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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Legislative Action Alerts are only sent to your inbox when legislation relevant to Indian health is introduced, debated, or voted upon. These timely alerts will provide background information and a pathway for you to get involved in the issue at hand.

New Indian Country Legislation for February 2024

Truth and Healing Commission on Indian Boarding School Policies Act of 2024

Representatives Sharice Davids (D-KS-03), a member of the Ho-Chunk Nation in Wisconsin, and Tom Cole (R-OK-04), a member of the Chickasaw Nation of Oklahoma, reintroduced the Truth and Healing Commission on Indian Boarding School Policies Act of 2024 (HR 7227) to establish a Truth and Healing Commission to investigate, document, and report on the histories of Indian boarding schools, Indian boarding school policies, and long-term impacts on Native Communities.

The proposed legislation would:

  • Establish a formal commission to investigate, document, and acknowledge past injustices of the federal government’s Indian Boarding School Policies.
    • This includes attempts to terminate Native cultures, religions, and languages; assimilation practices; and human rights violations.
  • Develop recommendations for federal entities to aid in healing the historical and intergenerational trauma passed down in Native families and communities.
  • Provide a forum for victims to speak about personal experiences tied to these human rights violations.

The legislation was introduced on February 5th, coinciding with events planned by the National Native American Boarding School Healing Coalition (NABS) to raise awareness of the trauma of Indian boarding school survivors and the aims of the legislative initiative. Representatives Davids and Cole attended a panel discussion that was part of the NABS events promoting the legislation, which featured a robust discussion of the impact of the Indian Boarding Schools Policy and the bipartisan support for the legislation. The National Indian Health Board (NIHB) attended to demonstrate support for the legislation and the work of our partners at NABS to advance these initiatives.

Congresswoman Davids shared about her own family’s personal experience with Indian Boarding Schools and the healing opportunity the Commission represents, “My grandparents are survivors of Indian Boarding Schools, but many other children never returned to their families or their communities. Those that did lost generations worth of cultural knowledge, stories, and traditions. Establishing a Truth and Healing Commission would bring survivors, experts, federal partners, and Tribal leaders to the table to fully investigate what happened to our relatives and work towards a brighter path for the next seven generations.” Congressman Cole shared the impact of the bill and its provisions, “It will provide needed answers and build a pathway to healing for survivors and tribal families. Turning acknowledgment into action will help ensure the harms of the past are never repeated.”

The House legislation is a companion bill to the Senate version (S. 1723) reintroduced by Senators Elizabeth Warren (D-MA), Brian Schatz (D-HI), and Lisa Murkowski (R-AK) in May 2023. The Senate bill was heard by the Senate Indian Affairs Committee in June 2023, and reported out favorably with an amendment in the form of a substitute—or a version of the bill drafted by the Committee. The House bill has been referred to the Committees on Education and the Workforce, Natural Resources, and Energy and Commerce; its first hearing is yet to be scheduled.

In a statement on the release of the Senate legislation, NIHB shared, “The Indian Boarding School Policies caused unimaginable suffering and trauma for the survivors and victims, and the generations of Native families who remain impacted by these policies. The resulting trauma has led to countless health disparities that Native communities face daily. The creation of this Commission is a necessary and important step in healing Native families and communities suffering from intergenerational trauma. The National Indian Health Board is proud to support the Truth and Healing Commission.”

The NIHB has written to endorse the new legislation from Reps. Davids and Cole, and these efforts align with NIHB’s Resolution 22-01.

PRC Improvement Act of 2024

Senators Mike Rounds (R-SD) and Maria Cantwell (D-WA) introduced the Purchased and Referred Care Improvement Act (S. 3797), which would amend Section 222 of the Indian Health Care Improvement Act (IHCIA) to prospectively clarify that under no circumstances should IHS beneficiaries be responsible for paying medical bills for PRC services that IHS authorized. The amendments to Section 222 make explicit that IHS beneficiaries are not liable to third-party collection agencies and require IHS to reimburse IHS beneficiaries who pay PRC bills out-of-pocket that IHS should have otherwise paid to avoid adverse impact on their credit reports.

If a PRC claim is approved, IHS is supposed to process the claim in a 30-day timeframe. While the IHCIA currently requires IHS to pay these outside, a 2020 analysis by the Department of Health and Human Services (HHS) found that an estimated 32,000 claims over a two-year period were not paid within this time frame. The HHS OIG Report highlighted longstanding challenges, such as limited access to sufficient staffing, that likely reduce the ability of IHS to properly process such claims. As such, payments to outside providers are often delayed, ultimately contributing to medical debt for tribal members.

Senator Rounds said of the bill, “The Indian Health Service has made a commitment to care for tribal members across the United States, and they need to honor that commitment. Because of the strict standards for PRC claims, […] it’s crucial that IHS reimburses tribal members for outside care once it’s approved. I’m pleased to introduce this legislation, which would hold IHS accountable […].” The bipartisan legislation was introduced on February 12th.

Specifically, the Purchased and Referred Care Improvement Act would:

  • Require IHS to develop procedures to reimburse beneficiaries for approved PRC services within 30 days if the patient paid out of pocket.
  • Allow a beneficiary to submit documentation to the agency as evidence when seeking reimbursement.
  • Strengthen liability provisions of the statute, making it clear that outside providers cannot collect wrongfully charged debt from beneficiaries with approved PRC claims.

This legislative effort is modeled on the successful Protecting Veterans Credit Act of 2017 (P.L. 115-174), which similarly required the US Department of Veterans Affairs (VA) to repair veterans’ credit when damaged by failure of payment for VA-approved outside medical care, reimburse veterans for care covered by a veteran which was approved by the VA, and to improve the process going forward to prevent wrongly reported medical debt owed by the VA. While work continues to introduce the other legislation and House companion legislation, the PRC Improvement Act of 2024 has been referred to the Senate Committee on Indian Affairs.

The National Indian Health Board fully supports the bill and has adopted Resolution 23-07, bringing awareness to this critical issue for tribal members impacted by medical debt, which should rightfully be within the US Government’s Trust Responsibility.

National Indian Health Board
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