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NPAIHB Legislative & Policy Update
Tuesday January 12, 2021
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Department of Health and Human Service/IHS
DTLL re Health IT Modernization IHS is recommending moving forward with full replacement of RPMS as the most appropriate and sustainable solution for IT modernization. Listening session will be held January 14, 2021. Comments are due January 24, 2021.
A few things to keep in mind re Section 105(l) leases in FY 2021 appropriations language, Section 431(a) includes the following information:
- Tribal lease payments to begin no earlier than the date the lease proposal is received
- Secretaries of the Interior and Health and Human Services directed to hold consultation with tribes and tribal organizations re. the requirements of Section 105(l) leases, and on how to implement a consistent and transparent process for the payment of the leases.
- Consultation will take place in FY 2021
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REGULATORY & POLICY UPDATES
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Health and Human Services
SUNSET Final Rule HHS finalized Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) regulation that would require all HHS regulations to expire in five (5)years from the date this SUNSET final rule becomes effective, 10 years after the year of the Section's promulgation, or 10 years after HHS assessed or reviewed the Section, whichever is latest.
Advisory Opinion on 340B Program The Office of General Counsel has concluded that drug manufacturers in the 340B program is required to deliver covered outpatient drugs to contracted pharmacies and to charge no more than the 340B ceiling price for those drugs.
- OGC Advisory Opinions are advisory, not enforceable
Indian Health Service
Reimbursement Rates for CY 2021 IHS posted notice of the CY 2021 reimbursement rates. Outpatient per visit rate for lower 48: $519; Medicare outpatient per visit rate: $414.
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HR 133, Consolidated Appropriations Act of 2021, over 5,500 pages, includes FY 2021 federal funding, COVID-19 funding, provisions impacting the Special Diabetes Program for Indians, and a plethora of other legislation. The entire legislation is available as a TXT file here, but is much easier to review if you look at the Appropriations Committee Summaries (linked below).
The Indian Health Service FY 2021 appropriation is found in Division G of the referenced document, and broken down below. (Original text for this table is found beginning on page 178 of this document. )
FY 2021 Indian Health Service Appropriations(amounts in thousands)
Indian Health Service | FY 2020 Final | FY 2021 Final | Increase <Decrease>
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Clinical Services
Hospitals
EHR
Dental Health
Mental Health
Alcohol & SUDS
PRC
IHC Improvement Fund
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2,324,606
8,000
210,590
108,933
245,603
964,819
72,280
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2,324,606
8,000
210,590
108,933
245,603
964,819
72,280
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<86,519>
26,500
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Preventive Health Public Health Nursing
Health Education
Community Health Rep
Community Health
Immunization (AK)
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91,984
20,568
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| 752 466 4 |
Other Services Urban Indian health Indian Health professions Tribal Mgmt Grant Program Direct Operations Self-governance
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57,684
65,314 2,465 71,538
5,806
| 62,684 67,314 2,465 82,456 5,806
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5,000
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Contract Support Costs
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820,000
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916,000
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96,000
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Tribal Section 105(l) leases
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101,000
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101,000
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Maintenance & Improvement
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168,952
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168,952
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Sanitation Facilities Const.
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193,577
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196,577
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3,000
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Health care Facilities Const.
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259,290
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259,290
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Facilities & Environmental Health Support
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261,983
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263,982
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1,999
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Equipment
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28,087
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29,087
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1,000
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TTL Indian Health Service
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6,047,094
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6,236,279
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189,185
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Key health related provisions include:
- Tribal governments have until December 31, 2021 to use the Coronavirus Relief Funds received (CARES ACT).
- Unemployment insurance benefits will have addt'l $300/week through Mar 14, 2021
- $1 billion addition to Provider Relief Fund
- Provider Relief Fund language changes re expenses and revenue losses
- $125m tribal set-aside at SAMHSA
- $7 million for tribal nutrition programs under the Older Americans Act
- $790 million to IHS for COVID testing/tracing, surveillance
- $210 million to IHS for vaccine distribution, education, and COVID related expense
The Indian Health Service held a Tribal consultation on January 04, 2021 on the $790m and $210m mentioned above. NPAIHB's comment letter was submitted on January 08, 2021.
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