Tribal Budget Formulation Workgroup Releases FY22 IHS Funding Recommendations with $200.5 Million for UIOs

Tribal Budget Formulation Workgroup Releases FY22 IHS Funding Recommendations with $200.5 Million for UIOs

On February 13-14, 2020, the Tribal Budget Formulation Workgroup (TBFWG) convened in Arlington, Virginia to develop the National Tribal Budget Recommendation for fiscal year (FY) 2022. On May 4, 2020, a summary of the TBFWG’s Budget Recommendation was released in a document called Reclaiming Tribal Health: A National Budget Plan to Rise Above Failed Policies and Fulfill Trust Obligations to Tribal Nations. The FY 2022 National Tribal Budget Recommendation is $12.759 billion, representing a 30% increase above the FY 2021 National Tribal Budget Recommendation.

The TBFWG recommended a $90.94 million increase for the urban Indian health line item, bringing the funding for Urban Indian Organizations (UIOs) to a total of $200.5 million.

Other UIO priorities the TBFWG included were:

  • 100% Federal Medical Assistance Percentage (FMAP) for UIOs
  • Reimbursement from the Department of Veterans Affairs for services provided to dually eligible American Indians and Alaska Natives (AI/ANs) for UIOs
  • Eligibility for malpractice insurance through the Federal Tort Claims Act (FTCA) for UIOs
  • Eligibility for UIOs to participate in more IHS grant programs.

In addition, the TBFWG highlighted § 105(l) leases by requesting mandatory funding for § 105(l) leases of $337 million, permanent reauthorization for the Special Diabetes Program for Indians (SDPI) with an increase of funding to $200 million per year, advance appropriations for IHS, and renewal of the Indian Health Care Improvement Act.

VIEW HISTORICAL BUDGET FORMULATION RECOMMENDATIONS

NCUIH President to Participate in Roundtable on Heroes Act Benefits for Indian Country

On Friday, May 15, NCUIH President and CEO of NATIVE HEALTH in Phoenix, Walter Murillo will participate in a Roundtable on Coronavirus in Indian Country: Tribal and Urban Organizations.

More Information

May 13, 2020

Media Contact: Adam Sarvana

(202) 225-6065 or (202) 578-6626 mobile

Friday Livestream: Chair Grijalva, Subcommittee Chair Gallego Lead Roundtable on Heroes Act Benefits for Indian Country, Still Unmet Tribal Needs

Washington, D.C. – Chair Raúl M. Grijalva (D-Ariz.) and Rep. Ruben Gallego (D-Ariz.) are hosting a livestreamed roundtable discussion on Friday, May 15, at 1:00 p.m. Eastern time with three national tribal organizations to discuss the House of Representatives’ newly introduced Heroes Act, the ongoing implementation of the CARES Act, and the pressing need for additional federal support in Native American communities across the country to combat the coronavirus.

Gallego is chair of the Subcommittee for Indigenous Peoples of the United States. The event is the second in an ongoing series on coronavirus impacts in Indian Country, which has remained in the national headlines as the virus continues to spread while the Trump administration fails to respond.

Title: Coronavirus in Indian Country: Tribal and Urban Organizations

When: 1:00 p.m. Eastern time on Friday, May 15

Watch Live: https://bit.ly/2zxImiJ (Facebook) or https://youtu.be/ly9iQe8BM4M (YouTube)

Speakers

  • Raúl M. Grijalva, Chair, House Committee on Natural Resources 
  • Ruben Gallego, Chair, Subcommittee for Indigenous Peoples of the United States
  • Kevin J. Allis, Chief Executive Officer, National Congress of American Indians
  • Dante Desiderio, Executive Director, Native American Finance Officers Association
  • Walter Murillo, President, National Council of Urban Indian Health

Trump and CMS Issue Second Round of Changes to Healthcare Regulations

On April 30, 2020, at President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) issued a second round of regulatory waivers and rule changes “to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services.”

Many of CMS’s temporary changes will apply immediately for the duration of the Public Health Emergency declaration. The changes build on an array of temporary regulatory waivers and new rules CMS announced on March 30 and April 10. Providers and states do not need to apply for the blanket waivers and can begin using the flexibilities immediately. CMS also is requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities. Below are the blanket waivers issued separated into categories:

  • New rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries:
    • Under the new waivers and rule changes, Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. A written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes.
    • Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law. With these changes, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements.
    • CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives.
    • CMS is announcing that Medicare and Medicaid are covering certain serology (antibody) tests. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home.
  • Additional highlights of the waivers and rule changes announced today:
    • CMS is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. For example, teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education. Inpatient psychiatric facilities and inpatient rehabilitation facilities can admit more patients to alleviate pressure on acute-care hospital bed capacity without facing reduced teaching status payments. Similarly, hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments.
    • Under current law, most provider-based hospital outpatient departments that relocate off-campus are paid at lower rates under the Physician Fee Schedule, rather than the Outpatient Prospective Payment System (OPPS). CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS.
    • Long-term acute-care hospitals can now accept any acute-care hospital patients and be paid at a higher Medicare payment rate, as mandated by the CARES Act.
  • Healthcare Workforce Augmentation:
    • Beneficiaries may need in-home services during the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, as mandated by the CARES Act. These practitioners can now (1) order home health services; (2) establish and periodically review a plan of care for home health patients; and (3) certify and re-certify that the patient is eligible for home health services
    • CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings.
    • CMS is waiving a requirement for ambulatory surgery centers to periodically reappraise medical staff privileges during the COVID-19 emergency declaration
  • Prioritizing Hospitalization Services:
    • CMS is allowing payment for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patients’ homes.
    • CMS is temporarily allowing Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in the safety of their homes. Previously, clients had to travel to a clinic to get these intensive services.
  • Expansion of Telehealth in Medicare:
    • CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.
    • Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department of the hospital.
    • Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.
    • CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of $14-$41 to $46-$110. The payments are retroactive to March 1, 2020.
    • As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.
    • CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.
  • In addition, CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs):
    • ACOs are groups of doctors, hospitals, and other healthcare providers, that come together voluntarily to give coordinated high-quality care to their Medicare patients. CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.
    • CMS is permitting states operating a Basic Health Program (BHP) to submit revised BHP Blueprints for temporary changes tied to the COVID-19 public health emergency that are not restrictive and could be effective retroactive to the first day of the COVID-19 public health emergency declaration.

In response to these changes Seema Verma, CMS Administrator, stated that “CMS’s changes will make getting tested easier” and the health care system “more accessible for Medicare and Medicaid beneficiaries.”

https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

IHS Announces Dissemination of Final $367 million in CARES Act funding with $20 million for UIOs

On April 23, the Indian Health Service (IHS) announced its decision to distribute $20 million to Urban Indian Organizations (UIOs) in COVID-19 relief aid from the remaining CARES Act resources. These funds will be distributed through existing Indian Health Care Improvement Act (IHCIA) contracts by providing a one-time base amount for each UIO and an additional amount based on each UIO’s Urban Indian users. The announcement came in a Dear Tribal Leader and Urban Indian Organization Leader Letter (DULL) which announced the final allocation decisions for the agency’s remaining $367 million in CARES Act funding.

The DULL also announced a transfer of $125 million to the IHS Facilities Account for IHS and tribal health programs facilities. An additional $50 million will be allocated to IHS health programs and Tribal Health Programs for Community Health Representatives and Public Health Nursing, while $26 million will be set aside for Tribal Epidemiology Centers. The remaining funds will be used for IHS telehealth expansion, COVID-19 prevention, COVID-19 testing, cleaning of IHS facilities, and COVID-19 response and recovery messaging.

These funding allocations finalize the total use of CARES Act funding for IHS. The agency received $1.032 billion from this third wave of COVID-19 legislation. NCUIH continues to advocate for the resources UIOs need to combat COVID-19 by working with lawmakers and federal agencies.

Reps. Gallego, Mullin Introduce Bill Boosting Resources for Urban Indian Health Organizations

https://rubengallego.house.gov/media-center/press-releases/icymi-reps-gallego-mullin-introduce-bill-boosting-resources-urban-indian

April 20, 2020
Press Release

WASHINGTON, DC – Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK) introduced H.R. 6535 last week to expand Federal Tort Claims Act (FTCA) coverage to urban Indian health organizations, giving them a desperately needed boost in resources as they suffer shortages, closures, and financial hardship as a result of the COVID-19 pandemic.

The Indian Health System, commonly referred to as the ITU system, is made up of the Indian Health Service (IHS), Tribal health programs, and urban Indian organizations (UIOs). UIOs provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers. H.R. 6535 would create parity within the ITU system by extending FTCA coverage to urban Indian organizations, who currently are forced to divert resources away from health care in order to foot exorbitant liability costs themselves.

“Urban Indian organizations, including Native Heath in my District, are on the front lines of this pandemic. Individual facilities are reporting skyrocketing costs in the hundreds of thousands and dangerous supply shortages. Three UIOs have already closed their doors as a result of the strain,” said Rep. Gallego, Chair of the Subcommittee for Indigenous Peoples. “We cannot afford to leave urban Indians without access to care during this public health crisis. My bill will both bring long overdue parity to urban Indian health providers and provide an infusion of desperate resources to an urban Indian health system on the brink.”

“Urban Indian Health Centers play a critical role in providing health care to Native Americans. Our bill ensures they are covered by the FTCA so that they won’t have to use their limited resources to cover costly liability bills. I want to thank Congressman Gallego for working with me on this legislation that will improve health care for Native Americans,” said Rep. Mullin.

The National Council for Urban Indian Health (NCUIH) said: We are extremely grateful for Congressman Gallego and Congressman Mullin’s leadership in introducing this legislation for a long-needed fix to the medical malpractice liability protection to ensure parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, which could be spent providing health care for the American Indians and Alaska Natives. As all other Indian Health Care Providers are covered by FTCA and it is extended to Community Health Centers as well as volunteers, this legislative fix is needed now more than ever to ensure continuity of health care in a time when it’s needed most.

###

NCUIH Joins National Native Organizations in COVID-19 Legislative Request

(April 20, 2020) – Last week, NCUIH along with a coalition of National Native Organizations sent a letter to Members of both chambers of Congress outlining a joint COIVD-19 recovery legislative proposal for health, education, nutrition, and human services.

NCUIH, along with the National Congress of American Indians, National Indian Health Board, Self-Governance Communication & Education Tribal Consortium, National Association of Food Distribution Programs on Indian Reservations, Native Farm Bill Coalition, Intertribal Agriculture Council, National Indian Education Association, American Indian Higher Education Consortium, National Indian Child Welfare Association, and United South and Eastern Tribes Sovereignty Protection Fund, sent the legislative priorities as Congress negotiates the fourth major legislative package on coronavirus.

The proposal included, among other essential proposals, requests for Congress to:

  • Provide sufficient appropriations to IHS for Indian Health Care Providers as they face the pandemic on the frontlines, including:
    • Provide $1 billion for Purchased/Referred Care (PRC).
    • Provide $1.215 billion for Hospitals and Health Clinics.
    • Establish a $1.7 billion Emergency Third-Party Reimbursement Relief Fund for IHS, Tribal Programs, and Urban Indian Organizations.
    • Provide $85 million for equipment purchases and replacements.
    • Provide $161 million for Urban Indian Health.
    • Provide $1 billion for Sanitation Facilities Construction.
    • Provide $750 million for maintenance and improvement of Indian Health Service and Tribal facilities.
  • Authorize technical Medicaid and Medicare fixes including 100% FMAP for services provided at UIO facilities and technical amendments including Tribal and UIO access to the Strategic National Stockpile.
  • Clarify that the VA is authorized to reimburse UIOs for services provided to Native Veterans.

Letters

C-SPAN Clip: NIHB Chair Victoria Kitcheyan Discusses Indian Health Priorities for COVID-19

APRIL 9, 2020 | CLIP OF VICTORIA KITCHEYAN ON NATIVE AMERICAN COMMUNITIES AND CORONAVIRUS

Clip Transcript

Call from: Michigan

Thank you so much for taking my call. I run an urban agency an urban indian center just south of Detroit called the American indian Services. We’re a mental health provider as well as a food provider. My question is, what is being done for the 75% of American Indians who live in cities? We’ve had a hard enough time just surviving because the State of Michigan has cut our budget repeatedly for the last 5 years. We’re trying to hang on and serve the American Indians in the cities. If people went home, the tribes would not be able to accommodate them. They would be bankrupt in weeks, so what’s going to be done for the Indian people living in the cities?

Victoria Kitcheyan

Thank you Faith for that question. The urban Indian organization, NCUIH, has been a champion in advocating for urban organizations and they were also included in the first funding package and, in fact, the urban indian priorities are something that cannot be forgotten because many of our tribal members live in urban areas and most recently the National Congress of American Indians and the National Indian Health Board signed on to a letter today advocating for the needs of the fourth funding package and in there the urban needs have also been advocated for. So, I understand your frustration and often the urbans are left out and so the federal agencies have to consult with the federally recognized tribes and they only have to concur with the urban organizations, but we cannot forget our relatives that are living in some of these most highly populated areas that need the resources just as much as we do on the reservation.

Udall, Senate Democrats Unveil COVID-19 “Heroes Fund,” $25,000 Proposed Pay Increase to Essential Workers and, Urban Indian Organizations and Tribal Workers on Frontlines of Pandemic Response

https://www.indian.senate.gov/news/press-release/audio-udall-senate-democrats-unveil-covid-19-heroes-fund-25000-proposed-pay

AUDIO: Udall, Senate Democrats Unveil COVID-19 “Heroes Fund,” $25,000 Proposed Pay Increase to Essential Workers and Tribal Workers on Frontlines of Pandemic Response

COVID-19 “Heroes Fund” would give Tribal frontline workers equal access to proposed $25,000 premium for essential workers, implement $15,000 Essential Worker Recruitment Incentive to attract and secure frontline workforce needed to fight public health crisis

Udall’s remarks on the COVID-19 Heroes Fund begin at 11:38 here.

WASHINGTON—Today, U.S. Senator Tom Udall (D-N.M.) joined Senate Democratic Leader Chuck Schumer (D-N.Y.) and Senators Patty Murray (D-Wash.), Sherrod Brown (D-Ohio), Bob Casey (D-Penn.), and Gary Peters (D-Mich.) to unveil the COVID-19 “Heroes Fund,” Senate Democrats’ proposal to establish a pandemic premium pay to reward, retain, and recruit essential workers. Senate Democrats’ proposed “Heroes Fund” consists of two major components: a $25,000 premium pay increase for essential workers—including Tribal workers—equivalent to a raise of $13 per hour from the start of the public health emergency until December 31, 2020, and a $15,000 essential worker recruitment incentive to attract and secure the workforce needed to fight the public health crisis.

A summary of Senate Democrats’ COVID-19 “Heroes Fund” proposal can be found here.

“Essential frontline workers in New Mexico, Indian Country, and across America are risking their own health to protect ours, to care for our loved ones, and to keep our communities safe and running. We owe these heroes – the health care workers, first responders, law enforcement, grocery clerks, delivery workers, and many others – more than just words of gratitude: we must make sure they are paid what they deserve,” Udall said.

“Importantly, this proposal will give Tribal frontline workers equal access to these benefits, and includes the necessary flexibility to meet the unique needs of Native communities,” Udall continued. ”Because this crisis is hitting Indian Country especially hard: frontline workers in Native communities are stretched thin, and, due to severe federal underfunding, Indian Country has long struggled to recruit and retain workers in fields like health care and law enforcement. So this proposal is absolutely necessary for Indian Country and for all communities — to support the frontline workers who are doing incredible, life-saving work, and to secure the workforce that we need to keep our nation healthy and strong.”

Across New Mexico, Indian Country, and America, essential frontline workers—doctors, nurses, grocery store workers, transit workers, public safety personnel, and many more—continue to put themselves at risk on the front lines of the COVID-19 pandemic. Udall and Senate Democrats’ proposal would compensate these workers for their great personal sacrifices and tireless dedication while increasing the recruitment of additional workers for the front lines that will be needed in the months ahead.

Udall and Senate Democrats fought for workers-first provisions in the recently-passed CARES Act, the $2 trillion package includes key provisions to support New Mexico, including: direct payments to individual New Mexicans and a major expansion of unemployment benefits, badly-needed direct relief for small businesses, an emergency infusion of resources into hospitals and to support health care workers, and reimbursement for state and Tribal governments that have stepped up to address the crisis.

Udall and Senate Democrats also fought to ensure Tribes had equitable access to federal resources in the recently-passed CARES Act. They secured over $10 billion in resources for Tribes and Native communities to address their unique needs, including providing over $1 billion to the Indian Health Service and establishing an $8 billion Tribal Government Relief Fund.

Portions of the first wave of grants from the package have recently been released to New Mexico, while the Indian Health Service announced disbursement of $600 million of the over $1 billion in funds Udall helped secure from the CARES Act.

“Thousands of workers report to the frontlines of our nation’s pandemic response each and every day, placing themselves squarely in harm’s way to serve the needs of others,” said Leader Schumer. “Senate Democrats’ proposed ‘Heroes Fund’ would provide premium pay to these essential workers—the doctors and nurses, grocery store workers, transit workers, and more who are central to fighting this crisis—and would establish an incentive system to retain and recruit the workforce needed for the long months to come. Essential frontline workers sacrifice daily for our collective health and well-being, and Senate Democrats are fully committed to supplying these heroes the financial support they deserve.”

Listen to the audio of Udall’s remarks, beginning at minute 11:38, here.

A summary of Senate Democrats’ COVID-19 “Heroes Fund” proposal can be found here and below:

The COVID-19 “Heroes Fund” Summary

Senate Democrats’ Proposal for Pandemic Premium Pay to Reward, Retain, & Recruit Essential Workers

Essential frontline workers are the true heroes of America’s COVID-19 pandemic response.  Senate Democrats believe in providing premium pay to frontline workers during this pandemic to reward essential frontline workers, ensure the retention of essential workers who are working grueling hours on the frontlines of this crisis, and promote the recruitment of additional workers who will be needed in the months ahead.

As the Congress looks at a potential fourth COVID-19 bill, the following proposal is meant for consideration by Members of Congress, key stakeholders, and the American people. Senate Democrats’ proposal consists of two major components:

1. A $25,000 pandemic premium pay increase for essential frontline workers, equivalent to a raise of an additional $13 per hour from the start of the public health emergency until December 31, 2020.

2. A $15,000 recruitment incentive for health and home care workers and first responders to attract and secure the workforce needed to fight the public health crisis.

Structure of the Pandemic Premium Pay

To meet the goals of reward, retention, and recruitment, Senate Democrats propose a set dollar amount per hour with a maximum amount for the year, for a definite duration, and with an additional bonus for workers who sign up to do such essential work during this crisis.

Amount of Pay Premium. The proposal—

  • Uses a flat-dollar amount per hour premium model in order to ensure it is clear, simple, and lifts up particularly those workers making lower wages.
  • Would give each essential frontline worker $13/hour premium pay on top of regular wages for all hours worked in essential industries through the end of 2020.
  • Would cap the total maximum premium pay at $25,000 for each essential frontline worker earning less than $200,000 per year and $5,000 for each essential worker earning $200,000 or more per year.

Duration of Premium. The premium pay period—

  • Must be for a specified and clear duration of time to ensure workers can rely on it for their economic security and plan for needs like additional child care.
  • Should cover all hours worked by each essential frontline worker through December 31, 2020, or until the worker’s salary-based maximum premium pay is reached.

Premium Pay as a Recruitment and Retention Incentive.  In order to recruit the additional health care workers, home care workers, and first responders needed over the coming months, thef proposal—

  • Would provide a one-time $15,000 premium for signing on to do essential work.
  • Would limit eligibility for this incentive premium to essential health and home care workers and first responders that are experiencing severe staffing shortages impeding the ability to provide care during the COVID-19 pandemic.[1]

Premium Pay and Worker Incentives Delivery Mechanism

The proposal would fully federally-fund the premium pay and recruitment and retention incentive. We will continue to seek input on the specific mechanism for delivering the pay to workers, as well as the universe of “essential workers” to be covered. The new federal fund would partner with entities designated as an “eligible employer” – states, localities, tribes, and certain private sector employers – to issue the funds premium payments to eligible workers. Frontline federal employees would also be granted the new benefit of up to $25,000.

COVID-19 Heroes Fund. The new COVID-19 Heroes Fund would provide funds directly to eligible employer-partners so that they could distribute the premium payments.

  • Employers in industries engaged in “essential work” would apply to the Heroes Fund for funds to be used to add line-item premium pay to employees’ or independent contractors’ paychecks. The eligible employer would track these payments, provide payroll records demonstrating premium payments, and return any unspent funds to the agency.
  • No employer would be required to participate, but all would be strongly encouraged to and the program would be widely advertised.
  • An entity that contracts directly with the state, locality, Tribe, or the federal government (e.g., to provide care to people with Medicare and Medicaid coverage) would be considered a private sector employer, and employees of this entity who are designated as “essential” would be eligible for premium pay. Similarly, an eligible employer is also an individual who hires someone designated as “essential” through programs established through the State (e.g., self-directed care arrangements). This would help ensure coverage of the 2.2 million home health aides, direct service providers, and personal care workers who provide services to more than 12 million Americans.
  • Eligible employers would submit applications for the recruitment and retention incentive premium on a rolling basis.

Federal Workforce. The proposal would ensure all federal government essential frontline employees receive the same $25,000 premium pay benefit provided to other essential workers.[2]

  • Coverage should be expansive to capture all federal employees with public-facing positions.  This includes Title 5 employees and employees of all other federal personnel systems (e.g., employees of the Postal Service, TSA, VA, FAA, District of Columbia, and federally-funded Indian programs[3]).
  • The benefit would be limited to frontline and public-facing positions – employees who are not teleworking from their homes.

Additional Background and Commentary

Precedents. Disasters require exceptional flexibility in standard work schedules and assignments and often put first responders and other essential workers in dangerous situations. To ensure this critical workforce is compensated appropriately, there are precedents for funding hazard premium pay and worker incentives through a federal program.

FEMA, through the Robert T. Stafford Disaster Response and Emergency Assistance Act and the Disaster Relief Fund, is currently authorized to reimburse state, local, and tribal governments for straight-time and premium pay associated with disaster response. Extraordinary costs (such as call-back pay, night-time or weekend differential pay, and hazardous duty pay) for essential employees who are called back to duty during administrative leave to perform eligible Emergency Work are eligible for reimbursement in certain circumstances.

This authority has been used many times over the last few years to pay for personnel costs associated with enforcing curfews, facilitating evacuation routes, and restoring critical infrastructure. Past usage illustrates precedent for federal funding of critical state, local, and tribal employees performing essential response functions that keep our communities safe in times of disaster.

Essential Frontline Worker definitions. As mentioned above, the definition of essential frontline workers for purposes of both the premium pay increase and the recruitment-retention incentive will be the subject of debate. This proposal is not meant to exclude any worker from this conversation. Rather, we hope this proposal will encourage a discussion about how large and diverse this universe of workers truly is. Our goal is to make federal, state, tribal, local and private sector essential workers that are at risk eligible for this benefit.

Retroactive Pay. Workers who have been on the frontlines since the initial declaration of the Public Health Emergency on January 27, 2020, could receive a lump sum of backpay of $13 per hour for work before enactment. These workers would continue to receive the $13 per hour premium pay on top of regular wages moving forward, but these workers would still be subject to the maximum premium pay cap outlined above.

Additional Benefits for Essential Health and Home Care Workers and First Responders. The employers of frontline health and home care workers and first responders should be eligible to apply for a second round of premium pay funds of up to $10,000 as those workers continue to combat the virus.

Death Benefits. It is a deeply disturbing but unfortunate reality that some of our frontline workers are making the ultimate sacrifice to the nation through their work fighting COVID-19. Their families rightfully deserve to receive the full amount of the premium pay as a lump sum in addition to all other forms of death benefits.

Protections from Corporate Expense Shifting. Certain large corporations engaged in the provision of essential services and goods employ essential frontline workers who are deserving of premium pay. However, massive corporations should make investments in providing premium pay of their own accord before trying to participate in this program.

Protecting Workers and PPE. Senate Democrats have been fighting to give essential workers the protections and equipment they need to stay safe. The CARES Act provided billions of dollars for PPE, and Democrats have pushed the Administration to appoint a czar to handle all manufacturing and distribution of critical PPE. We must do more to ensure all frontline workers have the protective gear they need to perform their jobs safely, and we need a strong emergency temporary standard to protect all workers.


[1] The recruitment and retention incentive might need to cover a broader swathe of workers in Indian Country and other underserved areas that experienced high levels of essential frontline worker vacancies prior to the COVID-19 pandemic.

[2] Certain federal workers are entitled under current law to a maximum 25 percent hazard premium pay for exposure to hazardous substances, including virulent biologicals.  However, President Trump has failed to activate this policy for the federal workforce during the COVID-19 pandemic.

[3] Federally-funded Indian program employees include any employee who works for 1) program operated by an Indian Tribe under an Indian Self-Determination and Education Assistance Act “638” contract or compact; 2) a Tribal Controlled Schools Act “297” grant Bureau of Indian Education school; or, 3) an urban Indian organization operating under an Indian Health Service contract pursuant to Title V of the Indian Health Care Improvement Act.

Indian Health Service (IHS) Opioid Grant Pilot Program (OGPP)

On April 3, 2020, the Indian Health Service (IHS) in a Dear Tribal Leader and Urban Indian Organization Leaders (DTLL/DUIOLL) announced that they will be creating a new Indian IHS Opioid Grant Pilot Program (OGPP). OGPP is being funded by the $10 million increase for the Alcohol and Substance Abuse Program budget line funding, authorized by The Consolidated Appropriations Act, 2019 (Public Law 116-6).

As an immediate step, IHS will publish a Notice of Funding Opportunity (NOFO) in the Federal Register this spring.  The NOFO will outline details of the eligibility criteria, objectives, and funding methodology.  In general, the IHS anticipates to award up to 18 grants: one grant opportunity open to each of the IHS Areas; three grant opportunities open to Urban Indian Organizations; and three grant opportunities open to highest priority IHS Areas with a targeted focus on Maternal & Child Health.

A component of the OGPP includes national management and administrative activities, including intensive programmatic technical assistance and support to grantees in developing, implementing, and evaluating their pilot program.

The OGPP was formed after considering the input from 26 letters and over 100 comments IHS received during the comment period on OGPP.

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

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.