PRESS RELEASE: Report Finds States Again Shoulder the Cost of an Unmet Federal Trust Responsibility

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Congress Must Reauthorize 100% FMAP for Urban Indian Health Care

FOR IMMEDIATE RELEASE

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

WASHINGTON, D.C. (September 15, 2023) – Today, the National Council of Urban Indian Health (NCUIH) announced the release of a policy report on the importance of setting the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs).  With Medicaid beneficiaries making up 46% of the UIO Native patient population, 100% FMAP for UIOs is critical to expanding community health programming and youth services, ultimately leading to improved long-term health outcomes.

“This report showcases what we already knew: when the federal government faithfully honors its Trust responsibility to Native people, health access in our communities improves,” said Francys Crevier, CEO of NCUIH. “This provision has broad support across Indian Country because it directly impacts our people. Congress must act now to permanently reauthorize 100% FMAP for UIOs.”

The report reflects the findings from case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs. The reports’ findings demonstrate that 100% FMAP for UIOs results in:

  • Increased services at UIOs;
  • Significant cost savings for states; and,
  • Flexibility for states to support UIOs in their health care delivery.

The report also provides an extensive history of 100% FMAP in the Indian health care system. The Indian Health Service and Tribal facilities have been extended 100% FMAP for decades, and UIOs have advocated for parity through legislation since 1999. Parity for UIOs allows patients to seek care closer to their homes and access community-focused and culturally competent care.

The full report is available at this link.

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About NCUIH 

The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

NCUIH to Present During NHSC Webinar on Loan Repayment & Scholarship Programs

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The Health Resources & Services Administration’s (HRSA) National Health Service Corps (NHSC) will be hosting an informational webinar and Q&A session on Tuesday, September 19, 1:00-2:00 p.m. ET for students, clinicians, and health care facilities that serve Tribal communities. The NHSC will be co-hosting this webinar with the National Indian Health Board (NIHB) with a presentation from the National Council of Urban Indian Health (NCUIH). The webinar will review eligibility requirements, share information on the application process, and respond to questions. To attend the webinar on Tuesday, September 19 at 1:00 p.m. ET, join here. No preregistration is required.

Background on NHSC

Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623). Today, NHSC supports more than 20,000 primary care medical, dental, and behavioral health providers through scholarships and loan repayment programs. It has increased access to quality health care in communities with significant health professional shortages for more than 50 years. NHSC participants serve at more than 9,000 community health care sites, serving over 21 million patients. A cornerstone of its work is increasing access to mental health and opioid use disorder treatment in impacted areas of the country by supporting more than 9,600 behavioral health providers. NHSC additionally offers a variety of loan repayment programs for health care professionals and can work towards eliminating school debt.

Action Alert: Special Diabetes Program for Indians Expires in 16 Days – Contact Congress

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Contact Congress | Social Media

Dear Indian Health Advocates,

We need your help contacting Congress to support the reauthorization of the Special Diabetes Program for Indians (SDPI)! With the program ending in 16 days, it remains critical that Congress reauthorizes SDPI to ensure there is no lapse in funding.

  • For 25 years, SDPI has supported research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction in American Indian and Alaska Native community-based programs and healthcare settings. SDPI’s integrated approach to diabetes healthcare and prevention programs in Indian Country has become a resounding success and is one of the most successful public health programs ever implemented.
  • Currently, 31 urban Indian organizations (UIOs) receive SDPI funding that enables UIOs to provide necessary services that reduce the incidence of diabetes-related illness among urban Indian communities.
  • The National Indian Health Board and 16 advocates, including NCUIH, have sent a letter urging Congressional leadership to bring the current legislation, H.R. 3561 and S.1855, to the floor for a vote and ultimately reauthorize SDPI by September 30, 2023.

To ensure that SDPI receives as much support as possible, we encourage you to contact your Member of Congress and request that they vote to support the bills by September 30, 2023. Please find a template email below with instructions.

Thank you for your leadership. Your outreach on this is invaluable to providing greater health equity for American Indians and Alaska Natives.

Sincerely,

The National Council of Urban Indian Health

Contact Congress Today

  • Step 1: Copy the email below.
  • Step 2: Find your Member of Congress here
  • Step 3: Paste the email into the form and send it.

Please contact Jeremy Grabiner (jgrabiner@ncuih.org) with questions.

Email to Your Members of Congress

Dear [Member of Congress],

As an Indian health advocate, I respectfully request you urge Congressional leadership to bring the Special Diabetes Program for Indians Reauthorization Act of 2023 to the floor for a vote and ultimately reauthorize the Special Diabetes Program for Indians (SDPI) by September 30, 2023.

For 25 years, SDPI has supported research-based interventions for diabetes prevention and cardiovascular disease risk reduction in American Indian and Alaska Native community-based programs and healthcare settings. SDPI’s integrated approach to diabetes healthcare and prevention programs in Indian Country has become a resounding success and is one of the most successful public health programs ever implemented.

With the program set to end in September 2023,  it remains critical that Congress reauthorizes SDPI to ensure there is no lapse in funding.

I respectfully ask that you honor the federal trust obligation to American Indians and Alaska Natives by supporting this effective public health program.

Thank you for your leadership and commitment to upholding the United States’ trust responsibility.
Sincerely,

[Contact Information]

Raise your voice on Social Media!

X (formerly Twitter)

From your X account, contact your Member of Congress.

  • Find your Member of Congress here.

Example tweet:

  • Dear [@Member’s handle], please urge Congressional leadership to bring the Special Diabetes Program for Indians Reauthorization Act of 2023 to the floor for a vote to protect the Special Diabetes Program for Indians! #SDPI

 

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

Advisory Board for Exceptional Children to Host Two-Day Meeting September 21-22, UIOs Encouraged To Attend

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The Bureau of Indian Education (BIE) announced that the Advisory Board for Exceptional Children (the Advisory Board) will hold a two-day meeting, in-person and online, on Thursday, September 21, 2023, from 8:00 a.m. to 4:30 p.m. Eastern Daylight Time (EDT) and Friday, September 22, 2023, from 8:00 a.m. to 4:30 p.m. EDT. The purpose of the meeting is to meet the mandates of the Individuals with Disabilities Education Act of 2004 (IDEA) for Indian children with disabilities.

The National Council of Urban Indian Health encourages urban Indian organization (UIO) leaders to attend and participate. The Advisory Board was established under the Individuals with Disabilities Act of 2004 (20 U.S.C. 1400 et seq.) to advise the Secretary of the Interior, through the Assistant Secretary-Indian Affairs, on the needs of Indian children with disabilities.

All Advisory Board activities will be conducted in-person and online. The onsite meeting location will be at the Crystal City Marriott, 1999 Richmond Highway, Arlington, Virginia. To attend the two-day meeting remotely, please register using this link: https://www.zoomgov.com/meeting/register/vJItf-2prTkjHQm8iBckGVMexfylXaLrHlo. Once registered, attendees can attend both meeting events. The meeting is open to the public in its entirety.

The following agenda items will be for the meeting on September 21- 22, 2023. The reports are regarding special education topics.

  • Office of Special Education Programs (OSEP). How can OSEP more directly support the BIE’s work in providing special education services that result in positive outcomes for children with disabilities across the BIE school system?
  • Office of the Secretary of the Interior. As the Secretary of the Interior, how do you ensure that all American Indian and Alaska Native children receive an equitable education?
  • BIE-Office of the Director. Provide updates on rural school internet access and include any challenges and potential resolves to the issues from BIE.
  • BIE Human Resources Office. During board meetings we consistently hear from Bureau Operated School (BOS) administrators that delays in the hiring process cost schools qualified hires. Can greater responsibility be provided to local school hiring authorities?
  • BIE Division of Performance and Accountability, (DPA)/BIE Special Education Program. Provide an update on IDEA, ESSA, and the Government Accountability Office (GAO) recommendations report.
  • Associate Deputy Director (ADD), Regions for Bureau Operated Schools (BOS), Navajo Schools (BOS & TCS) and Tribally Controlled Schools (TCS)/Special Education Programs: What services do you provide for BIE funded schools? Provide an update on the 2022–2023 school year. Discuss the successes, challenges, ongoing goals, and other items that would be pertinent to the Advisory Board.
  • On Thursday, September 21, two 15-minute sessions will be provided, 11:00 a.m. EDT and 2:00 p.m. EDT. Public comments can be provided via webinar or telephone conference call.
  • On Friday, September 22, 2023, two 15-minute sessions will be provided, 9:30 a.m. EDT and 12:15 p.m. EDT. Public comments can be provided during the meeting or telephone conference call.

Public comments can be emailed to the DFO at Jennifer.davis@bie.edu; or faxed to (602) 265–0293 Attention: Jennifer Davis, DFO; or mailed or hand delivered to the Bureau of Indian Education, Attention: Jennifer Davis, DFO, 2600 N Central Ave., 12th Floor, Suite 250, Phoenix, AZ 85004.

To make requests in advance for sign language interpreter services, assistive listening devices, or other reasonable accommodations, please contact Jennifer Davis at least seven (7) business days prior to the meeting to give the Department of the Interior sufficient time to process your request. All reasonable accommodation requests are managed on a case-by-case basis.

More information, please use this link: Federal Register :: Advisory Board of Exceptional Children.

Opportunity for AI/AN Representation on 2030 Census Advisory Committee

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The Census Bureau is seeking nominations of members representing stakeholder organizations, groups, interests, and viewpoints to the 2030 Census Advisory Committee (“the Committee”). Through the Committee, the Census Bureau can engage with diverse voices as it prepares for the next census and seeks external perspectives on its plans to address census undercounts, communicate with different communities, and collect census information in an easy and efficient way. Nominations for membership on the Committee must be received no later than September 20, 2023, and should be emailed to Census.2030.Advisory.Committee@census.gov with the subject line “2030 Census Advisory Committee Nomination.” This is a unique opportunity for historically underrepresented populations, including urban American Indian and Alaska Native (AI/AN) populations, to improve Census representation. Individuals, groups, and/or organizations may submit nominations on behalf of candidates interested in joining the Committee.

Nominations

Individuals, groups, and/or organizations may submit nominations on behalf of candidates. The diverse membership of the Committee assures perspectives and expertise reflecting the breadth of the Committee’s responsibilities, and, where possible, the Census Bureau will also consider the ethnic, racial, and gender diversity and various abilities of the United States population.

NCUIH and the Census

NCUIH has reported on and advocated for census equity to represent urban AI/AN populations accurately. The previous 2020 U.S. Decennial Census continued these inaccuracies, undercounting (AI/AN) peoples. After the 2020 Census, the U.S. Census Bureau conducted a Post-Enumeration Survey to evaluate the accuracy of the census and estimate over- or undercount by state and demographic group. The report found that in 2020, there was a statistically significant undercount of AI/AN people. Undercounting jeopardizes the health of AI/AN people as well as future budget calculations in Indian Country.

Additionally, as recently reported by NCUIH, the undercounting of AI/AN people went underreported. The urban AI/AN community demands greater representation in the general population and decisionmakers’ viewpoints. This is especially pertinent in urban AI/AN communities as more than 70% of AI/AN people now live in urban areas. The 2030 Census Advisory Committee is an important opportunity for urban AI/AN representatives and UIO (Urban Indian Organization) leaders to serve on the Committee and impact Census reform.

For further information, click here or contact Shana J. Banks, Chief, Advisory Committee Branch, Office of Program, Performance and Stakeholder Integration (PPSI), Census Bureau, at Shana.J.Banks@census.gov.

August Policy Updates: Budget Updates, UIO Focus Groups, & Important RFIs

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Welcome to the August edition of our monthly policy newsletter, delivering the latest updates and insights on key developments.

Budget Update:

Budget #

House Status:

  • The House Appropriations Committee advanced the Interior Appropriations bill on July 18.

Go deeper: House IHS Funding Bill Passes out of Committee with Advance Appropriations and Modest Increase for the Indian Health Service

Senate Status:

  • On July 27, 2023, the Senate Appropriations Committee passed their bill out of committee with a vote of 28-0 and will advance to the Senate floor for initial passage.
  • Similar to the House Bill, the Senate IHS Funding Bill also included Advance Appropriations and a modest increase for the Indian Health Service.
  • Establishment of UIO Interagency Workgroup: The bill also includes direction for IHS to establish a UIO Interagency Workgroup with the IHS, Department of Health and Human Services, Department of Housing and Urban Development, Department of Agriculture, Department of Justice, Department of Education, Department of Veteran Affairs, Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.​

Next Steps:

  • With the government funding deadline of September 30 rapidly approaching, Congressional leaders are negotiating a continuing resolution to fund the government at the current level until December.
  • A continuing resolution will give Senate and House leadership time to negotiate a final bill that can pass in both chambers.

Upcoming Events and Important Dates: UIO Listening Session, National Fentanyl and Opioid Summit

Calendar with events on it

Upcoming Comments and Submissions​:

  • September 1 – Comment deadline to the Indian Health Service on Health Information Technology Modernization​
  • September 15 – Comment deadline to the DOI, DOJ, and Department of Health and Human Services on Strengthening the Indian Child Welfare Act (ICWA) ​

Upcoming Events

  • August 22-24: IHS – Partnership Conference.​
  • August 22-24: National Indian Health Board/Northwest Portland Area Indian Health Board is hosting a National Fentanyl and Opioid Summit​
  • August 23: NCUIH UIO Listening Session on HIV/AIDS. Register here.
  • August 29: Substance Abuse Mental Health Services (SAMHSA) Tribal Technical Advisory Committee Meeting​
  • August 29: SAMHSA Tribal Listening Session and Virtual Tribal Consultation on Behavioral Health and Substance Use Disorder Resources for Native Americans​
  • August 29-30: DOI Self-Governance Advisory Committee Meeting​
  • August 30-31: IHS Tribal Self-Governance Advisory Committee Meeting​
  • September 6: IHS – Advance Appropriations Listening Session for Tribal and UIO to share information and solicit input on advance appropriations implementation.​ UIOs are encouraged to attend and ask any questions you have regarding advance appropriations and their impact on your contracts. Click here to join the listening session.

Important Requests for Information from UIO Leaders

RFI

We need input from Urban Indian leaders to help shape our advocacy and comments to federal agencies on policies affecting UIOs and American Indians/Alaska Natives living in urban areas.

Please email policy@ncuih.org with information on the following:

DOI – Strengthening ICWA

  • Does your UIO work with State courts or child welfare agencies on child welfare or if not, would you like to?​
  • Does your UIO work with Tribes on child welfare or if not, would you like to?​
  • How can we improve the implementation of ICWA for Native children in urban areas? ​

DOJ – Medical/Legal Partnership​s

NCUIH recently met with the DOJ Office for Access to Justice (ATJ). ATJ is looking to support increased access to legal assistance for urban Native communities.

  • Do any UIOs have successful medical-legal partnerships?

IHS – Medicaid fraud schemes targeting American Indians and Alaska Natives

IHS Director Tso wrote a letter to Tribal and UIO leaders regarding fraudulent billing activities of registered behavioral health providers, and it appears to now be affecting programs in the Billings Area.​

  • Have any of your organizations been impacted by fraudulent residential treatment practices exploiting vulnerable Native communities?​

Medicaid Unwinding

  • How is unwinding proceeding in your state?
  • Do you have any data regarding AI/AN disenrollment?​

NCUIH Requests Urban Indian Inclusion in MMIP and Human Tracking Initiatives

Not Invisible Commission

Secretary Deb Haaland and Deputy Attorney General Lisa Monaco hosted the first in-person plenary session of the Not Invisible Act Commission at the U.S. Department of the Interior in Washington, D.C. in February 2023.

On August 10, NCUIH submitted comments to the Department of Interior’s (DOI) Not Invisible Act Commission regarding the Missing and Murdered Indigenous People (MMIP) and human trafficking (HT) crises​ to ensure that urban Native communities are considered.

The bottom line: NCUIH recommended that the Commission ensure that resources are available to combat MMIP, HT, and violent crime against American Indians and Alaska Natives in urban areas.

Why it matters: The federal government must ensure that it properly tracks and reports data on instances of missing persons, murder, and human trafficking of American Indians and Alaska Natives in urban areas.​

Go deeper: Learn more about the Not Invisible Commission.

Legislative Updates: Native American Child Protection Act Advances in House, Advance Appropriations Legislation Introduced

ICWA

In June, the Native American Child Protection Act (H.R. 663/S.2273) was passed by unanimous consent out of Natural Resources.​ The bipartisan legislation amends the Child Protection and Family Violence Prevention Act to include UIOs in the Indian Child Abuse Treatment Grant Program and permits UIOs to sit on the National Indian Child Resource and Family Services Advisory Board.​

On July 24, the House and Senate introduced the Indian Program Advance Appropriations Act (H.R. 4832/ S. 2424)​ to provide advanced appropriations for the Bureau of Indian Affairs, the Bureau of Indian Education, and the Indian Health Service.

Upcoming: NCUIH UIO Focus Groups

NCUIH UIO Focus Groups

We are excited to announce our upcoming virtual web series, “NCUIH UIO Focus Groups: Setting Policy Priorities for 2024.”

Why it matters: The focus groups will also provide an invaluable opportunity to reflect on the achievements and challenges of 2023, fostering a deeper understanding of the progress made and the areas that require further attention.

The big picture: Participants will be encouraged to share their personal experiences, insights, and feedback, ensuring that the perspectives of our UIO partners play a pivotal role in shaping the path forward.

  • October 3: Full Ambulatory​ at 1:00-2:30 pm EDT [Register Here]
  • October 3: Outpatient and Residential​ at 3:00-4:30 p.m. EDT​ [Register Here]
  • October 4: Limited Ambulatory​ at 1:00-2:30 p.m. EDT​ [Register Here]
  • October 4: Outreach and Referral​ at 3:00-4:30 p.m. EDT​ [Register Here]
  • October 5: Makeup Session​ at 1:00-2:00 p.m. EDT [Register Here]

What if I can’t make it?: If you cannot attend your facility-type session or the makeup session, NCUIH will schedule a one-on-one session with you. Please email policy@ncuih.org to request a one-on-one session.

NCUIH In Action

ncuih

MR presenting NCUIH Vice President of Policy and Communications, Meredith Raimondi, presents at IHS Bemidji Area Meeting with Urban Indian Leaders

On July 20, NCUIH presented on urban Indian health updates at the IHS Bemidji Area Urban-face to-face meeting and gave an update on relevant federal policies, appropriations, Supreme Court cases, and legislation.​

Culleen Presents

NCUIH/NORC Report Briefing for CMS TTAG

On July 26, NCUIH staff (Chandos Culleen, JD, Director of Federal Relations, Isaiah O’Rear, M.A., M.Ed, Health Policy Statistician & Nahla Holland (Eastern Pequot Tribal Nation) Research Associate) presented to the Centers for Medicare & Medicaid Services Tribal Technical Advisory Group on our Traditional Healing and Primary Care Case Management/Indian Managed Care Entity Reports.​

Francys presents

NCUIH CEO, Francys Crevier, participates in a panel discussion on Native life expectancy

On August 9-10, the University of New Mexico Center for Native American Health hosted its “Native American Life Discrepancy in 2023: A Chronic Disease of Injustice” Symposium. ​NCUIH CEO, Francys Crevier explored the intersection of historical injustices, socio-economic challenges, and systemic barriers that continue to contribute to significant health issues facing Indian Country. She highlighted the critical importance of collaborative efforts, policy advocacy, and community-driven initiatives in addressing these inequalities and fostering sustainable positive change for urban Native American health and well-being.

Thank you for all your hard work and advocacy!

IHS Hosts Listening Session on Advance Appropriations, Provides Updates to Tribes and UIOs on Goals, Implementation Timelines, and Payment Processes

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On August 17, 2023, the Indian Health Service (IHS) hosted a listening session for Tribal and urban Indian organization (UIO) leaders to share information and solicit input on advance appropriations implementation. During the listening session, IHS shared that they are currently on track in terms of advance appropriations implementation. In September, IHS plans to start apportionment review and processing and in October, IHS will start distributing funds across the Indian Health, Tribal, and UIO (I/T/U) system. During this process, IHS is seeking input from Tribal and UIO Leaders on advance appropriations implementation regarding the following questions:

  • What additional information would be helpful to you?
  • Are there any considerations you think IHS is missing?
  • What is the best way to collect information about the impact of advance appropriations and success stories?

The IHS will host an identical listening session on Wednesday, September 6, 2023, from 3:00-4:30 p.m., Eastern Time. Click here to join the listening session.

Payment Processes

HHS financial systems will re-open after October 1, 2023, for Fiscal Year (FY) 2024 activities. All of the timelines and requirements to receive a payment remain the same. For example, funds will be paid out according to performance periods. If your UIO contract performance period is October – September, the earliest you could receive a payment for FY2024 is October 2023. If your performance period is November – October, the earliest you could receive a payment for FY2024 is November. Additionally, UIOs must have a signed Federal Acquisition Regulation (FAR) contract in place to receive a FY2024 payment.

Activities that did not receive FY 2024 advance appropriations include the following:

  • Electronic Health Record Modernization
  • Indian Health Care Improvement Fund
  • Health Care Facilities Construction
  • Sanitation Facilities Construction
  • Contract Support Costs
  • Section 105(l) Leases (Payments for Tribal Leases)

Background on IHS Advance Appropriations

The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for the Indian Health Service, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.

NCUIH Advocacy

After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.

On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.

IHS Provides Guidelines and Resources for IHS, Tribal, and Urban Indian Healthcare Facilities on Combating the Syphilis Epidemic

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On July 19, 2023, Indian Health Service (IHS) released a Dear Urban Leader Letter detailing the current syphilis epidemic impacting American Indian and Alaska Native (AI/AN) communities. AI/AN people have the highest rates of syphilis, which has serious consequences including congenital cases that are linked to stillbirths or infant death occurring shortly after birth. To combat this epidemic, IHS has introduced several guidelines and resources recommended for all IHS, Tribal, and urban Indian organizations (UIOs) healthcare facilities system including:

  • Annual syphilis testing
  • Three-point syphilis testing for all pregnant people
  • Enhance screening rates by screening outside of hospitals and clinics
  • Presumptive treatment of syphilis
  • Create and build awareness and encourage people to get tested and treated

Background

A recent surge in syphilis cases has significantly impacted and affected Indian Country. Given that American Indian and Alaska Native people have highest primary and secondary syphilis rates in the country, it is vital that health care providers and educational campaigns work together to reduce the prevalence of syphilis and other sexually transmitted infections (STIs). Prevention education and outreach can significantly reduce the health disparities caused by syphilis. For more information regarding syphilis prevention and education, Syphilis Resource Hub offers up to date and in-depth trainings and strategies regarding disease control and prevention.

NCUIH’s Role

The National Council of Urban Indian Health (NCUIH) proactively monitors the impact of diseases effecting Indian Country. As part of this effort, NCUIH regularly hosts panels and webinars to keep UIOs and other stakeholders informed about current trends or best practices pertaining to disease control and prevention education. For example, on June 21, 2023, NCUIH hosted an online webinar Strengthening Syphilis Care in Indian Country aimed to tackle challenges, share innovative solutions, and pave the way for enhanced syphilis and other STI services and capacities for UIOs and Americans Indians and Alaska Native people. NCUIH will continue to advocate and monitor for the resources needed to reduce health disparities for American Indian and Alaska Native people regardless of where they live.

IHS Initiates Listening Sessions for Tribal and Urban Indian Organization Leaders on Advance Appropriations Implementation

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On August 8, 2023, the Indian Health Service (IHS) sent a Dear Tribal Leader and Urban Indian Organization (UIO) Leader letter inviting Tribal and UIO leaders to participate in Agency-sponsored Listening Sessions to share information and solicit input on advance appropriations implementation. IHS will host two (2) identical Listening Sessions for Tribes and UIOs on August 17, 2023, and September 6, 2023. During the Listening Sessions, IHS will share additional information on implementation plans and strategies for advance appropriations, and seek Tribal and UIO input. The information discussed in these sessions will be used to prepare public-facing Frequently Asked Questions and other helpful materials.

Since advance appropriations was included in the final FY 2023 spending bill, the National Council of Urban Indian Health (NCUIH) has consistently requested that IHS host a Tribal Consultation and Urban Confer to ensure Tribes and UIOs are briefed on the implementation process and prepared for fund distribution. NCUIH recently met with IHS Director Roselyn Tso and emphasized the importance of hosting an Urban Confer before October 1, 2023. We look forward to continuing to engage with IHS to ensure successful implementation of advance appropriations for the whole IHS, Tribal, and UIO system.

The Advance Appropriations Implementation Listening Sessions will be on Thursday, August 17, 2023, 12:00-1:30 p.m., ET and Wednesday, September 6, 2023, 3:00-4:30 p.m., ET.

    • Click here to join the Thursday, August 17 Listening Session
    • Click here to join the Wednesday, September 6 Listening Session

Background on IHS Advance Appropriations

The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for the Indian Health Service, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.

NCUIH Advocacy

After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.

NCUIH has been advocating that advance appropriations be maintained for IHS until mandatory funding is achieved. On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.

NCUIH Requests IHS Support Interoperability, Reimbursement for Health IT Modernization

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On June 9, 2023, the National Council of Urban Indian Health (NCUIH) submitted comments to the Indian Health Service (IHS) on Health Information Technology (HIT) Modernization in response to the February 6, 2023 joint Dear Tribal Leader and Urban Indian Organization Leader letter and the May 5, 2023 Tribal Consultation and Urban Confer on IHS HIT Modernization Resources. In its comments, NCUIH incorporates previous comments to IHS regarding the HIT modernization and Resource and Patient Management System (RPMS) replacement and again notes that the inclusion of urban Indian Organizations (UIOs) in the HIT Modernization process is consistent with, and required by, the federal government’s trust responsibility and the Indian Health Care Improvement Act and is also sound public health policy. 

Recommendations 

In its comments, NCUIH made the following specific requests, and recommendations to IHS: 

  • Incorporate necessary new capabilities in the modernized Electronic Health Record (EHR) solution. 
    • Ensure that the new EHR contains the full suite of EHR Capabilities. 
    • Supports the unique interoperability needs of UIOs by ensuring that the modernized EHR is either a complete EHR or a modular EHR that a UIO will be able to upgrade as it creates demand for new capabilities. 
  • Develop a timeline for IHS, Tribal, and UIO (I/T/U) facilities to use as a planning base to prepare for the transition to a new system and develop uniform training packages to assist I/T/U facilities in training their staff members on the new EHR. 
  • Take all necessary and practicable steps to secure funding for direct reimbursement of Tribal and UIO facilities for the cost of commercial off-the-shelf (COTS) EHR systems.

Background on NCUIH Work on IHS Health IT Modernization 

NCUIH has submitted several written comments to IHS on HIT Modernization. NCUIH also submitted written testimony to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the Fiscal year (FY) 2024 funding for UIOs in which NCUIH requested increased funding for EHR Modernization. Specifically, NCUIH requested support for the IHS’ transition to a new EHR system for IHS and UIOs by supporting the President’s budget request of $913 million in FY 2024 appropriations.