House Energy and Commerce Holds Legislative Hearing on ACA including NCUIH’s Bill on 100% FMAP for UIOs

On March 23, 2021, the Subcommittee on Health of the Committee on Energy and Commerce held a legislative hearing on “Building on the ACA: Legislation to Expand Health Coverage and Lower Costs.” The hearing included a review of several key pieces of legislation including a top priority for urban Indian health and NCUIH – the extension of 100% FMAP to UIOs permanently.

The bill, H.R. 1888, the “Improving Access to Indian Health Services Act”, introduced by Rep. Ruiz (D-CA), would increase the FMAP for Urban Indian Health Programs to 100 percent. It would also authorize Medicaid payment for services furnished by Tribal facilities outside of the four walls of the facility. At the hearing, Dr. Ruiz emphasized that there is no sound policy reason for excluding Urban Indian Organizations from eligibility for the 100% FMAP and advocated for the Committee to pass H.R. 1888.

Why Does this Matter to UIOs?:

NCUIH has been working on permanent 100% FMAP for UIOs closely with our Congressional leaders. The federal government has a trust obligation to pay 100% FMAP rates for all IHS-beneficiaries regardless of their physical location. This is a necessary parity fix for urban Indian organizations.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Read Memo

Read the Bill

Representative Ruiz (D-CA) Introduces Legislation to Expand Resources for Urban Indian Organizations

The Urban Indian Health Parity Act (H.R. 1373), championed by Representative Raul Ruiz (D-CA), and introduced by the National Council of Urban Indian Health as a priority legislative item, worked closely with Congressional members to advocate for resources to meet the unmet needs of Urban Indian Organizations especially as the COVID-19 pandemic continues to ravage Native communities. This bipartisan legislation with 12 original cosponsors will ensure that the American Indians and Alaskan Natives living outside of Tribal lands will receive quality healthcare. The bill specifies that the federal government’s responsibility will go beyond Tribal reservations to provide 100% Federal Medical Assistance to Urban Indian Organizations.

Why Does this Matter to UIOs?

With additional resources freed up by this legislation, UIOs will be able to expand patient care and provide more services to tackle the COVID-19 pandemic.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

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NCUIH Submits Testimony to House and Senate Veterans Affairs Committees

On March 18, 2021, the House and Senate Veterans Affairs Committee invited the National Council of Urban Indian Health to submit testimony on ongoing issues facing urban Native veterans.

NCUIH made the following recommendations:

  • Urge VA to Reimburse UIOs ASAP and Include Urban Indians in Copayment Exemption
  • Provide Oversight to the VA to Interpret Eligibility in Favor of Increasing Access to Care and Consistent with the PL 116-315 and Indian Health Care Improvement Act (25 U.S.C 1602)
  • Remove Non-Committal Language of Only “Exploring Options” to Extend VHA Consolidated Mail Outpatient Pharmacy Access to UIOs

Why Does this Matter to UIOs?:

AI/AN veterans often prefer to use Indian Health Care Providers (IHCPs), including UIOs, for reasons such as cultural competency, community and familial relations, and shorter wait times.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Biden Releases COVID-19 Strategy Plan Prioritizing Urban Indian Health

The new Administration will bolster support for Tribal Nations and Urban Indian Health Programs (UIHPs) by affirming the ability and building the capacity of the Indian Health Service (IHS), Tribes, Bureau of Indian Education (BIE) schools, and UIHPs to provide vaccines for Native communities. The federal government will take all available steps to strengthen distribution and ordering for Tribes and Urban Indian Health Providers. President Biden has called on Congress to provide additional funds to IHS to support expanded health services, address lost revenues, and support testing and vaccination efforts.

House Releases Indian Health Draft COVID-19 Bills

The bill draft includes $84 million for urban Indian health and 2 years of 100% FMAP for UIOs.

On February 9, the House Energy and Commerce Committee released their draft bill text for the budget reconciliation package on COVID-19 relief. The markup of these drafts will happen by the Full Committee on February 11. The drafts include $6.1 billion for Indian health programs with $84 million for urban Indian health and two years of 100% FMAP to Urban Indian Organizations (UIOs) for Medicaid services for IHS-beneficiaries.

100% FMAP for UIOs has been a long-standing priority for NCUIH. In recent weeks, NCUIH has worked closely with key Congressional leaders to push for the inclusion of 100% FMAP for UIOs. Last week, three Senators spoke on the Senate floor about prioritizing Indian health and ensuring that UIOs would be eligible for full FMAP. Rep. Ruiz also led a letter signed by over 2 dozen House Representatives to request full FMAP for UIOs in the budget reconciliation package.

The Indian health provisions reflect many recommendations in the tribal inter-organization letter sent on February 2. These investments for Indian health will be critical for shoring up necessary resources to combat COVID-19 as January “was the deadliest so far in the US, with 958 recorded Native deaths – a 35% increase since December, a bigger rise than for any other group”.

Next Steps

The Committee will host a markup and the House plans to vote on the full package the week of February 22. NCUIH will continue to push for long-term 100% FMAP for UIOs and urge Congressional leaders to support inclusion of the many Indian health wins in the budget reconciliation package.

Overview of Indian Health Provisions

  • $6.094 billion in funding for Indian health programs
  • $2 billion for lost revenue
  • $500 million for Purchased/Referred Care
  • $140 million for information technologies, telehealth, and electronic health records infrastructure
  • $84 million for urban Indian health programs
  • $600 million for vaccine-related activities
  • $1.5 billion for testing, tracing, and mitigating COVID-19
  • $240 million for public health workforce
  • $420 million for mental and behavioral health prevention and treatment services among Indian tribes, tribal organizations, and urban Indian organizations
  • $600 million for funding support of tribal health care facilities and infrastructure
  • $10 million for potable water delivery.

Legislation Recommendations and Memorandum

Resource: Urban Indian Health Spending Fact Sheet

On January 13, the National Council of Urban Indian Health (NCUIH) released a new resource on urban Indian health spending. The spending fact sheet shows a comparison for average health care spending of $11,172 per person, however, Tribal and Indian Health Service (IHS) facilities receive only $4,078 per American Indian/Alaska Native (AI/AN) patient from the IHS budget. Urban Indian Organizations (UIOs) receive just $672 per AI/AN patient from the IHS budget. This fact sheet is for policymakers to have a better idea of the disparities that exist within the health care system. NCUIH will continue to advocate for parity in health care spending for UIOs and AI/ANs.

Why is this important to UIOs?

  • Health care spending for AI/AN patients is far lower than average spending per patient in the broader health care system.

Read the Fact Sheet here.

NCUIH Secures Huge Wins for Urban Indians in Final Enacted COVID-19 and Omnibus Bills

Policy Update: NCUIH Secures Huge Wins for Urban Indians in Final Enacted COVID-19 and Omnibus Bills

The bills include a $5 million increase for urban Indian health, FTCA, VA-IHS reimbursements, SDPI extension and COVID-19 renovation funds for UIOs.

On December 27, the “Consolidated Appropriations Act, 2021” (H.R. 133), consisting of a COVID-19 pandemic relief bill and an omnibus spending bill for Fiscal Year (FY) 2021 was signed into law. Due to the tireless advocacy by NCUIH and UIOs, there are many monumental wins for urban Indian health. Throughout the year, NCUIH assisted with facilitating over 25 calls for UIOs with federal agencies and held over 100 meetings with Congress. NCUIH representatives testified in over 13 Congressional hearings to advocate for the many long-standing priorities that were included in the final package.

Your advocacy and participation in the federal government process was critical to the adoption of the most robust urban Indian health provisions in over 50 years.

Short Overview

In summary, the package included the following National Council for Urban Indian Health (NCUIH) priorities for Urban Indian Organizations (UIOs):

  • $62.7 million for Urban Indian Health in FY21, a $5 million increase from FY20
  • $1 million to conduct an infrastructure study for facilities run by UIOs
    • NCUIH is working with IHS Office of Urban Indian Health Programs now to review the next steps on the study.
  • Reimbursement from the United States Department of Veterans Affairs (VA) to UIOs for urban Native veterans’ health
    • In 2010, the VA issued a MOU stating that all Indian Health Care Providers were eligible for reimbursement for services to Native veterans. NCUIH has fought tooth and nail with the Administration on their narrow interpretation of this MOU to be exclusive of UIOs. This legislation now expressly affirms that the VA must reimburse UIOs for services provided to veterans.
  • FTCA Coverage for UIOs
    • For over 20 years, FTCA coverage for UIOs has been a top priority and finally, for the first time ever, UIOs will no longer have to pay for costly insurance coverage for health providers. This will save a single UIO up to $250,000 annually!

The package provides the following for IHS, Tribal organizations and UIOs:

  • $210 million from CDC to IHS to I/T/U for COVID-19 vaccine distribution and administration
    • NCUIH requested a minimum of 5% set-aside for I/T/U and $210 million is equal to 4.67%.
    • Funds “may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability” related to COVID-19, which was confirmed by IHS on January 5, 2021. IHS explained that they are exploring alternative mechanisms including IHCIA Contracts for UIOs to use the funds related to facility improvements from the $210 million. NCUIH will advocate that UIOs should be eligible for this funding through IHCIA contracts. We will continue to monitor and follow up with IHS as more information becomes available.
  • $790 million to IHS for I/T/U for necessary expenses for testing, contact tracing, surveillance, containment, and mitigation
    • These funds must be made available within 21 days: January 17, 2021.
    • On a UIO leaders call with IHS on January 5, 2021, IHS stated that UIOs are eligible to use these funds for the “rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability.”
  • Extends SDPI through FY2023 at current levels ($150 million annually)
  • $125 million set aside for I/T/U in funding for Substance Abuse and Mental Health Services Administration (SAMHSA)
  • $15 million to make payments under the National Health Service Corps loan repayment program
  • Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations
  • Establish “Sec. 330n. Expanding Capacity for Health Outcomes” in Title 3 of the Public Health Service Act to include Indian Tribes, Tribal organizations, and urban Indian organizations

Next Steps

  • NCUIH submitted Urban Confer comments regarding the COVID-19 relief supplemental to IHS on Friday, January 8, 2021 and will continue to work with IHS on the UIO infrastructure study.

Analysis

Urban Indian Health

  • $62.7 million for Urban Indian Health in FY21, a $5 million increase from FY20
  • $1 million to conduct an infrastructure study for facilities run by UIOs
  • FTCA Coverage for UIOs (H.R. 6535/S. 3650)
    • Note: This bill was also enacted on January 5, 2021, in addition to being included in the package.
  • Urban Native Veterans Health Access Act
    • Reimbursement from VA to UIOs for urban Native veterans’ health

Indian Health Service

  • $6.236 billion in agency funding for IHS in FY21
    • ~$189 million over the FY2020 enacted level

Facilities

  • $58 million to IHS for costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’
  • $72.28 million for the Indian Health Facilities account

105(l) Leases

  • $101 million indefinite appropriation
    • Does not include restrictive language based on square footage

Health and Human Services (HHS)

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

  • National Health Service Corps
    • $15 million to Indian Health Service facilities, Tribally Operated Health Programs, and Urban Indian Health Programs to make payments under the National Health Service Corps loan repayment program
  • Good Health and Wellness in Indian Country (GHWIC)
    • $22 million in funding for the Good Health and Wellness in Indian Country (GHWIC) program
  • Minority HIV/AIDS Prevention and Treatment Program
    • $1.5 million Tribal set-aside under the Minority HIV/AIDS Prevention and Treatment Program

HRSA

Native Hawaiian Health Care

  • $20.5 million (minimum) for the Native Hawaiian Health Care Program

COVID-19 Response

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

  • $8.75 billion for CDC-wide activities and program support to prevent, prepare for, and respond to coronavirus, domestically or internationally

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

  • $210 million shall be allocated to IHS to be distributed through IHS directly operated programs, Tribes and Tribal organizations, and UIOs to plan, prepare for, promote, distribute, administer, monitor, and track coronavirus vaccines to ensure broad-based distribution access and vaccine coverage
    • Funds “may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability” related to COVID-19, which was confirmed by IHS on January 5, 2021.

Tribal Use of Prescription Drug Monitoring Programs (PDMP)

  • “CDC is directed to work with the Indian Health Service to ensure Federally-operated and tribally operated healthcare facilities benefit from the CDC’s PDMP efforts”

VA-TAC

  • The final bill also outlines concerns with the Tribal Advisory Committee (TAC), noting in the explanatory statement that “The agreement directs the Director, in consultation with the TAC, to develop written guidelines for each CDC center, institute, and office on best practices around delivery of Tribal technical assistance and consideration of unique Tribal public health needs. The goal of such guidelines should be the integration of Tribal communities and population needs into CDC programs. The Director shall report on the status of development of these written guidelines in the fiscal year 2022 Congressional Justification”.
    • Note: The TAC includes UIOs

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

  • $4.25 billion to provide increased mental health and substance abuse services and support

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

  • $125 million (minimum) set aside for I/T/U under SAMHSA for mental/behavioral health

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

  • $11,000,000 for grants to Indian Tribes, Tribal Organizations, or consortia. The agreement directs SAMHSA to ensure grants allow the use of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.
    • Note: UIOs are not specified, though a 2018 NOFO did list UIOs as eligible

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

  • $790 million to I/T/U for necessary expenses for testing, contact tracing, surveillance, containment, and mitigation
    • IHS stated that UIOs are eligible to use these funds for the “rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability.”
    • Funds available until September 30, 2022
    • Includes language authorizing transfer of funds to IHS
    • Requires funds to be dispersed within 21 days
    • Requires Tribes, states and other funding recipients to update their plans within 60 days of receiving funds

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

  • Extends SDPI through FY2023 at current levels ($150 million annually)
    • Includes language reaffirming the existing protections against balance billing of AI/ANs under Indian Health Care Improvement Act and requirement that inpatient hospitals accept the Medicare-Like Rate as “payment in full” when contracting with IHS/Tribes under Purchased/Referred Care

GUIDE ON EVIDENCE-BASED STRATEGIES FOR OBESITY PREVENTION PROGRAMS

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

  • Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations

BROADBAND CONNECTIVITY GRANTS

  • $1 billion for the Department of Commerce’s Assistant Secretary of Communications and Information to expand broadband, remote learning, telework, and telehealth access and adoption by grants to the following qualifying entities:
    • Tribal governments; Tribal Colleges or Universities; Tribal Organizations; Alaska Native Corporations, or the Department of Hawaiian Homelands (Does Not Include UIOs)

PUBLIC HEALTH PROVISIONS

Public Health Service Act

  • Establish “Sec. 330n. Expanding Capacity for Health Outcomes” in Title 3 of the Public Health Service Act to develop a program for eligible entities to expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers, and increase access to health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.
    • Eligible entities include Indian Tribes, Tribal organizations, and urban Indian organizations
    • Authorizes $10,000,000 for each of fiscal years 2022 through 2026 to carry out this section

The full legislative text of the entire year-end package can be found here

The Explanatory Statement (Report) for FY2021 Interior (Division G) can be found here

The Explanatory Statement (Report) for FY2021 LHHS (Division H) can be found here

 

Topic Section Funding Language
Urban Indian Health Urban Indian Health $62,684,000
  1. : See chart for language
UIO Infrastructure Study $1,000,000
  1. : “$1,000,000 is provided to conduct an infrastructure study for facilities run by urban Indian organizations (UIOs)”
FTCA
  1. : See chart for language
IHS-VA MOU – reimbursement from VA to UIOs who provide services to AI/AN veterans
  1. : “Section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645) is amended— (1) in subsection (a)(1), by inserting ‘urban Indian organizations,’ before ‘and tribal organizations’; and (2) in subsection (c)— (A) by inserting ‘urban Indian organization,’ before ‘or tribal organization’; and (B) by inserting ‘an urban Indian organization,’ before ‘or a tribal organization’.”
Indian Health Service (IHS) IHS funding $6,236,279,000
  1. : “The bill provides a total of $6,236,279,000 for the Indian Health Service (IHS)”
Costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’ $58,000,000
  1. : “That of the funds provided, $58,000,000 shall be for costs related to or resulting from accreditation emergencies, including supplementing activities funded under the heading ‘‘Indian Health Facilities,’’ of which up to $4,000,000 may be used to supplement amounts otherwise available for Purchased/Referred Care
Indian Health Care Improvement Fund $72,280,000
  1. : “Provided further, That of the funds provided, $72,280,000 is for the Indian Health Care Improvement Fund and may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account”
105(l) leases indefinite appropriation $101,000,000
  1. : “The bill includes language establishing an indefinite appropriation for payment of Tribal leases under section 105(1) of the Indian Self-Determination and Education Assistance Act, which are estimated to be $101,000,000 in fiscal year 2021.”
Health and Human Services NHSC Loan Repayment Program $15,000,000
  1. : “That, within the amount made available in the previous proviso, $15,000,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs”
Good Health and Wellness in Indian Country $22,000,000
Minority HIV/AIDS Prevention and Treatment Program $1,500,000
  1. : “The agreement includes $1,500,000 as a Tribal set-aside within the Minority HIV/ AIDS Prevention and Treatment program.”
HRSA— Hawaiian Health Care Program $20,500,000
  1. “Native Hawaiian Health Care. -The agreement includes no less than $20,500,000 for the Native Hawaiian Health Care Program.”
COVID-19 Response CDC COVID-19 Response $8,750,000,000
  1. : “For an additional amount for ‘CDC–Wide Activities and Program Support’, $8,750,000,000, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally”
CDC to IHS to I/T/U for COVID $210,000,000
  1. : “That of the amount in the preceding proviso, $210,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pgs. 1822-1823: “That amounts appropriated under this heading in this Act may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability at the State and local level.”
SAMHSA— Heath Surveillance and Program Support $4,250,000,000
  1. : “For an additional amount for ‘Heath Surveillance and Program Support’, $4,250,000,000, to prevent, prepare for, and respond to coronavirus, domestically or internationally”
Set aside for I/T/U in funding for SAMHSA $125,000,000
  1. : “That from within the amount appropriated under this heading in this Act in the previous provisos, a total of not less than $125,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes”
Medication-Assisted Treatment for Prescription Drug and Opioid Addiction $11,000,000
  1. “Medication-Assisted Treatment for Prescription Drug and Opioid Addiction.- Within the amount, the agreement includes $11,000,000 for grants to Indian Tribes, Tribal Organizations, or consortia. The agreement directs SAMHSA to ensure grants allow the use of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.”
Public Health and Social Services Emergency Fund IHS to I/T/U for testing, contact tracing, surveillance, containment, and mitigation $790,000,000
  1. : “That of the amount appropriated under this paragraph in this Act, $790,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pg. 1840: “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”
Special Diabetes Program for Indians (SDPI) SDPI Extends SDPI through FY2023 at current levels
  1. : “(a) TYPE I.—Section 330B(b)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’. (b) INDIANS. —Section 330C(c)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’.”
Guide on Evidence-Based Strategies for Public Health Department Obesity Prevention Programs Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations Creation of a guide of evidence-based strategies
  1. : “The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’), acting through the Director of the Centers for Disease Control and Prevention, not later than 2 years after the date of enactment of this Act, may— develop a guide on evidence-based strategies for State, territorial, and local health departments to use to build and maintain effective obesity prevention and reduction programs, and, in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations”
Broadband Connectivity Grants Tribal Broadband $1,000,000,000
  1. : “There is appropriated to the Assistant Secretary, out of amounts in the Treasury not otherwise appropriated, for the fiscal year ending September 30, 2021, to remain available until expended— (1) $1,000,000,000 for grants under subsection 15 (c)” […] “(c) TRIBAL BROADBAND CONNECTIVITY PROGRAM.— (1) TRIBAL BROADBAND CONNECTIVITY GRANTS.—The Assistant Secretary shall use the funds made available under subsection (b)(1) to implement a program to make grants to eligible entities to expand access to and adoption of— (A) broadband service on Tribal land; (B) remote learning, telework, or telehealth resources during the COVID–19 pandemic.”
Public Health Provisions Title 3 of the Public Health Service Act is amended by inserting Sec. 330N $10,000,000
  1. : “Title III of the Public Health Service Act is amended by inserting after section 330M (42 U.S.C. 254c–19) the following: SEC. 330N. EXPANDING CAPACITY FOR HEALTH OUTCOMES. (a) DEFINITIONS. —In this section: (1) ELIGIBLE ENTITY. —The term ‘eligible entity’ means an entity that provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations […] (b) PROGRAM ESTABLISHED.—The Secretary shall, as appropriate, award grants to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions, infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans. […] (k) AUTHORIZATION OF APPROPRIATIONS. —There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2022 through 2026.’’

House Passed NCUIH IHS – VA Bill

On December 3, the House passed the Health Care Access for Urban Native Veterans Act (H.R. 4153) which would amend the Indian Health Care Improvement Act (IHCIA) to enable the VA to reimburse Urban Indian Organizations (UIOs) for services to VA beneficiaries at urban Indian health centers.

This passage comes after advocacy from NCUIH and other national organizations serving American Indians/Alaska Natives (AI/AN). On July 15, 2019, NCAI passed a resolution calling on the United States Congress to enact legislation requiring the Veterans Affairs Administration to reimburse UIOs for health care provided to AI/AN veterans. Following the resolution, NCUIH testified before Congress on Native Veterans’ access to healthcare, asking the Department of Veterans Affairs to “fully implement the VA and Indian Health Services’ Memorandum of Understanding (VA-IHS MOU) and Reimbursement Agreement for Direct Health Care Services.”

On December 4, the National Council of Urban Indian Health (NCUIH), National Congress of American Indians (NCAI), and National Indian Health Board (NIHB) wrote a letter urging Congress to ensure the passage of this bill before the end of the year.

 

Why does this matter to UIOs?
  • Most AI/AN veterans live in urban areas and would benefit from the culturally competent care provided at UIOs. Reimbursement for these services would allow UIOs to adequately serve Native Veterans.

PRESS RELEASE: First-Ever Standalone NCUIH Bill Passes Congress to Shore Up Resources for Urban Indians

FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

December 20, 2020 (Washington, DC) – On December 20, the Senate voted to pass to H.R. 6535 by unanimous consent to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs) instead of having to divert scarce resources away from health care to foot exorbitant insurance costs. On December 17, the United States House of Representatives passed by unanimous consent under suspension of the rules. The passage of this non-controversial bill is a step forward in creating parity within the Indian Health System to ensure that the trust and treaty responsibility is upheld by the US government.

“We applaud Congress and the Administration for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts as we are in the midst of a pandemic. As our frontline workers risk their lives in this pandemic that is devastating Indian Country, this will be critical to saving Native lives and will increase available health care services. We are thankful to Senators Smith, Lankford, Udall, Hoeven and Schumer along with our House leaders, Representatives Gallego, Mullin, Grijalva, Pallone, Young, and Cole” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites. Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now go to the President for his signature.

House Passes NCUIH Bill to Extend FTCA Coverage to Urban Indian Health Workers

December 17, 2020

Today, the United States House of Representatives voted to pass H.R. 6535 to extend Federal Tort Claims Act (FTCA) coverage to urban Indian organizations (UIOs), which would put a stop to having to divert scarce resources away from health care to foot exorbitant insurance costs. This bill was passed by unanimous consent under suspension of the rules and will now be referred to the Senate for further consideration.

“We applaud the House, especially Rep. Ruben Gallego and Rep. Markwayne Mullin, for their steadfast efforts to help urban Indian health workers get coverage like their other IHS and Tribal counterparts. We urge the Senate to move quickly to pass this law before the end of this Congress. As we battle this pandemic that is devastating Indian Country, this will be critical to save Native lives and will increase available health care services,” said Francys Crevier (Algonquin), NCUIH CEO.

In August, the Centers for Disease Control and Prevention (CDC) reported that across 23 states, cumulative incidence rates of lab-confirmed COVID-19 among AI/ANs are 3.5 times higher than for non-Hispanic Whites.1 Also, according to CDC, COVID-19 hospitalization among AI/ANs were 4.7 times higher than for non-Hispanic Whites. As this pandemic devastates Indian Country, UIOs have been forced to make extremely difficult choices – facing competing priorities and expenses, like increased PPE and renovation costs, in addition to very costly malpractice insurance. As of November, “the Oklahoma City IHS Area now has the highest total number of cases” and the Oklahoma City Indian Clinic is one of the UIOs that pays the highest annual rate for medical malpractice insurance. If provided insurance parity with IHS and Tribal facilities, this UIO alone could direct up to an additional $250,000 to patient care at a time when increased access to care is needed most.

This legislation has broad bipartisan support in both chambers and is endorsed by IHS. NCAI also has a standing resolution supporting this legislation, Resolution #PDX-20-038, “Supporting Extension of Federal Tort Claims Act (FTCA) Coverage to Urban Indian Organizations.”

Next Steps

H.R. 6535 will now be referred to the Senate for further consideration. On December 4, 2020, NCUIH and the National Congress of American Indians sent a letter to Congress to urge them to pass this bill before the end of the year and will continue to work with the Senate to encourage swift passage.

Background

Contact:

Meredith Raimondi

Director of Congressional Relations

mraimondi@ncuih.org