In 2010, the Department of Health and Human Services (HHS) created a Secretary’s Tribal Advisory Committee (STAC), which has successfully been meeting for a little over a year. The STAC was one of the first Cabinet Level Tribal Advisory Committees to any Secretary in the Administration and HHS is grateful to the Tribal Leaders who are current members for their dedication and partnership. To date five meetings of the STAC have occurred. Secretary 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. HHS currently has three vacancies on the STAC and is requesting nominations for these vacancies.Primary Delegate Nominations:
HHS encourages Tribal leaders to submit nomination letters no later than Friday April 13, 2012. If you have further questions or concerns, please feel free to contact Stacey Ecoffey at Stacey.Ecoffey@hhs.gov. You may either fax your nomination to 202-205-2727 or email it to STAC@hhs.gov.
The Health Resources and Services Administration (HRSA) has distributed a pre-decisional, draft Tribal Consultation Policy for comment. HRSA will be accepting comments through March 16, 2012 at AIANhealth@hrsa.gov.
Click here to read the “Dear Tribal Leader Letter” (PDF)
Click here to read the draft Tribal Consultation Policy (.DOC)
On March 6th, NIHB At-Large Member and Navajo Area Representative, Vice President Rex Lee Jim of the Navajo Nation, testified before the House Committee on Natural Resources Subcommittee on Indian and Alaska Native Affairs during its oversight hearing on the, “Fiscal Year 2013 Budget Request of the Indian Health Service (IHS) and of the Office of the Special Trustee for American Indians." NIHB’s testimony focused on the differences between the President’s FY 2013 budget request for IHS and the recommendations developed by the IHS Budget Formulation Workgroup. Other witnesses included IHS Director, Dr. Yvette Roubideaux, and Michael F. Singer, Acting Principal Deputy Special Trustee in the U.S. Department of the Interior on a federal panel. In addition to President Jim, the Tribal panel featured Jefferson Keel, President of the National Congress of American Indians (NCAI); Chairman Michael Finley of the Confederated Tribes of the Colville Reservation; Carolyn Crowder, Health Director for Aleutian/Pribilof Islands Association Inc.; Jerry Isaac, President and CEO of Tanana Chiefs Conference; and Robert McGhee, Councilman of the Poarch Band of Creek Indians.
To read Vice President Jim’s testimony, click here.
To view a video of the hearing and other panelist testimony, click here
Congress established the Special Diabetes Program for Indians (SDPI) in 1997 for the prevention and treatment of diabetes in American Indian and Alaska Natives (AI/ANs). AI/ANs have the highest rates of type 2 diabetes in the United States, 2.8 times higher than the U.S. general population. The SDPI is currently funded at $150 million per year through Fiscal Year (FY) 2013. The program will expire in 2013 unless it is reauthorized. To ensure uninterrupted funding for SDPI, it is crucial that Congress pass a reauthorization this year. SDPI proves that federal investment in community-driven, culturally-appropriate prevention programs has immensely positive results:
Call your Senators and Representative, and ask them to add their name to an SDPI support letter because:
House of Representatives:
To determine your Representative and receive specific contact information for them, click here. The House SDPI support letter is being distributed by Reps. Diana DeGette (D-CO) and Ed Whitfield (R-KY)
To determine your Senators and receive specific contact information for them, click here. The Senate SDPI support letter is being distributed by Sens. Susan Collins (R-ME) and Jeanne Shaheen (D-NH).
To be connected to a Representative or Senator via phone, call the Congressional switchboard at: 202-224-3121Links
The Department of Veterans Affairs (VA) and the Department of Health and Human Services (HHS)/Indian Health Service (IHS) are initiating consultation to facilitate VA reimbursement for services provided by IHS and Tribal health facilities to Eligible American Indian and Alaska Native Veterans. Comments are due in 30 days from the date of the letter and an in person session will be held at the IHS Tribal Consultation Summit scheduled for March 13-14, 2012.
Click here to read the “Dear Tribal Leader Letter”
Click here to read a draft agreement between the IHS and the VA.
Click here for Save the Date Flyer (PDF)
Please call 952-445-9000 or 1-800-262-779 to reserve your room today! To receive group rate of $77 plus taxes, please reserve by April 4, 2012 and ask for the NIHOE rate.
Registration is free, but required by April 13, 2012.
Click Here to Register
Click Here for the Save The Date Flyer (PDF)
Click Here for the Agenda (PDF)
Hosted by the National Indian Health Board and the National Congress of American Indians
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.
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”
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: firstname.lastname@example.org or via phone at: 202-606-2530.
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 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.
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 email@example.com
To view the “Dear Tribal Leader Letter,” click here.
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
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.
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.
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:
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.firstname.lastname@example.org
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."
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.
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.
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
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.
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
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
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.
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.
Congressman Rahall is introducing an Indian health amendments package to H.R. 3200 to ensure that the necessary protections are in place for the Indian health care system.
Click here for a copy of the legislative alert about what you can do to help!
Health Care Reform Support Letter template
The California Rural Health Board and the Northwest Portland Health Board support Rahall’s amendments. Please click here to see their letter of support.
Various national organizations and councils on healthcare or community coalitions have submitted a written letter of support for the Rahall amendments. For a copy of the letter please click here.To understand more about the Rahall proposed amendments changes that protect the Indian health care system there are two documents provided. Click on the title below to view the document:
Congress is in the final stage of developing a final health care reform bill. Here are key documents for your use and review.
Indian Country Recommendations Regarding Indian Provisions in Health Care Reform Bills, dated December 23, 2009.
This is a cover memo describing the recommendation charts below.
Recommendations regarding the Indian Health Care Improvement Act (IHCIA) Provisions in the House and Senate Bills
Recommendations regarding Indian Specific Provisions, other than the IHCIA, in the House and Senate Bills Comprehensive chart
To download the manager’s amendment, click here.
Version of IHCIA (S. 1790) reported out by the Senate Committee on Indian Affairs with the House version as adopted in House health care reform bill (H.R. 3962), as of 11/28/09, click here
For a condensed table of contents of the comparison place click here
To view the congressional budget office report, please click here.
To view a list of Indian Specific Provisions in the Senate Health Care Reform Bill, please click here.
For information and a copy of the Chairman’s Mark – America’s Healthy Future Act of 2009, please visit the Senate Finance site:
Summary of Indian specific provisions in Chairman’s Mark. click here (PDF)
Kimberly Teehee, Senior Policy Advisor for Native American Affairs at the White House Domestic Policy Council has posted a video regarding the myths and rumors surrounding health insurance reform and the Indian Health Service (IHS).
To view this video blog click here
The Indian Health Care Improvement Act (IHCIA), the foundation for the health care delivery system of American Indians and Alaska Natives, has been waiting for reauthorization for 10 years and Indian Country is one step closer to reauthorization of the IHCIA.
The House successfully passed H.R. 3962 – the Affordable Health Care for America Act by a vote of 220-215. To read the NIHB press release click here.
Please reach out to your congressional members and thank them for their support.
The Indian Health Care Improvement Act (IHCIA) has not been included in the Senate Health Care Reform Bill. Majority Leader Reid needs to hear from YOU! Let him know that IHCIA is a top priority for Indian Country.
Call Senator Reid’s Office (202) 224-2158 and ask him to include IHCIA in the Senate’s health reform legislation.
To download copy of the NIHB Legislative Alert click here.
Senator Dorgan, Chairman of the Senate Committee on Indian Affairs, filed two amendments to the Senate health care reform bill – the Patient Protection and Affordable Care Act (H.R. 3590). The Senate bill does not include the IHCIA language. Including the IHCIA in the Senate bill will help strengthen the chances of the IHCIA remaining in the bill when the House and Senate health care reform bills are merged.
With the filing of these amendments, Indian Country is one-step closer to passage of the reauthorization of IHCIA and additional appropriations for contract care.
To view Dorgan Amendment SA 2923 - Adding the Indian Health Care Improvement Act Reauthorization and Extension Act (S. 1790). click here!
To view Dorgan Amendment SA 2922 - Adding funding for Contract Medical Care click here!
To download a copy of the legislative alert released on December 10, 2009 regarding, the Inclusion of the IHCIA in Senate Health Care Reform Bill click here.
To ensure that the amendments are debated and passed, we need your help! Contact your Senators and ask them to support Dorgan’s amendments.
It has taken more than 10 years to get to this point, and we are getting closer, but we need your help to reach the finish line.
Call and write your Senators TODAY!!
Urge them to include IHCIA in health care legislation!
Call the Capitol Switch Board (202) 224-3121 to speak with you Senator.
To find out your Senator’s contact information click here!
Send a letter to your Senator today!
To download a sample letter that you can use to contact your Senator click here!
To download a copy of the IHCIA Fact Sheet please click here.
To download a copy of this legislative alert, please click here.
Side by Side Comparison of HR 2708 with previous bills and current law
Senator Dorgan, Chairman of the Senate Committee of Indian Affairs with 15 originals cosponsors introduced a bill to reauthorize the Indian Health Care Improvement Act (IHCIA) S. 1790.
To download a copy of S. 1790 click here.
A chart that summarizes the amendments offered during the mark up of S. 1790 and the amendments to S. 1790 are available for download:
· Summary Chart
· Senator Dorgan’s Manager’s Amendment (#892)
· Cantwell-Udall Amendment (#816)
· Tester Amendment (#833)
· Franken Amendment (#824)
· Murkowski Amendment (#823, #771, #826)
· Murkowski Amendment (#852 -853)
For a side by side comparison of senate version of IHCIA (S. 1790) with the house version as adopted in house health care reform bill, as of 11/28/09, click here.To download a copy of the Comparison of the Senate Version of Indian Health Care Improvement Reauthorization and Extensions Action of 2009 with Current Law and 2nd Report on Recommendations from the National Tribal Steering Committee for the Reauthorization of the Indian Health Care Improvement Act click here.
A concept paper written by the Senate Committee on Indian Affairs click here to read the paper in full (pdf).
Open Tribal Leader Letter Supporting Reauthorization of the Indian health Care Improvement Act, dated June 2009
NIHB Letter to House of Representatives requesting support for IHCIA, Dated June 26, 2009
Please contact your congressional members and ask them to support the H.R. 2708.