NPAIHB Legislative & Policy Update
Tuesday January 12, 2021

ACTION ALERTS
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 languageSection 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
REGULATORY & POLICY UPDATES
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.  
 
NPAIHB has reinstated its Regulations Tracking Tool
LEGISLATIVE UPDATES
HR 133, Consolidated Appropriations Act of 2021over 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 ServiceFY 2020 FinalFY 2021 FinalIncrease
<Decrease>
Clinical Services
   Hospitals
   EHR
   Dental Health
   Mental Health
   Alcohol & SUDS
   PRC
   IHC Improvement Fund

2,324,606
8,000
210,590
108,933
245,603
964,819
72,280

2,324,606
8,000
210,590
108,933
245,603
964,819
72,280


<86,519>
26,500
4,097
6,174
5,757
11,037
Preventive Health
   Public Health Nursing
   Health Education
   Community Health Rep
   Community Health
   Immunization (AK) 

91,984
20,568
62,888
0
2,127

92,736
21,034
62,892
0
2,127


752
466
4
Other Services
   Urban Indian health
   Indian Health professions
   Tribal Mgmt Grant Program
   Direct Operations
   Self
-governance

57,684
65,314
2,465
71,538
5,806


62,684
67,314
2,465
82,456
5,806

5,000
2,000

10,918
Contract Support Costs
820,000
916,000
96,000
Tribal Section 105(l) leases

101,000
101,000
Maintenance & Improvement
168,952
168,952

Sanitation Facilities Const.
193,577
196,577
3,000
Health care Facilities Const.
259,290
259,290

Facilities & Environmental Health Support
261,983
263,982
1,999
Equipment
28,087
29,087
1,000




TTL Indian Health Service
6,047,094
6,236,279
189,185

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. 
 
Division by Division Summary of Authorizing Matters is a catch-all for multiple pieces of the appropriations puzzle, the most important component for tribal health in this is the amendment to 42 U.S.C ยง 254 (c) (3) that funds the Special Diabetes Program for Indians at $150 million/year through FY 2023. 
For more information
 Laura Platero, Executive Director
Veronica Smith, Health Policy Consultant
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