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Washington Report

An NIHB Publication

The Washington Report is an e-newsletter produced by the National Indian Health Board. Each issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis and action items.

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CMS Tribal Technical Advisory Group March 2024 Meeting and Hill Visits

The Medicare, Medicaid, and Health Reform Policy Committee (MMPC) and the Centers for Medicare and Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) held their first face-to-face meetings of 2024 the week of March 4th. In addition to the regularly scheduled meetings, NIHB and other Tribal partners organized hill visits to bring TTAG members to meet with Congressional leaders on the Group’s Medicare and Medicaid legislative priorities.

The TTAG raised a host of major issues during its two-day meeting with CMS leadership. The TTAG had the opportunity to engage with the Center for Medicaid and CHIP Services Director, Daniel Tsai, on the Group’s top priorities. TTAG members again raised the four walls restriction on reimbursement for clinic services provided to Medicaid beneficiaries outside the four walls of the clinic facility. Mr. Tsai shared with the Group that CMS is working on a regulatory package to formally amend clinic regulations, which would include a requirement to reimburse Medicaid clinic services provided outside the four walls of a Tribal clinic. CMS is further considering making reimbursement for such services optional for behavioral health clinics and rural health providers.

TTAG members also raised traditional healing waivers pending before CMS and the proposed reimbursement framework for such services recently shared by CMS. CMS officials presented the draft framework for approving Section 1115 waivers with traditional healing. The TTAG has been closely tracking the development of this framework and has already identified areas of concern that require more clarity from CMS on how it plans to proceed. Members also raised concerns that some states are discussing traditional healing policy options with CMS regional or headquarters offices without the consultation or inclusion of Tribes or Tribal health programs.

In addition to the meeting with CMS Leadership, TTAG members participated in hill visits to build awareness of the Group’s legislative priorities to support improved access to Medicare and Medicaid in Indian Country. The TTAG identified eight (8) legislative proposals broken within Medicare and Medicaid that require the action of Congress to make a policy reality. As part of the identification process, the TTAG developed a request, justification, and legislative language for each proposal. During the visits, TTAG members met with members of the Oklahoma and Washington Congressional delegations. TTAG members shared the goal behind the creation of the proposals and how they, through a Tribally driven process, decided which proposals to advance based on feedback from CMS on the statutory nature of the requests.

Overall, the TTAG Members were able to educate and build awareness around the ongoing challenges the Indian health system and its providers encounter with Medicare and Medicaid programs. As Congressional offices look for ways that the Medicare and Medicaid system can work better for Tribes, the TTAG proposals provide the necessary legislative fix to these persistent issues. NIHB and our Tribal partners will continue to raise awareness of the TTAG’s legislative priorities and welcome members who are visiting Washington, DC to engage with their elected representatives in Congress.


National Indian Health Board
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