June 18, 2019 |  Issue 19-24                 Missed Last Week's Washington Report? Click Here to Visit our Archives!
 UPCOMING EVENTS 

Tribal Leaders Diabetes Committee Meeting
June 19 - 20, 2019
Billings, MT


July 15 - 16, 2019
Washington, DC


July 23, 2019
9:00 AM to 5:00 PM ET
Washington, DC
 

 July 24 - 25, 2019
Washington, DC  


July 29, 2019
Albuquerque, NM


July 30 - 31, 2019
Albuquerque, NM


August 6 - 9, 2019
Oklahoma City, OK

August 13 - 14, 2019
Cherokee, NC

Community Health Aide Program (CHAP) TAG Vacancies
 In February 2018, with the announcement of CHAP expansion to Tribes beyond Alaska, IHS created a CHAP Tribal Advisory Group.

 Information on CHAP and CHAP TAG, including vacant  positions, is available on the CHAP
website .

Join the National Partnership for Dental Therapy!
Click HERE for more information!

Stay Current: Health Alerts from the CDC!
Don't wait for the emergency to arrive before signing up for emergency alerts from the Centers for Disease Control & Prevention!

 
Follow NIHB on Twitter and Instagram
@NIHB1
 
Top Story
House
House Set to Finish First Minibus Wednesday, and then Immediately Queue Debate on Minibus No.2
The House of Representatives will continue debate on a spending package of five appropriations bills this week, eyeing Wednesday 6/19 as the date to vote and pass the first minibus that includes funding for Labor-HHS; Defense; Energy-Water; and State-Foreign Operations. The nearly $1 trillion package included hundreds of amendments that the House will continue debate and votes on Tuesday in hopes of proceeding to final passage on Wednesday. While the Indian Health Service is funded under the Interior bill, this first minibus includes funding for important Tribal programs under Labor-HHS. These include the Centers for Disease Control and Prevention's Good Health and Wellness in Indian Country program, and set-aside funding for Tribes to address opioid prevention and treatment under the Substance Abuse and Mental Health Services Administration. To read NIHB's breakdown of the Labor-HHS bill, click here.

The second minibus also includes five spending bills, namely Interior-Environment (including the Indian Health Service); Commerce-Justice-Science; Agriculture-FDA; Transportation-HUD; and Military Construction-Veterans Administration. Legislators will likely begin votes on the various amendments to this package late Wednesday, as the House Rules Committee decides the final measures for debate. To read NIHB's analysis of the Interior bill and funding for the Indian Health Service, click here.

The House schedule for votes on these minibuses align with Majority Leader Steny Hoyer's (D-MD) aggressive timeline for passage of all twelve appropriations bills by June 30. Should the House pass both minibuses this week, it will have completed work on ten out of the twelve appropriations bills. Meanwhile, the Senate has not begun any formal work on FY 2020 spending packages. 

Overshadowing conversations on FY 2020 appropriations are ongoing discussions between House and Senate leaders and the White House on a budget deal to raise spending caps and address the debt ceiling. Legislators and White House officials must address spending caps and the looming debt ceiling in order to avoid another government shutdown and mandatory cuts to both defense and non-defense spending starting October 1 under budget sequestration. 

While bipartisan leaders have agreed to continue conversations on a budget deal, it remains unclear whether a final agreement will be reached. NIHB will provide more information as it becomes available.
NIHB UPDATES
NTHC
2019 National Tribal Health Conference Call for Proposals Now Open!
The National Indian Health Board (NIHB) is excited to announce that the Call for Proposals for the 2019 National Tribal Health Conference (NTHC) is now available! This year's conference, scheduled for September 16-20, 2019, will be held at the Pechanga Resort Casino in Temecula, California.
Tribal leaders, health directors, policy specialists, advocates, and allies are invited to submit abstracts. NIHB encourages presentations highlighting innovative and Tribally-driven approaches to improving the quality of health systems, strengthening the business of medicine, expanding pathways for successful advocacy efforts, enhancing government to government relationships, and evidenced based, wise, best or promising practices developed in and for Tribal communities.
This year's five conference tracks address a wide breadth of Tribal health priorities. Namely, they are:
  • Legislation and Advocacy
  • Federal Relations and Advocacy
  • Native Health Infrastructure and Quality Improvement
  • Opioids, Methamphetamines, Substance Use, and Behavioral Health
  • Emerging Trends in Native Health and Sovereignty
Submissions are due by 11:59 pm ET on July 12, 2019.
To access the Call for Proposals page, click HERE.
NTHCRegistration
Registration for 2019 National Tribal Health Conference Now Available!
NIHB invites Tribal leaders, health administrators, health policy experts, federal partners, and allies to register for the 2019 National Tribal Health Conference taking place in Temecula, California September 16-19, 2019 at the Pechanga Resort & Casino!
Take advantage of the Early Bird rate through July 31!

As the nation's premiere Tribal healthcare conference, the National Tribal Health Conference (NTHC) brings together over 800 individuals from across Indian Country to advance the promise of health and Tribes' own political and policy work in the arenas of healthcare, public, behavioral, and environmental health. 
Hotel and Venue Information
This year's NTHC is taking place at the Pechanga Casino & Resort in Temecula, California! NIHB has secured a Group Rate for hotel registration at $149 per night. NIHB's room block is only available through August 14, 2019 so book your stay today!
Gala
Outstanding Service Award Nominations for 2019 Now Open!
T he National Indian Health Board is inviting nominations for the 2019 Outstanding Service Awards. The awardees will be announced at the NIHB Annual Heroes in Native Health Gala on Wednesday, September 18th. This will coincide with the NIHB National Tribal Health Conference (NTHC) September 16- 20, 2019 at Pechanga Resort and Casino in Temecula, CA. 
 
The deadline for nominations is June 21, 2019 at 11:59PM ET.
 
In an effort to honor individuals, organizations and programs that have enriched and improved American Indian and Alaska Native health, health systems or policy each year, the NIHB invites nominations for awards that recognize excellence, achievement and contributions "above and beyond" the call of service. This is your opportunity to nominate individuals, organizations or programs that have significantly contributed to improving the health status, policy and/or health systems experienced by American Indians and Alaska Natives.  Click Here for a list of the 2018 Award Winners!
 
NIHB is seeking nominations for the following prestigious awards:
 
Local Impact Award  - Recognizes an individual or organization whose work has affected change or impacted health care on the local and or Tribal level. 
(24 awards available)
 
Area/Regional Impact Award  - Honors an individual or organization whose work has contributed to improving American Indian/Alaska Native health care or affected change on an area or regional basis.  (12 awards available - 1 from each IHS Service Area)
 
National Impact Award  - Honors an individual or organization whose work has made an impact on American Indian/Alaska Native health care on a national level.  (6 awards available)
 
Jake Whitecrow Award  - Recognizes an individual or organization with outstanding lifetime achievements in elevating health care advocacy, raising awareness or affecting positive change for American Indian and Alaska Native health care. (1 award available)
 
Youth Leadership Award - Commends a young American Indian or Alaska Native aged 14-22 for their leadership and outstanding efforts to increase the quality of healthcare or awareness of health issues within their peer group or community on a local or national level. (1 award available)
   

 
NIHB will present the awards during the NIHB 2019 National Tribal Health Conference (NTHC) at the Annual Heroes in Native Health Awards Gala in Temecula, CA on September 18, 2019. All nominations must be received through the online form by 11:59PM  ET on June 21, 2019 .  Awardees will be notified by July 15th, 2019.  Additional information on the Heroes in Native Health Awards Gala, including the opportunity to purchase tickets or a table and be a sponsor will be forthcoming.
CAPITOL HILL UPDATES
senateHELP
Senate Health, Education, Labor and Pensions Committee Aims to Advance Legislation Lowering Health Care Costs
The Senate Health, Education, Labor, and Pensions (HELP) Committee has been working behind the scenes for months on a package of legislation to lower health care costs and improve health outcomes. After soliciting public feedback on recommendations for lowering health care costs back in the Fall, last month HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) released the discussion draft of a package of legislation with five titles that specifically address surprise medical bills, prescription drug costs, health care transparency, public health, and exchange of health information. The Committee held a hearing on the discussion draft on Tuesday, June 18.  Chairman Alexander and Ranking Member Murray hope to pass the legislation by the end of June. The HELP Committee received over 400 comments on the discussion draft, including from NIHB.

To access NIHB's comments, click here.

To access the Section by Section summary of the legislation, click here.

To access the full discussion draft, click here. 

To watch a recording of the hearing, click here.
FEDERAL ADMINISTRATION AND STATE GOVERNMENT UPDATES
TrumpAdvisory
Trump Administration to Cut Expert Advisory Committees by September 30, 2019
In an Executive Order (E.O.) released last week, President Trump directed agencies to terminate "at least one-third" of their advisory committees that are not required to exist by statute. The Executive Order states that each agency shall evaluate the need for each of its current advisory committees established under section 9(a)(2) of Federal Advisory Committee Act (FACA) and those advisory committees established under section 9(a)(1) that are authorized by law but not required by statute (eligible committees). The FACA applies to any committee, council, task force, or other similar group, which is established by statute, or established or utilized by an agency official, for the purpose of obtaining advice or recommendations for the President, or on issues or policies within the scope of an agency official's responsibilities. 41 CFR ยง 102-3.25. 
 
According to statistics compiled by the General Services Administration, the government has more than 1,000 active advisory committees, 601 of which are required by various statutes.   Agencies may seek waivers before September 1, 2019, to avoid terminating their eligible advisory committees if the committees are determined to be "necessary for the delivery of essential services, for effective program delivery, or ... otherwise warranted by the public interest. " At this time, the impact to Tribal advisory committees is unclear since most Tribal Advisory Committees operate under the Intergovernmental exception to the Federal Advisory Committee Act. NIHB will provide more information as it becomes available.
CHAP
NIHB Submits Comments on CHAP Interim Policy Consultation
As NIHB reported last week, on June 7, 2019, IHS released a Dear Tribal Leader Letter (DTLL) announcing the extension of comments for the CHAP program.
NIHB submitted comments in response to this Tribal consultation, asking for Tribal flexibility in adopting CHAP but also stressing that any CHAP expansion must not adversely impact the CHR program. 

If you have any questions about this proposed rule, please contact NIHB Director Policy, Devin Delrow, at  [email protected]. 

To access NIHB's comments, click here. 
benefits
Benefits Eligibility: OMB Proposes Alternative Poverty Index Calculation
OMB proposed a rule that seeks to adjust the Federal Poverty Level (FPL) calculations by using a different measure to calculate inflation than the one currently used for federal programs (the Consumer Price Index - CPI).  An alternative index they are considering, called the "Chained Consumer Price Index," would calculate increases in inflation at a slower rate, which would slow the pace in which the federal poverty level is adjusted.  Over time, this could lead to fewer people being considered as living below the poverty line, and can have serious implications for eligibility for social safety net programs like Medicaid and nutrition assistance. 

Research from the Center for Budget and Policy Priorities (CBPP) found that:
  • More than 250,000 seniors would lose eligibility for or receive a lower subsidy from Medicare Part D Low-Income Subsidy Program.
  • Using the chained index would also move 300,000 children off of CHIP.
  • Consumers who get their insurance through the ACA would see decreased cost-sharing reductions, increased deductibles, and increased premiums. 
Comments are due June 21 and may be addressed via email to:
Nancy Potok, Chief Statistician
Office of Management and Budget
Subject line: "Directive No. 14"

NIHB will be filing comments on this rule. For more information, please contact NIHB Policy Analyst, Monica Martinez, at [email protected].  
HHSOpioid
Did you know? NIHB is including brief reports from its Tribal Data Project Director, Ed Fox, in the Washington Report to engage our readers in the  Center for Indian Health Policy and Research's (CIHPR) work. Each week, NIHB will share a new report on AI/AN health. Topics range from access to care, enrollment in federal health programs, occurrence of chronic conditions, and more. 

Poverty Guidelines and Indian Health Programs

It is useful to know what American Indian and Alaska Native (AI/AN) income data is available for program planning. Why? Because federal and state programs such as Medicaid, food stamps (SNAP), Low Income Home Energy Assistance Program (LIHEAP), school lunch, and even some parts of Medicare are 'means' tested programs. This means there are income eligibility requirements. The federal poverty guidelines, based on the poverty threshold is the basis of income and poverty estimates (see federal sources below).
 
The following list provides a dozen useful Digital Data Briefs to explore income data. In most cases it is state-level data, but sometimes county level data is available (see 10) when Special Census Supplemental Tables are compiled for AI/ANs.
 
In addition to planning based on estimates of income, we can also evaluate our success in making sure all who are eligible are enrolled in health insurance (see 3). If we have uninsured who are under 139% of the federal poverty guideline and we live in a state that expanded Medicaid we need to increase our outreach. (See 1 and 4). Data is also available to determine how many are potentially eligible for insurance at various level of income, e.g. 100% of FPL vs. 139% of FPL. Medicare premiums and cost sharing can be paid by Medicaid if income is under 100% of FPL (see 2). Some federal programs are limited to rural counties so it is helpful to have data specific to rural counties (see 10).
 
A final example is the coverage of children in Medicaid / Children's Health Insurance Program (CHIP). There is strong evidence that many who are eligible are not enrolled (see 12). By highlighting gaps, we can develop targeted strategies to fill those gaps.
 
  1. Percent under 139% of FPL with Medicaid
  2. 100% of FPL for eligibility for Medicaid payment of Medicare Premiums (65 and older)
  3. 2017 Income, Access to IHS, and the Uninsured
  4. 2017 Medicaid, Income and Access to IHS
  5. 2016 Income Distribution, all American Indians and Alaska Natives
  6. Select Income level for American Indians and Alaska Natives (states)
  7. Uninsured by Income Level
  8. Income level of remaining Uninsured
  9. Poverty Level by County (2015)
  10. Poverty by "Rural" Counties that are IHS CHSDA/PRCSDA with Measures of Persistent Poverty
  11. Comparing All Races to American Indians and Alaska Natives Poverty Ratio (% of poverty level)
  12. Children's rate of Uninsured increased 2016 to 2017 & Uninsured Children's by Income
Federal Sources:
UPCOMING EVENTS, CALLS, AND WEBINARS

CMSITU

Don't miss the National Indian Health Board's (NIHB) presentation at the Centers for Medicare and Medicaid Services' (CMS), Indian Health Service (IHS), Tribal Health Programs, and Urban Indian Programs (CMS I/T/U) regional training sessions!  CMS is committed to helping the I/T/U facilities to maximize their ability to access third party resources.  To meet this objective, CMS, in partnership with the States, the Department of Veteran Affairs, the Social Security Administration, the DHHS Office of the Inspector General, IHS and NIHB provide training to patient benefits advocates on the programs and benefits available through Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. 
 
The target audience for CMS ITU Trainings includes:
  • Business Office staff
  • Benefits Coordinators
  • Patient Registration staff
  • Medical Records staff
  • Purchased/Referred Care staff
Upcoming Regional Trainings:
June 18-19, 2019
5110 Southgate Drive
Billings, MT 59101
 
June25-26, 2019
700 East Main Street
Richmond, VA 23219
 
August 14-15, 2019
10 Laura Boulevard
Norwich, CT 06360

For more information, and to register, click here. 
HRSAwebinar
June 25: HRSA Webinar Detailing Auto-HPSA Changes
The Health Resources and Services Administration (HRSA) has announced a webinar on the Shortage Designation Modernization Project (SDMP). The webinar will provide information about the national update of automatically designated Health Professional Shortage Areas (HPSA) for summer 2019. The webinar will also provide dedicated time for Tribes and Urban Indian organization leaders to provide input on the project.

Date: June 25, 2019
Time: 2:00 - 4:00 PM ET
Dial-in: 888-282-0359
Code: 9059513
Link: https://hrsa.connectsolutions.com/auto-hpsa webinar/
MMPCftf
July 22-23: MMPC Face-to-Face Meeting
Strategic Planning Meeting
Monday, July 22
1:00pm to 5:00PM ET
American Immigration Lawyers Association Conference Center
1331 G Street NW
Washington, D.C., 20005

MMPC Face-to-Face Meeting
Tuesday, July 23
9:00AM to 5:00PM ET
Location TBD
Washington, D.C.
TTAGftf
July 24-25: TTAG Face-to-Face Meeting
TTAG Face-to-Face Meeting
Wednesday and Thursday, July 24-25
National Museum of the American Indian
Independence Avenue SW
Washington, D.C., 20560
NIHDTLL
NIH DTLL: NIH Policies on Intellectual Property, Inventions, and Patent Rights in Biomedical Research
  • Question: How do NIH Intellectual Property policies impact biomedical research with Tribal communities?
  • Consultation dates:
NIH DTLL: Request for Comments on NIH Draft Policy on Data Sharing  Management
  • Question: How do Tribes define Scientific Data? What are acceptable requirements when proposing research with Tribes?
  • Consultation dates:
    • June 18-20 Sacramento, CA.
    • July 15-18 in Washington, DC.
    • August 20-22 in Denver, CO.
    • A toll-free conference line will be made available.
    • Testimony, comments and questions before and after consultation are encouraged. Send email to [email protected]
NIH DTLL: Tribal Consultation and Listening Session on the All of Us Research Program
  • June 24, preceding NCAI's 2019 Mid-Year Conference in Sparks, NV.
  • NIH will participate in HHS regional consultations in CA, DC, CO.
  • All of Us Tribal Engagement information HERE
CDCatsdr
The Summer 2019 CDC/ATSDR TAC Meeting and 19 th Biannual Tribal Consultation Session will provide opportunities for Tribal leaders to speak about the public health issues affecting their Tribal Nation. These meetings will include, but are not limited to, discussions about securing sustainable funding to Indian Country, ensuring a Tribal voice in CDC policy and programs, and current CDC priorities. Tribal Nations also will have an opportunity to present formal testimony about Tribal public health issues.

The CDC's Agency for Toxic Substances and Disease Registry (ATSDR) will hold a meeting and Tribal Consultation Session from August 13 to August 14, 2019. Tribes will also have an opportunity to present testimony about Tribal public health issues. The meeting will be open to the public and the agenda will include discussions on securing sustainable funding to Indian Country and ensuring a Tribal voice in CDC policy, programs, and current CDC priorities.
 
All elected Tribal officials are encouraged to submit written testimony (on official Tribal letterhead) by 5:00 p.m., EDT, Friday, July 19, 2019 to Captain Carmen Clelland, Pharm, MPA, MPH, Director, Office of Tribal Affairs and Strategic Alliances via mail to 4770 Buford Highway, Mailstop V18-4, Atlanta, GA 30341-3717, or by email at [email protected]. 

Attendees must pre-register HERE by Friday, July 19, 2019.
Testimony must be submitted by 5:00 p.m. ET on Friday July, 19, 2019 to [email protected]. 

Time and date:
Start Date - 8/13/2019, 9:30-5:45 (EDT)
End Date - 8/14/2019, 9:30-5:45 (EDT)

Event Location: Harrah's Cherokee, 777 Casino Dr, Cherokee, NC, 28719

Registration Information: The registration form, agenda, and hotel information will be available later in June on the CDC Tribal Health website at www.cdc.gov/tribal/index.html

CDC contact information : Email Address for event is [email protected]
Grants and Resources
ACLltss
ACL Funding Opportunity: Tribal LTSS Resource Center
NOFO Number:  HHS-2019-ACL-AOA-IELT-0349
Deadline: July 5, 2019
The Administration for Community Living (ACL) is proposing to aware a new cooperative agreement to find a National Resource Center of American Indian, Alaska Native, and Native Hawaiian Long Term Services and Supports (LTSS). This center will address the unmet need of Tribal-specific and culturally appropriate LTSS information and guidance to  Tribes. The outcomes of this project will be to:
  1. Create a network of navigators that will assist Tribes in development of appropriate LTSS in response to identified, tribally-specific needs; and
  2. Based on documented best practices, the Center will develop a practical and hands-on toolkit for Tribes to assist in implementing LTSS in their individual Tribal communities.
The Resource Center will target its services to the 270 tribes that receive Title VI grants, however it will also have publicly-available resources that are accessible to all Tribes and organizations that work with the AI/AN and Hawaiian populations. The Resource Center will focus on improving the lives of those served by ACL by supporting the development of Tribal-specific LTSS that assist older adults and people with disabilities while also empowering tribes to develop programs that are integrated into their unique culture.

Contact Cecelia Aldridge with questions: [email protected] 
ACLTech
ACL Funding Opportunity: Technologies to Enhance Independence and Community Living for People with Cognitive Impairments
NOFO Number:  HHS-2019-ACL-NIDILRR-REGE-0343
Deadline: July 15, 2019

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), within the Administration for Community Living (ACL), announced a new funding opportunity on May 16, 2019. The project that NIDILRR is funding is called the "Rehabilitation Engineering Research Centers (RERCs) Program: RERC on Technologies to Enhance Independence and Community Living for People with Cognitive Impairments", whose goal is to improve the effectiveness of services authorized under the Rehabilitation Act by conducting research and developing innovative technologies that solve rehabilitation problems or remove environmental barriers.
 
Federally-Recognized Tribal Governments, Native American Tribal organizations, and Nonprofits with a 501(c)(3) status are among the eligible applicants.
 
Contact Patricia Barrett with questions: [email protected]
Resources
Resources Available to Tribes on Health Issues  
The following resources are now available to Tribes on issues related to health and wellness:

HRSA Grant Application Webinars
The Health Resources and Services Administration (HRSA) has created a series of FREE Grants Education and Technical Assistance Webinars for Tribes, Tribal Organizations, Indian Health, Tribal and Urban Indian Health Programs.  Topics include  the federal grant application process, how to write better grant proposals and evaluation plans for your projects, strategies for successful grant management, and more.  Please find below links to all the recorded sessions.
 
Apr 11, 2018
Federal Grants Application Process: The Basics
Where to Find Funding Opportunities, Grants Resources & Technical Assistance
Recording and slides available here .
May 9, 2018
Writing a Competitive Grant Application / HRSA Review Criteria
Recording and slides available here.
Jun 13, 2018
Applying for a HRSA Grant: A Grantee and a Reviewer's Perspectives /
The Benefits of Becoming a Reviewer
Recording and slides available here.
Jul 11, 2018
Writing a Successful Evaluation Plan for Your Grant Application
Recording and slides available here.
Aug 8, 2018
Preparing a Budget for your Grant Proposal
Part 1: Building a Budget recording and slides available here .
Part 2: HRSA Budget 101 / Tips & Resources recording and slides available here .
Sept 12, 2018
Effective Grants Management/Administration & Reporting
Recording and slides available here.

CMS  announced the five-year Maternal Opioid Misuse (MOM) model to help state Medicaid programs improve clinical care and social services for pregnant and postpartum women with opioid use disorder and their children. 
Resources
Resources Available to Tribes on Health Issues  
The following resources are now available to Tribes on issues related to health and wellness:

HRSA Grant Application Webinars
The Health Resources and Services Administration (HRSA) has created a series of FREE Grants Education and Technical Assistance Webinars for Tribes, Tribal Organizations, Indian Health, Tribal and Urban Indian Health Programs.  Topics include  the federal grant application process, how to write better grant proposals and evaluation plans for your projects, strategies for successful grant management, and more.  Please find below links to all the recorded sessions.
 
Apr 11, 2018
Federal Grants Application Process: The Basics
Where to Find Funding Opportunities, Grants Resources & Technical Assistance
Recording and slides available here .
May 9, 2018
Writing a Competitive Grant Application / HRSA Review Criteria
Recording and slides available here.
Jun 13, 2018
Applying for a HRSA Grant: A Grantee and a Reviewer's Perspectives /
The Benefits of Becoming a Reviewer
Recording and slides available here.
Jul 11, 2018
Writing a Successful Evaluation Plan for Your Grant Application
Recording and slides available here.
Aug 8, 2018
Preparing a Budget for your Grant Proposal
Part 1: Building a Budget recording and slides available here .
Part 2: HRSA Budget 101 / Tips & Resources recording and slides available here .
Sept 12, 2018
Effective Grants Management/Administration & Reporting
Recording and slides available here.

CMS  announced the five-year Maternal Opioid Misuse (MOM) model to help state Medicaid programs improve clinical care and social services for pregnant and postpartum women with opioid use disorder and their children. 
Pre-order Your 2020 Medicare and You Handbook
Pre-orders can be made through June, 2019. To pre-order your
Medicare & You handbook, click here, log in, and follow the instructions on the website.
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