IHS Releases Q&A Regarding CRRSAA Funding for UIO Facility-Related Expenses

On Friday May 21^st, Indian Health Service (IHS) Director of the Office of Urban Indian Health Programs released a Q&A regarding the use of the $790 million allocation to IHS for UIO facility improvements to support COVID-19 testing, contact tracing, containment, mitigation, and related activities authorized by the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA):

Question: Can the funding that urban Indian organizations (UIOs) receive from the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA) transferred from the Public Health and Social Services Emergency Fund (PHSSEF) for COVID-19 testing be used for facilities-related expenses (renovation, construction, or expansion, etc.)?

Response: Yes, funds may be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve COVID-19 preparedness capability at the State and local level. For the $790 million for testing and related activities that are transferred to IHS from the (PHSSEF), the appropriation has the following relevant provision:

“Provided further, That funds an entity receives from amounts described in the first proviso in this paragraph may also be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability at the State and local level”.

UIOs are contributing to coronavirus preparedness and response at the local level, and their facilities are not federally owned. Accordingly, so long as the urban Indian organization’s efforts are contributing in that manner and are otherwise consistent with the purpose of the appropriation for COVID-19 testing-related activities, this provision applies to UIOs. The authority to use CRRSAA funds transferred from the PHSSEF for facilities-related purposes is limited to facilities expenses related to COVID-19 testing. Other funds transferred through a UIO’s contract pursuant to the Indian Health Care Improvement Act (IHCIA) are generally not authorized for use for construction, renovation, or expansion, unless it is for the purpose of achieving or maintaining Joint Commission accreditation. In addition, any construction, renovation and expansion of urban Indian organization facilities must comply with FAR Part 36, “Construction and Architect-Engineer Contracts”. Finally, the UIO should consider whether the entire project is in support of their IHS IHCIA funded program, or whether only a share of the project is attributable to their program.

COVID-19 has exacerbated failing infrastructures at UIOs due to longstanding needs without funding. NCUIH has long been advocating for UIOs to have funding flexibility for facility renovations and upgrades to comply with COVID regulations.

Senator Van Hollen Asks IHS About Challenges for Urban Indians During the Pandemic

On April 28, 2021, the Senate Committee on Appropriations held a hearing with IHS
“Addressing Health Disparities in Indian Country: Review of the Indian Health Service’s COVID Response and Future Needs”. At the hearing Chairman Jeff Merkley and Ranking Member Lisa Murkowski welcomed testimony from Elizabeth Fowler, Acting Director of IHS and Jillian E. Curtis, CFO of the Indian Health Service. The hearing comes as an oversight to COVID-19 and funds appropriated to IHS and its impact in Native communities.

Many committee members expressed concern over IHS data systems and long-term funding needs for AI/AN people and Sen. Van Hollen, Chris [D-MD] focused his questioning to IHS concerning urban Indians. Senator Van Hollen expressed his gratitude to IHS and their collaborative efforts with Native American Lifelines of Baltimore and University of Maryland Baltimore to provide vaccines to urban Indians. Senator Van Hollen expressed concerns on health equity of urban Indians by citing that “urban Indian health on comprises 1% of the IHS budget and has faced chronic underfunding over the years.” Going further Rep. Van Hollen posed the question to Elizabeth Fowler asking for further information about the IHS has faced in supporting urban Native populations during this pandemic. In response, Ms. Fowler explained that some outreach and referral Urban Indian Organizations (UIOs) were not positioned to provide vaccines due to lack of resources including no Electronic Health Record system. Senator Van Hollen’s leadership is well appreciated on behalf the 70% of AI/AN living in urban areas. NCUIH is proud have advocates within Senate who recognize safe, quality, and equitable healthcare, funding is a must for urban Indian health.

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Today, May 13, 1-2 p.m. EST join The White House and leaders in the nonprofit and foundation sector, including NCUIH CEO Francys Crevier, for a conversation on vaccination hesitancy data, strategy, and recommendations.

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On April 27, Sen. Tina Smith and Sen. Lisa Murkowski re-introduced NCUIH endorsed legislation to improve tribal health data surveillance. The bill intends to address challenges faced by tribes and tribal epidemiology centers when trying to access federal healthcare and public health surveillance data systems. NCUIH worked closely on the development of this bill to ensure urban Indians are adequately counted. If passed, the bill would require:

• The Department of Health and Human Services to give tribes, tribal epidemiology centers, and the Indian Health Service access to public health surveillance programs and services.
• The Centers for Disease Control (CDC) to give technical assistance to tribes and tribal epidemiology centers and to engage in tribal consultations on American Indian/Alaska Native (AI/AN) birth and death records
• CDC to enter cooperative agreements with tribes, tribal organizations, urban Indian organizations, and tribal epidemiology centers to address misclassification of AI/AN birth and death records and public health surveillance information

Encourage states to enter into data sharing agreements with tribes and tribal epidemiology centers.

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