On November 15, 2024, the U.S. Department of Health and Human Services (HHS) released HHS’ supplemental response to the Not Invisible Act Commission’s (“Commission”) findings and recommendations on how to combat the missing and murdered Indigenous people (MMIP) and human trafficking crisis. The Commission’s findings and recommendations and the supplemental response by HHS mention urban Indian organizations (UIOs) and urban American Indian and Alaska Native people and communities. Importantly, HHS states that the National Center for Child Fatality Review and Prevention—“which provides technical assistance to state and local entities in conducting child death reviews, inclusive of AI/AN populations”—plans to “engage experts at Urban Indian Health Centers to create and implement a plan for also engaging [American Indian and Alaska Native] families living off Tribal lands.”

Read the HHS Full Supplemental Response here.

Background on the Commission

The National Council of Urban Indian Health (NCUIH) along with other national Native organizations worked in support of the Not Invisible Act legislation, which was enacted in October 2020. The Act required the Secretary of the Interior, in coordination with the Attorney General to establish and appoint a joint commission on violent crime against American Indian and Alaska Native people. Secretary of the Interior Haaland was the lead sponsor of the Not Invisible Act when she served in Congress. The bill was passed unanimously by voice vote in both chambers of Congress.

Commissioner Sonya Tetnowski is a citizen of the Makah Tribe and CEO of the Indian Health Center of Santa Clara Valley. She currently serves as the President California Consortium of Urban Indian Health (CCUIH) and previously served as NCUIH’s Board President. Ms. Tetnowski works daily in support of the health and wellness services to American Indians and Alaska Natives living in urban areas. Violence against American Indians and Alaska Natives is a public health crisis and is considered a social determinant of health (SDOH). NCUIH is committed to the reduction of violence impacting Native communities.

NCUIH Resources:

• Read NCUIH’s analysis of the Department of Justice and Department of Interior’s responses to the Commission’s findings and recommendations (June 4, 2024)
• PRESS RELEASE: NCUIH Welcomes Not Invisible Act Commission Report to Congress and Administration (November 17, 2023)

On December 11, 2024, the Scientific Report of the 2025 Dietary Guidelines Advisory Committee (Scientific Report) was officially submitted to the Secretaries of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA). The Report includes NCUIH’s September 30, 2024, recommendation to incorporate research on Traditional Foods into the 2025-2030 Dietary Guidelines by conducting a simulation that analyzed expert-identified foods and beverages integral to and consumed by American Indian and Alaska Native people with positive results.

• Read the full report here.

The DGAC is accepting written comments on the Scientific Report until Saturday, February 8, 2025. DGAC will also accept oral comments via virtual format on January 16, 2025, at 1 PM ET. Click here for more information on the comment opportunities on this Scientific Report.

Background

Under section 301 of Public Law 101-445 (7 U.S.C. 5341, the National Nutrition Monitoring and Related Research Act of 1990, title III), the Secretaries of HHS and USDA are directed to publish the Dietary Guidelines for Americans (Dietary Guidelines) jointly at least every five years. The law instructs that this publication shall contain nutritional and dietary information and guidelines for the general public; shall be based on the preponderance of scientific and medical knowledge current at the time of publication; and shall be promoted by each Federal agency in carrying out any Federal food, nutrition, or health program. The current edition of the Dietary Guidelines (2020-2025) provides guidance on the entire lifespan, from birth to older adulthood, including pregnancy and lactation. The Dietary Guidelines for Americans, 2025-2030 will continue to provide food-based dietary guidance across the entire lifespan to help meet nutrient needs, promote health, and reduce the risk of chronic disease. HHS and USDA appointed the 2025 Dietary Guidelines Advisory Committee (2025 DGAC) to conduct an independent scientific review that will help inform the Departments’ development of the next edition of the Dietary Guidelines.

Discussion of American Indian and Alaska Native Diets and Traditional Foods

The report conducted analyses for overall U.S. diets. The simulations considered foods and beverages that the CDC’s National Health and Nutrition Examination Survey reported as consumed. To be responsive to public comments that called for the Dietary Guidelines to be inclusive of American Indian and Alaska Native populations by considering American Indian and Alaska Native Traditional Foods, a separate simulation was conducted to simulate food and beverages identified by experts as included in select American Indian and Alaska Native diets.

The simulations “confirmed that nutrient requirements could be met using the foods identified as integral and included in those diets with limited exceptions; that finding was consistent across the U.S. population, not just the select American Indian and Alaska Native diets.” This positive news allows for the “inclusion of foods and beverages identified by experts as integral to and consumed by select American Indian and Alaska Native groups, who continue to experience significant health disparities.” The finding also advances the DGAC’s goals for health equity and “ensuring that the Dietary Guidelines are relevant and actionable across all segments of the U.S. population.” The Scientific Report states that more research is needed on the dietary patterns and preferences of American Indian and Alaska Native populations to address knowledge gaps regarding American Indian and Alaska Native diets.

NCUIH’s Role

In the September 30, 2024, comment to HHS, NCUIH:

• Recommended that the 2025 DGAC incorporate research on Traditional Foods into the 2025-2030 Dietary Guidelines.
• Requested HHS and USDA engage with American Indian and Alaska Native communities through Tribal Consultation and Urban Confer.

NCUIH will continue to monitor the development of the 2025-2030 Dietary Guidelines.

On November 5, 2024, the Health Resources and Services Administration (HRSA) published a notice informing the public of the availability of the complete lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) in a designated status as of October 15, 2024. These lists include Urban Indian Organizations (UIOs). HRSA’s HPSA Find tool on the Health Workforce Shortage Areas webpage can be used to find data on the geographic, population, and facility HPSA designations throughout the United States.

For further information on the HPSA designations listed on the website or to request additional designation, withdrawal, or reapplication for designation, please contact Dr. Shelby Hockenberry, Branch Chief, Shortage Designation Branch, Division of Policy and Shortage Designation, Bureau of Health Workforce, HRSA, 5600 Fishers Lane, Rockville, Maryland 20857, sdb@hrsa.gov, (301) 443-1993.

Background

Section 332 of the Public Health Service (PHS) Act, 42 U.S.C. 254e, provides that the Secretary shall designate HPSAs based on criteria established by regulation. HPSAs are defined in section 332 to include (1) urban and rural geographic areas with shortages of health professionals, (2) population groups with such shortages, and (3) facilities with such shortages. Section 332 further requires that the Secretary annually publish lists of the designated geographic areas, population groups, and facilities. Using the statute and regulations, HRSA automatically designates UIOs as HPSAs.

HPSA designation offers access to potential federal assistance for healthcare facilities and providers. Public or private nonprofit entities are eligible to apply for assignment of National Health Service Corps personnel to provide primary medical care, mental health, or dental health services in or to these HPSAs. National Health Service Corps health professionals enter into service agreements to serve in federally designated HPSAs. Entities with clinical training sites located in HPSAs are eligible to receive priority for certain residency training program grants administered by HRSA’s BHW. Other federal programs also utilize HPSA designations.

NCUIH Advocacy

As part of its advocacy, the National Council of Urban Indian Health (NCUIH) engages with HRSA to ensure that UIOs receive HPSA scores that accurately reflect the level of provider shortage for UIO service. UIOs have particularly highlighted how they are negatively impacted by the way their HRSA HPSA scores affect their ability to hire and retain staff participating in various loan repayment programs. NCUIH continues to engage with HRSA regarding the need to develop HPSA scores which reflect the level of need in the Indian health care system, as opposed to general geographic data.

Continuing Resolution Signed into Law, Averting a Government Shutdown

The House and Senate passed a Continuing Resolution (CR) to extend government funding set to expire on December 20, 2024, until March 14, 2025, which was signed into law by President Biden on December 21. The CR includes $100 billion for disaster relief in the wake of recent national disasters, a one-year extension of the Farm Bill to support agriculture, and extends all expiring health programs until March 31, 2025. The CR extends the Special Diabetes Program for Indians (SDPI), Medicare Telehealth Flexibilities, Community Health Center Funding, and the National Health Service Corps (NHSC) funding. A more detailed analysis of the Continuing Resolution is below.

Next Steps:

Congress will continue to negotiate a permanent spending bill for FY 2025 and NCUIH will monitor for updates.

Key Health Extender Provisions Included:

Special Diabetes Program for Indians (SDPI)

• SDPI is a highly effective program that funds life-saving efforts to fight diabetes and improve long-term health outcomes. SDPI has provided grants to 31 Urban Indian Organizations (UIOs) that enables them to provide necessary services to reduce the incidence of diabetes-related illness among urban Native communities.
• The CR extends current funding for SDPI through March 31, 2025, at $39.3 million. The program was set to expire on December 31, 2024.
• NCUIH engaged in extensive advocacy to increase signees on the SDPI Dear Colleague letters in the House and Senate, as well as repeatedly fighting for increased funding for the program.

Extension of Telehealth Flexibilities

• The CR provides a 3-month extension through March 31, 2025, on Medicare telehealth flexibilities, including removing geographic requirements and expanding originating sites for telehealth services, expanding practitioners eligible to furnish telehealth services, and temporarily delaying in-person requirements for mental health services at Federally Qualified Health Centers.
• This provision allows federally qualified health centers (FQHCs), rural health clinics, and Medicare to pay for mental health telehealth services, without any in-person requirements. Without continuation of this provision, physicians would be required to provide an in-person service within the six months prior to beginning telehealth services.

Extension of Community Health Center Funding

• Funding for Community Health Centers is extended through March 31, 2025, providing $1,050,410,959 during this time period. Community Health Centers were funded at $4 billion per year from 2019 to 2023.
• Currently, there are 10 UIOs that are dually funded from both the Health Center Program and the Indian Health Service.

Extension of the National Health Service Corps (NHSC) Funding

• The CR extends the NHSC funding at $85,068,493 million through March 31, 2025.

Congress Passes Key Bills Relevant to UIOs:

Congress also passed two bills impacting UIOs at the end of the legislative session. The Elizabeth Dole Home Care Act of 2024 (S.141) and the Native American Child Protection Act (H.R. 663) have both been sent to the President and are expected to become law.

S.141 – Elizabeth Dole Home Care Act of 2024

• On December 16, 2024, the Elizabeth Dole Home Care Act of 2024 passed the House and Senate.
• The bill is a comprehensive package of bills that significantly expands and reforms the delivery of services at the U.S. Department of Veterans Affairs (VA) for veterans, service members, and their families.
• This legislation directs the VA to collaborate with the Director of IHS and representatives from Tribal health programs and UIOs to ensure the availability of home-and community-based services for Native American veterans, including Native American veterans receiving health care and medical services under multiple health care systems.
• Read the bill text here.

H.R. 663 – Native American Child Protection Act

• On December 17, 2024, the Native American Child Protection Act has passed the House and Senate.
• This bill reauthorizes and revises programs to investigate and prosecute child abuse, child neglect, and family violence involving Native American children.
• The bill makes UIOs eligible for the Indian Child Abuse Treatment Grant Program, creates a National Indian Child Resource and Family Services Center (the Center) that will provide technical assistance and training to Tribes, Tribal organizations, and UIOs, and allows UIO representatives with expertise in child abuse and child neglect to sit on a 12-member Advisory Board to advise and assist the Center.
• Read the bill text here.
• Read NCUIH’s blog on H.R. 633 passage

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