabetes Clinic which has been a resounding success in providing care for diabetic patients.

  • On December 13, IHS held their HIT Modernization Summit where NCUIH’s Director of Technical Assistance, Dr. Kimberly Fowler, led the UIO caucus and UIO leaders were able to openly share questions, concerns, and comments regarding the HIT modernization process and the selection of the new Electronic Health Record (EHR). These questions were then asked during the Discussion and Q&A portion of the virtual summit.

    – During the summit, IHS announced that they are updating their HIT Modernization website to provide more up to date information and access to event information regarding the modernization process.

  • On December 13-14, IHS Tribal Self-Governance Advisory Committee (TSGAC) held their meeting in Washington, DC.

    – Jillian Curtis, Director, Office of Finance and Accounting, shared that FY 2024 sequestration is possible, and the Fiscal Responsibility Act (FRA) would trigger an automatic 1% discretionary sequester if the government is still operating under a partial year continuing resolution past April 30. Congress could override the sequester or use other scorekeeping methods to avoid sequester. Congress also has flexibility to turn off sequester for certain activities in subsequent legislation. Under the FRA, the default application of the sequester would be across the board. It is not yet clear whether the sequester would apply to advance appropriations.

Recent Dear Tribal Leader Letters (DULLs) and Dear UIO Leader Letters (DULLs)

NCUIH in Action: DOI Holiday Celebration, IHS Award Ceremony

FC at IHS Awards

Pictured L to R: Andrea Palm, Deputy Secretary of the Department of Health and Human Services (HHS), Francys Crevier, NCUIH CEO, and Roselyn Tso, Director of the Indian Health Service.

On December 8, NCUIH CEO, Francys Crevier was awarded the IHS Director’s Special Recognition Award: Urban Leadership Award by IHS Director, Roslyn Tso and Department Secretary of HHS, Andrea Palm.

“I am grateful for the 2022 Director’s Special Recognition Award, which recognizes the tireless efforts of the National Council of Urban Indian Health in advocating for the health and rights of Indigenous communities. This award is not just a personal achievement but a symbol of the collective impact we can make when we work together. Our Urban Indian Organizations, Tribes, and Tribal organization partners have been integral to our movement. I share this honor with our partners, our dedicated team, and the entire Native community living in urban areas as we continue our mission to foster positive change and ensure equitable access to health care.” – NCUIH CEO Francys Crevier (Algonquin)

NCUIH at IHS Award w Helena Indian Alliance

Pictured: Mike Touchette, Helena Indian Alliance (HIA) board chair, Francys Crevier, NCUIH CEO, Todd Wilson, HIA executive director, Renee Parsley, HIA board vice chair, and Jason Smith, HIA board treasurer.

Alongside Francys Crevier, Todd Wilson (Crow), a NCUIH board member and Executive Director of the Helena Indian Alliance in Montana, accepted an Urban Leadership Award on behalf of the Helena Indian Alliance for its outstanding contributions to urban leadership. Mr. Wilson has played a pivotal role in advocating for the rights and well-being of Indigenous communities, demonstrating exceptional dedication to improving health care in Indian Country. His leadership at the Helena Indian Alliance showcases a commitment to improving health care for urban Native populations. Kevin Sandoval, HIM/IT coordinator at the Helena Indian Alliance, won an IHS Director’s Special Recognition Award.

MR and Sec. Haaland

United States Secretary of the Interior, Deb Haaland (Pueblo of Laguna) and Meredith Raimondi, Vice-President of Policy and Communications, NCUIH.

On December 12, NCUIH represented UIOs at the Department of Interior Holiday Celebration with Sec. Deb Haaland.

MR and MJ @ TTAG

On November 28-29, NCUIH staff represented UIOs at the HHS Secretary’s Technical Advisory Committee (STAC) meeting in Washington, D.C. Dan Tsai, Director for Medicaid and CHIP at CMS, gave updates on the Medicaid unwinding, four walls, and 1115(a) demonstrations:

  • 1115(a) Demonstration Wavier:​ AZ has not approved the waiver, but several states have come forward to advocate for this.​ CMS reiterated that the agency understands the importance of AZ’s waiver.​

  • Four Walls:​ Extended implementation of the policy to February 2025 to work through legal challenges​. CMS is taking a look at Medicaid clinic payment system and looking at chronically homeless individuals.

NCUIH 2024 Urban Indian Health Policy Preview

NCUIH Policy Preview

Join us for an informative session as the NCUIH Policy Department explores 2024 Policy Priorities for American Indians and Alaska Natives. This engaging webinar promises a thorough exploration of key issues leading the charge in advocacy efforts, shaping the policy landscape for Native communities in the coming year.

Event Goal:

The goal is to share with participants a comprehensive understanding of the key issues shaping advocacy efforts and influencing the policy landscape for American Indians and Alaska Natives.

Objectives: 

  1. Develop a deeper understanding of the 2024 Policy Priorities driving American Indian/Alaska Native health initiatives

  2. Gain valuable insights into the advocacy efforts aimed at advancing urban Indian health policies.

Register

2024 NCUIH Annual Conference – Call for Proposals

NCUIH AC 24

We are accepting proposals from all American Indian and Alaska Native-serving organizations, with a priority for UIOs to present their capacity-building best practices, successes, and innovations at our 2024 annual conference, Sustaining Traditions: Culture, Identity, and Health, April 30 – May 1, 2024, at the Hilton Capitol Hill in Washington, D.C.

All presentation proposals and poster session submissions are due January 19, 2024. Selected break-out session presenters will receive a reduced registration to attend the conference. To learn more and submit a proposal, please view the form.

Other conference updates include sponsorships and room reservations.

Sponsorships: Several different sponsorship levels remain. If you are interested in sponsoring the conference, please see our sponsor guide or contact Tyler Dougherty.

Room Reservations: The negotiated room rate of $369 per night (plus tax) for single/double occupancy rooms is available until April 5, 2024. We encourage you to book your room soon to secure this special rate. To make your reservation at the Hilton Washington DC Capitol Hill, click here to access the room block.

Should you have any questions or require additional information, please do not hesitate to contact NCUIH conference organizers at conference@ncuih.org.

One last thing, check out these upcoming funding opportunities:

  • Health Resources & Services Administration (HRSA) – Maternal and Child Health Improving Oral Health Integration Demonstration Projects

    – Deadline: January 22, 2024 (Apply)

  • IHS – Community Opioid Intervention Prevention Program

    -Deadline: February 7, 2024 (Apply)

  • U.S. Department of Justice Office on Violence Against Women (OVW) – OVW Fiscal Year 2024 Legal Assistance for Victims Grant Program

    – Deadline: February 13, 2024 (Apply)

  • Youth Homelessness System Improvement (Department of Housing and Urban Development)

    – Deadline: February 15, 2024 (Apply)

  • Substance Abuse and Mental Health Services Administration (SAMHSA) – Strategic Prevention Framework Partnerships for Success for Communities, Local Governments, Universities, Colleges, and Tribes/Tribal Organizations

    – Deadline: February 21, 2024 (Apply)

  • National Institute of Food and Agriculture, U.S. Department of Agriculture – The Gus Schumacher Nutrition Incentive Program – Produce Prescription Program

    – Deadline: February 28, 2024 (Apply)

  • IHS – Indian Health Service Scholarship Program (IHSSP)

    -Deadline: February 28, 2024 (Apply)

  • AmeriCorps – Forest Corps Recruiting Native Youth for Opportunities to Support Cultural Resource Management Projects

    – Deadline: February 29, 2024 (Apply)