The Build Back Better Act maintained $100 million for UIO facilities and extension of key Medicaid parity provision for UIOs.

On November 19, 2021, the House passed President Biden’s Build Back Better (BBB) Act with a 220-213 vote. The BBB Act, allocates $2.347 billion to the Indian Health Service (IHS), $100 million for Urban Indian Health facilities, and extension of an additional 8 fiscal quarters of 100% Federal Medical Assistance Percentage (FMAP) for urban Indian organizations (UIOs) beginning April 1, 2021. As Congress negotiated the Reconciliation bill from $3.5 trillion to $1.75 trillion, funding for Indian Country was significantly reduced from the original reconciliation instruction allocation of $20.5 billion. Earlier this week, the President signed into law the bipartisan infrastructure bill which allows UIOs to use existing resources to fund infrastructure projects.

“Adequate funding for Indian Country is crucial now more than ever, especially as the COVID-19 pandemic has, and continues to be, the deadliest for American Indian and Alaska Native communities. We are grateful for our House champions who ensured that urban Indian health was a priority. We cannot build back better without Indian Country and encourage the Senate to retain these critical provisions.” said Francys Crevier, CEO of NCUIH (Algonquin).,

Background and Advocacy

UIOs, which are a fundamental, inseverable component of the Indian Health Service/Tribal Health Program/UIO (I/T/U) system, face chronic underfunding. The National Council of Urban Indian Health (NCUIH) has long advocated for adequate funding for ALL three parts of the I/T/U system to better serve the American Indian/Alaska Native (AI/AN) population.

NCUIH initially advocated for $200 million dollars on August 1, 2021. The draft reconciliation bill released on September 27 included $100 million for UIO facilities. Since 1986, $13.3 billion in facilities funding has been allocated to IHS, however UIOs are not eligible for the IHS Facilities or Sanitation line items. The allocation of $100 million for UIO facilities in BBB is historic and long overdue.

NCUIH and UIO advocacy to Congressional leadership helped retain provisions in the BBB Act affecting UIOs that were at risk of cuts during Congress’ negotiations to reduce the cost of the budget reconciliation bill. However, the overall stark decrease in the funding commitment for Indian Country is disappointing for AI/ANs and does not uphold the trust and treaty obligations of the federal government. This past week, NCUIH sent a letter to Speaker Pelosi’s office urging the passage of the BBB Act with support for Indian Country.

• NCUIH letter to Speaker Pelosi urging passage of BBB Act (November 16, 20201)
• NCUIH Policy Alert: House Draft of Build Back Better Includes Long Needed Infrastructure Funds for Urban Indian Health
• NCUIH letter to Speaker Pelosi and Majority Leader Schumer urging Congress to retain $20.5 billion for Indian Country and $42 million for UIOs in Build Back Better plan (October 25, 2021)
• NCUIH letter to Congressional leadership requesting $21 billion for Indian health infrastructure in the budget reconciliation package (August 1, 2021)
• Joint letter led by the National Congress of American Indians (NCAI) and signed by NCUIH requesting $21 billion for Indian health infrastructure among countless other Tribal priorities (April 13, 2021)

 

Next Steps

The Reconciliation bill will now be sent to the Senate for consideration. NCUIH will also be requesting that the Senate retain the $100 million for UIO facilities and extension of 100% FMAP.

 

Budget Reconciliation Bill Highlights

Committee on Natural Resources

Indian Health Service

• “MAINTENANCE AND IMPROVEMENT.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $945,000,000, to remain available until September 30, 2031, for maintenance and improvement of facilities operated by the Indian Health Service pursuant to a self-determination contract (as defined in subsection (j) of section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304(j))) or a self-governance compact entered into pursuant to subsection (a) of section 404 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5364(a)).”
• “MENTAL HEALTH AND SUBSTANCE USE DISORDERS.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $123,716,000, to remain available until September 30, 2031, for mental health and substance use prevention and treatment services, including facility renovation, construction, or expansion relating to mental health and substance use prevention and treatment services.
• “PRIORITY HEALTH CARE FACILITIES.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $1,000,000,000, to remain available until September 30, 2031, for projects identified through the health care facility priority system established and maintained pursuant to subparagraph (A) of paragraph (1) of subsection (c) of section 301 of the Indian Health Care Improvement Act (25 U.S.C. 1631(c)(1)(A)).”
• “SMALL AMBULATORY.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $40,000,000, to remain available until September 30, 2031, for small ambulatory construction.”
• “URBAN INDIAN ORGANIZATIONS.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $100,000,000, to remain available until September 30, 2031, for, notwithstanding the restrictions described in section 509 of the Indian Health Care Improvement Act (25 U.S.C. 1659), the renovation, construction, expansion, equipping, and improvement of facilities owned or leased by an Urban Indian organization (as defined in item (29) of section 4 of that Act (25 U.S.C. 1603(29))).”
• “EPIDEMIOLOGY CENTERS.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $25,000,000, to remain available until September 30, 2031, for the epidemiology centers established under paragraphs (1) through (2) of subsection (a) of section 214 of the Indian Health Care Improvement Act (25 U.S.C. 1621m(a)(1)–(2)).”
• “ENVIRONMENTAL HEALTH AND FACILITIES SUPPORT ACTIVITIES.—In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $113,284,000, to remain available until September 30, 2031, for environmental health and facilities support activities of the Indian Health Service.”

Committee on Education and Labor

Grants to Support the Direct Care Workforce

• “GRANTS AUTHORIZED.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $1,000,000,000, to remain available until September 30, 2031, for awarding, on a competitive basis, grants to eligible entities to carry out the activities described in subsection (c) with respect to direct support workers.
  • Urban Indian Organizations are listed as eligible entities for this grant to “provide competitive wages, benefits, and other supportive services, including transportation, child care, dependent care, workplace accommodations, and workplace health and safety protections, to the direct support workers served by the grant”

Committee on Energy and Commerce

Extension of 100 Percent Federal Medical Assistance Percentage for Urban Indian Health Organizations and Native Hawaiian Health Care Systems

• “The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended— (1) by striking ‘‘for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after the date of the enactment of the American Rescue Plan Act of 2021’’ and inserting ‘‘for the period of the 16 fiscal year quarters that begins on April 1, 2021’’; and (2) by striking ‘‘such 8 fiscal year quarters’’ and inserting ‘‘such period of 16 fiscal year quarters.”

Funding for Palliative Care and Hospice Education and Training

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $25,000,000, to remain available until expended, to support the establishment or operation of programs that— (1) support training of health professionals in palliative and hospice care (including through traineeships or fellowships); and (2) foster patient and family engagement, integration of palliative and hospice care with primary care and other appropriate specialties, and collaboration with community partners to address gaps in health care for individuals in need of palliative or hospice care.”
  • UIOs are mentioned as eligible applicants for funding

Funding for Local Entities Addressing Social Determinants of Maternal Health

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $100,000,000, to remain available until expended, for carrying out a program to award grants or contracts to community-based organizations, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, or other nonprofit organizations working with a community-based organization, or consortia of any such entities, operating in areas with high rates of adverse maternal health outcomes or with significant racial or ethnic disparities in maternal health outcomes.”

Funding to Grow and Diversify the Doula Workforce

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $50,000,000, to remain available until expended, for carrying out a program to award grants or contracts to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, or other appropriate public or private nonprofit entities (or consortia of any such entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the doula workforce, including through improving the capacity and supply of health care providers.”

Funding to Grow and Diversify the Maternal Mental Health and Substance Use Disorder Treatment Workforce

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $75,000,000, to remain available until expended, for carrying out a program to award grants or contracts to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, or other appropriate public or private nonprofit entities (or consortia of any such entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the maternal mental health and substance use disorder treatment workforce, including through improving the capacity and supply of health care providers.”

Funding for Maternal Mental Health Equity Grant Programs

• IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $100,000,000, to remain available until expended, for carrying out a program to award grants or contracts to community-based organizations, Indian Tribes and Tribal organizations, Urban Indian organizations, Native Hawaiian organizations, health care providers, accredited medical schools, accredited schools of nursing, teaching hospitals, accredited midwifery programs, physician assistant education programs, residency or fellowship programs, or other nonprofit organizations, schools, or programs determined appropriate by the Secretary, or consortia of any such entities, to address maternal mental health conditions and substance use disorders with respect to pregnant, lactating, and postpartum individuals in areas with high rates of adverse maternal health outcomes or with significant racial or ethnic disparities in maternal health outcomes.”

Funding for Expanding the Use of Technology-Enabled Collaborative Learning and Capacity Building Models for Pregnant and Postpartum Individuals

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $30,000,000, to remain available until expended, for carrying out a program to award grants or contracts to community-based organizations, Indian Tribes and Tribal organizations, Urban Indian organizations, health care providers, accredited medical schools, accredited schools of nursing, teaching hospitals, accredited midwifery programs, physician assistant education 15 programs, residency or fellowship programs, or other 16 schools or programs determined appropriate by the Secretary, or consortia of any such entities, that are operating in health professional shortage areas designated under section 332 of the Public Health Service Act (42 U.S.C. 254e) with high rates of adverse maternal health outcomes or significant racial and ethnic disparities in maternal health outcomes, to evaluate, develop, and expand the use of technology-enabled collaborative learning and capacity building models (as defined in section 330N of the Public Health Service Act (42 U.S.C. 254c–20)).”

Funding for Promoting Equity in Maternal Health Outcomes Through Digital Tools

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2022, out of any money in the Treasury not otherwise appropriated, $30,000,000, to remain available until expended, for carrying out a program to award grants or contracts to community-based organizations, Indian Tribes and Tribal organizations, Urban Indian organizations, health care providers, accredited medical schools, accredited schools of nursing, teaching hospitals, accredited midwifery programs, physician assistant education programs, residency or fellowship programs, or other schools or programs determined appropriate by the Secretary, or consortia of any such entities, that are operating in health professional shortage areas designated under section 332 of the Public Health Service Act (42 U.S.C. 254e) with high rates of adverse maternal health outcomes or significant racial and ethnic disparities in maternal health outcomes to reduce racial and ethnic disparities in maternal health outcomes by increasing access to digital tools related to maternal health care.”

Funding for Community Violence and Trauma Interventions

• “IN GENERAL.—In addition to amounts otherwise available, there is appropriated to the Secretary, for fiscal year 2022, out of any money in the Treasury not otherwise appropriated $2,500,000,000, to remain available until expended, for the purposes described in subsection (b):
  • (b) USE OF FUNDING.—The Secretary, acting through the Director of the Centers for Disease Control and Prevention, and in consultation with the Assistant Secretary for Mental Health and Substance Use, the Administrator of the Health Resources and Services Admin1istration, the Deputy Assistant Secretary for Minority Health, and the Assistant Secretary for the Administration for Children and Families, shall use amounts appropriated by subsection (a) to support public health-based interventions to reduce community violence and trauma, taking into consideration the needs of communities with high rates of, and prevalence of risk factors associated with, violence-related injuries and deaths, by—
    • (1) awarding competitive grants or contracts to local governmental entities, States, territories, Indian Tribes and Tribal organizations, Urban Indian organizations, hospitals and community health centers, nonprofit community-based organizations, culturally specific organizations, victim services providers, or other entities as determined by the Secretary (or consortia of such entities) to support evidence-informed, culturally competent, and developmentally appropriate strategies to reduce community violence, including outreach and conflict mediation, hospital-based violence intervention, violence interruption, and services for victims and individuals and communities at risk for experiencing violence, such as trauma-informed mental health care and counseling, social-emotional learning and school-based mental health services, workforce development services, and other services that prevent or mitigate the impact of trauma, build appropriate skills, or promote resilience”

The mark up is the Committee’s portion of the Build Back Better Act

 

Washington, D.C. -The Energy and Commerce Committee, led  by Chairman Frank Pallone, Jr. (NJ-06), met on September 13 -14 to mark up their portion of the Build Back America Act. Bills for committee markup included issues tackling the affordability of healthcare and prescription drug costs, closing the Medicaid gap, expansion of services for seniors and those with disabilities and critical in investments in public health and preparedness following the breakdowns during the COVID-19 pandemic.

 

“The Build Back Better Act is transformational legislation that invests in the American people, responds to the challenges of our time, and builds back a better future for generations to come” said Chairman Frank Pallone, Jr. (NJ-06).

Committee Mark Up Highlights

 

• Subtitle J: Budget Reconciliation Legislative Recommendations Relating to Public Health 

Key Components

• $50,000,000 for funding to grow and diversify the doula: Workforce grants to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, urban Indian organizations, or other appropriate public or private nonprofit 7 entities (or consortia of entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the doula workforce
• $75,000,000 for grants to health professions schools, academic health centers, State or local governments, territories, Indian Tribes and Tribal organizations, urban Indian organizations, or other appropriate public or private nonprofit 14 entities (or consortia of entities, including entities promoting multidisciplinary approaches), to establish or expand programs to grow and diversify the maternal mental health and substance use disorder treatment workforce.
• $2,500,000,000 for community violence and trauma interventions. Competitive grants or contracts to local governmental entities, States, territories, Indian Tribes and Tribal organizations, urban Indian organizations, hospitals and community health centers, nonprofit community-based organizations, culturally specific organizations, victim services providers, or other entities as determined by the Secretary (or consortia of such
• entities) to support evidence-based, culturally competent, and developmentally appropriate strategies to reduce community violence, including outreach and conflict mediation, 19 hospital-based violence intervention, violence interruption, and services for victims and individuals and 21 communities at risk for experiencing violence, such 22 as trauma-informed mental health care and counseling, school-based mental health services.
• Includes $15 billion in new investments for pandemic preparedness and $3 billion to establish the Advanced Research Projects Agency for Health (ARPA-H).

Bill Mark Up Summary

 

• Subtitle E: Budget Reconciliation Legislative Recommendations Relating to Drug Pricing

“Comprehensive Plan for Addressing High Drug Prices: A Report in Response to the    Executive Order on Competition in the American Economy” -released by Health and Human Services Secretary  Xavier Becerra

Key  Components

• Makes drug prices more affordable and equitable for all consumers and throughout the health care system-support drug price negotiation with manufacturers and stop unreasonable price increases to ensure access to drugs that can improve health for all Americans
• Improves and promotes competition throughout the prescription drug industry – Support market changes that strengthen supply chains, promote biosimilars and generics, and increase transparency
• Fosters scientific innovation to promote better health care and improve health – Support public and private research and make sure that market incentives promote discovery of valuable and accessible new treatments, not market gaming

 

• Subtitle F: Budget Reconciliation Legislative Recommendations Relating to Affordable Health Care Coverage

Key Component:

• Ensures affordability of coverage for certain low-income populations by expanding the Affordable Care Act (ACA) premium tax credits to below 100% of the federal poverty level in 2022 through 2024 and reduce cost sharing for these individuals as well.

 

• Subtitle G: Budget Reconciliation Legislative Recommendations Relating to Medicaid

Key Component:

• Establishes a federal Medicaid program by 2025 in states that have not yet expanded their programs under the ACA.

 

• Subtitle H: Budget Reconciliation Legislative Recommendations Relating to CHIP

Key Component:

• Permanently extends the Children’s Health Insurance Program (CHIP); require continuous twelve-month coverage for children in Medicaid and CHIP; and make permanent one full year of postpartum Medicaid coverage for pregnant women.

 

• Subtitle I:Budget Reconciliation Legislative Recommendations Relating to Medicare

Key Components:

• Energy and Commerce text includes provisions analogous to the House Ways and Means Committee with addition of dental, hearing and vision benefits to Medicare.
• $190 billion proposal for investment in home and community-based services (HCBS).

Next Steps

Markups are scheduled to be completed next week. Members will then begin to package them into one bill for consideration in the House. Timing of that vote is uncertain, but the target is to complete this by the September 27 agreed upon date to consider it in tandem with the bipartisan infrastructure package.[1]

[1] Updates on Budget Reconciliation; HHS Drug Pricing Proposal (natlawreview.com)

Policy Update: NCUIH Secures Huge Wins for Urban Indians in Final Enacted COVID-19 and Omnibus Bills

The bills include a $5 million increase for urban Indian health, FTCA, VA-IHS reimbursements, SDPI extension and COVID-19 renovation funds for UIOs.

On December 27, the “Consolidated Appropriations Act, 2021” (H.R. 133), consisting of a COVID-19 pandemic relief bill and an omnibus spending bill for Fiscal Year (FY) 2021 was signed into law. Due to the tireless advocacy by NCUIH and UIOs, there are many monumental wins for urban Indian health. Throughout the year, NCUIH assisted with facilitating over 25 calls for UIOs with federal agencies and held over 100 meetings with Congress. NCUIH representatives testified in over 13 Congressional hearings to advocate for the many long-standing priorities that were included in the final package.

Your advocacy and participation in the federal government process was critical to the adoption of the most robust urban Indian health provisions in over 50 years.

Short Overview

In summary, the package included the following National Council for Urban Indian Health (NCUIH) priorities for Urban Indian Organizations (UIOs):

• $62.7 million for Urban Indian Health in FY21, a $5 million increase from FY20
• $1 million to conduct an infrastructure study for facilities run by UIOs
  • NCUIH is working with IHS Office of Urban Indian Health Programs now to review the next steps on the study.
• Reimbursement from the United States Department of Veterans Affairs (VA) to UIOs for urban Native veterans’ health
  • In 2010, the VA issued a MOU stating that all Indian Health Care Providers were eligible for reimbursement for services to Native veterans. NCUIH has fought tooth and nail with the Administration on their narrow interpretation of this MOU to be exclusive of UIOs. This legislation now expressly affirms that the VA must reimburse UIOs for services provided to veterans.
• FTCA Coverage for UIOs
  • For over 20 years, FTCA coverage for UIOs has been a top priority and finally, for the first time ever, UIOs will no longer have to pay for costly insurance coverage for health providers. This will save a single UIO up to $250,000 annually!

The package provides the following for IHS, Tribal organizations and UIOs:

• $210 million from CDC to IHS to I/T/U for COVID-19 vaccine distribution and administration
  • NCUIH requested a minimum of 5% set-aside for I/T/U and $210 million is equal to 4.67%.
  • Funds “may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability” related to COVID-19, which was confirmed by IHS on January 5, 2021. IHS explained that they are exploring alternative mechanisms including IHCIA Contracts for UIOs to use the funds related to facility improvements from the $210 million. NCUIH will advocate that UIOs should be eligible for this funding through IHCIA contracts. We will continue to monitor and follow up with IHS as more information becomes available.
• $790 million to IHS for I/T/U for necessary expenses for testing, contact tracing, surveillance, containment, and mitigation
  • These funds must be made available within 21 days: January 17, 2021.
  • On a UIO leaders call with IHS on January 5, 2021, IHS stated that UIOs are eligible to use these funds for the “rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability.”
• Extends SDPI through FY2023 at current levels ($150 million annually)
• $125 million set aside for I/T/U in funding for Substance Abuse and Mental Health Services Administration (SAMHSA)
• $15 million to make payments under the National Health Service Corps loan repayment program
• Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations
• Establish “Sec. 330n. Expanding Capacity for Health Outcomes” in Title 3 of the Public Health Service Act to include Indian Tribes, Tribal organizations, and urban Indian organizations

Next Steps

• NCUIH submitted Urban Confer comments regarding the COVID-19 relief supplemental to IHS on Friday, January 8, 2021 and will continue to work with IHS on the UIO infrastructure study.

Analysis

Urban Indian Health

• $62.7 million for Urban Indian Health in FY21, a $5 million increase from FY20
• $1 million to conduct an infrastructure study for facilities run by UIOs
• FTCA Coverage for UIOs (H.R. 6535/S. 3650)
  • Note: This bill was also enacted on January 5, 2021, in addition to being included in the package.
• Urban Native Veterans Health Access Act
  • Reimbursement from VA to UIOs for urban Native veterans’ health

Indian Health Service

• $6.236 billion in agency funding for IHS in FY21
  • ~$189 million over the FY2020 enacted level

Facilities

• $58 million to IHS for costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’
• $72.28 million for the Indian Health Facilities account

105(l) Leases

• $101 million indefinite appropriation
  • Does not include restrictive language based on square footage

Health and Human Services (HHS)

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

• National Health Service Corps
  • $15 million to Indian Health Service facilities, Tribally Operated Health Programs, and Urban Indian Health Programs to make payments under the National Health Service Corps loan repayment program
• Good Health and Wellness in Indian Country (GHWIC)
  • $22 million in funding for the Good Health and Wellness in Indian Country (GHWIC) program
• Minority HIV/AIDS Prevention and Treatment Program
  • $1.5 million Tribal set-aside under the Minority HIV/AIDS Prevention and Treatment Program

HRSA

Native Hawaiian Health Care

• $20.5 million (minimum) for the Native Hawaiian Health Care Program

COVID-19 Response

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

• $8.75 billion for CDC-wide activities and program support to prevent, prepare for, and respond to coronavirus, domestically or internationally

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

• $210 million shall be allocated to IHS to be distributed through IHS directly operated programs, Tribes and Tribal organizations, and UIOs to plan, prepare for, promote, distribute, administer, monitor, and track coronavirus vaccines to ensure broad-based distribution access and vaccine coverage
  • Funds “may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability” related to COVID-19, which was confirmed by IHS on January 5, 2021.

Tribal Use of Prescription Drug Monitoring Programs (PDMP)

• “CDC is directed to work with the Indian Health Service to ensure Federally-operated and tribally operated healthcare facilities benefit from the CDC’s PDMP efforts”

VA-TAC

• The final bill also outlines concerns with the Tribal Advisory Committee (TAC), noting in the explanatory statement that “The agreement directs the Director, in consultation with the TAC, to develop written guidelines for each CDC center, institute, and office on best practices around delivery of Tribal technical assistance and consideration of unique Tribal public health needs. The goal of such guidelines should be the integration of Tribal communities and population needs into CDC programs. The Director shall report on the status of development of these written guidelines in the fiscal year 2022 Congressional Justification”.
  • Note: The TAC includes UIOs

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

• $4.25 billion to provide increased mental health and substance abuse services and support

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

• $125 million (minimum) set aside for I/T/U under SAMHSA for mental/behavioral health

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

• $11,000,000 for grants to Indian Tribes, Tribal Organizations, or consortia. The agreement directs SAMHSA to ensure grants allow the use of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.
  • Note: UIOs are not specified, though a 2018 NOFO did list UIOs as eligible

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

• $790 million to I/T/U for necessary expenses for testing, contact tracing, surveillance, containment, and mitigation
  • IHS stated that UIOs are eligible to use these funds for the “rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability.”
  • Funds available until September 30, 2022
  • Includes language authorizing transfer of funds to IHS
  • Requires funds to be dispersed within 21 days
  • Requires Tribes, states and other funding recipients to update their plans within 60 days of receiving funds

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

• Extends SDPI through FY2023 at current levels ($150 million annually)
  • Includes language reaffirming the existing protections against balance billing of AI/ANs under Indian Health Care Improvement Act and requirement that inpatient hospitals accept the Medicare-Like Rate as “payment in full” when contracting with IHS/Tribes under Purchased/Referred Care

GUIDE ON EVIDENCE-BASED STRATEGIES FOR OBESITY PREVENTION PROGRAMS

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

• Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations

BROADBAND CONNECTIVITY GRANTS

• $1 billion for the Department of Commerce’s Assistant Secretary of Communications and Information to expand broadband, remote learning, telework, and telehealth access and adoption by grants to the following qualifying entities:
  • Tribal governments; Tribal Colleges or Universities; Tribal Organizations; Alaska Native Corporations, or the Department of Hawaiian Homelands (Does Not Include UIOs)

PUBLIC HEALTH PROVISIONS

Public Health Service Act

• Establish “Sec. 330n. Expanding Capacity for Health Outcomes” in Title 3 of the Public Health Service Act to develop a program for eligible entities to expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers, and increase access to health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans.
  • Eligible entities include Indian Tribes, Tribal organizations, and urban Indian organizations
  • Authorizes $10,000,000 for each of fiscal years 2022 through 2026 to carry out this section

The full legislative text of the entire year-end package can be found here

The Explanatory Statement (Report) for FY2021 Interior (Division G) can be found here

The Explanatory Statement (Report) for FY2021 LHHS (Division H) can be found here

 

Topic	Section	Funding	Language
Urban Indian Health	Urban Indian Health	$62,684,000	: See chart for language
	UIO Infrastructure Study	$1,000,000	: “$1,000,000 is provided to conduct an infrastructure study for facilities run by urban Indian organizations (UIOs)”
	FTCA	–	: See chart for language
	IHS-VA MOU – reimbursement from VA to UIOs who provide services to AI/AN veterans	–	: “Section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645) is amended— (1) in subsection (a)(1), by inserting ‘urban Indian organizations,’ before ‘and tribal organizations’; and (2) in subsection (c)— (A) by inserting ‘urban Indian organization,’ before ‘or tribal organization’; and (B) by inserting ‘an urban Indian organization,’ before ‘or a tribal organization’.”
Indian Health Service (IHS)	IHS funding	$6,236,279,000	: “The bill provides a total of $6,236,279,000 for the Indian Health Service (IHS)”
	Costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’	$58,000,000	: “That of the funds provided, $58,000,000 shall be for costs related to or resulting from accreditation emergencies, including supplementing activities funded under the heading ‘‘Indian Health Facilities,’’ of which up to $4,000,000 may be used to supplement amounts otherwise available for Purchased/Referred Care
	Indian Health Care Improvement Fund	$72,280,000	: “Provided further, That of the funds provided, $72,280,000 is for the Indian Health Care Improvement Fund and may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account”
	105(l) leases indefinite appropriation	$101,000,000	: “The bill includes language establishing an indefinite appropriation for payment of Tribal leases under section 105(1) of the Indian Self-Determination and Education Assistance Act, which are estimated to be $101,000,000 in fiscal year 2021.”
Health and Human Services	NHSC Loan Repayment Program	$15,000,000	: “That, within the amount made available in the previous proviso, $15,000,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs”
	Good Health and Wellness in Indian Country	$22,000,000
	Minority HIV/AIDS Prevention and Treatment Program	$1,500,000	: “The agreement includes $1,500,000 as a Tribal set-aside within the Minority HIV/ AIDS Prevention and Treatment program.”
	HRSA— Hawaiian Health Care Program	$20,500,000	“Native Hawaiian Health Care. -The agreement includes no less than $20,500,000 for the Native Hawaiian Health Care Program.”
COVID-19 Response	CDC COVID-19 Response	$8,750,000,000	: “For an additional amount for ‘CDC–Wide Activities and Program Support’, $8,750,000,000, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally”
	CDC to IHS to I/T/U for COVID	$210,000,000	: “That of the amount in the preceding proviso, $210,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pgs. 1822-1823: “That amounts appropriated under this heading in this Act may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability at the State and local level.”
	SAMHSA— Heath Surveillance and Program Support	$4,250,000,000	: “For an additional amount for ‘Heath Surveillance and Program Support’, $4,250,000,000, to prevent, prepare for, and respond to coronavirus, domestically or internationally”
	Set aside for I/T/U in funding for SAMHSA	$125,000,000	: “That from within the amount appropriated under this heading in this Act in the previous provisos, a total of not less than $125,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes”
	Medication-Assisted Treatment for Prescription Drug and Opioid Addiction	$11,000,000	“Medication-Assisted Treatment for Prescription Drug and Opioid Addiction.- Within the amount, the agreement includes $11,000,000 for grants to Indian Tribes, Tribal Organizations, or consortia. The agreement directs SAMHSA to ensure grants allow the use of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.”
Public Health and Social Services Emergency Fund	IHS to I/T/U for testing, contact tracing, surveillance, containment, and mitigation	$790,000,000	: “That of the amount appropriated under this paragraph in this Act, $790,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pg. 1840: “That funds an entity receives from amounts described in the first proviso in this paragraph may also be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability at the State and local level”
Special Diabetes Program for Indians (SDPI)	SDPI	Extends SDPI through FY2023 at current levels	: “(a) TYPE I.—Section 330B(b)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’. (b) INDIANS. —Section 330C(c)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’.”
Guide on Evidence-Based Strategies for Public Health Department Obesity Prevention Programs	Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations	Creation of a guide of evidence-based strategies	: “The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’), acting through the Director of the Centers for Disease Control and Prevention, not later than 2 years after the date of enactment of this Act, may— develop a guide on evidence-based strategies for State, territorial, and local health departments to use to build and maintain effective obesity prevention and reduction programs, and, in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations”
Broadband Connectivity Grants	Tribal Broadband	$1,000,000,000	: “There is appropriated to the Assistant Secretary, out of amounts in the Treasury not otherwise appropriated, for the fiscal year ending September 30, 2021, to remain available until expended— (1) $1,000,000,000 for grants under subsection 15 (c)” […] “(c) TRIBAL BROADBAND CONNECTIVITY PROGRAM.— (1) TRIBAL BROADBAND CONNECTIVITY GRANTS.—The Assistant Secretary shall use the funds made available under subsection (b)(1) to implement a program to make grants to eligible entities to expand access to and adoption of— (A) broadband service on Tribal land; (B) remote learning, telework, or telehealth resources during the COVID–19 pandemic.”
Public Health Provisions	Title 3 of the Public Health Service Act is amended by inserting Sec. 330N	$10,000,000	: “Title III of the Public Health Service Act is amended by inserting after section 330M (42 U.S.C. 254c–19) the following: SEC. 330N. EXPANDING CAPACITY FOR HEALTH OUTCOMES. (a) DEFINITIONS. —In this section: (1) ELIGIBLE ENTITY. —The term ‘eligible entity’ means an entity that provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations […] (b) PROGRAM ESTABLISHED.—The Secretary shall, as appropriate, award grants to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions, infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans. […] (k) AUTHORIZATION OF APPROPRIATIONS. —There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2022 through 2026.’’