NCUIH President and CEO of Native Health in Phoenix, AZ, Walter Murillo (Choctaw) has been invited to testify before the Senate Committee on Indian Affairs on the COVID-19 impacts in Indian Country. The Senate Committee on Indian Affairs, led by Chair Brian Schatz (D-HI) and Vice-Chair Lisa Murkowski (R-AK), will also hear from the National Indian Health Board and Papa Ola Lokahi.
Safe Opening and Operation Work Eligible for Public Assistance (PA) Interim Policy
On April 5, 2021, FEMA Office of External Affairs released an interim policy to continue to maximize the framework that supports the safe opening and operation of work under the Public Assistance (PA) program. Eligibility is inclusive to certain private nonprofit (PNP) organizations for work performed when ensuring safe opening and operations associated with the COVID-19 emergency, from January 21, 2021 through September 30, 2021.
New Policy Inclusion of Qualified PNPs is Paramount to UIOs
Under the new interim policy, which includes Qualified PNPs, some Urban Indian Organizations (UIOs) will be eligible. UIOs are urged to review the requirements to determine eligibility.
Eligible Assistance
To have PNP designation in the FEMA PA Program, the facility must show a ruling letter from the Internal Revenue Service granting tax exemption under sections 501(c), (d), or (e) of the Internal Revenue Code of 1954; or documentation from the state substantiating that the non-revenue producing organization or entity is a nonprofit entity organized or doing business under state law.
The PNP must meet the program definition of an eligible facility and provide eligible service(s) that may be critical or noncritical, and were reasonably provided for safe opening and operation during the pandemic. Services may include education, utilities, emergency, medical, custodial care, and other essential social services.
FAQs
Eligibility Process
During the application process, applicants will need to provide general information to support eligibility determination.
Those interested in applying for a PA Grant should visit the FEMA Grants Portal or the Grants Line at (866) 337-8448. FEMA is currently allocating program delivery managers to support those interested in PA.
Next Steps
NCUIH will continue to monitor the changes in the FEMA PA policy. Issues raised during the consultation process are being considered for permanent updates in the FEMA Public Assistance Program and Policy Guide.
The Indian Health Service (IHS) Office of Urban Indian Health Programs (OUIHP) has published the National Uniform Data System (UDS) summary report for Calendar Year 2019 to its website. These yearly UDS reports provide information on the demographic profile of all 41 urban Indian organization (UIO) clients broken down by facility type (Full Ambulatory, Limited Ambulatory, Outreach and Referral, and Residential Treatment Center). Information reported includes the aggregated total number of patients, age, gender, zip code of residence, insurance sources, race/ethnicity of patients, number of visits by provider type, by key diagnoses and services, characteristics of special populations, quality of care indicators, health outcome, and disparities.
A brief description of relevant service population characteristics is in Table 1 of the report:
Yesterday, the Indian Health Service (IHS) released a March 26, 2021 Dear Urban Indian Organization (UIO) Leader Letter (DULL) announcing an updated allocation of $95 million in telehealth funding from the Coronavirus Aid, Relief, and Economic Security Act. Since IHS’ announcement of these funds in an April 23, 2020 DULL, NCUIH has regularly been asking IHS officials about updates regarding funding allocation.
Of the $95 million in telehealth funding, only $4 million will be allocated to UIOs through existing IHCIA contracts by providing a one-time, base amount for each UIO, and an additional amount based on each UIO’s Urban Indian users. $67 million will be allocated to the IHS and Tribal Health Programs (THPs) and the remaining $24 million will be used by IHS to support nationwide outreach, education, training, technical assistance, contract management, coordination and program/policy development activities, as well as the acquisition of a clinical video telehealth solution.
UIOs deliver quality and culturally competent healthcare to the >70% of American Indian/Alaska Natives (AI/ANs) living in urban areas. Despite this large number of the AI/AN population served, UIOs receive a disproportionately low amount allocated funds to serve their patients, especially during a global pandemic.
NCUIH is pleased to announce the release of the 2021 Legislative Priorities. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2021, as they relate to Indian Health Service (IHS)-designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The top priorities for 2021 include $200.5 million for UIOs in FY22, advance appropriations, behavioral health funding for UIOs, full 100% FMAP for UIOs permanently, removal of facilities restrictions and the establishment of an urban confer policy at HHS, among others. NCUIH will continue to work with Congress on advancing these priorities on behalf of UIOs for 2021.
Why Does this Matter to UIOs?:
The current public health crisis has exacerbated the need for legislative action as it pertains to UIOs.
Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org
NCUIH recently submitted testimony to the Senate Committee on Indian Affairs for the Oversight Hearing “A call to action: Native communities’ priorities in focus for the 117th Congress.” In the testimony, NCUIH outlined how decades of underfunding of the IHS system coupled with the recent COVID-19 pandemic have highlighted the urgency of rectifying the long-standing inequities UIOs face. UIOs do not have parity with IHS and Tribal Health Providers in many cost-saving programs. UIOs already operate on thin financial margins and receive funding from a single line item, which is less than 1% of the total IHS budget.
This chronic underfunding is exacerbated by UIOs inability to participate in essential cost-saving measures. NCUIH has worked closely with Representative Raul Ruiz (D-CA) and key Congressional leaders to push for the inclusion of 100% FMAP for services provided at UIOs. Last week, Representative Ruiz introduced H.R.1373 the Urban Indian Health Parity Act, bipartisan legislation, with 12 original cosponsors to extend the 100% FMAP provision permanently to expand resources for American Indians and Alaska Natives living in urban areas especially as COVID-19 pandemic continues to ravage Native communities.
Why Does this Matter to UIOs?:
There is a pressing need for the health care services provided by UIOs. Urban AI/ANs experience disproportionate rates of chronic diseases and are therefore more likely to need access to health care. Urban AI/ANs are 3 times more likely to have diabetes, more than 1.5 times more likely to have been hospitalized for respiratory infections in the past, and more than 1.5 times more likely to have coronary heart disease than non-Hispanic whites.
Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org
FOR IMMEDIATE RELEASE
Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org
Press Contact: Sara Williams, swilliams@NCUIH.org
Washington, D.C. (March 23, 2021) – National Council of Urban Indian Health CEO Francys Crevier (Algonquin) testified before the Subcommittee for Indigenous Peoples of the United States, led by Chair Teresa Leger Fernández (D-NM). The hearing is addressed the “Emerging Coronavirus Impacts in Indian Country.”
“Urban Indian Organizations have continuously provided services in the hardest hit urban areas during the entire pandemic,” said Crevier. “There have been vast improvements from where we were a year ago with regards to the availability of supplies, tests, and vaccines, but that will never make up for the sheer number of Native lives lost. Unfortunately, despite improvements, the situation facing Natives has not relented. The bottom line is that what little data exists for Natives shows a stark reality: COVID-19 is killing Native Americans at a faster rate than any other community.”
Rep. Ruben Gallego (D-AZ), an urban Indian health champion, requested additional information about why Urban Indian Organizations (UIOs) cannot make any facilities-related upgrades using federal funds. Ms. Crevier explained that the Indian Health Care Improvement Act contains unnecessary limitations on UIOs and urged for a legislative fix to allow UIOs to use federal funds for facilities. Rep. Chuy Garcia (D-IL) discussed the long-standing inequities experienced by UIOs due to lack of full funding.
“Structural deficiencies led to the devastating impact of COVID-19 on Native American communities,” Said Rep. Leger Fernandez. “We must also identify ways to address the root causes of the impacts. I heard over and over in today’s testimony about the need for full funding as is required by the trust responsibility.”
House Natural Resources Chairman Raul Grijalva (D-AZ) asked Francys Crevier about the importance of an urban confer process. She identified why it is critical for federal agencies like the Department of Health and Human Services (HHS) to have policies that address communicating with UIOs. Ranking Member Don Young (R-AK) discussed the re-introduction of the Rep. Betty McCollum advance appropriations bill for all of the Indian Health Service, including UIOs.
The hearing also included testimony from Chief William Smith, Chairperson and Alaska Area Representative, National Indian Health Board. In his testimony, Chief Smith highlighted the importance of extending permanent 100% Federal Medical Assistance Percentages to UIOs and the need for mandatory appropriations for the Indian Health Service, Tribal organizations, and UIOs.
Ranking Member Bruce Westerman (R-AR) acknowledged the disproportionality of the effect of COVID-19 on American Indian and Alaska Native (AI/AN) populations and that the current funding provided in the American Rescue Plan Act is commendable. Still, it is not sustainable for the needs and efficacy of combatting the historical health issues that plague AI/AN people. To reiterate Rep. Westerman’s request for increased funding, Rep. Young called for the subcommittee to introduce a historical “Native people only” bill to address funding and all the needs that impact AI/AN populations and Native people.
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
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
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:
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
National Council of Urban Indian Health
1 Massachusetts Avenue NW
Suite 800-D
Washington, DC 20001
Phone: 202.544.0344