Letter to Tribal Leaders and Urban Indian Organization Leaders on IHS CARES Act Funding (April 3, 2020)

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Letter to Tribal Leaders and Urban Indian Organization Leaders on IHS CARES Act Funding (April 3, 2020)

The Indian Health Service announces the availability of, and distribution decisions for, $600 million in new resources appropriated in the recently enacted Coronavirus Aid, Relief, and Economic Security Act (CARES Act), Pub. L. No. 116-136, to address coronavirus (COVID-19) prevention, preparedness, and response in American Indian and Alaska Native (AI/AN) communities.

Policy Analysis: The Coronavirus Aid, Relief, and Economic Security Act (CARES Act)

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Washington, DC (March 27, 2020) – Today, the President signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which is the third phase of legislation in response to the coronavirus pandemic. The CARES Act passed the House of Representatives today and cleared the Senate earlier this week.  The bill provides $1.032 billion to the Indian Health Service (IHS) in critically needed resources to support the Indian Health System during the pandemic, including expanded support for medical services, equipment, supplies and public health education for IHS direct service, tribally operated and Urban Indian Organizations; expanded funding for purchased/referred care; and new investments for telehealth services, electronic health records improvement, and expanded disease surveillance by tribal epidemiology centers.

Overview

Funding

Indian Health Service (IHS)

  • The bill provides $1.032 billion to the Indian Health Service (IHS) in critically needed resources to support the Indian Health System during the pandemic, including expanded support for medical services, equipment, supplies and public health education for IHS direct service, tribally operated and Urban Indian Organizations; expanded funding for purchased/referred care; and new investments for telehealth services, electronic health records improvement, and expanded disease surveillance by tribal epidemiology centers.
  • Not less than $450 million shall be distributed through Tribal shares and Urban Indian Organizations.

Center for Disease Control and Preventions

  • Provides for a total of $4.3 billion for program wide activities and support with no less than $1.5 billion to be made available to States, localities, territories, tribes, tribal organizations, UIOs, or health service providers to tribes. Activities include:
  • Surveillance, Epidemiology, Laboratory Capacity, Infection Control, Mitigation, Communications, Other Preparedness and Response Activities
  • Of this, at least $125 million is to be made available to tribes, tribal organizations, UIOs or health service providers to tribes.

Substance Abuse and Mental Health Services Administration (SAMHSA)

  • A total of $435 million is allocated for Health Surveillance and Program Support for SAMHSA. This includes prevention, preparation, and response to COVID-19.
  • No less than $15 million is to be allocated for tribes, tribal organizations, UIOs or health/ behavioral health service providers to tribes.

Health Resources and Services Administration (HRSA)

  • HRSA Rural Health is appropriated $180 million of which no less than $15 million is to be allocated for tribes, tribal organizations, UIOs, or health service providers to tribes to carry out telehealth and rural health activities.

Legislative Authorizations

Special Diabetes Fund for Indians (SDPI)

  • Reauthorizes SDPI at current funding levels through November 30, 2020. Allocates $25,068,493 for the period from October 1, 2020 to November 30, 2020.

Policy Analysis of House Coronavirus Relief Package

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NCUIH Legislative Alert:
Analysis of House Coronavirus Relief Package

Dear UIOs,

Yesterday, the House of Representatives released their latest piece of legislation in response to the novel coronavirus (COVID-19), entitled the Take Responsibility for Workers and Families Act. This bill includes major policy changes NCUIH and UIOs have been working towards, such as 100% FMAP and a fix for the Medicaid clinic “four walls” issue.

NCUIH supports this bill and asks that you please contact your Senators to support the inclusion of UIO-specific authorizing language and emergency supplemental appropriations provisions in the Senate’s coronavirus relief legislation. The Senate is currently working on its next draft of the third coronavirus bill and past drafts have not included authorizing language for 100% FMAP applicability to UIOs.

Below you will find a summary of the relevant provisions to UIOs. Some major pieces include:

The funds in the provisions highlighted below would remain available until September 30, 2021, unless otherwise noted. Provisions with specific references to urban Indian organizations (UIOs) appear highlighted.
Click Here for PDF Version

 

DIVISION A—THIRD CORONAVIRUS PREPAREDNESS AND RESPONSE SUPPLEMENTAL APPROPRIATIONS ACT, 2020

TITLE I—Agriculture, Rural Development, Food and Drug Administration, and Related Agencies

INDIAN HEALTH SERVICE (pages 72- 74)

  • The bill provides for a total of $1,032,000,000 for preparedness, response, surveillance, and health service activities for coronavirus, including for:
    • Urban Indian Organizations
    • Public Health Support
    • Electronic Health Record Modernization
    • telehealth and other IT upgrades
    • Purchased/Referred Care
    • Catastrophic Health Emergency Fund
    • Community Health Representatives
    • Tribal Epidemiology Centers
    • Other activities to protect the safety of patients and staff
  • Not less than $450,000,000 shall be distributed through Tribal shares and contracts with Urban Indian Organizations. Any remaining funding that is not distributed through Tribal shares or UIO contracts “shall be allocated at the discretion of the Director of the Indian Health Service.”
  • When these funds are transferred to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act (ISDEAA), they will be transferred on a one-time basis (non-recurring), are not part of the amount required by ISDEAA, and may only be used for the purposes of coronavirus preparedness, response, surveillance, and health service activities.
  • Funds may be used to supplement amounts otherwise available under the ‘‘Indian Health Facilities’’ account.
  • In order to use any of these funds to select core components appropriate to support the initial capacity of an Electronic Health Record system, the Committees on Appropriations of the House of Representatives and the Senate must be briefed 90 days in advance of executing a Request for Proposal for the components.
TITLE VIII—DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES

HEALTH RESOURCES AND SERVICES ADMINISTRATION (page 85)

PRIMARY HEALTH CARE

  • $1,300,000,000 for necessary expenses to prevent, prepare for, and respond to coronavirus, for grants and cooperative agreements under the Health Centers Program, as defined by section 330[1] of the Public Health Service Act, and for eligible entities under the Native Hawaiian Health Care Improvement Act, including maintenance of current health care center capacity and staffing levels.RYAN WHITE HIV/AIDS PROGRAM
  • $90,000,000 for the ‘‘Ryan White HIV/ AIDS Program’’ to prevent, prepare for, and respond to coronavirus through modifications to existing contracts and supplements to existing grants and cooperative agreements.[2]
  • Supplements shall be awarded using a data-driven methodology determined by the Secretary of Health and Human Services.

HEALTH CARE SYSTEMS

  • $5,000,000 to prevent, prepare for, and respond to coronavirus, for activities authorized under sections 127 and 1273 of the Public Health Service Act to improve the capacity of poison control centers to respond to increased calls and communications.
  • Of this amount, not less than $15,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.

RURAL HEALTH

  • $460,000,000 to prevent, prepare for, and respond to coronavirus, including telephonic and virtual care for the underinsured, and for continuation and expansion of telehealth and rural health activities under sections 330A and 330I of the Public Health Service Act and section 711 of the Social Security Act.
  • Not less than $15,000,000 of this amount shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.

CENTERS FOR DISEASE CONTROL AND PREVENTION (page 87)
CDC–WIDE ACTIVITIES AND PROGRAM SUPPORT

  • Total of $5,500,000,000 to prevent, prepare for, and respond to coronavirus, domestically or internationally.
  • Not less than $2,000,000,000 of the amount provided shall be for grants to or cooperative agreements with States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, for such purposes including to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.
  • Every grantee that received a Public Health Emergency Preparedness grant for fiscal year 2019 shall receive not less than 100 percent of that grant level.
  • Of this amount, not less than $125,000,000 of such funds shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes.
  • The Director of CDC may satisfy the funding thresholds above by making awards through other grant or cooperative agreement mechanisms.
  • $500,000,000 shall be for public health data surveillance and analytics infrastructure modernization.
  • That funds may be used for grants for the rent, lease, purchase, acquisition, construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability at the State and local level.
  • Funds shall remain available until September 30, 2024.

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (page 90)

  • $10,000,000 for worker-based training to prevent and reduce exposure of hospital employees, emergency first responders, and other workers who are at risk of exposure to coronavirus through their work duties.

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (page 93)
HEALTH SURVEILLANCE AND PROGRAM SUPPORT

  • Total of $435,000,000 to prevent, prepare for, and respond to coronavirus, for program support and cross-cutting activities that supplement activities funded under the headings ‘‘Mental Health’’, ‘‘Substance Abuse Treatment’’, and ‘‘Substance Abuse Prevention’’.[3]
  • Of this amount, not less than $15,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes.
  • $60,000,000 of these funds shall be for services to the homeless population.
  • $50,000,000 of these funds shall be for suicide prevention programs.

CENTERS FOR MEDICARE & MEDICAID SERVICES (page 94)

  • For ‘‘Program Management’’, $550,000,000, to remain available until September 30, 2022 to prevent, prepare for, and respond to coronavirus, of which $100,000,000 shall be for necessary expenses of the survey and certification program, prioritizing nursing home facilities in localities with community transmission of coronavirus.

ADMINISTRATION FOR CHILDREN AND FAMILIES (pages 95-102)
LOW INCOME HOME ENERGY ASSISTANCE

  • $1,400,000,000 for ‘‘Low Income Home Energy Assistance’’

CHILDREN AND FAMILIES SERVICES PROGRAMS (pages 98-102)

  • Total of $5,202,000,000.
  • $2,500,000,000 for activities to carry out the Community Services Block Grant Act
  • $25,000,000 shall be available for grants to support the procurement and distribution of diapers through non-profit organizations
  • Each State, territory, or tribe shall allocate not less than xx percent of its formula award to non-profit organizations
  • $100,000,000 for carrying out activities under the Runaway and Homeless Youth Act

ADMINISTRATION FOR COMMUNITY LIVING (pages 102-103)
AGING AND DISABILITY SERVICES PROGRAMS

  • $1,205,000,000 total to prevent, prepare for, and respond to coronavirus
  • $1,070,000,000 shall be for activities authorized under the Older Americans Act of 1965
    • $200,000,000 for supportive services
    • $720,000,000 for nutrition services
    • $30,000,000 for nutrition services under title 19 VI
    • $100,000,000 for support services for family caregivers under part E of title III
    • $20,000,000 for elder rights protection activities

OFFICE OF THE SECRETARY (pages 104- 109)
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

  • $6,077,000,000 for ‘‘Public Health and Social Services Emergency Fund’’, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including the development of necessary countermeasures and vaccines, prioritizing platform-based technologies with U.S.-based manufacturing capabilities, the purchase of vaccines, therapeutics, diagnostics, and necessary medical supplies, as well as medical surge capacity, workforce modernization, enhancements to the U.S. Commissioned Corps, telehealth access and infrastructure, initial advanced manufacturing, and related administrative activities 
  • The Secretary may take such measures authorized under current law to ensure that vaccines, therapeutics, and diagnostics developed from funds provided in this Act will be affordable in the commercial market
  • Products purchased with funds appropriated in this paragraph may be:
    • Deposited in the Strategic National Stockpile, at the discretion of the Secretary of Health and Human Services
    • 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
    • Used for the construction, alteration, or renovation of non-Federally owned facilities for the production of vaccines, therapeutics, and diagnostics where the Secretary determines that such a contract is necessary to secure sufficient amounts of such supplies
  • Not later than seven days after the date of enactment of this Act, and weekly thereafter until the Secretary declares the public health emergency related to coronavirus no longer exists, the Secretary shall report to the Committees on Appropriations of the House of Representatives and the Senate on the current inventory of personal protective equipment in the Strategic National Stockpile, including the numbers of face shields, gloves, goggles and glasses, gowns, head covers, masks, and respirators, as well as deployment of personal protective equipment during the previous week, reported by state and other jurisdictions
  • $100,000,000,000, to remain available until expended, to prevent, prepare for, and respond to coronavirus, to provide grants to public entities, not-for-profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers, including for profit entities, to reimburse for health care related expenses or lost revenues directly attributable to the public health emergency resulting from the coronavirus
    • Grants shall be awarded in coordination with the Administrator of the Centers for Medicare & Medicaid Services and shall not be used to provide grants to reimburse for health care related expenses or lost revenues that have been reimbursed or are eligible for reimbursement from other sources
  • $4,500,000,000, to remain available until September 30, 2022, to prevent, prepare for, and respond to coronavirus, to reimburse the Department of Veterans Affairs for expenses incurred by the Veterans Affairs health care system to provide medical care to civilians

PUBLIC HEALTH EMERGENCY FUND (page 109)

  • $5,000,000,000 for the ‘‘Public Health Emergency Fund’’to remain available until expended, to prevent, prepare for, and respond to coronavirus, to be deposited into the Public Health Emergency Fund, as established under section 319(b) of the Public Health Service Act.
    • Funds appropriated under this heading in this Act may, at the discretion of the Secretary of Health and Human Services, be deposited in the Strategic National Stockpile

GENERAL PROVISIONS—TITLE I (page 127-133)
SEC. 10803.
(a) Funds appropriated in this title may be made available to restore amounts, either directly or through reimbursement, for obligations incurred by agencies of the Department of Health and Human Services to prevent, prepare for, and respond to coronavirus, domestically or internationally, prior to the date of enactment of this Act.
(b) Grants or cooperative agreements with States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes, under this title, to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities to prevent, prepare for, and respond to coronavirus shall include amounts to reimburse costs for these purposes incurred between January 20, 2020, and the date of enactment of this Act.

[1] Sections 330(r)(2)(B), 330(e)(6)(A)(iii), and 330(e)(6)(B)(iii) shall not apply to funds provided under this heading in this Act.
[2] Under parts A, B, C, D, F, and section 2692(a) of title XXVI of the Public Health Service Act. Sections 2604(c), 2612(b), and 2651(c) of the Public Health Service Act shall not apply to funds provided under this heading in this Act.
[3] In carrying out titles III, V, and XIX of the Public Health Service Act.

 

DIVISION G—HEALTH POLICIES

TITLE I—MEDICAID

SEC. 70101. INCREASING FEDERAL SUPPORT TO STATE MEDICAID PROGRAMS DURING ECONOMIC DOWNTURNS.

SEC. 70102. LIMITATION ON ADDITIONAL SECRETARIAL ACTION WITH RESPECT TO MEDICAID SUPPLEMENTAL PAYMENTS REPORTING REQUIRE20
MENTS.

  • During the period that begins on the date of enactment of this section and ends the date that is 2 years after the last day of the emergency period, the Secretary of Health and Human Services shall not take any action (through promulgation of regulation, issue of regulatory guidance, or otherwise) to—
    • (1) finalize or otherwise implement provisions contained in the Medicaid Fiscal Accountability Regulation proposed rule published on November 18, 2019; or
    • (2)promulgate or implement any rule or provision similar to the provisions described in paragraph (1) pertaining to the Medicaid program established under title XIX of the Social Security Act[1] or the State Children’s Health Insurance Program established under title XXI of such Act[2]

SEC. 70103. AUTHORITY TO AWARD MEDICAID HCBS GRANTS TO RESPOND TO THE COVID–19 PUBLIC HEALTH EMERGENCY. (pages 254-268)

  • This section includes UIOs in the definition of “Indian tribe” for purposes of awarding home and community-based services (HCBS) grants. 
  • “Indian tribe.—The term ‘‘Indian tribe’’ means an Indian tribe, a tribal organization, or an urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)), and includes a tribal consortium of Indian tribes or tribal organizations (as so defined).”
  • GRANTS TO INDIAN TRIBES.
    • During the COVID–19 public health emergency period, the Secretary may award grants to an Indian tribe in the same manner, and subject to the same requirements, as apply to a State, except as otherwise provided in this paragraph.
    • The bill includes information on the application, monthly grant payment amounts, tribal share of monthly HCBS expenditures, and the grant period.

SEC. 70105. COVERAGE AT NO COST SHARING OF COVID–19 VACCINE AND TREATMENT. (pages 269 – 274)

SEC. 70106. OPTIONAL COVERAGE AT NO COST SHARING OF COVID–19 TREATMENT AND VACCINES UNDER MEDICAID FOR UNINSURED INDIVIDUALS. (pages 275 – 276)

SEC. 70107. TEMPORARY INCREASE IN MEDICAID FEDERAL FINANCIAL PARTICIPATION FOR TELEHEALTH SERVICES. (pages 277 – 278)

SEC. 70108. EXTENSION OF FULL FEDERAL MEDICAL ASSISTANCE PERCENTAGE TO INDIAN HEALTH CARE PROVIDERS. (page 278)

  • Extends 100% FMAP to Urban Indian organizations,[3] Indian health care providers[4]
  • Provides a fix for the Medicaid clinic “four walls” issue.
  • The section reads:
    • Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—
      • (1) in subsection (a)(9), by inserting ‘‘and including such services furnished in any location by or through an Indian health care provider (as defined in section 1932(h)(4)(A))’’ before the semicolon; and
      • (2) in subsection (b)—
        • (B) by striking ‘‘Indian Health Care Improvement Act)’’ and inserting ‘‘Indian Health Care Improvement Act), or through an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act) pursuant to a grant or contract with the Indian Health Service under title V of the Indian Health Care Improvement Act’’.“

SEC. 70110. INCREASED FMAP FOR MEDICAL ASSISTANCE TO NEWLY ELIGIBLE INDIVIDUALS. (page 282 – 283)

SEC. 70111. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND INCLUSION OF ADDITIONAL PROVIDERS. (page 283- 290)

  • Includes FQHC

SEC. 70114. EXTENSION OF EXISTING SECTION 1115 DEMONSTRATION PROJECTS. (page 292- 295)

  • Upon request by a State, the Secretary of Health and Human Services shall approve an extension of the waiver and expenditure authorities for a demonstration project described in subsection (a) for a period up to and including December 31,2021, to ensure continuity of programs and funding during the emergency period.
EXPEDITED APPLICATION PROCESS.
  • The Federal and State public notice and comment procedures or other time constraints otherwise applicable to demonstration project amendments shall be waived to expedite a State’s extension request pursuant to this section.

SEC. 70118. EXTENSION OF THE COMMUNITY MENTAL HEALTH SERVICES DEMONSTRATION PROGRAM.

  • Extends program end date from May 22, 2020 to November 30, 2020.
[1] 42 U.S.C. 1396 et seq.
[2] 42 U.S.C. 1397aa et seq.
[3] As defined in section 4 of the Indian Health Care Improvement Act.
[4] As defined in section 1932(h)(4)(A) of the Social Security Act.
TITLE II—MEDICARE

SEC. 70201. COVERAGE OF THE COVID-19 VACCINE UNDER THE MEDICARE PROGRAM WITHOUT ANY COST-SHARING. (page 298-300)

SEC. 70202. HOLDING MEDICARE BENEFICIARIES HARMLESS FOR SPECIFIED COVID-19 TREATMENT SERVICES FURNISHED UNDER PART A OR PART B OF THE MEDICARE PROGRAM. (page 300-305)

SEC. 70204. ENHANCING MEDICARE TELEHEALTH SERVICES FOR FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH CLINICS DURING THE EMERGENCY PERIOD. (page 305-308)

  • The Secretary shall pay for telehealth services that are furnished via a telecommunications system by an FQHC to an eligible telehealth individual SPECIAL PAYMENT RULE.—
  • The Secretary shall develop and implement payment methods that apply under this subsection to an FQHC that furnishes a telehealth service to an eligible telehealth individual during such emergency period.
  • Such payment methods shall be based on payment rates that are similar to the national average payment rates for comparable telehealth services under the physician fee schedule.
TITLE V—PUBLIC HEALTH POLICIES

Subtitle A—Improving Public Health and Medical Response
PUBLIC HEALTH DATA SYSTEM TRANSFORMATION. EXPANDING CDC AND PUBLIC HEALTH DE PARTMENT CAPABILITIES.—(page 417)

Subtitle B—Tribal Health (pages 435 – 443)
SEC. 70521. IMPROVING STATE, LOCAL, AND TRIBAL PUBLIC HEALTH SECURITY. (pages 435-442)

  • Includes urban Indian organizations’ as eligible entities and describes the determination of funding amount.
  • The Secretary shall award at least 10 cooperative agreements under this section

SEC. 70522. PROVISION OF ITEMS TO INDIAN PROGRAMS AND FACILITIES. (page 442)

  • Ensures that items (drugs, vaccines and other biological products, medical devices, and other supplies) from the Strategic National Stockpile are deployed to urban Indian organizations.

SEC. 319F–5. DISTRIBUTION OF QUALIFIED PANDEMIC OR EPIDEMIC PRODUCTS TO INDIAN PROGRAMS AND FACILITIES. (page 443)

  • Specifically includes urban Indian organizations
  • Secretary distributes qualified pandemic or epidemic products[1] to States or other entities, such products are distributed directly to health programs or facilities operated through an urban Indian organization

SEC. 70542. DIABETES PROGRAMS.

  • Extends Special Diabetes Program for Indians (SDPI) to November 30, 2020.
[1] As defined in section 319F–3(i)(7).

Families First Coronavirus Response Act includes $64 Million for Indian Health Service

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On March 18, 2020, H.R. 6201 The Families First Coronavirus Response Act (Act) was signed into law. The legislation allocates $64 million to the Indian Health Service to cover the costs of COVID-19 diagnostic testing for Indians receiving care through the Indian Health Service or through an Urban Indian Health Organization. The Act also guarantees coverage of testing for COVID-19 at no cost sharing for Indians receiving contract health services. In addition, the legislation includes $250 million for the Senior Nutrition program in the Administration for Community Living (ACL). This will provide approximately 25 million additional home-delivered and pre-packaged meals to low-income seniors who depend on the Senior Nutrition programs in their communities.

Currently, Congress is working on a third relief package that is expected to pass soon. The package is expected to provide $1.2 trillion in relief to individuals, governments, and industries. The tribal and urban Indian priorities in this package focus on healthcare, health system capacity, economic development, and governance.

Senators Warren and Udall Unveil Bill to Guarantee Tribal Health Authorities Access to the Strategic National Stockpile

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Source: https://www.warren.senate.gov/newsroom/press-releases/senators-warren-and-udall-unveil-bill-to-guarantee-tribal-health-authorities-access-to-the-strategic-national-stockpile

Indian Health Service and other tribal health organizations currently lack guaranteed, direct access to federal repository of drugs and medical supplies for emergencies; Legislation would allow the Indian Health Service, tribal health authorities, and urban Indian organizations to access the Strategic National Stockpile and help combat the coronavirus crisis

Text of Bill (PDF) | One-Pager (PDF)

Washington, D.C. — United States Senators Elizabeth Warren (D-Mass.) and Senate Committee on Indian Affairs (SCIA) Vice Chairman Tom Udall (D-N.M.) today unveiled the Tribal Medical Supplies Stockpile Access Act, legislation that would guarantee that the Indian Health Service (IHS), tribal health authorities, and urban Indian organizations have access to the Strategic National Stockpile (SNS), a federal repository of drugs and medical supplies that can be tapped if a public health emergency could exhaust local supplies.

Currently, IHS and tribal health authorities’ access to the SNS is very limited and is not guaranteed in the SNS statute. In contrast, states’ and large municipalities’ public health authorities have ready access to the SNS. The lawmakers’ bill comes as the Department of Health & Human Services (HHS) indicated that IHS is likely to face shortages of necessary equipment as coronavirus disease 2019 (COVID-19) continues to spread.

“We must ensure that IHS, tribal nations, and Native communities are prepared to confront the coronavirus outbreak head-on, and that means ensuring that their health services have access to crucial medical supplies and equipment during public health emergencies,” Senator Warren said. “It is as important as ever to empower Indian Country to tackle a public health crisis, and that is what our bill does.”

“Tribal communities face unique challenges in responding to public health threats — that is why it is critical that we listen and respond to Tribal leaders and experts at IHS who say they are likely to face shortages of essential equipment and medical supplies that are needed to respond to this public health crisis,” said Senator Udall. “We must do everything we can to make sure Tribes don’t bear the worst costs of this public health crisis. This legislation will ensure that IHS facilities, Tribal health departments and urban Indian organizations have access to the emergency medical supplies they need. I will continue to push Congress and the Trump administration to make sure Indian Country has access to federal coronavirus resources and that there is meaningful engagement with Native communities and Tribal leaders in our response to COVID-19.”

The Tribal Medical Supplies Stockpile Access Act is supported by the National Indian Health Board, the National Congress of American Indians, the National Council of Urban Indian Health, United South and Eastern Tribes Sovereignty Protection Fund, Seattle Indian Health Board, and the Friends Committee on National Legislation.

“The COVID-19 pandemic has placed immense pressures on the chronically underfunded and under-resourced Indian health system. Direct access to the Strategic National Stockpile will bring much-needed relief and critical medical and pharmaceutical supplies into IHS, Tribal and urban Indian health facilities to prepare and respond to the current COVID-19 pandemic, and future health emergencies.” — National Indian Health Board

“We are encouraged by the leadership of Senator Warren and Senator Udall to increase health care access for American Indians and Alaska Natives through the Strategic National Stockpile. As the coronavirus continues to have greater impacts, Congress must do everything possible to uphold its trust responsibility to Indian Country by providing appropriate resources including N95 respirators. The stockpile is designed for those who need it most in times of emergency and Indian Country should not be left behind.” — Francys Crevier, Executive Director, National Council of Urban Indian Health

“We are grateful for the leadership of Senator Warren and Senator Udall and recognizing the importance of addressing the COVID-19 pandemic in American Indian and Alaska Native communities. Seattle Indian Health Board is right in the epicenter of the outbreak in the United States, and we continue to do everything possible to limit the spread of the virus while taking every safety precaution for our patients, staff, and community. This has come at the cost of revenue, staff, and resources. But with access to the Strategic National Stockpile, we can mitigate future impacts and continue to be leaders in addressing the COVID-19 pandemic.” — Esther Lucero, Chief Executive Officer, Seattle Indian Health Board

“As a Quaker organization who works to hold the United States to its trust and treaty obligations with Native nations, we thank Senators Warren and Udall for ensuring that American Indians and Alaska Natives are not forgotten during this global pandemic. The chronic underfunding of tribal and urban Indian health organizations has led Indian Country to be ill-prepared for a health crisis of this scale. Access to the Strategic National Stockpile will provide supplies and medicines critical to addressing the COVID-19 outbreak. Congress has a trust obligation to provide health facilities serving American Indians and Alaska Natives with the resources needed to protect the well-being of Native people and communities.” — Kerri Colfer, Congressional Advocate on Native American Policy at the Friends Committee on National Legislation

During her time in the Senate, Senator Warren has worked to protect and advance tribal sovereignty, to emphasize the federal government’s trust and treaty responsibilities to tribal nations, and to affirm Washington’s government-to-government relationship with tribal nations. She has introduced a number of bills to advance the health and welfare of Native peoples, including the Native American Suicide Prevention Act, the American Indian and Alaska Native Child Abuse Prevention and Treatment Act, and the Comprehensive Addiction Resources Emergency (CARE) Act, and has cosponsored other legislation to achieve that goal. She has also unveiled with Congresswoman Deb Haaland (D-N.M.) a proposal for the Honoring Promises to Native Nations Act, legislation that will address chronic underfunding and barriers to sovereignty in Indian Country.

In response to the coming economic downturn due to coronavirus, Senator Warren has called for a $750 billion economic stimulus package that would focus on recovery from the grassroots up, not Wall Street down. Such a package would apply the lessons from the 2008 bailout and provide direct help to families harmed by the coronavirus outbreak, including universal paid leave, increasing Social Security benefits by $200 a month, broad cancellation of student loan debt, and protecting and expanding housing.

 

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Udall Leads Bipartisan Group of Senators Urging Vice President Pence to Ensure Coronavirus Resources for Tribes and Urban Native Communities

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Call comes as first case is confirmed in Indian Country, and following Congressional approval of coronavirus emergency funding bill that includes $40 million in funds for Tribes, Tribal organizations and Urban Indian Health Organizations

WASHINGTON — Today, U.S. Senator Tom Udall (D-N.M.). vice chairman of the Senate Committee on Indian Affairs, led a bipartisan group of 27 senators in writing to Vice President Mike Pence requesting the administration meaningfully engage with Native communities and Tribal leaders on their response to the 2019 novel coronavirus (COVID-19).  The senators sent the letter following congressional passage of a coronavirus emergency supplemental appropriations bill that includes $40 million for Tribes, Tribal organizations and Urban Indian Health Organizations impacted by COVID-19.

In addition to Udall, the letter is signed by Senate Democratic Leader Chuck Schumer (D-N.Y.), and U.S. Senators Lisa Murkowski (R-Alaska), Jeff Merkley (D-Ore.), Dan Sullivan (R-Alaska), Ron Wyden (D-Ore.), Bernie Sanders (I-Vt.), Kamala Harris (D-Calif.), Jack Reed (D-R.I.), Tina Smith (D-Minn.), Elizabeth Warren (D-Mass.), Sheldon Whitehouse (D-R.I), Jacky Rosen (D-Nev.), Patty Murray (D-Wash.), Amy Klobuchar (D-Minn.), Martin Heinrich (D-N.M.), Jon Tester (D-Mont.), Dianne Feinstein (D-Calif.), Gary Peters (D-Mich.), Richard Blumenthal (D-Conn.), Tammy Baldwin (D-Wisc.), Cory Booker (D-N.J.), Brian Schatz (D-Hawaii), Debbie Stabenow (D-Mich.), Maria Cantwell (D-Wash.), Catherine Cortez Masto (D-Nev.), and Tammy Duckworth (D-Ill.).

The United States has confirmed COVID-19 cases in a number of states where Tribes and urban Indian communities are located. Given these developments and past issues accessing federal resources for the Zika, Ebola, H1N1, and SARS outbreaks, Tribes and Urban Indian Organizations are concerned that federal COVID-19 response efforts and resources will not reach them.

In their letter to the Vice President, the senators wrote, “As you undertake your work leading the Administration’s 2019 novel coronavirus (COVID-19) response, [we] urge you to meaningfully engage with Native communities and Tribal leaders.”

“The U.S. government has specific trust and treaty responsibilities to provide American Indians and Alaska Natives (AI/ANs) with comprehensive quality healthcare.  While the IHS serves as the primary agency charged with provision of AI/AN healthcare, all federal healthcare-related programs and initiatives – including the COVID-19 response – share equally in the requirement to fulfill these trust and treaty obligations,” the senators continued.

“Additionally, to ensure proper precautions and response measures are deployed efficiently, it is imperative that Tribal and urban Indian health teams have access to Congressionally-allocated COVID-19 resources and the most up-to-date information regarding the presence of COVID-19 in their communities,” wrote the senators.

The full text of the letter can be found below and HERE.

Dear Mr. Vice President,

As you undertake your work leading the Administration’s 2019 novel coronavirus (COVID-19) response, we urge you to meaningfully engage with Native communities and Tribal leaders.  Specifically, we ask that you ensure the Administration: 

– Includes a representative of the Indian Health Service (IHS) on the Administration’s COVID-19 task force;

– Provides Tribal leaders, Tribal health departments, and urban Indian health programs with equal access to COVID-19 related information that is provided to their state and local counterparts; and

– Directs all COVID-19 resources identified by Congress for Native communities’ use to impacted IHS facilities, Tribes, and urban Indian health programs in a timely manner.

The U.S. government has specific trust and treaty responsibilities to provide American Indians and Alaska Natives (AI/ANs) with comprehensive quality healthcare.  While the IHS serves as the primary agency charged with provision of AI/AN healthcare, all federal healthcare-related programs and initiatives – including the COVID-19 response – share equally in the requirement to fulfill these trust and treaty obligations.

Additionally, to ensure proper precautions and response measures are deployed efficiently, it is imperative that Tribal and urban Indian health teams have access to Congressionally-allocated COVID-19 resources and the most up-to-date information regarding the presence of COVID-19 in their communities.  As the IHS noted in its February 24th announcement, the state of the COVID-19 threat “is a rapidly evolving situation, and information is likely to become dated quickly.”[1]  As such, it is incumbent on the Administration to keep Indian Tribes, Tribal health departments, and urban Indian health programs apprised of any relevant developments in real time.

Thank you for your attention to these matters.  We look forward to working with you to uphold the Federal government’s Tribal trust and treaty responsibilities and to engage in meaningful government-to-government relations with Indian Tribes and urban Indian communities regarding the national COVID-19 response.

Sincerely,

Tribal Budget Formulation Work Group Recommends $196.8 Million for Urban Indian Health in FY 22

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NCUIH and UIO Leaders Attend FY 2022 IHS National Tribal Budget Work Session

On February 13 – 14, 2020, the Tribal Budget Formulation Work Group (TBFWG) convened in Arlington, Virginia to develop the National Tribal Budget Recommendation for fiscal year (FY) 2022. This is a two-day annual meeting where the two tribal representatives from each Indian Health Service (IHS) Area come together to review and consolidate all the Areas’ budget recommendations into a set of national health priorities and budget recommendations. During this year’s session, the TBFWG recommended a $90,900,000 increase to the Urban Indian Health budget line item from their FY 2021 recommendation made last year, which was approximately $105,900,000. This is a substantial increase from the recommendation in the FY 2021 President’s budget as the total TBFWG recommendation for Urban Indian Health, $196,800,000, nearly doubles the FY 2021 recommendation. The Urban Indian Health line item was listed as the 11th overall priority in the TBFWG’s National Tribal Budget Recommendation.

In addition, during this year’s session, the TBFWG recommended a $2,763,251,000 increase to the Program Expansion component of the FY 2022 IHS budget, which is a 30% increase over the FY 2021 budget recommendation. The National Council of Urban Indian Health (NCUIH) Board members, staff, and other Urban Indian Organization (UIO) leaders were in attendance at the National Tribal Budget Work Session, although no Urban Indian representative sits on the TBFWG.  Reports from several Areas made clear that UIOs had engaged thoroughly in their Area budget formulation meetings, leading to the TBFWG recommendation.  In fact, the Bemidji, Billings, California, Great Plains, Oklahoma, Phoenix, Portland, and Tucson Areas recommended an increase to Urban Indian Health, as indicated in the chart below.

Although NCUIH did not have an opportunity to present at the session, NCUIH Director of Federal Relations, Julia Dreyer, presented UIO budget priorities during an IHS webinar on January 29, 2020.

Region Recommended Increase for Urban Indian Health
Average 90,941
Alaska 0
Albuquerque 0
Bemidji 316,571
Billings 136,405
California 54,865
Great Plains 274,325
Nashville 0
Navajo 0
Oklahoma 137,163
Phoenix 46,314
Portland 70,786
Tucson 54,865

PRESS RELEASE: NCUIH Releases 2018-2019 Urban Indian Organization Shutdown Report

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FOR IMMEDIATE RELEASE
Contact: Meredith Raimondi
202-417-7781
mraimondi@ncuih.org

Report Shows Devastating Impacts of Shutdown and Highlights Urgency for Advance Appropriations and 100% FMAP

WASHINGTON, DC (February 14, 2020) – The National Council of Urban Indian Health (NCUIH) has released the 2018 – 2019 Urban Indian Organization Shutdown Report. The report summarizes and presents the results of a survey NCUIH circulated during the 2018-2019 shutdown to capture important metrics and narratives regarding its impacts. The United States federal government shutdown of 2018-2019 occurred from midnight Eastern Standard Time on December 22, 2018 until January 25, 2019. Nineteen out of forty-one Urban Indian Organizations (UIOs) reported. The responses from this survey were used in NCUIH’s policy and legislative advocacy initiatives during and after the shutdown. Although the Indian health care delivery system consists of three prongs — Indian Health Service (IHS), Tribal Health Programs, and UIOs — the report focuses on UIOs.

“The 2018-2019 Urban Indian Organization Shutdown Report demonstrates that the longest U.S. government shutdown in history had instant, longstanding, and severe negative impacts on UIOs and the American Indians and Alaska Natives (AI/ANs) they serve across the country. The federal trust responsibility to provide for the healthcare of all AI/ANs mandates that federal funding problems be fixed so that the impacts of any future shutdowns are minimized, and the lives of AI/ANs are not put at risk. Because UIOs operate on very low margins, every aspect of their abilities to deliver essential healthcare was affected by the 2018-2019 shutdown, including their abilities to hire and retain staff, to provide direct services, and, in some cases, even to remain open and available for their patients. IHS funding at the level of need, an increase in the Urban Indian Health budget line item, advance appropriations, and 100% FMAP for UIOs are all necessary fixes to protect the delivery of healthcare to AI/ANs,” said Francys Crevier, Executive Director of NCUIH.

The interruption in funding precipitated by the shutdown had dire consequences for UIOs and, consequently, on American Indians and Alaska Natives (AI/ANs) across the country. The impact on AI/ANs, many of whom depend on UIOs for their healthcare needs, ranged from patients unable to get vital medication for chronic conditions to fatal overdoses. UIOs had to make difficult decisions regarding cancellation of certain services, reduction in practitioner hours, staff retention, facility operation, and whether to use savings earmarked for other purposes to shield staff and patients from the impact of the shutdown.

NCUIH shifted its policy and advocacy focus during the shutdown to limit the disruptions to the daily operations of the UIOs it represents and urged Congress and the administration to immediately end the shutdown and restore funding to IHS. Following the shutdown and restoration of funding, NCUIH remains dedicated to establishing safeguards for UIOs against potential shutdowns in the future. NCUIH is working with Congressional officials to raise awareness for bills that would provide the Indian Health Service (IHS) with advance appropriations (H.R. 1128, S. 229) and provide 100% Federal Medical Assistance Percentage (FMAP) for UIOs (H.R. 2316, S. 1180).

Key Findings

UIOs operate on very low margins.

  • UIOs operate on very low margins such that even very minor changes to their funding structures lead to devastating impacts on the services they provide to AI/ANs and even affect their abilities to keep their facilities operational.

All aspects of the urban Indian healthcare delivery system were impacted by the shutdown, but the UIO workforce was the first to experience its disastrous effects.

  • The survey results point to a pattern which suggests that among the difficult decisions UIOs were forced to make during the 2013 and the 2018-2019 shutdowns, delaying hiring, reducing hours, and laying off staff were typically the first decisions made.

UIO services were greatly impacted.

  • Another pattern the survey highlighted is that UIOs were forced to cut back on services that were not as consequential as others, such as dental services, transportation, case management, and community outreach services. However, some UIOs were forced to cut even the essential services such as substance abuse services and purchase requests for diabetes and blood pressure medications.

UIOs were forced to use savings designated for other purposes to shield staff and patients from the impact of the last two government shutdowns.

  • Yet another pattern illustrated in the survey results suggests that UIO leaders made an effort to protect their staff and current services by using savings earmarked for program growth.

President’s FY 2021 Budget Proposal Includes $50 Million for Urban Indian Health

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The Request for FY 2021 is an Increase of $1 Million from FY 2020 Request, $8 Million Below FY 2020 Enacted

President Trump delivered a fiscally conservative budget proposal for FY2021. Although Congress and the President will negotiate new funding levels once the caps expire in September 2021, the President and congressional leaders had previously settled on new funding caps for the fiscal year ahead. The total Health and Human Services (HHS) budget is set at $96.4 billion which represents a nearly 10 percent cut to its most recent budget and includes $6.2 billion in Indian Health Service (IHS) funds.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line at $49,636,000. This is an $8 million decrease from the enacted budget for FY 2020, but it is a $1 million increase from the President’s FY 2020 budget request for the line item. Meanwhile, IHS received an overall increase of $185 million.

Special Diabetes Program for Indians (SDPI)

  • President Trump’s budget also includes continued funding for the Special Diabetes Program for Indians (SDPI) at the current funding levels of $150 million through FY 2021.

Federal Tort Claims Act

  • The budget expands the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving each UIO an estimated $100,000 annually in malpractice insurance.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. IHS was forced to reallocate $72 million in FY 2019 to pay $101 million for leases under section 105(l) of The Indian Self-Determination and Education Assistance Act (ISDEAA). Approximately $782,000 of which came from urban medical inflation funds.

Centers for Disease Control and Prevention and National Institutes of Health

  • The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent.  Funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues such as opioid abuse.  The President proposes to give the National Institutes of Health a $38 billion budget for FY2021 – about $3 billion less than the current funding level. This cut would affect priorities to include research on the opioid epidemic and stimulants such as methamphetamine, issues that are at critical levels in Indian Country.

National Health Service Corps

  • The National Health Service Corps loan repayment program is reauthorized with $15 million – UIOs employees of UIOs are eligible for participation in the loan repayment program.

HIV/AIDS at HRSA

  • New programs include a focus on HIV/AIDS with $302 million allocated to Health Resources and Service Administration (HRSA) for HIV prevention diagnosis services expansion at health centers and treatment through the Ryan White HIV/AIDS program.

Quick Glance

  • $6,232,568,000 – IHS budget authority total
  • $4,507,113,000 – IHS services budget
  • $49,636,000 million – Urban Indian Health
  • $150,000,000 million – Special Diabetes Program for Indians
  • $101,000,000 million – Section 105(l) ISDEAA
  • $15,000,000 million – The National Health Service Corps loan repayment program
  • $302,000,000 million – HRSA for HIV prevention

A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

NCUIH Contact: Carla Lott (cmlott@ncuih.org), Director of Congressional Relations

Distribution of the Fiscal Year (FY) 2020 Urban Indian Health Funding Increase

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On January 27, 2020, Indian Health Service (IHS) Deputy Director, Michael D. Weahkee, sent out a Dear Urban Indian Organization Leader Letter (DULL) regarding the IHS’s decision on the distribution of funds for the fiscal year (FY) 2020 increase. The letter provides that IHS issued the standard distribution of funds in accordance with the 2018 Urban Confer. 10 percent of the funds will be distributed to the Office of Urban Indian Health Programs (OUIHP) and 90 percent of the funds will be distributed to Urban Indian Organizations (UIOs) via IHS contracts. An equitable distribution methodology will divide the 90 percent evenly among the UIOs for FY 2020.

The DULL provides that the Urban Indian Health funding increase available for distribution in FY 2020 to the OUIHP and UIOs is $5,000,000. The Agency will move forward with distribution as outlined below:

FY 2020 Urban Indian Health Funding Increase – Category

Total Amount

Percentage of Funds
OUIHP

$500,000

10%
39 UIOs: $115,385 per Urban Indian Organization

$4,500,000

90%
Total FY 2020 Funding Increase Distribution

$5,000,000

100%

Why is this important to UIOs?

  • This is the UIOs overall funding distribution increase for FY 2020.
NCUIH Contact: Julia Dreyer (jdreyer@ncuih.org), Director of Federal Relations