NCUIH Signs Letter of Support for John R. Lewis Voting Rights Act

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On November 8, 2023, the National Council of Urban Indian Health (NCUIH) joined the Nonprofit Infrastructure Coalition, National Urban Indian Family Coalition, and 29 other nonprofit organizations in the effort to support voting rights in the United States, by signing a letter to Representative Terri Sewell (D-AL-07) expressing support for the John R. Lewis Voting Rights Advancement Act of 2023 (H.R 14). This legislation would protect voting rights in the United States and provide critical updates and modernizations to the Voting Rights Act of 1965 (VRA). Discriminatory voting policies adversely affect Native communities, and this bill would ensure state and local voting enforcements will be subject to increased oversight from the federal government and cannot enforce voting policies that target minority communities.

Background

In 1965, Congress passed the Voting Rights Act, a landmark piece of legislation that included numerous provisions aimed at ensuring minority voters had an equal opportunity to vote and prohibited racial discrimination in voting. In 2013, the United States Supreme Court in Shelby County v. Holder, overturned many key anti-discrimination provisions in the Voting Rights Act of 1965.  One of the key provisions overturned was an enforcement mechanism that prohibited states or political subdivisions, with a history of discriminatory practices, to make changes to voting laws and practices without clearance from federal officials first. In Shelby, the Supreme Court ruled that the formula determining a history of discriminatory voting practices was unconstitutional, removing significant oversight from the federal government.

The John R. Lewis Voting Rights Advancement Act would restore protections in the original Voting Rights Act of 1965 and strengthen legal protections against discriminatory voting practices. This includes key provisions to protect voting access in Indian Country, such as prohibiting changing jurisdiction boundaries, creating at-large districts, relocating voting locations, reducing in-person voting days or hours, or making changes to the voter registration list in areas where a single language minority represents 20% or more of the population on Indian lands in the state or political subdivision.

Biden Administration Announces Voter Registration Pilot Program at Indian Health Service Facilities

According to the Native American Voting Rights Coalition an estimated 1,000,000 eligible American Indian and Alaska Native voters are not currently registered to vote, with numerous obstacles preventing them from registering to vote and participating in elections. Some of these include lack of traditional addresses, lack of access to required identification forms, cultural and political isolation, and difficulties reaching the polls.

In an effort to improve voting access for American Indians and Alaska Natives, the Biden Harris Administration has transformed certain Indian Health System facilities into voter registration sites. On March 5, 2023, President Biden announced agency actions to make the voting process more accessible in alignment with recommendations made by the Native American Rights Fund (NARF). This included a new initiative at the Indian Health Service (IHS) piloting “high-quality voter registration services across five different IHS facilities before the end of 2023”. The first site announced in this initiative Native Health in Phoenix, Arizona.

Native Health has been active in voting rights and dedicated to increasing Native participation in the voting process. In 2022, they distributed Get Out the Vote information at various events, invited guests for voting related discussions on their podcast, Native Talk Arizona, and highlighted the importance of voter registration through social media. As part of this pilot program and being a National Voter Registration Act designated site, they will continue this work by ensuring anyone who steps into their clinic is provided with an opportunity to register to vote.

Indian Health Service Extends Recommended Dates for Maternal RSV Vaccine for Pregnant AI/AN People

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The Indian Health Service Chief Medical Officer, Dr. Loretta Christensen, has extended the recommended dates for administration of maternal respiratory syncytial virus (RSV) Vaccine for pregnant American Indian and Alaska Native (AI/AN) people. This extension aims to protect newborn infants from RSV during the 2023-2024 respiratory virus season. Eligible AI/AN people who are 32-36 weeks pregnant should continue to be offered one dose of Pfizer’s bivalent RSVpreF vaccine (Abrysvo™) through the end of February 2024.

RSV is a common cause of respiratory infection in U.S. infants and is the leading cause of hospitalization among U.S. infants. The highest incidence of RSV-associated hospitalization occurs in infants aged <3 months. RSV prevention products focus on passive immunization of infants through maternal immunization or immunoprophylaxis with monoclonal antibodies.

Healthcare providers are encouraged to offer RSVpreF vaccine (Abrysvo™, Pfizer) to pregnant people during 32 weeks’ gestation through 36 weeks and 6 days’ gestation to prevent RSV-associated lower respiratory tract disease in infants. Either RSVpreF vaccination or nirsevimab (Beyfortus™) immunization for infants is recommended, but administration of both products is not needed for most infants.

In most of the continental U.S., pregnant people should receive RSV vaccine from September through January. However, RSV seasons can vary in different parts of the U.S. Local, state, and territorial health departments can determine the best times to start and stop administration of RSV vaccines in their jurisdictions.

Read the Recommendation

NCUIH Selected as One of 11 Organizations for Pfizer Communities in Action for Health Equity Grant

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We are excited to announce that we have received the Pfizer Communities in Action for Health Equity grant, enabling us to collaborate on advancing health equity for historically disregarded communities. This grant will support our efforts in providing crucial support and technical assistance to Urban Indian Organizations (UIOs), raising awareness of their health policy needs, and addressing the healthcare disparities faced by Native people in urban areas. Through engagement with stakeholders, we aim to drive meaningful policy changes for improved health and equitable healthcare delivery. At NCUIH, our commitment to culturally competent care drives us to find sustainable solutions, and over the next year, we will continue our project in “Addressing Urban Indian Health Disparities through Policy Change.” This initiative aligns with the Pfizer Multicultural Health Equity Collective and Pfizer’s Institute of Translational Equitable Medicine, which aim to dismantle the drivers of health inequity through the Communities in Action for Health Equity grant program.

“The Communities in Action for Health Equity grants program resulted from many candid discussions with health equity leaders about how we can move forward more equitable care and actually drive systemic change,” said Niesha Foster, Vice President, Global Health and Social Impact, Pfizer. “Our partners are truly at the forefront of this work and while we know this will be a multi-year effort, we feel Pfizer can play an important role in bringing multi-disciplinary leaders together and investing in the community-led solutions they helped identify.”

To learn more about our project and partners, visit https://www.pfizer.com/news/announcements/pfizer-awards-2m-nonprofit-organizations-addressing-systemic-health-inequities.

IHS Responds to NCUIH’s Request to Provide Clarity on the Health IT Modernization Implementation During Virtual Summit

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On December 13, 2023, the Indian Health Service (IHS) held the Health Information Technology (HIT) Modernization Virtual Summit. IHS gave Tribal and urban Indian organization (UIO) leaders an update on the HIT Modernization Program and provided a forum to engage with IHS on the Program. The purpose of the Summit was to raise awareness of the new enterprise Electronic Health Record (EHR) solution and to give Tribal and UIO leaders an opportunity to engage in a conversation with IHS on the HIT Modernization Program. In providing updates on the HIT Modernization implementation process, IHS also responded to comments that the National Council of Urban Indian Health recently submitted to the agency regarding HIT Modernization on December 8.

For more information on the Summit, please click here.

NCUIH Requested IHS Provide Clarity on the HIT Modernization Implementation

On December 8, 2023, NCUIH submitted comments and requests to IHS Director, Roselyn Tso, in response to a Tribal Consultation and Urban Confer and request for input on the HIT Modernization Program. In its comments, NCUIH urged IHS to maintain transparency in the HIT Modernization process to ensure that UIOs stay informed on the progress of the complex, multi-year rollout for the new EHR.

In its comments, NCUIH requested that IHS:

  • Clarify the HIT Modernization implementation process. This includes providing clarity on the vendor’s scope of work, the data migration process, and the ways in which IHS will support all facility types.
  • Provide an update to the timeline for HIT Modernization implementation. Specifically, NCUIH seeks clarity on the multi-year rollout cohort identification process.
  • Provide frequent and regular updates to the IHS HIT Modernization webpage.
  • Communicate the status of the Enterprise Collaboration Group (ECG).
IHS Responds to NCUIH’s Request Regarding Focus Groups and the Enterprise Collaboration Group

In NCUIH’s recently submitted comments to IHS regarding HIT Modernization, NCUIH requested clarification on the differences between the Focus Group and the ECG. During the Summit, IHS provided more information on the entities’ role in the HIT Modernization process.

Focus Groups are for every facility regardless of which EHR they are choosing to utilize. The ECG will be comprised of subject matter experts from IHS as well as Tribes and UIOs who provided statements of interest. It will be a chartered entity with many committees that will facilitate structured conversations to help manage the system. The ECG is for entities that will use the new system.

Other Takeaways from the HIT Modernization Program Updates

Timeline

The contract with GDIT is a 10-year indefinite delivery, indefinite quantity (IDIQ) contract. Initial go-live(s) expected to occur late Fiscal Year 2025. IHS requested Tribes and UIO maintain their current HIT system and keep data up to date to support EHR replacement if desired.

Substance Use Disorder Treatment and the New EHR

The EHR will support substance abuse/alcohol abuse treatment centers. IHS stated that it is working to understand how to share patient information with a health information exchange (HIE) partner in compliance with 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records). Because there are limits on how patient information can be shared, IHS is discussing how to share the information effectively under the rules and doing so in the HIE environment.

Background on HIT Modernization

During the November 8, 2023, Tribal Consultation and Urban Confer on HIT Modernization, IHS announced that it selected General Dynamics Information Technology, Inc. (GDIT) to build, configure, and maintain a new IHS enterprise EHR system utilizing Oracle Cerner technology. The new EHR will replace the Resource and Patient Management System.

For more information about HIT Modernization implementation, please click here.

NCUIH Action

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.

NCUIH will continue to closely follow IHS’s progress and policies with HIT Modernization.

NCUIH Releases 2023 Annual Policy Assessment

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The Policy Assessment informs urban Indian organizations policy priorities for 2024, identifies barriers to workforce recruitment and retention, and addresses critical funding needs.

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2023 Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 3, 4, and 5, 2023.

Together these focus groups allow NCUIH to work with UIOs to identify policy priorities in 2024 and identify barriers that impact delivery of care to Native patients and their communities.  Of the 41 UIOs, 18 attended and participated in the focus group sessions. This is the fourth year that NCUIH has conducted the assessment via focus groups sessions.

Read the 2023 Policy Assessment

Overview of the Policy Assessment

During the focus group sessions, UIO leaders had the opportunity to share their opinions on the successes and challenges they experienced in 2023 and provide input on the policy areas where they would like to see the greatest policy support from NCUIH. Some of the key policy priority areas identified included increasing funding for the Indian Health Service and urban Indian health line items, securing 100% FMAP for UIOs, passing the Urban Indian Health Confer Act, reauthorizing the Special Diabetes Program for Indians, and reimbursing UIOs for traditional healing services.

Key Findings from the Policy Assessment are as follows:

  • Funding Remains a Key Focus and Challenge
  • Workforce Recruitment and Retention Remains Key Concern Amid Competitive Market
  • Health Information Technology Modernization Challenges
  • Actions Taken to Address Missing and Murdered Indigenous Persons, Despite Absent Adequate Funding
  • Need for Increased HIV Prevention and Treatment Resources
  • Barriers to the Provision of Traditional Healing
  • Clear Need to Increase and Diversify Resources to Address Food Insecurity
  • Lack of Stable Housing for Native People

Next Steps

NCUIH will release a comprehensive document of the 2024 Policy Priorities in the coming weeks.

Past Assessments and Priorities

January Policy Updates: CR Passed, SDPI Update, and 2024 Policy Overview

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Happy New Year! 🍇

In this Edition:

  • 🔎 Explore the latest on the government shutdown and a 2024 forecast, with a focus on Special Diabetes Program for Indians (SDPI) funding.
  • 🏛 Stay informed on crucial legal cases, including the Supreme Court’s consideration of issues impacting Native communities.
  • ✍ Participate in upcoming federal agency comment opportunities, shaping policies on health, substance use disorder, and more.
  • 📆 Mark your calendars for key events, consultations, and legislative updates.
  • 📋 Join us next week to learn about NCUIH’s 2024 Urban Indian Health Policy Priorities and find out what’s on the horizon.
  • ⏳ Don’t miss the opportunity to register now for the 2024 NCUIH Annual Conference and stay updated on NOFOs.

Short-Term Reprieve: FY24 Continuing Resolution Temporarily Extends SDPI Authorization

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Today, President Biden signed a short-term stopgap bill to avoid a government shutdown on January 20th.

  • The bill would continue the two-tiered system with new deadlines on March 1st and March 8th. The latest stopgap includes minimal changes to spending, mainly just continuing the current continuing resolution. ​
  • Most importantly, it will extend SDPI through March 8 at current funding levels.

H.R. 5378 – Lower Costs More Transparency Act​

  • This bill has passed the House and has been received in the Senate. This bill funds SDPI at $170 million for FY24-25 among other provisions.
  • Why it matters: The bill’s reauthorization of SDPI would allow for UIOs to continue to use grant funding to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. While the FY2024 Continuing Resolution re-authorizes SDPI, it is set to expire in March, making this legislation even more crucial to avoid lapses in critical diabetes research and care funding.

Monitoring the Bench: Supreme Court Updates from NCUIH

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Becerra v. San Carlos Apache/Becerra v. Northern Arapaho Tribe (Consolidated) 

Issue: Whether IHS must pay “contract support costs” (CSCs) not only to support IHS-funded activities but also to support the Tribe’s expenditure of income collected from third parties.

Relation to UIOs: No strong relation to UIOs because it relates to CSCs, but will affect Tribal healthcare facilities, and potentially restrict the scope of CSCs to cover services at Tribal facilities. ​

Case Status: Granted Cert by the Supreme Court, no Oral Argument date set yet.

Relentless, Inc. v. Department of Commerce and Loper Bright Enterprises v. Raimondo 

Issue: Whether the court should overrule Chevron v. Natural Resources Defense Council, or at least clarify that statutory silence concerning controversial powers expressly but narrowly granted elsewhere in the statute does not constitute an ambiguity requiring deference to the agency.

Relation to UIOs: Both cases have the potential to overturn Chevron deference, which would open up administrative agencies to more litigation and create discrepancies in how regulations are enforced.

Case Status: Oral Argument was held on January 17, 2024 .

IHS Hosting Urban Confer on Fentanyl and Opioid Programs & Health IT Modernization

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On February 2, 2024, IHS is holding an Urban Confer on the potential implementation of $250 million to support funding for fentanyl and opioid abuse prevention, treatment, recovery services, and harm reduction interventions.

  • The confer will take place on Friday, February 2, 2024, from 1pm-2:30pm EST via Zoom.
  • NCUIH will hold a prep session on February 2, 2024 for UIO leaders.

On February 8, 2024, IHS is holding Tribal Consultation/Urban Confer. on Health IT Modernization Tribal Consultation/Urban Confer.

  • The confer will take place on Thursday Feb 8, 2024, at 1:30pm EST via Zoom. Register here.

Upcoming Federal Agency Comments: Grants Regulation, Traditional Knowledge, Resources for Native Americans

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January 31 – Substance Abuse and Mental Health Services Administration (SAMHSA) – Behavioral Health and Substance Use Disorder Resources for Native Americans Program​

  • SAMHSA is seeking recommendations on this newly authorized program​.
  • What factors should be considered in determining non-competitive awards to eligible entities?​
  • What measures should be established to demonstrate outcomes and report data on the results of services?​
  • How can the administrative process be streamlined to capture program requirements and facilitate assisting application submission?​

February 23 – US Patent and Trademark Office (USPTO) – Tribal Consultation on World Intellectual Property Organization (WIPO) Genetic Resources, Traditional Knowledge, Traditional Cultural Expressions of Indigenous Peoples​. More Info.

  • The Tribal Consultation will consist of four national webinars: two for federally recognized Tribal Nations and their proxies, and two for state and non-recognized Tribes, Native Hawaiians, their representatives, and inter-Tribal organizations. ​
  • USPTO and the WIPO seek Tribal input on how best to protect genetic resources, traditional knowledge, and traditional cultural expressions of Indigenous Peoples.

Upcoming Events and Important Dates

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January 19- 23: US Patent and Trademark Office (USPTO) Online Listening Sessions. Register here.

January 24: Administration for Community Living (ACL) Tribal Consultation (hybrid).

January 24-25: FY 2026 National Tribal Budget Formulation Workgroup Area Report Webinars. Join day 1 here. Join day 2 here.

February 2: IHS Urban Confer on the proposed supplemental funding request to support fentanyl and opioid programs. Join here.

February 6: HHS Tribal Consultation: Draft Tribal and Tribal Epidemiology Center Data Access Policy. Register here.

February 8: IHS Health IT Modernization Tribal Consultation/Urban Confer. Register here.

February 12-15: National Congress of American Indians (NCAI) Executive Council Winter Session (ECWS) and 2024 State of Indian Nations Address (Feb. 12). Register here.

February 13-14: IHS FY 2026 National Tribal Budget Formulation Work Session (Hybrid). More info.

February 15: Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call.

February 21: Next NCUIH Monthly Policy Workgroup meeting. Join here.

February 21: IHS Tribal Self-Governance Advisory Committee (TSGAC) Meeting. More info.

February 21-22: Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Tribal Advisory Council (hybrid). Register here.

ICYMI: 

  • January 9, 11, 17, 18: IHS Tribal Consultation on the Definition of Indian Tribe.

    -Consulted on what definition of Indian Tribe should be included in the updated IHS Tribal Consultation Policy: List Act Definition (25 U.S.C. § 5130); or ISDEAA Definition (25 U.S.C. § 5304(e)).

    The ISDEAA definition includes Alaska Native Corporations (ANCs) and is currently utilized in the IHS Tribal Consultation Policy

  • January 18: NCUIH submitted comments to HHS Office of Civil Rights (OCR) on the Proposed Rule on HHS Grants Regulation.

    -NCUIH requested that the agency include language in the proposed rule that clearly states that nothing in the rule will limit ability of Tribes or UIOs to serve American Indian and Alaska Native people exclusively using HHS awards, and ensure OCR and HHS grant staff are properly trained on the unique political status of American Indian and Alaska Native people.

  • Dec. 21: IHS Direct Service Tribal Advisory Committee (DSTAC) Quarterly Meeting.

    -IHS Chief Medical Officer reported that IHS has reduced opioid prescribing by 75% and they continue to support low barrier access to naloxone.

    -IHS has put together an obstetrician readiness manual that can be used when birth is outside a formal labor and delivery office.

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

  • January 16: IHS DTLL/DULL – Appointment of the new IHS Deputy Director for Quality Healthcare and Enterprise Risk Management.

    -IHS has appointed Ms. Michelle Boylan, RN, MA, MBA, CPHQ, as the new Deputy Director for Quality Healthcare and Enterprise Risk Management.

  • January 12: IHS DULL – Urban Confer on the proposed supplemental funding request to support fentanyl and opioid programs.

    -The confer will take place on Friday, February 2, 2024, from 1pm-2:30pm EST via Zoom.

  • January 11: White House DTLL – White House Tribal Consultation on Executive Order (EO) 14112.

    -Announcing January 22, 2024 Consultation to discuss 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.”

    -This EO does not address funding for UIOs.

  • January 10: HHS DTLL – HHS Tribal Data Policy.

    -Tribal Consultation is on February 6, 2024, to discuss the current draft of the HHS Tribal and Tribal Epidemiology Center (TEC) Data Access Policy.

    -2022 Government Accountability Office report recommended that HHS develop a policy clarifying the HHS data to be made available to TECs.

  • Dec. 21: IHS DTLL – Federal Register Notice for calendar year 2024 reimbursement rate.

    -Announces publication of the Federal Register Notice for CY 2024 reimbursement rates: Lower 48 Medicaid AIR is $719, Lower 48 Medicare AIR is $667.

    -New page on the IHS website explains the process for these rates.

NCUIH 2024 Urban Indian Health Policy Preview

NCUIH Policy Preview

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

Event Goal:

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

Objectives: 

  1. Develop a deeper understanding of the 2024 Policy Priorities driving American Indian and Alaska Native health initiatives.
  2. Gain valuable insights into the advocacy efforts aimed at advancing urban Indian health policies.

The session is open to only UIO staff and will be facilitated by Jeremy Grabiner, NCUIH’s Interim Director of Congressional Relations.

Register

Urban Voices Amplified: Empowering Native Votes in Collaboration with the National Urban Indian Family Coalition

NUIFC GOTV

As part of our commitment to empowering Native American communities, and in collaboration with the National Urban Indian Family Coalition (NUIFC), we’re thrilled to share our Get Out the Vote (GOTV) Social Media Toolkit with you. This toolkit includes five eye-catching graphics tailored to encourage Indian Country to register and vote.

NCUIH

Here you’ll find high-resolution graphics designed to be shared across Instagram, X (formerly Twitter), LinkedIn, and Facebook.

Together, let’s inspire Native Americans to exercise their right to vote and make a lasting impact on our communities.

Additionally, we’re excited to share a digital poster that you can download, print, and hang up in your community spaces. This poster serves as a visual reminder to encourage voter registration and participation.

2024 NCUIH Annual Conference – Early Bird Registration Open

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Register now before rates go up in March!

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

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

One last thing, check out these upcoming funding opportunities:

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

    – Deadline: January 22, 2024 (Apply)

  • IHS – Community Opioid Intervention Prevention Program

    -Deadline: February 7, 2024 (Apply)

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

    – Deadline: February 13, 2024 (Apply)

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

    – Deadline: February 15, 2024 (Apply)

  • SAMHSA – Strategic Prevention Framework Partnerships for Success for Communities, Local Governments, Universities, Colleges, and Tribes/Tribal Organizations

    – Deadline: February 21, 2024 (Apply)

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

    – Deadline: February 28, 2024 (Apply)

  • IHS – Indian Health Service Scholarship Program (IHSSP)

    -Deadline: February 28, 2024 (Apply)

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

    – Deadline: February 29, 2024 (Apply)

NCUIH Urges Office of Management and Budget to Fully Fund IHS and Fund Critical Indian Health Programs

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On September 29, 2023, the National Council of Urban Indian health (NCUIH) submitted comments to the Office of Management and Budget (OMB) Director, Shalanda Young, regarding the formulation of the President’s Fiscal Year (FY) 2025 Budget. In its comments, NCUIH made seven key recommendations to fully fund and support health services for urban Indian organizations (UIOs) and urban American Indian and Alaska Native (AI/AN) people.

Background

OMB serves as a clearinghouse for budget formulation by developing overarching presidential priorities, coordinating across agencies, and publishing the annual President’s Budget. For more information on OMB, please click here.

NCUIH’s Recommendations

In its comments, NCUIH recommended that the President’s FY2025 budget:

  • Fully fund the Indian Health Service (IHS) and the Urban Indian Health Line Item , as recommended by the Tribal Budget Formulation Workgroup. Full funding for IHS in the President’s FY 2025 Budget will address the following UIO priorities:
    • Infrastructure and facility needs
    • Food security
    • Traditional Healing
    • Health information technology and electronic health record modernization
  • Safeguard IHS and UIO funding by transitioning the IHS budget from discretionary funding to mandatory funding and exempting IHS funding from sequestration.
  • Propose setting the Federal Medical Assistance Percentage (FMAP) at 100% for Medicaid services provided at UIOs.
  • Request inclusion of $80 million for the Native Behavioral Health Resource Program (NBHRP).
  • Propose permanent reauthorization of the Special Diabetes Program for Indians (SDPI) at $250 million, if not reauthorized in the FY 2024 budget.
  • Request a legislative fix permitting the U.S. Public Health Service Commissioned Corps Officers to be detailed to UIOs

NCUIH will continue to monitor the FY 2025 budget formulation process and report developments across federal agencies and in Congress.

NCUIH Publishes Update to Report on Recent Trends in Third-Party Billing at UIOs

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On December 1, 2023, the National Council of Urban Indian Health (NCUIH) published its report, “Recent Trends in Third-Party Billing at Urban Indian Organizations: A Focus on Primary Care Case Management and Indian Managed Care Entities.” This report serves as an update to NCUIH’s previous report on recent trends in third-party billing. The focus of this report is on the experience of UIOs enrolled in Medicaid and Children’s Health Insurance Program as either a primary care case manager (PCCM) or Indian Managed Care Entity (IMCE). On July 26, 2023, NCUIH staff (Chandos Culleen, Director of Federal Relations; Isaiah O’Rear, Health Policy Statistician; and Nahla Holland (Eastern Pequot Tribal Nation), Research Associate) presented the report and its findings to the Centers for Medicare & Medicaid Services (CMS) Tribal Technical Advisory Group.

Read the Report

Key findings related to UIO Experience with PCCM/IMCE include:

  • PCCM/IMCE benefited UIOs and their patients through improving continuity of care for Medicaid and CHIP enrollees.
  • PCCM/IMCE benefited UIOs by providing a comprehensive view of the patient’s care, reducing the need for self-advocacy and reporting.
  • UIOs reported a best practice of strong working relationships with state Medicaid offices, Tribal Relations Liaisons, and other partners.
  • Challenges faced by UIOs include insufficient capitation rate for UIOs providing PCCM services, poor communication with state Medicaid offices, and lack of 100% FMAP for UIOs resulting in UIO exclusion from PCCM program.

The findings of this report indicate that UIO participation as a primary case manager in Medicaid and CHIP provides resources that may enhance the level of care available for American Indian and Alaska Native beneficiaries. The benefits provided through PCCM/IMCE, such as improvement in care coordination, increased access to preventative care, and reduced reliance on patient self-advocacy, may be of interest to other Indian health care providers. However, further work is needed to address barriers identified in the report, including insufficient capitation rates, a need for improved communication with state Medicaid offices, and a need for further education regarding the roles of UIOs in the Indian healthcare system.

This report was completed during NCUIH’s third year of participating in a research project commissioned by CMS through a contract with NORC at the University of Chicago. NCUIH is thankful for this partnership between the Division of Tribal Affairs and Office of Minority Health at CMS and NORC, as it has made this project and subsequent report possible. We look forward to continued collaboration as we strive to achieve healthy equity for American Indian and Alaska Native people.

House Passes Bipartisan Bill that Includes the Reauthorization of the Special Diabetes Program for Indians at $170 Million

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On December 11, 2023, the House passed the Lower Costs, More Transparency Act (H.R. 5378) with a vote of 320-71. The bill has now been received in the Senate. The original sponsor, Rep. Cathy McMorris Rodger (R-WA-05) introduced this bipartisan legislation on September 8, 2023, which would extend funding for the Special Diabetes Program and the Special Diabetes Program for Indians (SDPI) through 2025, including $124.4 million for the rest of fiscal year (FY) 2024 and $170 million in FY 2025 for each program, plus $42.8 million for the remainder of calendar year 2025 for each program. The bill’s reauthorization of SDPI would allow for urban Indian organizations (UIOs) to continue to use grant funding to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. Under the FY 2024 Continuing Resolution (CR), SDPI is set to expire January 19, 2024, making this legislation even more crucial to avoid lapses in critical diabetes research and care funding.

Specifically, the bill increases transparency to the health care system and extends important public health legislation by:

  1. A 13 percent increase in funding for both the Special Diabetes Program (SDP) and the Special Diabetes Program for Indians (SDPI), to $170 million each year for fiscal years 2024 and 2025
  2. Codifying the Hospital Price Transparency rule and the Transparency in Coverage rule, which requires hospitals to make public all standard charges for all items and services, and requires insurers to make public their negotiated in-network provider rates for all items and services
  3. Extending these price transparency requirements to other providers and services, including labs, imaging providers, and ambulatory surgical centers
  4. A 10 percent increase in mandatory funding for Community Health Centers (CHCs)
  5. A 13 percent increase in funding for the National Health Service Corps (NHSC)
  6. A seven-year reauthorization for the Teaching Health Centers Graduate Medical Education (THCGME) program
  7. Lowering health care costs and reducing seniors’ cost-sharing by ensuring that Medicare beneficiaries are not paying more for drug administration if a drug is administered in a hospital outpatient department instead of a physician’s office
  8. Prohibiting the use of “spread pricing,” or markups charged by PBMs, for prescription drugs in Medicaid, and including provisions to help ensure that Medicaid payments to pharmacies are adequate and accurate
  9. Increasing access to affordable generic drugs by requiring the Food and Drug Administration to provide more information to generic drug manufacturers during the development process, speeding their path to market and increasing competition.

 This bill is endorsed by The Alliance to Fight for Health Care, Better Solutions for Healthcare, Families USA, The Leukemia & Lymphoma Society, the National Association of Community Health Centers, the American Association of Teaching Health Centers, the American Association of Colleges of Osteopathic Medicine, the American Academy of Family Physicians, Advocates for Community Health, AARP, American Benefits Council, Small Business Majority, the National Alliance of Healthcare Purchaser Coalitions, the Purchaser Business Group on Health (PBGH), The ERISA Industry Committee, EmployersRx, Consumers First, Consumers for Fair Hospital Pricing, and United States of Care, and more.

Need for a Crucial Investment in SDPI

SDPI is set to expire on January 19, 2024, with first funding deadline for the current FY 2024 Continuing Resolution. 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. SDPI has demonstrated success with a 50% reduction in diabetic eye disease rates, drops in diabetic kidney failure, and 50% decline in End Stage Renal Disease.  Additionally, the reduction in end stage renal disease between 2006 and 2015 led to an estimated $439.5 million dollars in accumulated savings to the Medicare program, 40% of which, of $174 million, can be attributed to SDPI.

Currently, 31 UIOs are in this program and are at the forefront of diabetes care. Facilities use these funds to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities.

SDPI has been funded at $150 million since 2004, despite significant inflation and increases in healthcare expenditures over the past twenty years. With the program set to expire in January 2024, the permanent reauthorization of SDPI at a minimum of $170 million requested in the President’s FY 2024 budget with automatic annual funding increases tied to the rate of medical inflation is essential to continue the success of preventing diabetes-related illnesses for all of Indian Country.

NCUIH Advocacy

The National Council of Urban Indian Health (NCUIH) has long supported the permanent reauthorization of SDPI and will continue to advocate for the UIOs’ requested amount of $250,000,000. On September 12, 2023, the National Indian Health Board (NIHB), the NCUIH, and 15 other Tribal partners sent a letter to House and Senate leadership requesting the reauthorization of the SDPI and brought for consideration for a floor vote by the time the program expired, on September 30, 2023. On September 14, 2023, NCUIH also released an action alert regarding SDPI to assist Indian Health Advocates in contacting congress about the potential lapse in SDPI funding.

Next Steps

This bill has been received in the Senate. NCUIH will continue to monitor the bill’s progress.

NCUIH Endorses Bicameral Bill to Secure Funding for Native Mothers and Infants

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On May 15, 2023, Senator Cory Booker (D-NJ) and Representative Lauren Underwood (D-IL-14) reintroduced the National Council of Urban Indian Health (NCUIH)-endorsed bicameral Black Maternal Health Momnibus (H.R.3305/S.1606), which now awaits consideration in the House and Senate. The bill addresses the United States’ highest maternal mortality rate of any high-income country through historic investments that comprehensively address every driver of maternal mortality, morbidity, and disparities in the United States. Specifically, the legislation includes urban Indian organizations (UIOs) as eligible entities for multiple grant programs that support Native American and Alaksa Native mothers and infants.

Specifically, the Momnibus includes 13 individual bills that support mothers and infants to reduce maternal mortality:

  1. The Social Determinants for Moms Act
    1. (UIOs ARE ELIGIBLE) Makes critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition.
  2. WIC Extension for New Moms Act
    1. Extends WIC eligibility in the postpartum and breastfeeding periods.
  3. Kira Johnson Act
    1. Provides funding to community-based organizations that are working to improve maternal health outcomes and promote equity.
  4. Maternal Health for Veterans Act
    1. Increases funding for programs to improve maternal health care for veterans.
  5. Perinatal Workforce Act
    1. Grows and diversifies the perinatal workforce to ensure that every mom in America receives maternal health care and support from people they trust.
  6. Data to Save Moms Act
    1. (UIOs ARE ELIGIBLE) Improves data collection processes and quality measures to better understand the causes of the maternal health crisis in the United States and inform solutions to address it.
  7. Moms Matter Act
    1. (UIOs ARE ELIGIBLE) Supports moms with maternal mental health conditions and substance use disorders.
  8. Justice for Incarcerated Moms Act
    1. (UIOs ARE ELIGIBLE) Improves maternal health care and support for incarcerated moms.
  9. Tech to Save Moms Act
    1. (UIOs ARE ELIGIBLE) Invests in digital tools to improve maternal health outcomes in underserved areas.
  10. IMPACT to Save Moms Act
    1. Includes innovative payment models to incentivize high-quality maternity care and non-clinical support during and after pregnancy.
  11. Maternal Health Pandemic Response Act
    1. (UIOs ARE ELIGIBLE) Invests in federal programs to address maternal and infant health risks during public health emergencies.
  12. Protecting Moms and Babies Against Climate Change Act
    1. (UIOs ARE ELIGIBLE) Invests in community-based initiatives to reduce levels of and exposure to climate change-related risks for moms and babies.
  13. Maternal Vaccination Act
    1. Promotes maternal vaccinations to protect the health of moms and babies.

Background on Native Mothers and Infant Health Disparities

According to the Office of Minority Health (OMH), Native infants have almost twice the infant mortality rate as non-Hispanic whites.  Native infants are also almost three times more likely than non-Hispanic whites to die from accidental deaths before the age of one year. Contributing factors to these disparities include cost, discrimination, and lack of cultural competency during prenatal care. Additional ongoing and historical trauma due to colonization, genocide, forced migration, and cultural erasure also contribute to health inequities, including pregnancy-related deaths and other maternal health conditions. Approximately 41% of American Indian and Alaska Native women cite cost as a barrier to receiving the recommended number of prenatal visits and 23% of American Indian and Alaska Native people report they have faced discrimination in clinical settings due to being an American Indian and Alaka Native. Consequently, American Indian and Alaska Native people are more likely to have underlying chronic health conditions, and they face systemic barriers to care including higher rates of poverty and needing to travel long distances to receive quality health care services.

NCUIH and UIO Work on Native Maternal and Infant Health

UIOs provide a range of services such as primary care, behavioral health, traditional, and social services— including those for infants, children, and mothers. At least 23 of these clinics provide care for maternal health, infant health, prenatal, and/or family planning. They also provide pediatric services and participate in maternal-child care programs such as WIC and the Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting program (MIECHV).

NCUIH has engaged in extensive advocacy on behalf of American Indian and Alaska Native mothers and infants and for increased funding and support to UIOs. Last year, NCUIH successfully advocated for the reauthorization of MIECHV and an increase to the Tribal set-aside from 3% to 6% for the Tribal Home Visiting Program in the FY 2023 final appropriations package, and continues to advocate on behalf of American Indian and Alaska Native mothers and infants.

Next Steps

This bill has been introduced in the House and Senate and awaits consideration. NCUIH will continue to monitor the bills’ progress.