August Policy Updates: Focus Groups, Traditional Foods Report, FY25 Funding and more!

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🔍 Policy Priorities: Join September UIO focus groups to shape 2025 policies.

🍲🌾New NCUIH Resource: NCUIH Infographic on Traditional Food Programs at UIOs.

🏦 Report Update: NCUIH publishes a report on Medicaid Reimbursement at UIOs during the COVID-19 Pandemic.

📊 Appropriations Updates: FY25 bills advance with proposed increases to Indian Country programs; a Continuing Resolution might be needed post-September 30.

🇺🇸 NCUIH in Action: NCUIH represents UIOs at White House Voting Rights Convening.

📞 Advocacy: Advocating for the Urban Indian Health Parity Act and the Truth and Healing Commission bill.

✍🏽 Upcoming Comment Deadlines: September 6: IHS Health Information Technology (HIT) Modernization comments due; September 9: CMS Medicaid Four Walls Exemption feedback due; October 1: United States Department of Agriculture (USDA) Dietary Guidelines comments due.

📅 Important Dates: Mark your calendars for upcoming meetings, conferences, and events.

Next Week: Focus Groups to Shape 2025 Policy Priorities

2024 UIO Focus Groups

These sessions are an opportunity for UIO leaders and their staff to discuss your vital priorities that shape our advocacy efforts in 2025. We will host 5 individual sessions to allow UIO leaders and their staff from each UIO type to have unique discussions with NCUIH staff:

September 3 

  • 1:00-2:30 p.m. EST – Full Ambulatory
  • 3:00-4:30 p.m. EST – Outpatient and Residential

September 4   

  • 1:00-2:30 p.m. EST – Limited Ambulatory
  • 3:00-4:30 p.m. EST – Outreach and Referral

September 5   

  • 1:00-2:30 p.m. EST – Makeup Session

If you are unable to attend any of these dates, please email Policy@NCUIH.org to set up an individual session. We would love to hear from you!

NCUIH Resources: Report on Medicaid Reimbursement at UIOs during COVID-19 Pandemic and Infographic on Traditional Food Programs at UIOs

Traditional Foods Report

NCUIH’s Infographic “Analysis of Traditional Food Programs” complements NCUIH’s recently released report on Traditional Foods at UIOs and highlights:

  • Importance of traditional foods in Native communities.
  • Impact of colonization on traditional food practices.
  • Overview of common programs at UIOs that can incorporate traditional foods: Special Diabetes Program for Indians (SDPI), Nutritional Counseling, Food Prescriptions, and Community Gardens.
  • Access the Infographic here.

NCUIH’s report “Medicaid Reimbursement Rates at Urban Indian Organizations During the COVID-19 Pandemic” focuses on the impact of Medicaid reimbursement rates at UIOs during COVID-19. Despite UIOs providing additional services and growing programs to serve the urban Native community during COVID-19 pandemic, reimbursement rates did not significantly rise.

  • Access the report here.

Appropriations Updates: Senate Advances 2025 Funding Bill, Protects Key Indian Country Programs

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Senate Advances Labor-HHS Appropriations Bill: 

On August 1, 2024, the Senate Appropriations Committee advanced their FY 2025 Labor, Health, and Human Services (LHHS) appropriations bill which proposes increased or maintained funding for key Indian Country programs.

  • By the numbers: Includes $8 million for Improving Native American Cancer Outcomes, which would create an Initiative for Improving Native American Cancer Outcomes to be located at a National Cancer Institute-designated cancer center demonstrating strong partnerships with Tribes, Tribal Organizations, and UIOs;$24 million for the Good Health and Wellness in Indian Country program; and $23.67 million for Tribal Behavioral Health Grants.
  • What’s Ahead: FY 2024 funding is set to end on September 30, 2024. If Congress cannot come to a funding agreement by that deadline, a Continuing Resolution will be needed to maintain funding levels at FY24 levels until an agreement is reached.
  • Go deeper: Read NCUIH’s analysis of the bill.

Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 

NCUIH sent out an action alert urging advocates to contact Congress to support mandatory funding for IHS Contract Support Costs (CSCs) and 105(l) lease funding.

  • Ways to advocate: Call or email your Representative, and post on social media using the template language provided in the action alert. Contact Congress.

NCUIH in Action: Engaging at White House Event on Native American Voting Rights

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NCUIH CEO, Francys Crevier (Algonquin) and Executive Director of White House Initiative for Native Americans and Tribal Colleges and Universities, Naomi Miguel (Tohono O’odham).

On July 31, NCUIH CEO Francys Crevier attended the White House Convening on Native American Voting Rights. Ensuring every Native vote is heard is essential to our democracy & the well-being of our people. UIOs are at the forefront of this mission, promoting civic engagement & health equity.

What else?: The election is coming up, and NCUIH has created special resources for UIOs. Download Posters and Flyers

Legislative Updates: Addressing Federal Indian Boarding Schools, Audio-Only Telehealth Services, and 100% FMAP for UIOs

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Two potential pathways for the Truth and Healing Commission on Indian Boarding School Policies Act of 2023 (S. 1723/H.R. 7227) bill to be passed:

  • On July 8, 2024, the Senate bill was placed on the legislative calendar. The expectation is that the bill will pass the Senate.
  • Additionally, Senators Brian Schatz (Hawaii- Chair of the Senate Committee on Indian Affairs) and Lisa Murkowski (Alaska – Vice-Chair) filed a bipartisan amendment attaching the bill to the National Defense Authorization Act (NDAA), providing the bill with two potential pathways to be passed.
  • The Congressional Budget Office (CBO) score for the House bill was released with $90 million authorized over FY24-FY2034, funded from unobligated ARPA (American Rescue Plan Act) IHS funding.
  • The House bill is awaiting a committee report before being scheduled for a floor vote.
  • Why it matters: the bill would establish a formal commission to investigate, document, and acknowledge past injustices of the federal government’s Indian Boarding School Policies.

On August 2, Rep. Teresa Leger Fernandez (D-NM-3) introduced the NCUIH-endorsed IHS Audio-Only Telehealth Bill, which would make permanent a COVID-19 Public Health Emergency temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or UIOs.

  • Why it matters: IHS, tribally operated facilities, and UIOs would benefit from continued reimbursement from Medicare for audio-only telehealth services as program budgets heavily depend upon third-party reimbursements.
  • Go Deeper: Read more on NCUIH’s blog.

Recent update on 100% Federal Medical Assistance Percentage (FMAP) for UIO Medicaid Services: 

NCUIH is working to advance legislation by the end of 2024 for 100% FMAP for UIO Medicaid services.

Next Steps: Congress is currently in recess until September 9 and will only have three weeks of work before the session ends on September 27. During this short session, the focus is expected to be on addressing the government funding that expires on September 30, making it unlikely that other legislation will advance before the election. However, the lame-duck session—the period between the November election and the start of the new Congress—will be crucial for passing key legislation. Reports suggest that Congress could move on an end-of-year package that includes health extenders. NCUIH will continue to advocate for the inclusion of 100% FMAP in any legislation Congress considers during this time.

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this legislation, NCUIH is available to assist. Email policy@ncuih.org.
  • Reminder: UIOs can still work with their states to improve Medicaid reimbursement rates even without 100% FMAP.

NCUIH Advocates for Full Funding to Meet Indian Country Needs and UIO and Tribal Engagement in Recommendations to the White House

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On August 9, NCUIH submitted comments to the White House regarding Executive Order (EO) 14112 Section 4(a): Assessing Additional Funding to Better Live up to the Trust Responsibility.

 Go deeper: NCUIH recommended that forthcoming White House guidance to agencies working to calculate the unmet scope of the trust responsibility direct them to: capture the full level of federal funding need to meet the trust obligation for health to all of Indian Country and engage with UIOs through urban confer and continue to seek tribal feedback.

Upcoming Federal Comment Opportunities: Syphilis Outbreak, HIT Modernization, Medicaid Four Walls Exemption, and Dietary Guidelines

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September 5: HHS Office of the Assistant Secretary for Health (OASH) – Syphilis and Congenital Syphilis Outbreak 

OASH seeks information from Indian Country about possible HHS actions that may support efforts to reduce the number of syphilis and congenital syphilis cases among American Indians and Alaska Natives. Specifically, they seek comments on the following questions:

  • What are your top three priorities for addressing the syphilis and congenital syphilis epidemic in Indian country?
  • What are the top three changes that HHS could implement to reduce the cases of syphilis and congenital syphilis in your communities?
  • What successful models or innovations have you implemented that could be adapted and scaled by other communities?

What’s next: The deadline for written comments is September 5, 2024, and can be submitted to STI@hhs.gov, using the following subject line: “Tribal Consultation.”

September 6: IHS – Health IT Modernization Multi-Tenant Domain Considerations. 

IHS seeks to better understand how to enhance the benefits and address challenges with the new Electronic Health Record (EHR) system, now called PATH (Patients at the Heart). IHS specifically seeks comments on the following questions:

  • What can IHS do to increase the value proposition for urban partners to participate in PATH EHR (Electronic Health Record)?
  • What challenges and risks might your facilities face when transitioning to PATH EHR?
  • What should IHS consider when preparing end users to operate within a shared EHR environment with a single patient record?

What’s Next: The deadline for written comments is September 6, 2024, and can be submitted to consultation@ihs.gov or urbanconfer@ihs.gov, using the following subject line: ” Health IT Modernization.”

There will also be a joint IHS Tribal Consultation/Urban Confer session on November 7, 2024, 1:30-3 PM ET, on HIT Modernization Site Readiness and Training. This will be a hybrid event at IHS Headquarters in Rockville, MD. Register here.

September 9: CMS – Outpatient Prospective Payment System (OPPS) Proposed Rule

  • CMS hosted an All Tribes Consultation Webinar on August 8, 2024.
  • CMS is requesting information related to a Tribal Technical Advisory Group (TTAG) request to apply the IHS Medicare encounter rate to all outpatient Tribal clinics for Medicare services.
  • CMS also proposes to establish a permanent exception to the Medicaid clinic services benefit four walls requirement for IHS and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas.

What’s Next: The deadline for written comments is September 9, 2024, and can be submitted electronically at https://www.regulations.gov (follow the “Submit a comment” instructions), or by mail to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1809-P, P.O. Box 8010, Baltimore, MD 21244-8010.

October 1 – United States Department of Agriculture (USDA) Dietary Guidelines for America   

  • USDA is seeking public comment as the 2025 Dietary Guidelines Advisory Committee conducts its scientific review process. Learn more here.

What’s next: Written comments are due October 1, 2024, and can be submitted online (preferred method) at the Federal eRulemaking Portal, or by mail to Janet M. de Jesus, MS, RD, HHS/OASH Office of Disease Prevention and Health Promotion (ODPHP), 1101 Wootton Parkway, Suite 420, Rockville, MD 20852. All submissions received must include the agency name and Docket OASH-2022-0021.

Upcoming Events and Important Dates

Calendar with events on it

Sept. 5: Association of American Indian Physicians (AAIP) Conference in Salt Lake City, UT. NCUIH will be presenting its reports on Traditional Healing. Register here.

Sept. 10-12: IHS Direct Service Tribes Advisory Committee (DSTAC) 4th Quarter Meeting. Location TBD. Visit IHS website for more information.

Sept. 10-12: HHS Secretary’s Tribal Advisory Committee (STAC) – Northwest Portland Area

Sept. 10: Medicare, Medicaid and Health Reform Policy Committee (MMPC) Monthly Meeting

Sept, 17-18: Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting in Washington, D.C (hybrid). Link to join meeting on September 17. Link to join meeting on September 18.

ICYMI: Recent IHS Tribal and Urban Leader Letters, IHS Strategic Plan Recommendations, and Budget Insights

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Recent Dear Tribal and Urban Leader Letters (DTLL/DULL) 

August 12: IHS writes to Tribal and UIO leaders to share tools to address climate change, associated health risks, and strategies to address environmental justice (EJ).

IHS wrote to share tools to address climate change, associated health risks, and strategies to address environmental justice:

Important Events:

July 22-23: IHS Tribal Self-Governance Advisory Committee (TSGAC) Meeting

  • IHS representatives reported that reclassifying CSC and 105 (l) leases to mandatory funding would protect the entire IHS budget.

TSGAC’s recommendations for improving the IHS strategic plan:

  • Develop a public strategic plan scorecard
  • Develop evaluation or monitoring mechanism
  • Tribal consultation requirements in the plan’s objectives/activities

July 25: IHS FY 2026-2027 Tribal Budget Formulation Planning and Evaluation Meeting

  • The FY25 President’s Budget provides an additional $1 billion annually in FY26 and FY27 to fully address the 2023 estimated backlog of essential maintenance, alteration, and repair (BMAR) for IHS and tribal facilities, and to account for anticipated growth in the BMAR through FY 2026.
  • IHS staff stated that the FY 2025 House Bill includes a $115 million decrease to the Electronic Health Record (EHR) Modernization Project. This decrease is likely due to the Fiscal Responsibility Act (FRA).

One last thing, check out this upcoming funding opportunity:

Health Resources and Services Administration (HRSA) New Access Points (NAPs)

  • HRSA announces that applications to establish NAPs are now open to expand access to affordable, high-quality primary health care, including mental health and substance use disorder services, for underserved communities and populations. HRSA will only be able to make awards for this Notice of Funding Opportunity if Congress appropriates additional funds for the Health Center Program in FY 2025. HRSA-funded health centers operate more than 15,000 service sites nationwide. If Congress appropriates additional funding in FY 2025, these NAPs will expand the number of health centers in the HRSA Health Center Program and help HRSA-funded health centers open new locations. NAP applicants may be currently funded health centers, look-alikes, or new organizations (those not yet part of the Health Center Program).
  • Applications are due in Grants.gov on August 30, 2024, and in HRSA’s Electronic Handbooks on September 30, 2024 (Apply).
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NCUIH Recommends Noncompetitive Funding Model and Support for Whole Family Substance Abuse Treatment in IHS Behavioral Health Initiatives

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On July 22, 2024, the National Council of Urban Indian Health (NCUIH) submitted comments to the Indian Health Service (IHS) Director, Roselyn Tso, in response to a May 21, 2024, Dear Tribal Leader and Dear Urban Indian Organization Leader letter (DTLL/DULL) and June 20, 2024, Urban Confer on IHS Behavioral Health Initiative Funding. In its comments, NCUIH recommended that IHS consider developing a funding methodology similar to the Special Diabetes Program for Indians (SDPI) National Funding Formula, which was developed to avoid competition for funds and to reduce barriers to access in an effort to ensure equitable distribution of funds for behavioral health grant funding.

Background

President Biden’s December 6, 2023, Executive Order (EO) 14112, “Reforming Federal Funding and Support for Tribal Nations To Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination,” directs Federal agencies to implement reforms to federal funding and support programs to make them more accessible, flexible, and equitable. In accordance with EO 14112, the IHS Division of Behavioral Health (DBH) is evaluating Agency-wide processes for distributing appropriated funding for behavioral health initiatives. In fiscal year 2024, the IHS administers more than $59 million in behavioral health initiatives funding, including the seven grant programs that address substance abuse, domestic violence, suicide, and youth regional treatment centers aftercare.

Almost every UIO provides behavioral health, mental health, or substance use disorder care, in addition to primary care services, Traditional Healing and Medicine, and social and community services. Further, seven UIOs have intensive inpatient/residential services as part of their behavioral health services. To fund this important work, 18 UIOs utilize the seven behavioral health grant programs that IHS is seeking feedback on to support and save lives, but the need for these programs is felt at all 41 UIOs.

NCUIH’s Recommendations and Requests

In response to the May 21 DTLL/DULL and June 20 Urban Confer, NCUIH made the following recommendations and requests to IHS regarding Behavioral Health Initiative Funding:

  • Ensure noncompetitive program awards across the I/T/U system
  • Support whole family treatment
  • Support for youth residential treatment centers at UIOs
  • Ensure funding reform for these programs does not create additional reporting requirements
  • Continue to engage with UIOs

NCUIH will continue to monitor as IHS conducts the grant funding evaluation process.

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House Committee Report Reveals Persistent Voting Barriers for Native Communities and Calls for Legislative Action

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In July 2024, House Committee on Administration Ranking Member Joseph D. Morelle (D-N.Y.), released a critical report titled Voting for Native Peoples: Barriers and Policy Solutions. This report underscores the ongoing struggles faced by Native communities in exercising their right to vote—a fundamental right that has been undermined for decades.

The Report provides a detailed history of the oppression and discrimination against Native peoples by the United States federal government, highlighting physical, identification, language, and systematic barriers that continue to hinder full participation in the electoral process. It also highlights the efforts of state and local governments to dilute Native votes and engage in racial gerrymandering, stating that “lawmakers further dilute Tribal citizens’ voting strength by packing supermajorities of Native voters into single electoral districts, even where the community is large enough to constitute a majority and elect candidates of choice in more than one district.”

The report also calls for actionable solutions to the problems outlined. It advocates for the passage of key legislation, including the Native American Voting Rights Act, the Freedom to Vote Act (H.R. 11), and the John R. Lewis Voting Rights Advancement Act (H.R. 14), which aim to dismantle the barriers to voting and restore essential protections for Native voters. NCUIH endorsed the Native American Voting Rights Act in the 117th Congress and supports the reintroduction of this legislation in a future Congress.

Key Findings and Policy Proposals:

Barriers to Voting for Native Peoples:

  • Physical Barriers: The report highlights “Native Americans face substantial barriers to accessing in person voting and voter services, including voter registration and ballot drop boxes, due to extreme physical distances”.
  • Language Barriers: “Few states and localities offer robust assistance in Indigenous languages, sometimes in violation of federal law.”
  • Identification Barriers: “Several states have enacted, implemented, or enforced voter identification laws, including documentation requirements to register to vote and to cast a ballot in person or by mail, that abridge the right of Native peoples to participate fully and equally in the nontribal political process.”
  • Systematic Barriers: “[The]federal government’s removal, reservation, assimilation, and termination policies of the nineteenth and twentieth centuries created systemic obstacles that compound the barriers Tribal citizens face to full and equal participation in the nontribal political process.”
  • Residential Address Barriers: “Tribal members commonly use descriptive addresses, specifying where they live using highway or Bureau of Indian Affairs route numbers, mile markers, and other landmarks. Tribal members who rely primarily on descriptive addresses often face substantial obstacles when attempting to register to vote and cast a ballot. Most troublingly, in some instances, Tribal members have been completely barred from the political process or certain methods of voter registration when they attempt to use a descriptive address”.

Proposed Policy Solutions:

  • The Frank Harrison, Elizabeth Peratrovich, and Miguel Trujillo Native American Voting Rights Act (NAVRA): this legislation would address many of the barriers to voting faced by Native peoples by establishing baseline, consistent standards for voting throughout Indian Country, ensuring that Native Americans no longer bear the burden of lengthy, costly litigation to defend and enforce their right to vote. NCUIH has endorsed this legislation.
  • John R. Lewis Voting Rights Advancement Act (VRAA): this bill would restore important provisions of the Voting Rights Act that have been severely curtailed by the U.S. Supreme Court and other federal courts over the past two decades. The VRAA also strengthens Section 2 of the Voting Rights Act—a key pillar that allows plaintiffs, including Tribal nations and individual voters, to bring claims for vote denial and vote dilution.

For more details, read the full report here.

NCUIH Advocacy on Native Voting

NCUIH has taken several steps to address some of the barriers discussed in the report. In February 2024, NCUIH signed a letter of support for the John R. Lewis Voting Rights Advancement Act and endorsed the legislation. Additionally, NCUIH has worked closely with the National Urban Indian Family Coalition to Get Out The Vote and improve voter registration abilities at Urban Indian Organizations.

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Action Alert: Tell Congress to Support Tribal Self-Determination

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Contact Congress to Support Mandatory Funding for IHS Contract Support Costs and 105(l) lease funding

Dear Advocates,

We need your help contacting Congress today!  

Representatives Melanie Stansbury (D-NM-01), Teresa Leger Fernandez (D-NM-03), and Sharice Davids (D-KS-03) are leading a letter to House Appropriations leadership in support of reclassifying Indian Health Service (IHS), Bureau of Indian Affairs (BIA), and Bureau of Indian Education (BIE) Contract Support Costs and 105(l) lease funding as mandatory in Appropriations legislation for Fiscal Year 2025 (FY25).

Why do we need to reclassify these costs? 

  • The U.S. Supreme Court’s recent decision in Becerra, Secretary of Health and Human Services, et al vs. San Carlos Apache Tribe determined that IHS must reimburse Tribes for CSCs incurred when collecting and spending program income from third-party payers. The CSCs line item of the IHS budget will have to increase to account for the increased costs.
  • This will be done during the appropriations process and could potentially result in other areas of the IHS budget being decreased to meet the increased requirement for CSCs.
  • For more information on the impacts of this case, please refer to our FAQ here.

Why is this urgent?  

  • The Appropriations Committee has previously described this situation as an “untenable position” and that if these costs remain in the discretionary budget “they have the potential to impact all other . . . equally important tribal programs.”
  • Shifting these costs to mandatory funding creates more space in the IHS budget for discretionary funding.
  • This means increased CSC costs will not impact funding for other IHS programs and will enable true increases in funding for these essential services.
  • Congress is currently working on their appropriations bills for Fiscal Year 2025, and this is a key moment to take a significant step towards fulfilling the trust responsibility to ensure healthcare access for American Indian and Alaska Native people.

You can use the text below as a template to call and/or email your Representative. If you can please, both call and email your representative. You can find your representative here.

Sincerely,
The National Council of Urban Indian Health

Ways to Advocate

Contact Congress | Post on Facebook

Contact Congress!

Step 1: Copy the email below.
Step 2: Find your representative here.
Step 3: Go to their website and click contact.
Step 4: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Representative!

Dear Representative [NAME],

As an urban Indian health advocate, I respectfully request you sign on to the Stansbury-Leger Fernandez-Davids letter to House Appropriations leadership in support of reclassifying Indian Health Service (IHS), Bureau of Indian Affairs (BIA), and Bureau of Indian Education (BIE) Contract Support Costs and 105(l) lease funding as mandatory in Appropriations legislation for Fiscal Year 2025 (FY25).

The reclassification of CSCs and 105(l) costs is crucial due to the recent U.S. Supreme Court decision in Becerra, Secretary of Health and Human Services, et al vs. San Carlos Apache Tribe. The Court determined that IHS must reimburse Tribes for CSCs incurred when collecting and spending program income from third-party payers. As a result, the overall CSCs line item in the IHS budget will need to be increased to cover these additional costs. This increase, if not reclassified as mandatory funding, could lead to significant budget reallocations within the IHS, potentially impacting other essential programs.

Shifting CSCs and 105(l) costs to mandatory funding will free up discretionary funding within the IHS budget. This move will not only prevent negative impacts on other IHS programs but also allow for true increases in funding for vital services.

As Congress works on appropriations bills for FY25, this is a critical moment to take a significant step towards fulfilling the trust responsibility to ensure healthcare access for American Indian and Alaska Native people. Your support in signing this letter will be instrumental in achieving this goal.

You can sign on to the letter by reaching out to If you have any questions, please contact Kaila Hood (kaila.hood@mail.house.gov), Sofia Mingote (sofia.mingote@mail.house.gov), or Vittoria Casey (vittoria.casey@mail.house.gov).

Thank you for your leadership and your commitment to Indian Country.

Sincerely,
[NAME]

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon, or in any way diminishes, Tribal sovereignty or the government-to-government relationship.

NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

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Representative Leger Fernandez Introduces NCUIH-Endorsed Legislation to Maintain Medicare Coverage for Audio-Only Telehealth Services in Indian Country

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On August 05, 2024, Congresswoman Teresa Leger Fernández (D-NM-03) introduced the National Council of Urban Indian Health (NCUIH)-endorsed Telehealth for Tribal Communities Act of 2024 (H.R. 9271) which would make permanent a Covid 19 Public Health Emergency (PHE) temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or urban Indian organizations (UIOs). Providing access to audio-only telehealth services allows patients to access care even when broadband access is limited or unavailable. Prior to the PHE ending in May 2023, IHS patients used audio-only services 60% of the time and video telehealth 39% of the time, demonstrating how valuable this provision is to patients. This legislation will help address the persistent challenge of accessing healthcare in Indian Country.

“The National Council of Urban Indian Health is pleased to endorse the Telehealth for Tribal Communities Act introduced by Representative Leger Fernandez. This legislation is critical to increase access to care for our American Indian and Alaska Native communities. Maintaining the Public Health Emergency’s Medicare reimbursement of audio-only telehealth demonstrates a commitment to addressing health disparities in Native communities. I urge Congress to swiftly pass this bill, which is critical to ensure our patients have continuous access to culturally competent care wherever they reside,” said Francys Crevier (Algonquin), CEO, National Council of Urban Indian Health. 

The bill was cosponsored by Congressman Raúl M. Grijalva (D-AZ-07), Congresswoman Gwen Moore (D-WI-04), and Congressman Raul Ruiz (D-CA-25)

This bill is also endorsed by the National Indian Health Board, National Congress of American Indians, Northwest Portland Area Indian Health Board, President Buu Nygren of The Navajo Nation, Health, Education and Human Services Committee (HEHSC) of the 25th Navajo Nation Council, Jemez Health and Human Services Department in New Mexico, American Telemedicine Association, and Alliance for Connected Care.

Next Steps

The bill was referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. It currently awaits consideration.

Resources

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Department of Veterans Affairs Announces Revised Urban Indian Organization Reimbursement Agreement Program Template, Broadens Scope of Services

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On July 11, 2024, the Department of Veterans Affairs (VA)published a Dear Facility Leader letter announcing implementation of the revised VA-Urban Indian Organization (UIO) Reimbursement Agreement Program (RAP) template (hereinafter “revised agreement”). VA states that the revised agreement contains several key improvements designed to expand the scope of reimbursements and honors the unique capabilities and traditions of American Indian and Alaska Native Health Programs, including reducing duplicative terms, expanding timely filing to 36 months, and broadening the scope of services. For example, the revised agreement explicitly includes reimbursements for durable medical equipment (DME), prosthetics/orthotics and supplies, and home health services, while no longer explicitly excluding reimbursement for residential treatment. It also now includes dental services under “Reimbursement Rates for Direct Care Services.”

Download the Template

Background

The VA Indian Health Service (IHS)/Tribal Health Program (THP)/UIO RAP provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible American Indian and Alaska Native Veterans. The agreements program was first initiated in 2012 for IHS and Tribal health facilities. It was expanded in 2022 to include UIOs. The RAP is part of a larger effort to improve access to care and coordination for American Indian and Alaska Native Veterans under a broader VA-IHS Memorandum of Understanding managed by Veterans Health Administration (VHA). On May 1, 2024, VA hosted an Urban Confer regarding the revised template for the VA-UIO RAP template.

NCUIH’s Actions

NCUIH submitted comments on May 15, 2024, in response to the May 1, 2024, Urban Confer. In its comments, NCUIH recommended that VA continue to engage with and provide updates to UIOs on the revised agreement through its development; improve the UIO reimbursement rates under the revised agreement; ensure changes to the scope of services include services provided at UIOs; and provide technical assistance to UIOs to support UIO participation. NCUIH also previously submitted comments to VA in February 2022, requesting VA improve VA’s urban confer process and continue to improve VA’s relationship with UIOs.

NCUIH will continue to monitor developments regarding the RAP.

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Senate Appropriations Committee Advances Labor Health and Human Services Spending Bill, Protects Key Indian Country Programs

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On August 1, 2024, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Labor, Health, and Human Services (LHHS). The bill appropriates $122.8 billion for Health and Human Services (HHS), which is $7.3 billion above the FY24 levels and $1 billion above the President’s request. These increases reflect the Committee’s dedication to protecting healthcare funding and prioritizing funding for Indian Country. The National Council of Urban Indian Health (NCUIH) applauds and thanks the Senate Appropriations Committee for including urban Indian organizations (UIOs) in the report language for the Improving Native American Cancer Outcomes program.

Next Steps

Senate Leadership will now work with House Leadership to develop the final LHHS appropriations spending bill. As a final appropriations bill is produced, NCUIH will continue to advocate to protect funding for Indian Country and maintain maximum funding levels.

Funding Increased and Maintained for Key Indian Country Programs

Key provisions of the bill include:

  • $8 million for the Improving Native American Cancer Outcomes program, an increase of $2 million from FY24
  • $24 million for the Good Health and Wellness in Indian Country program, a maintained level from FY24
  • $23.67 million for Tribal Behavioral Health Grants (Native Connections), a maintained level from FY24
  • $14.5 million for grants for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

Protects Funding for HIV/AIDS Prevention and Treatment

The Senate Appropriations Committee protected funding for HIV/AIDS prevention and treatment, including $2.57 billion for the Ryan White HIV/AIDS Program, $157.25 million for Ending the HIV Epidemic, and $60 million for the Minority HIV/AIDS Fund. The Committee emphasized their support for the Ryan White HIV/AIDS program, “which provides a wide range of community-based services, including primary and home healthcare, case management, substance use disorder treatment, mental health, and nutritional services”. The Senate bill funds critical HIV/AIDS prevention and treatment programs, many of which were cut in the House version of the bill that was passed in July 2024. NCUIH will continue to advocate to protect HIV/AIDS funding and increase Tribal set-asides, as the appropriations process continues.

Increased Funding to Address Opioid and Fentanyl Crisis

The Senate Appropriations Committee significantly increased funding for programs addressing the growing opioid and fentanyl crisis. Senate Appropriations Chair Murray (D-WA) highlighted “As communities work to tackle the devastating opioid and mental health crises, this bill provides significant new funding to support their efforts”. In particular, the bill includes $14.5 million for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction programs.

NCUIH Advocacy to Increase Funding for Indian Country Programs

NCUIH worked closely with Appropriators to advocate for increased funding for Indian Country. In written testimony, NCUIH advocated for $10 million for the Improving Native American Cancer Outcomes program, $30 million for the Good Health and Wellness in Indian Country program, and to protect funding for HIV/AIDS treatment and prevention. NCUIH successfully advocated to include UIOs in the Native American Cancer Outcomes program and will continue to push this effort as the bill moves to conference. The Committee showed significant support for Indian Country through this appropriations process.

Bill Highlights:

Line Item FY 2024 Enacted FY 2025 President’s Budget Request FY 2025 Committee  Passed
Health Resources and Services Administration   $8.9 billion $8.26 billion $8.94 billion
Substance Abuse and Mental Health Services Administration   $7.4 billion $8.13 billion $7.55 billion
National Institute of Health $48.6 billion $50.77 billion $48.81 billion
Centers for Disease Control   $9.2 billion $11.64 billion $9.39 billion
Good Health and Wellness in Indian Country $24 million —————– $24 million
Improving Native American Cancer Outcomes $6 million —————– $8 million
Ryan White HIV/AIDS Program $2.57 billion $2.58 billion $2.57 billion
Ending the HIV Epidemic $165 million $175 million $157.25 million
Minority HIV/AIDS Fund $60 million $60 million $60 million
Minority HIV/AIDS Fund – Tribal Set Aside $5 million ———— —————
Tribal Behavioral Health Grants (Native Connections) $23.67 million $23.67 million $23.67 million

Health Resources and Services Administration

Health Resources and Services Administration: $8.94 billion
  • No report language.
Ryan White HIV/AIDS Program: $2.57 billion
  • Bill report pg. 55: The Committee recommendation includes $2,571,041,000 for the HIV/AIDS Bureau. The mission of the Bureau is to address the unmet care and treatment needs of persons living with HIV/AIDS. The Bureau administers the Ryan White Care Act (Public Law 111–87), which provides a wide range of community-based services, including primary and home healthcare, case management, substance use disorder treatment, mental health, and nutritional services.
Federal Office of Rural Health Policy: $385.9 million
  • Bill report pg. 57: The Committee recommendation for Rural Health programs is $385,907,000, an increase of $21,300,000 above the fiscal year 2024 enacted level.
Native Hawaiian Health Care Program: $27 million
  • Bill report pg. 41: The Committee includes no less than $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including to coordinate and support healthcare service provision to Native Hawaiians and strengthen the capacity of the Native Hawaiian Health Care Systems to provide comprehensive health education and promotion, disease prevention services, traditional healing practices, and primary health services to Native Hawaiians.
National Health Service Corps: $128.6 million
  • Bill report pg: 42: The Committee provides $128,600,000 for the National Health Service Corps [Corps]. The Committee recognizes the success of the Corps program in building healthy communities in areas with limited access to care. The program has shown increases in retention of healthcare professionals located in underserved areas.
National Center of Excellence for Eating Disorders: $1 million
  • Bill report pg. 45: Within the total for PCTE, the Committee continues to support up to $1,000,000 in coordination with SAMHSA’s Center of Excellence for Eating Disorders, to provide trainings for primary care health professionals to screen, intervene, and refer patients to treatment for the severe mental illness of eating disorders, as authorized under section 13006 of the 21st Century Cures Act (Public Law 114–255).

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $24 million
  • Bill report pg 75: The Committee’s recommended level includes $24,000,000 for Good Health and Wellness in Indian Country.

Office of the Secretary – General Departmental Management 

Minority HIV/AIDS Fund: $60 million
  • Bill report pg. 237: The Committee includes $60,000,000 for the Secretary’s Minority HIV/AIDS Fund to strengthen and expand services provided by minority-serving community-based organizations [CBOs] for HIV education and awareness campaigns, testing, prevention, linkage to care, and engagement in care to racial and ethnic minority individuals at risk for or living with HIV in order to address the decline in HIV testing and the challenges with linkage to and retention in care and treatment that occurred during the COVID–19 pandemic. Funding may be prioritized for minority-serving CBOs in the South, which has the highest burden of HIV of any region nationwide.

Substance Abuse and Mental Health Services Administration

Substance Abuse and Mental Health Services Administration: $7.54 billion
  • Bill report pg: 157: The Committee recommends $7,554,306,000 for the Substance Abuse and Mental Health Services Administration [SAMHSA]. The recommendation includes $133,667,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended) and $12,000,000 in transfers from the PPH Fund.
Substance Abuse Prevention Services: $246.88 million
  • Bill report pg: 172: The Committee recommends $246,879,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization with responsibility for improving accessibility and quality of substance use prevention services.
Tribal Behavioral Grants (Native Connections): $23.67 million
  • Bill report pg. 173: SAMHSA has administered Tribal Behavioral Health Grants for mental health and substance use prevention and treatment for Tribes and Tribal organizations since fiscal year 2014. In light of the continued growth of this program, as well as the urgent need among Tribal populations, the Committee continues to urge the Assistant Secretary for SAMHSA to engage with Tribes on ways to maximize participation in this program.
Zero Suicide: $30.2 million – $3.4 million AI/AN Set-Aside 
  • Bill report pg: 162: The Committee includes $30,200,000 for suicide prevention programs. Of the total, $26,200,000 is for the implementation of the Zero Suicide model, which is a comprehensive, multi-setting approach to suicide prevention within health systems.
    • American Indian and Alaska Native Set Aside – Additionally, suicide is often more prevalent in highly rural areas and among the American Indian and Alaskan Native populations. According to the CDC, American Indian/Alaska Natives [AI/AN] have the highest rates of suicide of any racial or ethnic group in the United States. In order to combat the rise in suicide rates among this population, the Committee recommends $3,400,000 for AI/AN within Zero Suicide.
Mental Health Services Block Grant: $1.04 billion
  • Bill report pg. 164: The Committee recommends $1,042,571,000 for the Mental Health Block Grant [MHBG]. The recommendation includes $21,039,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended). In addition to the funding made available in this bill, the Bipartisan Safer Communities Act included $250,000,000 over 4 fiscal years, with $62,500,000 made available each fiscal year through September 30, 2025, to support the MHBG.
988 Suicide & Crisis Lifeline: $539.62 million
  • Bill report pg. 159: —Suicide is a leading cause of death in the United States, claiming over 49,000 lives in 2022. The Committee provides $539,618,000 for the 988 Lifeline and Behavioral Health Crisis Services. This amount includes funding to continue to strengthen the 988 Lifeline and enable the program to continue to respond in a timely manner to an increasing number of contacts. The 988 Lifeline coordinates a network of independently operated crisis centers across the United States by providing suicide prevention and crisis intervention services for individuals seeking help. The Committee requests a briefing within 90 days of enactment on the 988 Lifeline spend plan and related activities.
Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.49 billion
  • Bill report pg. 174: The Committee acknowledges the important role of the Community Mental Health Services and Substance Use Prevention, Treatment, and Recovery Services Block Grants in supporting States’ efforts to provide resources for expanded mental health and substance use disorder treatment and prevention services. The Committee reiterates the request for a report as included in Public Law 118–47 regarding the lack of transparency and information that is provided to Congress and the public about how States are distributing those funds and what programs or services they are going toward.
State Opioid Response Grants: $1.6 billion
  • Bill report pg. 170: The Committee provides $1,600,000,000 for grants to States to address the opioid crisis. Bill language provides not less than 4 percent for grants to Indian Tribes or Tribal organizations. The Committee supports the 15 percent set-aside for States with the highest age-adjusted mortality rate related to substance use disorders, as authorized in Public Law 117–328. The Assistant Secretary is encouraged to apply a weighted formula within the set-aside based on state ordinal ranking. Activities funded with this grant may include treatment, prevention, and recovery support services. The Committee continues to direct SAMHSA to conduct a yearly evaluation of the program to be transmitted to the Committees on Appropriations of the House of Representatives and Senate no later than 180 days after enactment of this act. SAMHSA is directed to make such evaluation publicly available on SAMHSA’s website. The Committee further directs SAMHSA to continue funding technical assistance within the administrative portion of the appropriated amounts for the SOR grants, to provide locally based technical assistance teams as has been done through the Opioid Response Network. The Committee recognizes the importance and essential work currently being done by the Opioid Response Network in delivering technical assistance to State and Territory SOR grantees, sub-recipients and others addressing opioid use disorder and stimulant use disorder in their communities.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $8 million
  • Bill report pg. 129: The Committee notes that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $8,000,000, an increase of $2,000,000, for the Initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to locate this Initiative at an NCI-designated cancer center demonstrating partnerships with Indian Tribes, Tribal organizations, and urban Indian organizations to improve the screening, diagnosis, and treatment of cancers among Native Americans, particularly those living in rural communities.
Native Hawaiian/Pacific Islander Health Research Office: $7 million
  • Bill report pg. 130: The Committee includes $7,000,000, an increase of $3,000,000, for a Native Hawaiian/Pacific Islander Health Research Office. This office should focus on both addressing Native Hawaiian and Pacific Islander [NHPI] health disparities as well as supporting the pathway and research of NHPI investigators. The office should develop partnerships with academic institutions with a proven track record of working closely with NHPI communities and NHPI-serving organizations and located in States with significant NHPI populations to support the development of future researchers from these same communities.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $14.5 million
  • Bill report pg: 168: The Committee includes $114,000,000 for medication-assisted treatment, of which $14,500,000 is for grants to Indian Tribes, Tribal organizations, or consortia. These grants should target States with the highest age adjusted rates of admissions, including those that have demonstrated a dramatic age-adjusted increase in admissions for the treatment of opioid use disorders. The Committee continues to direct the Center for Substance Abuse Treatment to ensure that these grants include as an allowable use the support of medication assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.
Peer-Support Services: $14 million
  • Bill report pg. 46: Within BHWET, the Committee includes $14,000,000 to fund training, internships, and certification for mental health and substance use peer support specialists to create an advanced peer workforce prepared to work in clinical settings.
Infant and Early Childhood Mental Health Program: $15 million
  • Bill report pg. 161: The Committee pro- vides $15,000,000 for grants to entities such as State agencies, Tribal communities, universities, or medical centers that are in different stages of developing infant and early childhood mental health services. These entities should have the capacity to lead partners in systems-level change, as well as building or enhancing the basic components of such early childhood services, including an appropriately trained workforce. Additionally, the Committee recognizes the importance of early intervention strategies to prevent the onset of mental disorders, particularly among children. Recent research has shown that half of those who will develop mental health disorders show symptoms by age 14. The Committee encourages SAMHSA to work with States to support services and activities related to infants and toddlers, such as expanding the infant and early childhood mental health workforce; increasing knowledge of infant and early childhood mental health among professionals most connected with young children to promote positive early mental health and early identification; strengthening systems and networks for referral; and improving access to quality services for children and families who are in need of support.
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Technical Assistance and Research Fellow Reflects on Her Summer 2024 Internship Experience

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Photo of Tyla Hall

Tyla Hall, National Council of Urban Indian Health (NCUIH) Technical and Research Center (TARC) Intern

This summer I had the opportunity to intern at the National Council of Urban Indian Health (NCUIH) and work with the Technical Assistance and Research Center (TARC) team. Over the 10 weeks, I assisted in numerous projects, attended many internal briefs, and gained a wide range of knowledge.

I was excited to intern at NCUIH as I am going into my senior year at the University of Florida. This upcoming spring I will graduate with a Bachelor of Science in Business Administration with a concentration in Information Systems. After meeting with Dr. Kimberly Fowler and learning more about what the TARC team does I knew that not only was I going to gain the experience needed to work in this industry, but I was also going to enjoy it.

My favorite project was creating an infographic based on the “Thematic Analysis of Traditional Foods Programs at Urban Indian Organizations”. Working with Nahla Holland and Margot Bailowitz, we created a vision of how the infographic should look and what information we wanted to convey. I loved that I was given a lot of stylistic freedom in making this infographic as I would consider myself a creative person and it’s not often that I can showcase this trait in technical fields. After creating multiple drafts, we met with the Communications and Graphic Design team, where even more drafts were made. This project taught me many things, like how to communicate with different departments and how much effort goes into something we view as simple. But most importantly, I learned how to take constructive criticism from multiple people. I was appreciative of the feedback I received as it allowed me to deliver the best results.

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