Legislative
Located on Capitol Hill, the National Indian Health Board is a dedicated advocate in Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. We maintain a presence in the halls of Congress, working with representatives from across the country to achieve quality, lasting health care for tribal members.
In our efforts to secure quality health care we track legislation and regulations, lead discussions on health care reform, provide recommendations and analysis of the Indian Health Service budget and assist tribes in securing federal funding.
The NIHB Guide to Congress for 2009 [134 KB]
What's New?
HHS Releases 2012 Tribal Budget and Regional Tribal Consultation Dates
On January 11th, the Department of Health and Human Services released a “Dear Tribal Leader Letter” inviting Tribes to the 14th Annual U.S. Department of Health and Human Services (HHS) Tribal Budget Consultation (ATBC) which will take place from March 7- 9, 2012, in the Great Hall of the Hubert H. Humphrey Building at 200 Independence Avenue, SW, Washington, DC as well as to its 2012 Annual Regional Tribal Consultations held across the country.
In an effort to continuously improve the consultation process and in order to facilitate better communication and consultation with Tribes, HHS will develop an improved agenda format for the 2012 ATBC based on feedback from Tribal and Federal participants. The Department understands the importance of hearing from Tribes on national crosscutting issues, regional perspectives, as well as Tribal-specific concerns and has developed a format that will allow for all.
Dear Tribal Leader Letter and Other Information (PDF)
NIHB Submits Comments on FACA to IHS
The National Indian Health Board has submitted comments to the Indian Health Service (IHS) in response to a November 9th “Dear Tribal Leader Letter” regarding the Federal Advisory Committee Act (FACA) and IHS Advisory Groups.
Click here to read NIHB’s comments.
Click here to read the “Dear Tribal Leader Letter”
OPM Releases Dear Tribal Leader Letter on FEHB
In a “Dear Tribal Leader Letter” dated December 21st, the Office of Personnel Management (OPM) provided an update on Tribal access to the Federal Employees Health Benefits (FEHB) Program. Under the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), Tribes and Tribal organizations operating programs under the Indian Self-Determination and Education Assistance Act are eligible to purchase health insurance for their employees under the FEHB Program.
Tribal employers may begin to enroll employees starting on March 22, 2012 with an effective coverage date of May 1, 2012. All Tribes, Tribal organizations, and Urban Indian organizations wishing to participate in the FEHB program must notify OPM by February 1, 2012 via email at: tribalprograms@opm.gov or via phone at: 202-606-2530.
Dear Tribal Leader Letter OPM FEHB Dec 2011 (PDF)
FEHB FastFacts for Tribal Employees (PDF)
FEHB Guide for Tribal Employees (PDF)
Timeline for Purchasing FEHB (PDF)
December 20, 2011 - This weekend, Congress approved a $1 trillion omnibus appropriations package containing a 6% increase in funding to the Indian Health Service (IHS).
Please click here for details.
Update on Fiscal Year (FY) 2012 Appropriations
Although Fiscal Year (FY) 2012 officially began on October 1st, Congress has yet to pass nine of the twelve appropriations bills for this year. This includes the Interior, Environment, and Related Agencies Appropriations bill, which contains funding for the Indian Health Service (IHS)...
On December 2, 2011, the White House will host its third annual Tribal Nations Conference. NIHB has created fact sheets on current issues in Indian Health for the use of Tribal Leaders and others at this event.
The Indian Health Services Budget and Sequestration (PDF)
Affordable Care Act and Indian Health Care improvement Act Implementation (PDF)
The Special Diabetes Program for Indians (PDF)
Suicide and Substance Abuse Prevention (PDF)
Supercommittee Fails
On November 21st, the Joint Select Committee on Deficit Reduction aka Supercommittee officially admitted defeat in the quest to find $1.2 trillion in federal deficit reduction over the next 10 years.
Click here for more information on what this means for federal spending and the Indian Health Service.
IHS Initiates Consultation on FACA
A recent “Dear Tribal Leader Letter” from Indian Health Service (IHS) Director, Dr. Yvette Roubideaux, has initiated a formal consultation with Tribes on the Federal Advisory Committee Act (FACA). In particular, input and advice is needed to help ensure that all IHS advisory groups remain compliant with FACA. The comment period will be open for 60 days, beginning on November 9th. Comments may be emailed to consultation@ihs.gov
To view the “Dear Tribal Leader Letter,” click here.
CMS Releases Final Tribal Consultation Policy
On November 17th, the Centers for Medicare & Medicaid Services (CMS) released the final version of its Tribal Consultation Policy. The final policy is the result of comments to CMS by its Tribal Technical Advisory group and other Tribal leaders. To discuss the policy further, CMS has scheduled an All Tribes conference call:
Date: December 9, 2011
Time: 1:00-3:00 pm EST
Call-in: 1-888-637-7740
Passcode: 538239
Dear Tribal Leader Letter (PDF)
Supreme Court to hear Health Reform Cases
On November 14th, the Supreme Court announced announced that it will hear arguments regarding the constitutionality of various provisions of the Patient Protection and Affordable Care Act (ACA), including the controversial individual mandate, this March.
Click here for an NIHB update.
NIHB Submits Written Comments in Support of Prevention and Public Health Fund
On October 25th, the National Indian Health Board submitted written comments for the record of a Senate Health, Education, Labor, and Pensions hearing entitled, “The State of Chronic Disease Prevention.” In the comments, NIHB discusses the health disparities faced by Indian Country, the wisdom and cost-effectiveness of investing in prevention, and the great potential that the Prevention and Public Health Fund poses for reducing disparities for Native people. Click here to read the comments.
At the October 12th hearing, much of the testimony focused on the question of whether the Joint Select Committee on Deficit Reduction should spare the Prevention and Public Health Fund from cuts to funding in its final report. The Obama Administration has recommended that it be reduced by $3.5 billion. As Chairman Tom Harkin (D-IA) said in his opening statement, “…The Prevention and Public Health Fund is so fundamental to addressing the gap that exists between what is and what can be done to address chronic disease. The Prevention Fund supports evidence-based health promotion programs; however, this fund is only a small down payment in comparison to the size of the problem.”
Ultimately, the Committee asked for hard data from HHS and the disease prevention organizations to use in a letter to the Joint Select Committee on Deficit Reduction on its priorities for funding to show that the Prevention and Public Health Fund is making cost-effective progress.
To view a video recording of the hearing in its entirety and to read witness testimony, please click here.
HHS Secretary's Tribal Advisory Committee: Current Vacancies, Nomination Request
In 2010, the Department of Health and Human Services (HHS) created a Secretary’s Tribal Advisory Committee (STAC) and has successfully been meeting for nearly a year. The STAC was one of the first Cabinet Level Tribal Advisory Committee to any Secretary in the Administration.
To date four meetings of the STAC have occurred. Secretary Kathleen Sebelius, Tribal STAC members, and senior leadership from HHS, together, have been working to focus collective efforts to improve how HHS works with Tribes, delivers services and reduces barriers to access of HHS programs and services. The STAC signals a new level of attention to Government-to-Government relationship between HHS and Indian Tribal Governments.
The Secretary has released a “Dear Tribal Leader Letter” to announce vacancies for the 2 primary delegates and for 2 alternate delegates. Listed below are the areas from which HHS seeking nominations.
Primary Delegate Nominations:-
Aberdeen Area
Click here for the “Dear Tribal Leader Letter” -
Albuquerque Area
Click here for the “Dear Tribal Leader Letter”
-
Bemidji Area
Click here for the “Dear Tribal Leader Letter” -
Portland Area
Click here for the “Dear Tribal Leader Letter”
Click here to read the STAC Charter
Click here for the current STAC Membership List
Nomination letters should be submitted no later than Thursday December 1, 2011. If you have further questions or concerns, please feel free to Stacey Ecoffey at: Stacey.ecoffey@hhs.gov
U.S. Government Accountability Office (GAO) Releases Report on IHS and Forensic Data Collection in Sexual Assault, Domestic Violence Cases
On October 26th, 2011, the United States Government Accountability Office (GAO) released a report entitled, "Indian Health Service: Continued Efforts Needed to Help Strengthen Response to Sexual Assaults and Domestic Violence."
Summary
In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of Indian Health Service (IHS) and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors.
Results
GAO's survey of IHS and tribally operated hospitals showed that the ability of these hospitals to collect and preserve medical forensic evidence in cases of sexual assault and domestic violence--that is, to offer medical forensic services--varies from hospital to hospital. GAO found that the utility of medical forensic evidence in any subsequent criminal prosecution depends on hospital staff's properly preserving an evidentiary chain of custody, which depends largely on coordinating with law enforcement agencies.
Recommendations
GAO is making five recommendations aimed at improving IHS's response to sexual assault and domestic violence, including to develop an implementation and monitoring plan for its new sexual assault policy and to modify sections of the policy regarding required training and subpoenas or requests to testify.
For more information and to read the report, please visit: http://www.gao.gov/products/GAO-12-29?source=ra
NIHB Board Member Sally Smith Testifies at Senate Committee on Indian Affairs Field Hearing
On October 22, 2011, NIHB Board Member and Alaska Area Representative, H. Sally Smith, testified at a Senate Committee on Indian Affairs Oversight Field Hearing at the Dena’ina Civic and Convention Center in Anchorage, Alaska. Entitled, “H.O.P.E. for the Future: Helping Our People Engage to Protect Our Youth,” the hearing centered on root causes of the youth suicide epidemic currently plaguing Indian Country and featured witnesses from the federal government, as well as Alaska Native witnesses. Ms. Smith’s testimony on behalf of NIHB focused on adverse childhood experiences (ACEs) as a major cause of suicide and called for greater funding for the Indian Health Service, mental health studies, and suicide prevention grant programs.
Click here to read the testimony
Senators Urge Improvements to IHS Contract Health Services
On September 27th, seven senators from the Senate Committee on Indian Affairs sent a letter to HHS Secretary Sebelius and IHS Director, Dr. Yvette Roubideaux, urging the Secretary and other top administration officials to act quickly to improve health care delivery to American Indians and Alaska Natives. The Senators pointed to a U.S. Government Accountability Office (GAO) report issued September 23rd that highlights billing and other problems in the IHS system that make it difficult for American Indians and Alaska Natives to receive care from health providers and makes it difficult for health care providers offering the services to get reimbursed.
The senators requested that IHS submit a comprehensive corrective action plan to address each of the problems and recommendations made in the GAO report, including a timeline for (1) corrective actions, (2) a date when each action will be commenced, (3) a date when each action is expected to be completed, and (4) identifiable goals that will lead to completion of each corrective action.
To view the letter, please visit: http://bingaman.senate.gov/policy/gao_ihs.pdf
Indian-Specific Health Care Provisions Must Stay
By Geoffrey Strommer
April 28, 2011
A year after passage of national health care reform with the Patient Protection and Affordable Care Act (ACA or “Act”), the entire Act, including the many Indian-specific provisions within, is in danger of being taken away. This is why 349 tribes, either directly or through a tribal organization, signed on to a friend of the court brief filed this month in federal court which argues that these provisions are separate from other provisions in the Act and should stand on their own even if the controversial individual mandate provision is held to be unconstitutional. Many tribes have already implemented these new authorities to address critically important health care needs of Indian people.
Judge’s Improper Departure from Supreme Court Precedent
Federal district courts in Virginia and Florida held the “individual mandate” to be unconstitutional, but Judge Vinson in the Florida case took a huge step beyond that. In a January 31, 2011, decision, he not only ruled that the “individual mandate” was unconstitutional, he went on to declare the entire ACA unconstitutional. Judge Vinson reasoned that the Act was finely crafted by Congress and that if the individual mandate must be removed because it is unconstitutional the entire statute cannot function as originally designed, so the entire Act must be struck down. In contrast, the normal rule, based on decades of established Supreme Court precedent, is that when a court finds a portion of a statue unconstitutional, they have an obligation to preserve as a much of a statute as can be preserved, by separating and saving those portions that are practically and legally independent.
The tribal amicus brief argues that the Indian-specific provisions, including the permanent reauthorization of the Indian Health Care Improvement Act (IHCIA), have a separate history from the individual mandate provision, that they involve legally independent rights and obligations related solely to Indian tribes and Indian people and should remain valid if the individual mandate is severed from the ACA. In fact, the IHCIA component was added at the last minute to the bill that became the ACA because it was a moving legislative vehicle, not because it was related to the “individual mandate” component.
A Major Setback
If the Indian-specific provisions sink with other sections of the health care reform ship, Indian Country would suffer a major setback. The IHCIA is critically important legislation that helps address chronic health disparities in Indian country. Tribes worked tirelessly for ten years to enact these provisions. If the entire Act is held to be unconstitutional, tribes will need to start the lobbying process again, losing valuable time and money. More importantly this would delay the implementation of the vital programs and services that these provisions authorize in Indian country. Such reforms include enhanced authorities to recruit/retain health care professionals to overcome high vacancy rates, comprehensive behavioral health initiatives, and expressed authority to operate modern methods of health care delivery such as long-term care and home- and community-based care, among others.
Tribes Already Taking Advantage of the New Reforms
Many tribes and tribal organizations are already taking advantage of these Indian specific provisions and have included them in agreements with the Indian Health Service. For example, the Maniilaq Association, a large tribal organization in rural Alaska, has incorporated into its agreement several provisions that expand its authority to provide both home and facility based long-term care programs. This expanded authority is critical for Maniilaq as it readies to open a new long-term care center that will provide desperately needed services to the elder population in the region. The Seminole Tribe of Florida has also included a number of these new provisions in its agreements with IHS. With these new provisions the Tribe has established a comprehensive program to protect children and preserve families that involves coordinating medical and mental health services with support from education, social services, counseling, and other tribal and non-tribal services. The Houlton Band of Maliseet Indians of Maine have been able to hire a much needed physician because of a change of the law that allows tribes to hire physicians licensed anywhere in the United States just like the Indian Health Service.
The Strong Voice of Indian Country
It is expected that the Supreme Court will ultimately decide if the individual mandate is constitutional. It is important for tribes to ensure that the courts that are wrestling with these questions understand clearly the independent nature of the Indian-specific health care provisions and urge that they be upheld regardless of what happens to the individual mandate provisions. The recently filed tribal amicus brief reflects the unqualified unity of tribes on these questions. We hope that the Courts are listening.
Geoff Strommer is the managing partner of the Portland, Oregon, office of Hobbs, Straus, Dean & Walker. Geoff headed up the effort to file an amicus brief on behalf of the National Indian Health Board and many tribes in State of Florida, et al., v. HHS.
For this article – click here
President Obama’s FY 2012 Budget Request For the
Indian Health Service (IHS)
February 16, 2011
The President’s Indian Health Service (IHS) budget request for Fiscal Year (FY) 2012 totals $4.624 billion. This figure represents a 14.1% increase over the FY 2010 appropriated level and 4.9% increase over the President’s budget request for FY 2011.
Click here to download summary.
Proposed Continuing Resolution for FY 2011 continues Current IHS Funding Levels with adjustments
February 16, 2011
With the current Continuing Resolution (CR) expiring on March 4, 2011, Congress is racing to enact a budget proposal to fund the federal government through the remaining seven months of FY 2011. The House Appropriations Committee has proposed H.R. 1, a bill that would cut $100 billion from the President’s original FY 2011 budget request ($60 billion from current funding levels) in order to achieve deficit reduction. While a number of government agencies and programs would suffer major reductions - and even elimination - under this proposal, the Indian Health Service (IHS) remains intact by FY 2010 standards.
Click here to download summary.
Legislative Inquiries:
NIHB Legislative Director
Jennifer Cooper, JD, MPA
Washington, DC 20003
Phone: 202-507-4070
Email: JCooper@nihb.org