Press Release: New NCUIH Report on Urban Third-Party Reimbursement

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Washington, DC (August 27, 2020)— The National Council of Urban Indian Health (NCUIH)  is proud to announce the publication of its report – “Recent Trends in Third-Party Billing at Urban Indian Organizations”. The report provides an overview of billing methods and payment methodologies that Urban Indian Organizations (UIOs) use for third-party reimbursement, data insights, and related policies and issues relevant both in the recent past and in the age of coronavirus.

“We have long known that Urban Indian Organizations do not receive adequate funding from the federal government,” said NCUIH Executive Director Francys Crevier. “This report demonstrates how resilient UIOs have been in spite of this, setting up robust third-party billing arrangements in a complex policy environment.  Unfortunately, the COVID-19 pandemic represents a catastrophic threat to the stability they have built”.

Key Findings Include:

  • Third-party reimbursement is more crucial to the stability of the Urban Indian healthcare system than ever. Between fiscal year (FY) 2010 to FY2018, third-party reimbursement nearly tripled, while funding from IHS appropriations remained relatively unchanged.
  • UIOs were projected to earn a minimum of $212.7 million in reimbursement in FY 2020.  Yet due to the coronavirus pandemic, NCUIH estimates that UIOs lost over a quarter of that expected revenue by June 21, 2020 (between $55.1 to $60.5 million).
  • In FY2018, UIOs received $672 per American Indian and Alaska Native (AI/AN) patient from the Indian Health Service (IHS) budget’s Urban Indian Health line item.
  • The average Medicaid reimbursement rate UIOs receive is around $245 – nearly half the 2020 all-inclusive rate of $479 available to tribal health programs and IHS facilities.  The lowest rate NCUIH has on record was $70 in 2018, and 50% of UIOs currently receive between $170 and $300 per encounter.

The authors of the report – Sunny Stevenson, JD (sstevenson@ncuih.org) and Andrew Kalweit, MPH (akalweit@ncuih.org) – presented initial findings at a Webinar on August 6, 2020 and will also present at the IHS Partnership Virtual Trainings on October 1, 2020.  A recording and slides for the first presentation are available online, alongside training materials.

NCUIH is thankful for the partnership with the Division of Tribal Affairs and Office of Minority Health at the Centers for Medicare and Medicaid Services, as well as NORC at the University of Chicago, which made this project possible. We look forward to continued collaboration as we strive to achieve healthy equity for American Indian and Alaska Native people.

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About the National Council of Urban Indian Health
The National Council of Urban Indian Health (NCUIH) is the national organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/ANs) living in urban settings. NCUIH envisions a nation where comprehensive, culturally competent personal and public health services are available and accessible to AI/ANs living in urban communities throughout the United States.  NCUIH is the only organization that represents all 41 Urban Indian Organizations (UIOs) federally funded by the Indian Health Service.

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PRESS RELEASE: National Native Organizations (NCUIH, NCAI, NIHB) Call for Congressional Action in Light of New CDC Report

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

CDC study finds that COVID-19 has a disproportionate impact on American Indians and Alaska Natives who are 3.5 times more likely to test positive for COVID-19.

Washington, D.C. (August 26, 2020) – Today, the National Council of Urban Indian Health (NCUIH), the National Indian Health Board (NIHB), and the National Congress of American Indians (NCAI) (the National Native Organizations) renewed a call for urgent action by Congress on COVID-19 emergency legislation for Indian Country in light of a new CDC study from August 19, 2020. Previously, the National Native Organizations expressed the need for Congress to immediately reconvene to pass emergency COVID-19 legislation. The last emergency supplement to Indian Country was on March 27, 2020 in the CARES Act, in which Indian Country received just 0.5% of the funding.

On August 19, 2020, the Centers for Disease Control and Prevention (CDC) released the results of a COVID-19 study that examined the impact of COVID-19 on American Indians and Alaska Natives (AI/ANs). The report revealed many concerning details about COVID-19’s impact on AI/ANs, including that, in the 23 selected states CDC studied, AI/ANs were 3.5 times more likely to test positive for COVID-19 than non-Hispanic whites.

“The CDC study proves what we have known for months to be true – American Indians and Alaska Natives are disproportionately contracting and dying every single day from COVID-19. Inaction by the federal government is a failure of the federal trust responsibility to provide health care to Natives in exchange for cessation of our lands. This is not the first time a virus is killing our people while the federal government stands by without any plan for Indian Country. The time is now for our Congressional leaders to take action and provide our people the resources obligated to them by the federal government before more lives are needlessly lost”, said Francys Crevier, Executive Director of the National Council of Urban Indian Health.

“We are grateful that Congress directed nearly $200 million to CDC to support Tribes during the COVID-19 pandemic, but it is evident by the data that more resources and funding are needed. The CDC report highlights serious COVID-19 related challenges faced by American Indians and Alaska Natives, which is information that the National Indian Health Board has been relaying to media, Members of Congress and the Administration for months. Our messages are clear: Native people are disproportionately and negatively impacted by COVID-19; data gaps for Native health persist and need to be addressed; and serious investment is needed for public health infrastructure and health information technology within the Indian health system. Tribes need these resources, so we have a fighting chance to combat COVID-19 and the capacity to track the virus and all disease processes in Indian Country,” Stacy Bohlen, Executive Director of the National Indian Health Board.

“The federal government’s chronic underfunding of American Indian and Alaska Native public health systems has undeniably fueled the disproportionate impacts of COVID-19 on tribal communities,” said National Congress of American Indians CEO Kevin Allis. “Increased resources, including for public health infrastructure, are greatly needed to address these disparities and ensure that the United States upholds its trust and treaty responsibility to provide quality healthcare to tribal nations and their citizens.”

Background

On July 20, 2020, in response to these glaring inequities, NCUIH, NIHB, NCAI, and other organizations representing AI/ANs sent a letter to House and Senate leadership including recommendations for the fourth COVID-19 relief package. On July 27, 2020, the House Native American Caucus also sent a letter echoing the importance of addressing these needs. The recommendations included $2 billion in emergency funding for IHS and at least $1 billion for health infrastructure, Federal Torts Claim Act coverage and 100% Federal Medical Assistance Percentage (FMAP) for urban Indian organizations, reauthorization of the Special Diabetes Program for Indians, and delivery of funds through preexisting IHS self-determination and self-governance contracts, among other provisions. These policies will provide AI/AN providers with the resources necessary to combat the disproportionate impact that COVID-19 has on AI/ANs.

Study Overview and Limitations

The CDC also found that AI/ANs infected by COVID-19 tended to be younger, with 12.9% of AI/ANs under 18 testing positive for COVID-19 compared to 4.3% of non-Hispanic Whites. The study was unable to identify disparities in COVID-19 disease severity and health outcomes compared to other racial and ethnic groups due to lack of available data for AI/ANs, illustrating the need for further research. Studies from the CDC, including this one, have shown that AI/ANs are among the racial and ethnic minority groups at a highest risk for severe COVID-19 outcomes. Factors contributing to higher rates of COVID-19 infection include historical trauma, preexisting health disparities, multigenerational households, and lack of access to running water.

The report also acknowledged several limitations due to incomplete data for AI/ANs.  First, data is voluntarily reported to CDC, which results in missing data and an incomplete picture of the prevalence of COVID-19 infection among our population. Second, the report included data from only 23 states, and the analysis only included one half of reported COVID-19 cases among AI/ANs during the same time period. Third, the methodology in this report used bridged-races estimates as population denominators which are known to inflate the Hispanic AI/AN population, resulting in an underestimation of mortality rates among AI/AN populations. The federal government must do a better job in meeting its trust responsibility to gather accurate and complete data to assess the true impact of COVID-19 in AI/AN communities.

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About the National Council of Urban Indian Health

The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.A

About the National Congress of American Indians 

Founded in 1944, the National Congress of American Indians is the oldest, largest, and most representative American Indian and Alaska Native organization in the country. NCAI advocates on behalf of tribal governments and communities, promoting strong tribal-federal government-to-government policies, and promoting a better understanding among the general public regarding American Indian and Alaska Native governments, people, and rights. For more information visit www.ncai.org.

About the National Indian Health Board

Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, the National Indian Heatlh Board (NIHB) seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.

NUIFC Press Release: The National Council of Urban Indian Health Joins An Unprecedented National Coalition For Census & Civic Engagement Work In All Native Communities

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SEATTLE, WA — The National Urban Indian Family Coalition (NUIFC) is excited to welcome the National Council of Urban Indian Health (NCUIH) to a national coalition of Native organizations working collaboratively on a robust, unprecedented civic engagement initiative focused on ensuring an accurate Census count and empowering hundreds of thousands Native voters in communities on and off the reservation.

“We have so much at stake and we’re taking extraordinary efforts to make sure our voices are heard in the most important election and Census of our lifetime,” says Janeen Comenote, NUIFC Executive Director. “The addition of NCUIH to our already powerful coalition of urban Indian organizations both locally and nationally strengthens our collective ability to impact the body politic in the U.S.”

“It is of paramount importance that we ensure that American Indians and Alaska Natives (AI/AN) living in urban settings are civically engaged, exercising their rights and raising their voices. As this is the first time ever that NCUIH has been awarded funds to focus on Census and Voting initiatives at the national level, we are encouraged to see attention given to urban AI/AN mobilization to positively impact and educate decision makers and the general public on our reality and challenges especially amid a global pandemic that is ravaging our communities.”

— FRANCYS CREVIER, NCUIH’S EXECUTIVE DIRECTOR

NCUIH joins an impressive list of national Native organizations including, the National Congress of American Indians, the Native American Rights Fund, Urban Indian Health Institute, the Center for Native American Youth, and the NUIFC. The addition of the NCUIH rounds out a full geographic footprint both on and off the reservation in Indian Country.

“NCUIH is thrilled to partner with the National Urban Indian Family Coalition (NUIFC) and the Wallace H. Coulter Foundation on a critically important census and civic engagement initiative for Urban Native Americans,” says Alejandro Bermudez Del-Villar, NCUIH’s Programs & Development Director. “It is of paramount importance that we ensure that American Indians and Alaska Natives (AI/AN) living in urban settings are civically engaged, exercising their rights and raising their voices. As this is the first time ever that NCUIH has been awarded funds to focus on Census and Voting initiatives at the national level, we are encouraged to see attention given to urban AI/AN mobilization to positively impact and educate decision makers and the general public on our reality and challenges especially amid a global pandemic that is ravaging our communities.”

NCUIH was formed in 1998 to support the development of quality, accessible, and culturally competent health services for American Indians and Alaska Natives living in urban communities. Today, NCUIH works in partnership with more than 40 urban Indian organizations offering quality, accessible, and culturally sensitive health care programs in their community and are a trusted institution in Indian country.

To this end, NCUIH will conduct online civic education through multiple platforms, invest into Urban Indian Health Organizations to engage in community engagement around the Census and election, and work directly with its youth council to foster civic participation among young Natives.

In 2018, the NUIFC launched the first ever national urban American Indian & Alaska Native Civic Engagement initiative, which was an overwhelming success and contributed to the election of the country’s first two Native American Congresswomen. This year NUIFC has steadily grown this national coalition with the primary goal of supporting an even larger network of Urban Indian organizations as they build political power and ensure an accurate Census count. With more than 70 percent of all American Indians and Alaska Natives residing in metropolitan centers, it is vital that our work include as many urban stakeholders as possible.

PRESS RELEASE: NCUIH Vice President to Testify at House Natural Resources Legislative Hearing on FTCA Bill for UIOs

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

WASHINGTON, DC (July 20, 2020) – On July 22, Robyn Sunday-Allen, NCUIH Vice President and Chief Executive Officer of the Oklahoma City Indian Clinic, will testify before the House Subcommittee for Indigenous Peoples of the United States. Ms. Sunday-Allen will be testifying on Tuesday, July 22 at 2 PM in support of H.R. 6535, the Coverage for Urban Indian Health Providers Act. H.R. 6535 would extend Federal Tort Claims Act coverage to urban Indian organizations (UIOs).

“Oklahoma City Indian Clinic has been operating on the front lines of this crisis with limited resources. We spend hundreds of thousands of dollars each year on liability insurance for our providers. With parity in FTCA, we would put every cent back into services which will allow us to fulfill our mission of providing excellent health care to American Indians. Increasing access to quality health care and preventive wellness services and producing positive health outcomes for urban American Indians living in central Oklahoma is the business we are in,” said Robyn Sunday- Allen, CEO of Oklahoma City Indian Clinic, and NCUIH Vice President.

Passage of H.R. 6535 would ensure that UIOs achieve parity with the rest of the IHS/Tribal health providers/urban Indian organizations system (I/T/U system). Currently, UIOs are the only part of the I/T/U system who do not receive FTCA coverage. This act, if passed, would save individual UIOs up to $250,000 a year on medical malpractice insurance, money that could be used to hire additional providers, provide additional programs, and to respond to COVID-19 and future public health emergencies.

The Senate held a hearing on the companion bill (S. 3650) on July 1, 2020.  At the hearing, Indian Health Service (IHS) Director RADM Weahkee endorsed the bill on behalf of IHS.

FTCA coverage for UIOs currently has bipartisan support in the House and Senate, Executive Branch, and from the Tribal Budget Formulation Workgroup.

The link to watch the livestream of the hearing can be found here.

PRESS RELEASE: NCUIH Commends Supreme Court Decision as Monumental Victory for Indian Country

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McGirt v. Oklahoma reasserts the US treaty with the Muscogee (Creek) Nation.

FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

WASHINGTON, DC (July 9, 2020) – On July 9, 2020, in a historic decision the US Supreme Court sided with the Muscogee (Creek) Nation in McGirt v. Oklahoma, a case set to decide the jurisdictional fate for the eastern part of Oklahoma. In a 5-4 decision, the court acknowledged the treaties which the US government has continually broken. “On the far end of the Trail of Tears was a promise. Forced to leave their ancestral lands in Georgia and Alabama, the Creek Nation received assurances that their new lands in the West would be secure forever…Because Congress has not said otherwise, we hold the government to its word” (McGirt v. Oklahoma). This marks a major victory for Indian Country, as the Muscogee (Creek) Nation’s treaties with the US government are upheld.

“Tribal sovereignty is a top priority for the National Council of Urban Indian Health (NCUIH). We know all too well that the promises made to American Indians and Alaska Natives are often broken. Today’s decision is truly a win for all of Indian Country. We commend the court for its decision today and congratulate the Muscogee (Creek) Nation in its victory. We also urge the federal government to do more to rectify longstanding injustices against Indian Country. As allies, we at NCUIH will continue to do all we can to advocate for the sovereignty of all Indian Nations. Today, sovereignty has won,” said Francys Crevier, Executive Director of NCUIH.

“As a Muscogee (Creek) citizen, this decision is more than the court upholding the United States government’s legal obligation as written in treaty, it is the highest court in the land acknowledging that my great-great grandmother’s lands are still ours. No court can define the meaning of our lands, but thankfully, this decision conveys to the world what we have long known to be true,” said Julia Wakeford (Mvskoke), Policy Assistant at NCUIH.

These lands were guaranteed through direct relations with the US Federal government and the Tribe, a relationship which has been undermined by the state of Oklahoma. In the official opinion offered by Justice Neil Gorsuch, it was made clear that only through direct legislative means can this reservation be disestablished. In McGirt v. Oklahoma, the federal government followed through on its treaty obligations, with the court disavowing many actions taken against tribes in this country: “Unlawful acts, performed long enough and with sufficient vigor, are never enough to amend the law. To hold otherwise would be to elevate the most brazen and longstanding injustices over the law, both rewarding wrong and failing those in the right. The judgment of the Court of Criminal Appeals of Oklahoma is Reversed.” (McGirt v. Oklahoma)

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

PRESS RELEASE: House FY21 Interior Appropriations Bill includes $66 Million for Urban Indian Health, $8.4 Million above FY20

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

The bill includes $6.5 Billion for Indian Health Service.

Washington, DC (July 9, 2020) – Today, the House Appropriations Committee released the bill report for the Fiscal Year (FY) 2021 Interior, Environment, and Related Agencies funding bill. The bill includes $6.5 billion for the Indian Health Service (IHS), an increase of $445 million above the FY 2020 enacted level and $199 million above the President’s budget request for FY 2021. The full Appropriations Committee will mark up the bill on Friday at 9:00 a.m.

The bill includes $66.1 million for Urban Indian Health line item in the IHS budget. The National Council of Urban Indian Health (NCUIH) requested $106 million Urban Indian Health as recommended by the Tribal Budget Formulation Workgroup (TBFWG) for FY 2021. The bill also includes $83.9 million in Direct Operations for IHS and directs IHS to confer with UIOs to conduct a study on infrastructure needs. Additionally, Alzheimer’s Disease and the Hepatitis C & HIV/AIDS Initiative would receive $5 million respectively with provisions to work with UIOs.

“We are grateful for Chair McCollum, Ranking Member Joyce and the Committee for their tireless efforts in ensuring all of Indian Country has the resources needed to protect and care for our relatives. We are encouraged by the inclusion of $66.1 million for urban Indian health and the long-needed infrastructure study for urban Indian health facilities who require new resources to safely operate amid this pandemic,” said Francys Crevier, Executive Director of NCUIH.

In June, NCUIH testified before the House Committee on Appropriations Subcommittee on Interior, Environment and Related Agencies for a hearing on the Indian Health Service (IHS) COVID-19 Response. NCUIH highlighted the dire need for facilities and infrastructure funding, which is currently unfunded, in the wake of the COVID-19 crisis. In February, NCUIH testified as part of American Indian and Alaska Native Public Witness Day.

Indian Health Service

Note: Additional analysis is forthcoming.

Indian Health Service – $6.5 billion, an increase of $445 million above the FY 2020 enacted level and $199 million above the President’s budget request.

  • Urban Indian Health – $66.1 million, $8,443,000 above the FY20 enacted level and $16,491,000 above the President’s budget request
  • Health Services – $4.5 billion, an increase of $225 million above the FY 2020 enacted level and $33 million above the President’s budget request. This reflects the move of Payment for Tribal Leases (Indian Self-Determination and Education Assistance Act section 105(l) lease cost agreements, commonly referred to as “section 105(l)” leases) to a separate, indefinite appropriation account.
    • Note: UIOs are ineligible for the 105(l) leases. Over the past few years, IHS has diverted over $1.5 million of UIO funds to cover the cost of these leases, so a separate appropriation to cover 105(l) lease costs will ensure future UIO funding is not diverted again for this reason.
  • Health Facilities – $935 million, an increase of $23 million above the FY 2020 enacted level and $166 million above the President’s budget request.
    • Note: Even though the bill language does not exclude UIOs, there is still the limitation found in 25 U.S.C. § 1659 that limits UIO facility renovation or construction to “minor” activities for the sole purpose of meeting Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation standards.
  • Alzheimer’s Disease – $5 million
    • The Committee directs IHS, in consultation with Indian Tribes and Urban Indian Organizations (UIOs), to develop a plan to assist those with Alzheimer’s, the additional services required, and the costs associated with increasing Alzheimer’s patients and submit this information to Congress within 270 days of enactment of this Act.
  • Hepatitis C & HIV/AIDS Initiative- $5 million
    • The Committee encourages IHS to confer with UIOs to determine how they may participate in this Initiative.

Next Steps

On Tuesday, the House Interior Appropriations Subcommittee approved the bill with funding for the Indian Health Service. On Friday, the full House Appropriations Committee will markup the Interior bill. While the House is expected to move swiftly, the Senate is in recess until July 20 and has yet to begin their COVID-19 emergency response package. Majority Leader Mitch McConnell has signaled the Senate will still recess for August meaning that the Senate Appropriations process may not be underway until September. As it is an election year, the chances of a passage for an Interior Appropriations Bill in both chambers is dwindling and it’s looking like a Continuing Resolution will be needed.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

PRESS RELEASE: Senate Passes Package with Health Care Access for Urban Native Veterans Act at a Critical Time

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

The Health Care Access for Urban Native Veterans Act was also included in the House passed HEROES Act.

Washington, DC (June 4, 2020) – Today, the Senate passed S. 886, the Indian Water Rights Settlement Extension Act with a substitute amendment offered by Senators Tom Udall, Jerry Moran and Mitt Romney. The four-bill package included S. 2365, the Health Care Access for Urban Native Veterans Act of 2019 which allows the Indian Health Service and the U.S. Department of Veterans Affairs to enter into agreements for the sharing of medical facilities and services with urban Indian organizations.

“In the middle of pandemic that is ravaging Native communities, urban Indian veterans are being left behind by the United States government. Now more than ever, Native veterans need access to life-saving health care. We are grateful for the Senate Committee on Indian Affairs including Chairman Hoeven and Ranking Member Udall for recognizing the urgency of pushing this legislation across the finish line,” said Francys Crevier, Executive Director.

Current Status

The House of Representatives companion bill (H.R. 4153) was ordered to be reported favorably by the Committee on Natural Resources on March 11, 2020. It was also included in the recent HEROES Act passed by the House on May 15, 2020.

Background on S.886

S. 886, the Indian Water Rights Settlement Extension Act, as amended, includes:

  • S. 2365, the Health Care Access for Urban Native Veterans Act of 2019 allows the Indian Health Service within the U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs, and the U.S. Department of Defense to enter into agreements for the sharing of medical facilities and services with urban Indian organizations;
  • S. 279, the Tribal School Federal Insurance Parity Act
  • S. 1875, the Aamodt Litigation Settlement Completion Act of 2019
  • S. 1207, the Navajo-Utah Water Rights Settlement Act

Background on the Health Care Access for Urban Native Veterans Act

Last year, the National Congress of American Indians passed a resolution calling on Congress to “enact legislation ensuring the provision of health care to American Indian and Alaska Native veterans living in urban centers.” This important urban Indian health bill also has widespread endorsements by NCUIH’s valued partners across Indian Country along with valuable veteran organizations, Iraq and Afghanistan Veterans of America, and VoteVets.

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

PRESS RELEASE: House Passes Latest COVID-19 Bill with $64 Million for UIOs, 100% FMAP for UIOs for 1 Year, VA-IHS Fix for UIOs, and Third Party Relief Fund

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

NCUIH also testified before the House Natural Resources Committee today on the HEROES Act.

Washington, DC (May 15, 2020) – Today, the House of Representatives passed the latest iteration of COVID-19 legislation, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. This new stimulus bill totals over $3 trillion and includes additional state and local government funding, additional health care funding including $2.1 billion for IHS with $1 billion for reduced third party billing collections and $64 million for Urban Indian Organizations (UIOs), 100% FMAP for UIOs for 1 year, and VA reimbursement parity for UIOs. NCUIH’s President and CEO of NATIVE HEALTH Walter Murillo also testified before the House Committee on Natural Resources Subcommittee on Indigenous Peoples on the HEROES Act today.

walter “The COVID-19 pandemic significantly affects densely populated areas and UIOs are seeing high positive-testing rates. As our health workers are risking their lives every day, we need the federal government to ensure our frontline heroes receive the same protections as all other public health employees. There is more work to be done and we look forward to working with our elected federal representatives in Congress on ensuring the HEROES Act and future legislation provides urban Indian organizations the resources to address this crisis,” said Walter Murillo in his testimony before the House Committee on Natural Resources.

“NCUIH applauds the work of the House of Representatives to introduce this bill with a focus on helping Indian Country address this pandemic which is causing devastation in our communities every day. As NCUIH has been tirelessly advocating for Urban Indian Health in each package, we are appreciative of the inclusion of $64 million for Urban Indian Organizations (UIOs), at least $1 billion in funds to recoup the third-party dollars lost by UIOs and Indian Health Care Providers, 100% FMAP for UIOs through June 30, 2021, and a permanent fix for UIO services provided to Native Veterans. We look forward to working with our Senate champions to ensure these provisions are included in the final package and are hopeful for the addition of the essential parity fix of FTCA for UIOs,” said Francys Crevier, Executive Director.

In his opening remarks for today’s roundtable, Chair of the Subcommittee of Indigenous Peoples, Rep. Ruben Gallego stated, “Inequities are felt beyond the borders of our reservation. For example, urban Indians in places like Phoenix face their own unique challenges in getting access to care. Indian Country has suffered more than any other Americans during the H1N1 pandemic and Spanish flu pandemic a century ago – also because of federal government failures.”

“Unmet needs have been estimated to be close to 32 billion dollars. Accordingly we strongly support increased funding for the system that includes emergency third party reimbursement relief fund and technical Medicaid and Medicare fixes such as the authorization of Medicaid reimbursements for Qualified Indian Provider Services,” said Kevin Allis, CEO of NCAI in his testimony today.

Bill Highlights

  • $2.1 billion for IHS “to prevent, prepare for, respond to, and provide health services related to coronavirus”
    • $1 billion to supplement reduced third party billing collections
    • Not less than $64 million for Urban Indian Organizations (UIOs)
  • $2.1 billion for CDC “to prevent, prepare for, and respond to coronavirus, domestically or internationally”
    • $1 billion for “necessary expenses for grants for core public health infrastructure for State, local, Territorial, or Tribal health departments”
    • Not less than $100 million to “be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes”
  • $3 billion for SAMHSA “to prevent, prepare for, and respond to coronavirus”
    • Not less than $150 million to “be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes”
  • 100% FMAP for services provided through urban Indian organizations “from July 1, 2020 – June 30, 2021”
    • Note: this is only a temporary authorization of 100% FMAP for UIOs
  • Health inequities research: IHS “in coordination with Tribal Epidemiology Centers and other Federal agencies, shall conduct or support research and field studies for the purposes of improved understanding of Tribal health inequities among AI/ANs”
  • VA reimbursement parity for UIOs serving dually eligible AI/AN Veterans

Next Steps

The Senate is still working to develop its own iteration of the next coronavirus package, but Senate Republicans have yet to reach an agreement with Senate Democrats on its timing or content. NCUIH will continue to advocate for the inclusion of UIOs in the final package including the addition of the FTCA parity bill that was introduced in the Senate and House, permanent 100% FMAP for UIOs, VA-IHS parity for UIOs, and the $1.7 billion relief fund advocated for by NCAI, NIHB, and NCUIH.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

PRESS RELEASE: Senators Smith, Lankford, McSally and Udall Introduce Bill to Expand Resources for Urban Indian Organizations amid Pandemic

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

The long-needed fix would allow urban Indian organizations to direct funds back to the patients who need it most.

Washington, DC (May 8, 2020) – Yesterday, Senators Tina Smith (D-MN) and James Lankford (R-OK) introduced bipartisan legislation with Senators Tom Udall (D-NM) and Martha McSally (R-AZ) to expand Federal Tort Claims Act (FTCA) coverage to urban Indian organizations, giving them a desperately needed boost in resources as many suffer critical supply shortages, closures, and financial hardship as a result of the COVID-19 pandemic. The Coverage for Urban Indian Health Providers Act (S.3650), would amend the Indian Health Care Improvement Act to create parity within the Indian Health System. This is a companion bill to H.R. 6535, introduced on April 17, 2020 by Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK).

Urban Indian organizations (UIOs) are doing everything they can to keep their doors open during this pandemic while still dealing with paying for costly medical malpractice insurance. Unfortunately, urban Indian organizations may be forced to make extremely difficult choices – facing competing priorities and expenses like increased PPE prices, trying to pay for testing and supplies, in addition to very costly malpractice insurance. S. 3650 would create parity within the Indian Health Service health 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.

“We are extremely grateful for the leadership of Senator Smith, Lankford, McSally and Udall in introducing this bipartisan legislation for a long-needed fix to the medical malpractice liability protection, which ensures parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, funds that could be spent on PPE and testing kits for the American Indians and Alaska Natives they serve – made even more essential as our communities are hit by this pandemic. As all other Indian Health Care Providers are covered by FTCA and Community Health Centers employees as well as volunteers are also covered, this legislative fix is critical to ensure continuity of health care in a time when it’s needed most,” said Francys Crevier, Executive Director of the National Council of Urban Indian Health (NCUIH).

“Minnesota’s urban Indigenous community has been hit hard by the coronavirus pandemic, yet many urban Indian health organizations are often forced to spend hundreds of thousands of dollars on costly liability protection instead of being able to use those resources to provide health care to Native community members,” said Sen. Smith. “This is unacceptable. We need to make sure that urban Indian organizations can use every dollar they have to give urban Indigenous individuals the care they need. I’m glad to work in a bipartisan way to bring financial relief to these vital organizations.”

“There are two prominent UIOs in Oklahoma that faithfully serve our Tribal communities’ healthcare needs in addition to the other important Tribal health facilities around the state. I am glad our bill addresses this disparity in the law to help ensure equal access to medical malpractice liability coverage for the services they offer,” said Sen. Lankford. “Federal tort law currently omits coverage for UIOs, and especially during the coronavirus pandemic, UIOs, like other already covered Tribal health facilities, need to have the peace of mind that they can utilize their funds for care, not court cases.”

“Urban Indian health programs funded by the IHS are facing revenue shortfalls while ramping up services to combat the COVID-19 pandemic. And, as a result, many of these critical health care programs are struggling to keep the lights on and their doors open. They shouldn’t be the only branch of the IHS that has to divert resources away from health care services to cover exorbitant liability costs,” said Sen. Udall. “The federal government’s trust and treaty responsibilities to Native Americans do not stop at reservation boundaries. Nearly 70 percent of American Indians and Alaska Natives live in urban areas and Congress must ensure they have access to quality health care — especially during this public health crisis. This legislation is a common-sense measure to provide Urban Indian Health Programs with the same federal protections given to all other Indian Health Care Providers.”

“Arizona is home to four Urban Indian Organizations, all of which are forced to spend hundreds of thousands of dollars annually on liability insurance that could otherwise be spent on patients,” said Sen. McSally. “Our legislation will fix this inequity by extending federal liability coverage to our urban Indian health groups, dramatically decreasing the cost of malpractice insurance while freeing up more money for patient care. Bringing parity to Urban Indian Health is an important step to improving Native American health care across the board.”

“On behalf of the NCUIH and NATIVE Health in Phoenix, we appreciate the strong commitment from Arizona Senator McSally in ensuring parity for urban Indian health care providers. In addition to stretching already limited resources more thin, especially during this time of crisis, we are unable to share providers across our clinics. We are hopeful that Congress will act quickly to enact this bipartisan fix to allow our programs to have more resources to put directly back into patient care during this this pandemic,” said Walter Murillo, President of NCUIH, CEO of NATIVE Health.

“Oklahoma City Indian Clinic has been operating on the front lines of this crisis with limited resources. We spend hundreds of thousands of dollars each year on liability insurance for our providers. With parity in FTCA, we would put every cent back into services which will allow us to fulfill our mission of providing excellent health care to American Indians.  Increasing access to quality health care and preventive wellness services and producing positive health outcomes for urban American Indians living in central Oklahoma is the business we are in.  We applaud the leadership of Senator Smith and Senator Lankford on helping redirect resources back to patients and families who rely on our services,” said Robyn Sunday Allen, NCUIH Vice-President and CEO of Oklahoma City Indian Clinic.

“We are grateful to our Senator Tina Smith as well as Senators Udall, McSally and Lankford for introducing this important legislation to help Urban Indian Organizations like Indian Health Board of Minneapolis. Despite the coronavirus pandemic and its implication and impact that is has on our clinic as well as our community, IHB continues to provide health care services that are vital to the ongoing needs of the community we serve. We are hopeful for FTCA coverage to allow us to redirect those resources back to our patients during this pandemic,” said Dr. Patrick Rock, CEO of the Indian Health Board of Minneapolis.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

PRESS RELEASE: Senate Clears COVID-19 Testing Package, President Expected to Sign

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FOR IMMEDIATE RELEASE

Contact: Meredith Raimondi, 202-417-7781, mraimondi@ncuih.org

The bill includes $750 million to Indian Country for COVID-19 testing and response.

Washington, DC (April 23, 2020) – On April 21, 2020, H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act, passed the Senate by voice vote.  The bill is now in the House of Representatives and is on track to pass today. The President has indicated he will sign the bill.

“As our urban Indian organizations (UIOs) have been on the front lines of the COVID-19 crisis from day 1, we are grateful for the inclusion of Tribes and urban Indians in the most recent legislation. We appreciate a continued commitment to Indian Country by Leader Chuck Schumer. We hope that the government acts swiftly to provide these life-saving tests and resources to our programs on the ground. We will continue to work with our national partner organizations NIHB and NCAI to push for more assistance in the next package, “said Francys Crevier.

The bill includes $25 billion for COVID-19 testing with not less than $11 billion to states, local territories, tribes, tribal organizations, urban Indian organizations, or health service providers to tribes. Out of the $11 billion, not less than $750 million will be allocated in coordination with the Director of the Indian Health Service to tribes, tribal organizations, urban Indian organizations, or health service providers to tribes. These funds are to be used for: “necessary expenses to develop, purchase, administer, process, and analyze COVID–19 tests, including support for workforce, epidemiology, use by employers or in other settings, scale up of testing by public health, academic, commercial, and hospital laboratories, and community-based testing sites, health care facilities, and other entities engaged in COVID-19 testing, conduct surveillance, trace contacts, and other related activities related to COVID–19 testing.”

The deal will total $484 billion, including $310 billion to replenish the funding for the Paycheck Protection Program. This bill also expands the scope of the Paycheck Protection Act allowing for small banks, credit unions, and non-profits to be eligible for the funds. Of this $310 billion, $75 billion is intended for eligible health care providers. Eligible health care providers include “public entities, Medicaid or Medicare enrolled suppliers and providers, and for-profit and not-for-profit entities” that “provide diagnoses, testing, or care for individuals with possible cases of COVID-19.”

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.