The National Indian Health Board is a dedicated advocate in Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php.
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In This Week's Washington Report
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NIHB and NCAI Push for Indian Health Care Funding and Advance Appropriations
The National Indian Health Board and the National Congress of American Indians join forces to elevate Tribal Leader voices to Capitol Hill on securing Advance Appropriations for the Indian Health Service (IHS). This action alert is for the House Appropriations Committee: we ask the committee to support and include IHS advance appropriations in the current appropriations bill. Advance appropriations would help shield the IHS and Tribal health systems from the harmful impacts of continuing resolutions and government shutdowns. Support and passage of advance appropriations in the next appropriations cycle would begin the necessary process for establishing budget certainty and help improve the health care delivery system for Tribal nations and their citizens. It is a meaningful step in fulfilling the United States’ trust responsibility and treaty obligations to Tribal nations for Indian health care.
Tribal leaders are encouraged to call, e-mail, and send letters to Members of Congress including the House Committee on Appropriations and House Subcommittee on Interior Environment, and Related Agencies, Senate Committee on Appropriations and Senate Subcommittee on Interior, Environment, and Related Agencies, and representatives from their state or district. NIHB and NCAI have prepared scripts and templates that can be downloaded:
For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD at apayment@nihb.org.
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Senate Committee on Indian Affairs to Hold Hearing on Federal Indian Boarding Schools
On Wednesday, June 22 at 2:30 PM ET / 8:30 AM HT, U.S. Senator Brian Schatz (D-HI), chairman of the Senate Committee on Indian Affairs, will lead a hearing titled “Oversight Hearing on Volume 1 of the Department of the Interior’s Federal Indian Boarding School Initiative Investigative Report & Legislative Hearing on S. 2907, Truth and Healing Commission on Indian Boarding School Policies Act". This hearing will be both an oversight and legislative hearing.
Chairman Schatz will hear from the administration and Native leaders and experts on the Department’s report, S. 2907, and how to address the needs of impacted Native communities. View tomorrow's livestream of the hearing here.
Witnesses:
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The Honorable Deb Haaland, Secretary of the Interior, U.S. Department of the Interior, Washington, DC
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The Honorable Kirk Francis, Chief, Penobscot Indian Nation, Indian Island, ME
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Ms. Sandra White Hawk, President, National Native American Boarding School Healing Coalition, Minneapolis, MN
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Ms. Norma Ryūkō Kawelokū Wong Roshi, Native Hawaiian Policy Lead, Office of former Hawai‘i Governor John Waihe‘e, Honolulu, HI
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Ms. La Quen Náay Liz Medicine Crow, President/CEO, First Alaskans Institute, Anchorage, AK
To learn more about National Indian Health Board's past efforts on Federal Indian boarding schools and to view more on Federal Indian Boarding School Initiative, see here.
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Representative Chellie Pingree (D-ME-1)
Representative Pingree is a U.S. representative for Maine's first congressional district since 2009 which includes the August and Portland metropolitan areas. Although there are no Tribal nations within Pingree's first congressional district, Pingree is the Chair of the Appropriations Subcommittee on Interior, Environment, and Related Agencies which is responsible for funding the Indian Health Service (IHS) as well as Interior Department, Environmental Protection Agency, national parks and other public lands. As the Chair, Pingree has great influence over IHS appropriations. Pingree assumed the leadership role at the beginning of the 117th Congress.
Later today, the Appropriations Subcommittee on Interior will begin the markup on the Fiscal Year (FY) 2023 appropriations bill. IHS would receive a $1.5 billion boost over fiscal 2022 levels, bringing the total to $8.1 billion. Pingree stated, “Supported by President Biden’s ambitious request to increase funding over last year, I’m confident the FY 2023 Interior Appropriations bill will further the United States’ commitment to clean energy, environmental justice, health infrastructure on tribal lands, and the arts. Through investments in clean energy technology, climate mitigation programs, and by restoring environmental protection, the Interior bill will take a whole-of-government approach to securing a safe and habitable world for future generations.”
Indian Healthcare Legislation
Pingree cosponsored the Truth and Healing Commission on Indian Boarding School Policies Act H.R.5444/S.2907. This bill would establish a Commission to investigate and document the detrimental Indian boarding school policies and historical trauma resulting from those policies and to make recommendations, among others, for federal resources and assistance to aid in healing from that trauma. NIHB Resolution no. 22-01 encourages the U.S government to accept responsibility for the board school policy, provide direct non-competitive funding to Tribes, assist with healing from historical and intergenerational trauma from the boarding school policies, provide resources for programmatic services that encourages reclamation of American Indian/Alaska Native (AI/AN) languages, pass the Truth and Healing Commission on Indian Boarding School Policies Act. Read the resolution here.
Representative Pingree also co-sponsored H.R 1667 Dr. Lorna Breen Health Care Provider Act. The bill provides for the Secretary of HHS to, among other things, establish a program to award grants to Indian Tribes or Tribal organizations to support the training of health care students, residents, or health care professionals in evidence-based or evidence-informed strategies to address mental and substance use disorders and improve mental health and resiliency among health care professionals. The bill was signed by the President and became law on March 18, 2022.
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Fort Defiance To Be Reimbursed for Contract Support Costs After 90 Percent Slash To Funding
On May 26, 2022, the United States District Court of New Mexico ruled in favor of the Fort Defiance Indian Hospital Board (FDIHB) to be reimbursed for contract support costs (CSC). The Court ordered Indian Health Service (IHS) to reimburse FDIHB $16.6 million in monthly payments for CSC for Fiscal Year (FY) 2022. The ruling found that a 90 percent reduction of contract support costs is causing "irreparable injury" to Fort Defiance. Detrimentally harming Fort Defiance's inability to provide essential health services to patients amid the COVID-19 pandemic, Fort Defiance was forced to reduce the number of contract nurses because the reduction in CSC would have covered the salaries of permanent staff members. Fort Defiance asserted the Agency was "inspired" by the Cook Inlet decision.
Fort Defiance Indian Health Board, Inc.
The Fort Defiance Indian Health Board (FDIHB) is a Tribally-charted nonprofit healthcare organization that owns and operates a hospital campus in Fort Defiance, Arizona, and runs a health clinic in Sanders, Arizona. The FDIHB serves more than 47,000 people and most of the Navajo Nation. Under the Indian Self-Determination and Education Assistance Act (ISDEAA), the Navajo Nation designed Fort Defiance as a 'Tribal organization' for the purpose of contracting with IHS to run and operate certain health programs.
Since 2010, the FDIHB has successfully been in three-year contracts with IHS. During contract renewal proposal negotiation that began in August of 2021, FDIHB submitted FY 2022 'Annual Funding Agreement' which included a proposal of indirect CSC of $18,405,910. Replying back, IHS then stated the correct indirect CSC rate should be $18,515,007. In December of 2021, IHS replied with a partial declination that denied the full indirect CSC funding and to only fund at $1,887,739 – a 90 percent reduction rate. Pointing to prior years of funding, IHS indicated that earlier indirect CSC had included duplicative funding amounts and FY 2022 indirect CSC should therefore be reduced. FDIHB had been proposing CSC using an approved methodology. IHS did not state an issue with the methodology in the first rounds of contract negotiation.
After IHS reduced indirect CSC by 90 percent, the FDIHB filed a lawsuit against IHS in February 2022. While the outcome of the lawsuit is still pending, FDIHB then asked the Court to either permanently restore its full indirect CSC of $18.5 million or temporarily cover that sum until the decision of the lawsuit. The Court held a hearing on April 26 and a decision was made on May 26. In this decision, the judge stated that is very likely IHS, in its partial declination, violates the ISDEAA and that the erroneous 90 percent reduction rate claim is "likely to succeed" amid the lawsuit. This is on the basis that IHS may not retroactively reduce the 'secretarial amount' of CSC in years prior to the initial contract term and that the same methodology to calculate CSC rate was used during the recent and prior contract negotiation proposals. There was no substantial and material change from recent to prior CSC rates to justify a 90 percent reduction. Thus, while still waiting for the outcome of the lawsuit, the judge ordered to comply with Fort Defiance's FY 2022 renewal contract proposal of $18,515,007 in indirect CSC – to reimburse the loss of the 90 percent reduction in the amount of $16,627,268 on a prorated monthly basis.
Cook Inlet Tribal Council, Inc.
The Cook Inlet Tribal Council, Inc. (CITC) represents eight federally-recognized Tribes in Alaska. Under ISDEAA, CITC has a contract with IHS to operate an alcohol recovery program. Opened in 1992 in Anchorage, Alaska, the center has expanded over the years from residential treatment to including outpatient facilities and capabilities. In 2014, CITC received $2 million from IHS to run the program. CITC proposed to change the agreement of the contract to add $400,000 in annual facility costs to be funded as contract support costs. Although IHS declined this proposal, CITC sued IHS and was ordered to reimburse Cook Inlet in 2018.
Taking a turn of events, in August of 2021, the Cook Inlet Tribal Council, Inc. V. Dotomain ruled that council's facility costs are not CSC and overturned the 2018 ruling. Since the facility costs are what IHS would normally incur if they were to run the program, they are not eligible for reimbursement as CSC. The case points back to the council's first contract negotiations in 1992 where the facilities costs that included rent and a partial salary for a facilities coordinator were paid from the secretarial amount – not from CSC.
Indian Health Service Contract Support Cost Amendment Act
In response to the Cook Inlet decision, the National Indian Health Board (NIHB) took formal action to support a legislative fix for contract support cost administration to correct the decision. NIHB and Tribal organizations wrote to Congressional leadership to urge the adoption of an amendment to ISDEAA.
On April 7, 2022, Representative Tom Cole (R-OK-4) introduced a bill to amend the ISDEAA that would secure existing Tribal contract support cost reimbursements. The bill titled Indian Health Service Contract Support Cost Amendment Act, H.R 7455, restores the status quo of CSC in light of the Cook Inlet decision.
NIHB applauds the work of Representative Cole and his work for Tribal nations to continue providing healthcare without disruptions and is committed to overseeing the passage of this bill. To read the letter NIHB sent to Cole's office on April 26 sharing our support for H.R 7455, view here.
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