Updated Medicare CPT Codes and Payment for Additional COVID-19 Vaccine Doses

On August 12, the Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) for the Pfizer-BioNTech and Moderna COVID-19 vaccines, authorizing the use of an additional dose in immunocompromised individuals. The new authorizations allow for a third dose to be given at least 28 days following the two-dose regimen of the same vaccine to those over the age of 18 (ages 12 and older for Pfizer-BioNTech) who are solid organ transplant recipients or have certain conditions that are an equivalent level of immunocompromise. After review, the Centers of Disease Control and Prevention (CDC) officially recommended that people with moderately to severely weakened immune systems receive the additional shot. CDC’s independent advisory panel, the Advisory Committee on Immunization Practices outlined clinical considerations regarding the additional dose. Urban Indians should talk to their healthcare provider about their medical condition, and whether getting an additional dose is appropriate for them.

Effective August 12, the Medicare CPT code for the Pfizer vaccine is 0003A and the CPT code for the Moderna vaccine is 0013A. CMS has also authorized payment for the administration of additional doses of the COVID-19 vaccine, which will be reimbursed at $40.

For more information on Medicare COVID-19 codes click here.

For more information on Medicare COVID-19 payments click here.

HHS Statement on COVID-19 Booster Shots

On August 18, The Department of Health and Human Services (HHS) released a statement on the Administration’s plan for COVID-19 booster shots for the American people. In the statement, medical experts observed that protection against COVID-19 wanes over time following initial doses of the vaccine, especially in those who are considered high risk or those who were vaccinated during the earlier phases of the vaccination rollout. HHS announced that a booster shot will be necessary to prolong vaccine protection against the virus and will begin offering booster shots this fall based on FDA and CDC evaluation:

“We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose. At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster. We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.”

The statement also highlighted that more data is expected from the Johnson & Johnson (J&J) COVID-19 vaccine in the next few weeks. After data is collected, HHS will inform the public on a plan for the J&J booster shot as well.

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Native American Child Protection Act Now Includes Urban Indian Organizations

The Senate held a legislative hearing on the NCUIH-endorsed Native American Child Protection Act. The bill includes two updates for UIOs that were advocated for by NCUIH and noted by Heidi Todacheene, Senior Advisor, Office of the Assistant Secretary for Indian Affairs at the Department of the Interior. In her testimony, Ms. Todacheene noted that the bill expands “services to be extended to the urban Indian organizations, and as you know those are critical services to help tribal communities, especially in places where American Indian, Alaskan natives don’t have access to some of the services on reservations.”

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Senators Smith and Cantwell Call on Appropriations Interior Subcommittee Leaders to Support $200.5 Million in Appropriations for UIOs

On August 10, Senator Smith and Senator Cantwell sent a letter to Senator Merkley and Senator Murkowski, leaders of the Subcommittee on Interior, Environment, and Related Agencies, requesting their support for the $200.5 million for urban Indian health in the FY 2022 Interior, Environment, and Related Agencies Appropriations Act. The letter emphasized the historic underfunding and lack of facilities funding for UIOs, as well as health disparities in AI/AN communities that have been worsened by COVID-19. Senators Smith and Cantwell called the increase in funding a part of fulfilling of the government’s trust responsibility to urban Indians.

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Rep. Smith Advocacy Key to Increased Funding for Urban Indian Health

On July 13, Congressman Adam Smith’s office published a press release regarding the historic funding increase for urban Indian organizations (UIOs) in the Fiscal Year (FY) 2022 Interior, Environment, and Related Agencies bill and highlighted the significance of UIOs, such as the Seattle Indian Health Board (SIHB), in both Native and non-Native communities. Due to Congressman Smith’s advocacy, the FY22 Interior Appropriations bill, which passed the House Appropriations Committee on July 1, includes $200.5 million for urban Indian health— $137,816,000 above the enacted level.

“Urban Indian organizations, such as the Seattle Indian Health Board (SIHB), play a pivotal role in providing health care for Native and non-Native communities across the country. They have been at the forefront of responding to the COVID-19 pandemic and supporting urban American Indians and Alaska Natives who are often marginalized in the traditional health care system,” said Congressman Smith. “This proposed increase in funding to urban Indian health organizations will strengthen clinics across the country, give them the tools to continue to combat the COVID-19 pandemic, and eliminate disparities and inequities in the health care system. The proposed increase in funding to Tribal Epidemiology Centers, including the Urban Indian Health Institute at SIHB, is long overdue to expand research and disease surveillance to improve health outcomes in American Indian and Alaska Native communities.”

NCUIH applauds Congressman Smith for being a champion of urban Indian health and fighting for equitable access to healthcare for American Indians and Alaska Natives both on and off the reservation.

2021 Summer Legal Fellows Reflect on Time with NCUIH

With the end of the summer comes the departure of our 2021 Summer Legal Fellows. With Bryn Whitney-Blum and Hayden Godfrey returning to their respective law schools, we asked them to reflect on their time with NCUIH. Please read their posts below. We wish them all the best as they complete their education!

My name is Bryn Whitney-Blum. I am a second-year law student at the George Washington University Law School, and I have a background in reproductive justice, maternal health, HIV/AIDS health care, and direct services. I applied to NCUIH as a legal fellow because of the unique opportunity to apply my interest in health equity and policymaking to serving urban Indian communities. The chance to advocate for a range of health care priorities within the framework of Indigenous sovereignty and justice set NCUIH apart from other internships, and I looked forward to applying my first year of legal education to congressional and federal policy.

At NCUIH, I learned about the incredible importance of persistent communication and advocacy in fulfilling the federal government’s trust responsibility to urban Indians. NCUIH’s policy team is full of powerhouse advocates, and after spending my summer working with this team I completely understand how NCUIH’s work has led to millions in federal funding and legislative support for UIOs. As a policy fellow, I researched and drafted comments to federal agencies, tracked legislation and policy, attended urban confer and Tribal consultations, and even got to meet with Department of Justice officials to follow up on comments I had submitted on Missing and Murdered Indigenous Persons. At this fellowship, I translated the skills and principles I gained from law school to substantive policy advocacy, and my experience at NCUIH has added meaning and motivation to my professional path as a public interest lawyer. I am so grateful to Sunny, Julia, Meredith, Sam, Al, Elaina, Jenna, Mary, and Francys for sharing their knowledge and passion with me, and I look forward to seeing all they will continue to achieve for urban Indian health.

Osiyo nigada! My name is Hayden Godfrey and I am a second-year law student at the University of Arizona James E. Rogers College of Law. I am Tsalagi and a federally enrolled citizen of the Cherokee Nation of Oklahoma. At Arizona Law, I am pursuing certification as a subject matter expert through our Indigenous Peoples Law and Policy program. I am also the President of the Arizona Law Chapter of the Native American Law Students Association (NALSA). The issues of sovereignty that impact our Tribal Nations are among the most critical issues that we face in Indian Country. Factors outside of our communities that seek to diminish our inherent nationhood threaten our very ways of life, preventing us from impactfully policing our communities, from protecting our friends and relatives from abduction or murder, and from attending to the health care needs of our Tribal members, among countless issues that arise out of broken trust obligations.

Through interviewing to become a Law Fellow with NCUIH, I felt that I would have an opportunity to devote the skills that I have honed through my legal studies to practically advocate for my Tribe and all others in our battles to improve the material conditions that we all suffer as the result of hundreds of years of genocidal Federal policy toward Indigenous people. Our fight for self-determination cannot reach its full potential until we have an Indigenous population that does not have to account for these historical traumas in our movement. NCUIH’s mission, being the only such organization that serves the 70 percent of AI/AN people who reside in urban areas, myself included in that statistic as an urban Indian, fell ideally into my desires to fulfill the needs of my own demographic so that we can be a stronger political force in the future. Our sovereignty and our means for protecting our own populations arise out of our political relationship with Congress, which is why it is more imperative now than ever to stand up for our political rights.

I spent Summer 2021 employed with NCUIH, where I worked with the policy team to address issues in federal Indian policy as they arose in legislation and regulation at the agency level. As a Summer Law Fellow with NCUIH, I spent my time drafting comments for regulatory agencies on regulations involving Urban Indian Organizations (UIOs), tracking and editing acts of legislation that impact Indian health, performing substantive legal and policy research on Medicaid reimbursement rates for Indian health providers, and other policy-related tasks involving Tribal communities or culturally sensitive questions. My background as an American Indian and citizen of my Tribe ultimately permitted me to answer sensitive questions that arose in a thoughtful manner that incorporated my own Indigenous understanding of the subject matter. In law school, I learned to formulate air-tight legal arguments, while at NCUIH, I learned to be an advocate for all Indigenous people in the United States. Without my experiences this summer at NCUIH, I would not have the same capacity to bring the professional skills that I have cultivated into my future in Indian policy and activism.

I will always carry the memories from this summer at NCUIH with me as I stride into the future. I have learned so much in such a short amount of time. I would like to thank Julia, Meredith, Sunny, and Francys for all that they have imparted during this all-too-short experience. They have been genuinely exemplary in their professionalism and zeal in their advocacy for communities much like my own. The passion and the drive that they bring into their activism will always remain with me in my own activism for the vulnerable communities whom we serve. I would accordingly like to express my gratitude for the privilege of serving Tribal communities this summer in our fight for equity, because I will derive my momentum from the passion that I have witnessed in you all. Wado.

House Appropriations Committee Approves Labor-HHS Bill with Funding Increases for Indian Country

On July 15, 2021, the House Appropriations Committee approved its fiscal year (FY) 2022 Labor, Health and Human Services, Education, and Related Agencies funding bill by a 33-25 vote. The bill authorizes $119.8 billion for the Department of Health and Human Services (HHS)— an increase of $22.9 billion above the FY 2021 enacted level and $129 million below the president’s FY 2022 budget request. Other key provisions include a $15 million set-aside for IHS facilities/Tribally-Operated Health Programs/Urban Indian Health Programs under the National Health Service Corps (NHSC) Loan Repayment Program, increased funding for the Centers for Disease Control and Prevention (CDC)— including an increase for the Good Health and Wellness in Indian Country (GHWIC) program, increased funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), and increased American Indian/Alaska Native (AI/AN) set-aside funding for Zero Suicide grants. A more detailed analysis follows below.

Bill Highlights

CDC

  • Bill Report: “The Committee recommendation for the Centers for Disease Control and Prevention (CDC) program level includes $9,612,761,000 in discretionary budget authority, $55,358,000 in mandatory funds under the terms of the Energy Employees Occupational Illness Compensation Program Act, and $903,300,000 in transfers from the Prevention and Public Health (PPH) Fund.” The bill funds the CDC at $10.6 billion, an increase of $2.7 billion above the FY2021 enacted level.

GHWIC

  • Bill Report: “The Committee’s recommended level includes an increase of $5,000,000 for Good Health and Wellness in Indian Country.”

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NCUIH Endorses UIO-inclusive Bill for Virtual Peer Behavioral Health Support Services

The Virtual Peer Support Act of 2021 (H.R. 2929/S. 157) seeks to expand virtual peer support services for “Tribal communities” alongside community-based providers through federal grant allocations. UIOs are included within the definition of “Tribal communities,” making this an inclusive effort to legislate for Indian health with UIO needs in mind.

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Senate Introduces Bill Authorizing Special Behavioral Health Program for Indians after NCUIH Efforts

Sen. Tina Smith introduces bill to amend the IHCIA to authorize special behavioral health programs for Indians, including urban AI/AN persons and the UIOs that serve them. This revision of the IHCIA helps Congress to fulfill its trust obligations to AI/AN populations while Urban Indians continue to disproportionately suffer from behavioral health issues at a rate much higher than the general population.

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House Passes Vote on NCUIH-Endorsed Tribal Health Data Bill

On June 22, 2021, the House of Representatives met to debate legislation including H.R. 3841, the Tribal Health Data Improvement Act of 2021, under suspension of the regular House procedural rules. Rep. Markwayne Mullin (R-OK), citizen of the Cherokee Nation, introduced the bill on June 11 on behalf of himself and cosponsor Rep. Tom O’Halleran (D-AZ). The House requested a recorded vote on June 23, 2021 where H.R. 3841 passed with broad bipartisan support.

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