Tag Archive for: DULL

NCUIH Requests IHS Support All Facility Types and Integrate Social Services into the New IHS Electronic Health Record System

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On September 6, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Director, Roselyn Tso, regarding the IHS’ January 18, 2024, Dear Tribal Leader and Urban Indian Organization Leader letter (DTLL/DULL) about the August 8, 2024, joint Tribal Consultation and Urban Confer (TC/UC) session on Health Information Technology (HIT) Modernization: Multi-Tenant Domain Considerations. In its comments, NCUIH requested that IHS support all facility types to address inefficiencies during the implementation process and ensure social services are integrated into IHS’ new electronic health record (EHR) system.

Background on IHS HIT Modernization

During the November 8, 2023, TC/UC on HIT Modernization, IHS announced that it selected General Dynamics Information Technology, Inc. (GDIT) to build, configure, and maintain a new IHS enterprise EHR system utilizing Oracle Cerner technology. The new EHR, named Patients at the Heart (PATH), will replace the Resource and Patient Management System (RPMS).

For more information about HIT Modernization implementation, please click here.

NCUIH’s Requests

In its comments following the TC/UC, NCUIH recommended:

  • IHS should increase the value proposition for urban Indian organizations (UIOs) to participate in the PATH EHR:
    • Integrate social services into the PATH EHR
    • Support the unique interoperability needs of UIOs
    • Ensure security of patient health information
  • IHS should address the following challenges and risks that UIOs may face when transitioning from their current EHRs to the shared PATH EHR:
    • Lack of support for all UIO facility types
    • Failure to be included in pilot site and implementation cohort selection

NCUIH Advocacy on HIT Modernization

NCUIH has previously submitted several comments to IHS on HIT Modernization:

NCUIH also submitted written testimony  to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the Fiscal year (FY) 2024 funding for UIOs in which NCUIH requested increased funding for EHR Modernization. Specifically, NCUIH requested support for the IHS’ transition to a new EHR system for IHS and UIOs by supporting the President’s budget request of $913 million in FY 2024 appropriations.

NCUIH will continue to closely follow IHS’s progress and policies with HIT Modernization.

NCUIH Recommends Noncompetitive Funding Model and Support for Whole Family Substance Abuse Treatment in IHS Behavioral Health Initiatives

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On July 22, 2024, the National Council of Urban Indian Health (NCUIH) submitted comments to the Indian Health Service (IHS) Director, Roselyn Tso, in response to a May 21, 2024, Dear Tribal Leader and Dear Urban Indian Organization Leader letter (DTLL/DULL) and June 20, 2024, Urban Confer on IHS Behavioral Health Initiative Funding. In its comments, NCUIH recommended that IHS consider developing a funding methodology similar to the Special Diabetes Program for Indians (SDPI) National Funding Formula, which was developed to avoid competition for funds and to reduce barriers to access in an effort to ensure equitable distribution of funds for behavioral health grant funding.

Background

President Biden’s December 6, 2023, Executive Order (EO) 14112, “Reforming Federal Funding and Support for Tribal Nations To Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination,” directs Federal agencies to implement reforms to federal funding and support programs to make them more accessible, flexible, and equitable. In accordance with EO 14112, the IHS Division of Behavioral Health (DBH) is evaluating Agency-wide processes for distributing appropriated funding for behavioral health initiatives. In fiscal year 2024, the IHS administers more than $59 million in behavioral health initiatives funding, including the seven grant programs that address substance abuse, domestic violence, suicide, and youth regional treatment centers aftercare.

Almost every UIO provides behavioral health, mental health, or substance use disorder care, in addition to primary care services, Traditional Healing and Medicine, and social and community services. Further, seven UIOs have intensive inpatient/residential services as part of their behavioral health services. To fund this important work, 18 UIOs utilize the seven behavioral health grant programs that IHS is seeking feedback on to support and save lives, but the need for these programs is felt at all 41 UIOs.

NCUIH’s Recommendations and Requests

In response to the May 21 DTLL/DULL and June 20 Urban Confer, NCUIH made the following recommendations and requests to IHS regarding Behavioral Health Initiative Funding:

  • Ensure noncompetitive program awards across the I/T/U system
  • Support whole family treatment
  • Support for youth residential treatment centers at UIOs
  • Ensure funding reform for these programs does not create additional reporting requirements
  • Continue to engage with UIOs

NCUIH will continue to monitor as IHS conducts the grant funding evaluation process.

IHS Responds to NCUIH’s Request to Provide Clarity on the Health IT Modernization Implementation During Virtual Summit

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On December 13, 2023, the Indian Health Service (IHS) held the Health Information Technology (HIT) Modernization Virtual Summit. IHS gave Tribal and urban Indian organization (UIO) leaders an update on the HIT Modernization Program and provided a forum to engage with IHS on the Program. The purpose of the Summit was to raise awareness of the new enterprise Electronic Health Record (EHR) solution and to give Tribal and UIO leaders an opportunity to engage in a conversation with IHS on the HIT Modernization Program. In providing updates on the HIT Modernization implementation process, IHS also responded to comments that the National Council of Urban Indian Health recently submitted to the agency regarding HIT Modernization on December 8.

For more information on the Summit, please click here.

NCUIH Requested IHS Provide Clarity on the HIT Modernization Implementation

On December 8, 2023, NCUIH submitted comments and requests to IHS Director, Roselyn Tso, in response to a Tribal Consultation and Urban Confer and request for input on the HIT Modernization Program. In its comments, NCUIH urged IHS to maintain transparency in the HIT Modernization process to ensure that UIOs stay informed on the progress of the complex, multi-year rollout for the new EHR.

In its comments, NCUIH requested that IHS:

  • Clarify the HIT Modernization implementation process. This includes providing clarity on the vendor’s scope of work, the data migration process, and the ways in which IHS will support all facility types.
  • Provide an update to the timeline for HIT Modernization implementation. Specifically, NCUIH seeks clarity on the multi-year rollout cohort identification process.
  • Provide frequent and regular updates to the IHS HIT Modernization webpage.
  • Communicate the status of the Enterprise Collaboration Group (ECG).
IHS Responds to NCUIH’s Request Regarding Focus Groups and the Enterprise Collaboration Group

In NCUIH’s recently submitted comments to IHS regarding HIT Modernization, NCUIH requested clarification on the differences between the Focus Group and the ECG. During the Summit, IHS provided more information on the entities’ role in the HIT Modernization process.

Focus Groups are for every facility regardless of which EHR they are choosing to utilize. The ECG will be comprised of subject matter experts from IHS as well as Tribes and UIOs who provided statements of interest. It will be a chartered entity with many committees that will facilitate structured conversations to help manage the system. The ECG is for entities that will use the new system.

Other Takeaways from the HIT Modernization Program Updates

Timeline

The contract with GDIT is a 10-year indefinite delivery, indefinite quantity (IDIQ) contract. Initial go-live(s) expected to occur late Fiscal Year 2025. IHS requested Tribes and UIO maintain their current HIT system and keep data up to date to support EHR replacement if desired.

Substance Use Disorder Treatment and the New EHR

The EHR will support substance abuse/alcohol abuse treatment centers. IHS stated that it is working to understand how to share patient information with a health information exchange (HIE) partner in compliance with 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records). Because there are limits on how patient information can be shared, IHS is discussing how to share the information effectively under the rules and doing so in the HIE environment.

Background on HIT Modernization

During the November 8, 2023, Tribal Consultation and Urban Confer on HIT Modernization, IHS announced that it selected General Dynamics Information Technology, Inc. (GDIT) to build, configure, and maintain a new IHS enterprise EHR system utilizing Oracle Cerner technology. The new EHR will replace the Resource and Patient Management System.

For more information about HIT Modernization implementation, please click here.

NCUIH Action

NCUIH has submitted several written comments to IHS on HIT Modernization:

NCUIH also submitted written testimony  to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the Fiscal year (FY) 2024 funding for UIOs in which NCUIH requested increased funding for EHR Modernization. Specifically, NCUIH requested support for the IHS’ transition to a new EHR system for IHS and UIOs by supporting the President’s budget request of $913 million in FY 2024 appropriations.

NCUIH will continue to closely follow IHS’s progress and policies with HIT Modernization.

HHS Provides Update on Suspected Behavioral Health Treatment Center Fraud Targeting Native Americans in Arizona

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On November 14, 2023, the Department of Health and Human Services (HHS) sent a Dear Tribal Leader and Urban Indian Organization Leader Letter (DTLL/DULL) to provide an update on suspected behavioral health treatment center fraudulent activities in Arizona. The DTLL/DULL provided a list of resources to stay up to date on the matter and described a “whole of government” approach that the Indian Health Service (IHS), Tribal leaders, Urban Indian Health Program leaders, the Arizona Health Care Cost Containment System (AHCCCS), and the State of Arizona are working toward. Specifically, they have established mechanisms to help affected people receive care, transportation, and other needed services. HHS stresses the importance of staying vigilant in addressing this matter.

Background

Suspected fraudulent providers are believed to be targeting vulnerable American Indian and Alaska Native (AI/AN) people who are unsheltered and experiencing the impacts of substance use disorder (SUD) health conditions. Reports indicate the suspected fraudulent providers entice vulnerable individuals with food, money, shelter, and offer treatment and safe housing to lure them into facilities that do not provide treatment. Initially, suspected fraudulent providers focused on recruiting in reservation communities in Arizona and New Mexico, but more recently there are reports of recruitment efforts throughout Indian Country and direct solicitation to the IHS, Tribal Health Programs, and Urban Indian Health Programs in an effort to gain referrals.

On May 16, 2023, Arizona Governor Katie Hobbs and Attorney General Kris Mayes joined the AHCCCS Office of Inspector General (OIG) to announce payment suspensions against registered behavioral health providers of Medicaid services based on credible allegations of fraudulent billing activities. This first of many actions to stop these criminal activities was a coordinated effort by the Arizona Attorney General’s Healthcare Fraud and Abuse Section, the Federal Bureau of Investigation (FBI), HHS, the U.S. Attorney’s Office, and the Internal Revenue Service. The suspected false and fraudulent claims have been associated with unethical treatment practices, patient brokering, unnecessary services, and overcharging. These actions have led to the suspension of more than 100 unique registered behavioral health providers since the May 16 announcement, and the search for additional fraudulent providers continues.

Resources to Stay Up to Date

IHS will provide regular communication, new information, and additional details as they become available. Several resources are immediately available:

Should you have any questions, please contact your IHS Area Office directly.

IHS to Host Health Information Technology Modernization Program Virtual Summit for Tribal and Urban Indian Leaders on December 13

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On November 13, 2023, the Indian Health Service (IHS) released a Dear Tribal Leader Letter (DTLL) and Dear Urban Indian Organization (UIO) Leader (DULL) letter announcing that they will be hosting a Health Information Technology (HIT) Modernization Program Virtual Summit (Virtual Summit) on Wednesday, December 13, 2023 from 11:00 am – 5:30 pm EST. This one-day Virtual Summit is an opportunity for Tribal and UIO leaders to learn more about the new Electronic Health Record (EHR) and engage in robust and meaningful conversations with the IHS on important issues impacting Tribal and urban Indian communities as a result of the HIT Modernization program. During the Virtual Summit, IHS will host a caucus allowing Tribal and UIO leaders the opportunity to independently exchange viewpoints and share information.

Please register for the Virtual Summit here.

View the Virtual Summit Agenda here.

Background

HIT “is a broad concept that encompasses an array of technologies to store, share, and analyze health information.” This includes, but is not limited to, “the use of computer hardware and software to privately and securely store, retrieve, and share patient health and medical information.”  HIT Modernization for the IHS, Tribal organization, and urban Indian organization (I/T/U) system is long overdue. Although HIT is necessary to provide critical services and benefits to American Indian and Alaska Native patients, the IHS has historically faced challenges in managing clinical patient and administrative data through the Resource Management System (RPMS). Initially developed specifically for the IHS, years of underfunding and a resulting failure to keep pace with technological innovation have left the RPMS impractical by current HIT standards. RPMS has been in use for nearly 40 years and has developed significant issues and deficiencies during this time, especially in recent years as HIT systems have rapidly advanced in sophistication and usefulness. As the Department of Health and Human Services (HHS) Office of the Chief Technology Officer (OCTO) and IHS found in the 2019 Legacy Assessment, systemic challenges with RPMS “across all of the IHS ecosystem currently prevent providers, facilities and the organization from leveraging technology effectively.”

During the November 8, 2023 Tribal Consultation and Urban Confer on HIT Modernization, IHS announced that they have selected General Dynamics Information Technology, Inc. to build, configure, and maintain an new IHS enterprise EHR system utilizing Oracle Cerner technology. The new EHR will replace the RPMS.

NCUIH Action

NCUIH has submitted several written comments to IHS on HIT Modernization. NCUIH also submitted written testimony to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the Fiscal year (FY) 2024 funding for UIOs in which NCUIH requested increased funding for EHR Modernization. Specifically, NCUIH requested support for the IHS’ transition to a new EHR system for IHS and UIOs by supporting the President’s budget request of $913 million in FY 2024 appropriations.

IHS Provides Updates on Timeline and Resources for Seasonal Influenza, RSV, and COVID-19 Vaccines

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On September 22, 2023, the Indian Health Service (IHS) sent a Dear Tribal Leader Letter (DTLL) and Dear Urban Indian Organization Leader Letter (DULL) to provide an update concerning seasonal vaccines and resources available for vaccine-related activities to purchase COVID-19 vaccines. In the letter, IHS discussed vaccines for Influenza, Respiratory Syncytial Virus (RSV), and COVID-19.

IHS provided the following updates:

Influenza Vaccine

Supply of the 2023-2024 seasonal influenza vaccine is expected to be adequate to provide access for all recommended age groups, including the influenza vaccines preferentially recommended for people ages 65 years and older. The Centers for Disease Control and Prevention (CDC) continues to recommend the seasonal influenza vaccine for all people ages six months and older. September and October are the best times for most people to get vaccinated.

RSV Vaccine

Vaccination to prevent RSV is also available for certain high-risk persons. This includes approved RSV vaccines available for persons ages 60 years and older, and one of the RSV vaccines, ABRYSVO, is approved for use in pregnant individuals 32-36 weeks gestational age to prevent lower respiratory tract disease (LRTD) and severe LRTD in infants from birth through 6 months of age. There is also the long-acting monoclonal antibody, nirsevimab, which has been approved and recommended to prevent RSV for all infants under 8 months entering their first RSV season, and all American Indian and Alaska Native children ages 8-19 months entering their second RSV season.

COVID-19 Vaccine

In September, the Food and Drug Administration approved and authorized, and the CDC recommended, an updated monovalent mRNA COVID-19 vaccine designed to protect against the currently circulating strains of the virus. All people ages 6 months and older, regardless of prior COVID-19 vaccination status, are recommended to receive this vaccine. The vaccine is now available, so please do not wait to get your updated COVID-19 vaccine.

Like other adult vaccines, after regulatory approval/authorization and recommendation, the updated 2023-2024 COVID-19 vaccines (Pfizer, Moderna, and Novavax, once authorized) will be commercially available through the channels used to procure other routine vaccines. Updated COVID-19 vaccines are available in retail pharmacies.

Vaccines will be available to uninsured or underinsured adults through the HHS Bridge Access Program for a limited time. CDC’s Bridge Access Program provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. This program will end by December 31, 2024.

Pediatric COVID-19 vaccines will continue to be available to all American Indian and Alaska Native children via the CDC’s Vaccines for Children (VFC) program. The VFC program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. The CDC buys vaccines at a discounted rate for distribution to registered VFC providers. Children who are eligible for VFC vaccines are entitled to receive those vaccines recommended by the Advisory Committee on Immunization Practices. Eligible children are children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine:

  • Medicaid eligible: A child who is eligible for the Medicaid program. (For the purposes of the VFC program, the terms “Medicaid-eligible” and “Medicaid-enrolled” are equivalent and refer to children who have health insurance covered by a state Medicaid program)
  • Uninsured: A child who has no health insurance coverage
  • American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)
  • Underinsured

For any questions related to vaccines, please contact CAPT Kailee Fretland, Pharmacist, Office of Clinical and Preventive Services, IHS, by e-mail at kailee.fretland@ihs.gov.

For any questions pertaining to COVID-19 supplemental funding, please contact Ms. Jillian Curtis, Chief Financial Officer, IHS, by e-mail at jillian.curtis@ihs.gov.

NCUIH Vaccine Advocacy

The National Council of Urban Indian Health (NCUIH) has long supported equitable vaccination access for urban American Indian and Alaska Native people.  With support from the CDC, NCUIH has been working to promote equitable adult vaccination and prevent severe illnesses such as COVID-19 and influenza.  We do this by enhancing the resource and evidence base, developing effective strategies for health care organizations, and creating culturally appropriate materials for individual clinicians that reflect the needs of urban American Indian and Alaska Native people.

Join NCUIH on November 9, 2023, for the second session in our vaccine Community of Learning (CoL) series, “Paths to Vaccine Equity: Annual Vaccinations.” Speakers from NCUIH and Amy Pisani, CEO of Vaccinate Your Family, will discuss the new RSV vaccine and updates to the COVID-19 and influenza vaccines. Participants will learn how collaboration with vaccine organizations can help support vaccine awareness and patient education.

For more information on NCUIH’s vaccine advocacy work, please click here.

FY 2024 Appropriations Update: IHS to Maintain Continuity of Operations with Advance Appropriations

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On October 1, 2023, Indian Health Service (IHS) Director, Roselyn Tso, sent a Dear Tribal Leader and Urban Indian Organization Leader letter sharing critical information regarding the current status of fiscal year (FY) 2024 appropriations for the IHS. This letter is in response to the recently enacted “Continuing Appropriations Act, 2024 and Other Extensions Act” (the continuing resolution) which funds the Federal Government through November 17, 2023. The letter notes that because IHS received its first ever advance appropriations in the Consolidated Appropriations Act, 2023 (Public Law 117-328), which provides $5.1 billion in FY 2024 for nearly all programs in the IHS Services and Facilities accounts, the IHS has authorization and funding to continue operations and the provision of direct health care services. The FY 2024 advance appropriations and carryover funds from previously appropriated funds, including COVID supplemental funds, are not limited to the pro-rata percentage applied by the continuing resolution, and the IHS has access to this full funding amount as of October 1.

In the coming days, the IHS will begin distributing FY 2024 advance appropriations to IHS programs, Tribal Health Programs, and Urban Indian Organizations (UIOs). You can find additional information on IHS advance appropriations at the link that follows: IHS Blog: IHS Provides an Update on Advance Appropriations Implementation.

Payment Processes

HHS financial systems will re-open after October 1, 2023, for FY 2024 activities. All of the timelines and requirements to receive a payment remain the same. For example, funds will be paid out according to performance periods. If your UIO contract performance period is October – September, the earliest you could receive a payment for FY 2024 is October 2023. If your performance period is November – October, the earliest you could receive a payment for FY 2024 is November. Additionally, UIOs must have a signed Federal Acquisition Regulation (FAR) contract in place to receive a FY 2024 payment.

Activities that did not receive FY 2024 advance appropriations include the following:

  • Electronic Health Record Modernization
  • Indian Health Care Improvement Fund
  • Health Care Facilities Construction
  • Sanitation Facilities Construction
  • Contract Support Costs
  • Section 105(l) Leases (Payments for Tribal Leases)

Background on IHS Advance Appropriations

The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for IHS, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.

NCUIH Advocacy

After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.

On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.

IHS Provides Update Following Confer on Urban Indian Interagency Workgroup

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On August 30, 2023, the Indian Health Service (IHS) sent a Dear Urban Indian Organization Leader Letter (DULL) to follow up on a virtual urban confer convened on July 13, 2022, to explore UIO leaders interest in forming an Urban Indian Interagency Workgroup. In the letter, IHS summarized the 16 comments IHS received from UIOs, such as:

  • “Establish a new Urban Indian Interagency Workgroup in conjunction with the White House Council on Native American Affairs to ensure more comprehensive and effective collaboration throughout the Federal Government;”
  • “Develop a Federal funding strategy to pilot test innovative approaches and programs that address the needs of Urban Indians;” and,
  • “Provide technical assistance to Federal agencies to establish urban confer policies to address social determinants of health, such as housing, poverty, and education.”

As a next step, IHS plans to provide the Urban Indian Interagency Workgroup confer recommendations to the U.S. Department of Health and Human Services’ (HHS) Office of Intergovernmental and External Affairs and the Office of the Secretary’s Intradepartmental Council on Native American Affairs.

Background

The formation of an Urban Indian Interagency Workgroup to identify the needs and develop strategies to better serve urban American Indian and Alaska Native (AI/AN) populations has been a priority for NCUIH. On February 3, 2022, Senator Van Hollen, along with Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of this workgroup. NCUIH worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of Ai/Ans who do not reside on Tribal land.

The Senate Appropriations Subcommittee directed IHS to continue to explore the formation of this interagency working group in its Fiscal Year 2023 Interior Appropriations bill, noting that “in addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.”

The workgroup would help identify federal funding strategies to better address the needs of urban AI/ANs, advance the development of a wellness-centered framework to inform health services, strengthen support for practice-based traditional healing approaches, improve urban confer policies at HHS and associated agencies, and ensure that UIOs can regularly meet with federal agencies to address relevant topics of concern.

IHS hosted a virtual urban confer session on July 13, 2022, to explore the formation of an Urban Interagency Workgroup with other federal agencies.

NCUIH’s Recommendation to IHS

On September 12, 2022, NCUIH submitted comments to IHS regarding the formation of an Urban Interagency Workgroup with other federal agencies. NCUIH made the following recommendations in response to the urban confer:

  • Respect Tribal sovereignty and the government-to-government relationship in the formation of an interagency workgroup.
  • Create a committee within the White House Council on Native American Affairs (WHCNAA) focused on how federal agencies can better serve AI/Ans living in urban areas.
    • The White House Council on Native American Affairs (WHCNAA) was established to improve outcomes for AI/AN communities through a stronger relationship between the federal government and Native people.
    • Developing an Interagency Oversight Committee on Urban Indian Affairs within WHCNAA would allow cross-collaboration across all agencies and ensure that all other WHCNAA committees are accurately incorporating urban Indian communities into their work.
  • IHS should provide technical assistance to federal agencies to develop urban confer policies.
    • Urban confer policies or UIO-specific consultations do not supplant or otherwise alter Tribal consultations and the government-to-government relationship between Tribes and federal agencies. IHS should provide support and assistance to federal agencies as they begin the development of such policies.

NCUIH will continue to monitor for any further development on the formation of an Urban Interagency Workgroup. NCUIH will also continue to engage with IHS, the White House, and Congress on moving this proposal forward.

NCUIH Policy Blog:  NCUIH Submits Comments to the Indian Health Service on the Creation of an Urban Indian Interagency Workgroup

DULL: IHS initiating Urban Confer exploring the formation of an Urban Interagency Workgroup

Letter to the Biden Administration requesting the establishment of an Urban Interagency Workgroup

Fiscal Year 2023 Interior Appropriations bill

IHS Provides Guidelines and Resources for IHS, Tribal, and Urban Indian Healthcare Facilities on Combating the Syphilis Epidemic

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On July 19, 2023, Indian Health Service (IHS) released a Dear Urban Leader Letter detailing the current syphilis epidemic impacting American Indian and Alaska Native (AI/AN) communities. AI/AN people have the highest rates of syphilis, which has serious consequences including congenital cases that are linked to stillbirths or infant death occurring shortly after birth. To combat this epidemic, IHS has introduced several guidelines and resources recommended for all IHS, Tribal, and urban Indian organizations (UIOs) healthcare facilities system including:

  • Annual syphilis testing
  • Three-point syphilis testing for all pregnant people
  • Enhance screening rates by screening outside of hospitals and clinics
  • Presumptive treatment of syphilis
  • Create and build awareness and encourage people to get tested and treated

Background

A recent surge in syphilis cases has significantly impacted and affected Indian Country. Given that American Indian and Alaska Native people have highest primary and secondary syphilis rates in the country, it is vital that health care providers and educational campaigns work together to reduce the prevalence of syphilis and other sexually transmitted infections (STIs). Prevention education and outreach can significantly reduce the health disparities caused by syphilis. For more information regarding syphilis prevention and education, Syphilis Resource Hub offers up to date and in-depth trainings and strategies regarding disease control and prevention.

NCUIH’s Role

The National Council of Urban Indian Health (NCUIH) proactively monitors the impact of diseases effecting Indian Country. As part of this effort, NCUIH regularly hosts panels and webinars to keep UIOs and other stakeholders informed about current trends or best practices pertaining to disease control and prevention education. For example, on June 21, 2023, NCUIH hosted an online webinar Strengthening Syphilis Care in Indian Country aimed to tackle challenges, share innovative solutions, and pave the way for enhanced syphilis and other STI services and capacities for UIOs and Americans Indians and Alaska Native people. NCUIH will continue to advocate and monitor for the resources needed to reduce health disparities for American Indian and Alaska Native people regardless of where they live.

IHS Initiates Listening Sessions for Tribal and Urban Indian Organization Leaders on Advance Appropriations Implementation

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On August 8, 2023, the Indian Health Service (IHS) sent a Dear Tribal Leader and Urban Indian Organization (UIO) Leader letter inviting Tribal and UIO leaders to participate in Agency-sponsored Listening Sessions to share information and solicit input on advance appropriations implementation. IHS will host two (2) identical Listening Sessions for Tribes and UIOs on August 17, 2023, and September 6, 2023. During the Listening Sessions, IHS will share additional information on implementation plans and strategies for advance appropriations, and seek Tribal and UIO input. The information discussed in these sessions will be used to prepare public-facing Frequently Asked Questions and other helpful materials.

Since advance appropriations was included in the final FY 2023 spending bill, the National Council of Urban Indian Health (NCUIH) has consistently requested that IHS host a Tribal Consultation and Urban Confer to ensure Tribes and UIOs are briefed on the implementation process and prepared for fund distribution. NCUIH recently met with IHS Director Roselyn Tso and emphasized the importance of hosting an Urban Confer before October 1, 2023. We look forward to continuing to engage with IHS to ensure successful implementation of advance appropriations for the whole IHS, Tribal, and UIO system.

The Advance Appropriations Implementation Listening Sessions will be on Thursday, August 17, 2023, 12:00-1:30 p.m., ET and Wednesday, September 6, 2023, 3:00-4:30 p.m., ET.

    • Click here to join the Thursday, August 17 Listening Session
    • Click here to join the Wednesday, September 6 Listening Session

Background on IHS Advance Appropriations

The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for the Indian Health Service, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.

NCUIH Advocacy

After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.

NCUIH has been advocating that advance appropriations be maintained for IHS until mandatory funding is achieved. On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.