NCUIH Secures Huge Wins for Urban Indians in Final Enacted COVID-19 and Omnibus Bills

Policy Update: NCUIH Secures Huge Wins for Urban Indians in Final Enacted COVID-19 and Omnibus Bills

The bills include a $5 million increase for urban Indian health, FTCA, VA-IHS reimbursements, SDPI extension and COVID-19 renovation funds for UIOs.

On December 27, the “Consolidated Appropriations Act, 2021” (H.R. 133), consisting of a COVID-19 pandemic relief bill and an omnibus spending bill for Fiscal Year (FY) 2021 was signed into law. Due to the tireless advocacy by NCUIH and UIOs, there are many monumental wins for urban Indian health. Throughout the year, NCUIH assisted with facilitating over 25 calls for UIOs with federal agencies and held over 100 meetings with Congress. NCUIH representatives testified in over 13 Congressional hearings to advocate for the many long-standing priorities that were included in the final package.

Your advocacy and participation in the federal government process was critical to the adoption of the most robust urban Indian health provisions in over 50 years.  

Short Overview

In summary, the package included the following National Council for Urban Indian Health (NCUIH) priorities for Urban Indian Organizations (UIOs):

The package provides the following for IHS, Tribal organizations and UIOs:

Next Steps

Analysis

Urban Indian Health

Indian Health Service

Facilities

105(l) Leases

Health and Human Services (HHS)

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

HRSA

Native Hawaiian Health Care

COVID-19 Response

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

Tribal Use of Prescription Drug Monitoring Programs (PDMP)

VA-TAC

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

GUIDE ON EVIDENCE-BASED STRATEGIES FOR OBESITY PREVENTION PROGRAMS

IHS / Tribal Facilities / Urban Indian Organizations (UIOs)

BROADBAND CONNECTIVITY GRANTS

PUBLIC HEALTH PROVISIONS

Public Health Service Act

The full legislative text of the entire year-end package can be found here

The Explanatory Statement (Report) for FY2021 Interior (Division G) can be found here

The Explanatory Statement (Report) for FY2021 LHHS (Division H) can be found here

 

 

Topic

Section

Funding

Language

Urban Indian Health

Urban Indian Health

$62,684,000

  1. : See chart for language

UIO Infrastructure Study

$1,000,000

  1. :$1,000,000 is provided to conduct an infrastructure study for facilities run by urban Indian organizations (UIOs)”

FTCA

-

  1. : See chart for language  

IHS-VA MOU – reimbursement from VA to UIOs who provide services to AI/AN veterans

-

  1. : “Section 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645) is amended— (1) in subsection (a)(1), by inserting ‘urban Indian organizations,’ before ‘and tribal organizations’; and (2) in subsection (c)— (A) by inserting ‘urban Indian organization,’ before ‘or tribal organization’; and (B) by inserting ‘an urban Indian organization,’ before ‘or a tribal organization’.”

Indian Health Service (IHS)

IHS funding

$6,236,279,000

  1. : “The bill provides a total of $6,236,279,000 for the Indian Health Service (IHS)”

Costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’

$58,000,000

  1. : “That of the funds provided, $58,000,000 shall be for costs related to or resulting from accreditation emergencies, including supplementing activities funded under the heading ‘‘Indian Health Facilities,’’ of which up to $4,000,000 may be used to supplement amounts otherwise available for Purchased/Referred Care

Indian Health Care Improvement Fund

$72,280,000

  1. : “Provided further, That of the funds provided, $72,280,000 is for the Indian Health Care Improvement Fund and may be used, as needed, to carry out activities typically funded under the Indian Health Facilities account”

105(l) leases indefinite appropriation  

$101,000,000

  1. : “The bill includes language establishing an indefinite appropriation for payment of Tribal leases under section 105(1) of the Indian Self-Determination and Education Assistance Act, which are estimated to be $101,000,000 in fiscal year 2021.”

Health and Human Services

NHSC Loan Repayment Program

$15,000,000

  1. : “That, within the amount made available in the previous proviso, $15,000,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs”

Good Health and Wellness in Indian Country

$22,000,000

Minority HIV/AIDS Prevention and Treatment Program

$1,500,000

  1. : “The agreement includes $1,500,000 as a Tribal set-aside within the Minority HIV/ AIDS Prevention and Treatment program.”

HRSA— Hawaiian Health Care Program  

$20,500,000

  1. “Native Hawaiian Health Care. -The agreement includes no less than $20,500,000 for the Native Hawaiian Health Care Program.”

COVID-19 Response

CDC COVID-19 Response

$8,750,000,000

  1. : “For an additional amount for ‘CDC–Wide Activities and Program Support’, $8,750,000,000, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally”

CDC to IHS to I/T/U for COVID

$210,000,000

  1. : “That of the amount in the preceding proviso, $210,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pgs. 1822-1823: “That amounts appropriated under this heading in this Act may be used for grants for the construction, alteration, or renovation of non-Federally owned facilities to improve preparedness and response capability at the State and local level.”

SAMHSA— Heath Surveillance and Program Support

$4,250,000,000

  1. : “For an additional amount for ‘Heath Surveillance and Program Support’, $4,250,000,000, to prevent, prepare for, and respond to coronavirus, domestically or internationally”

Set aside for I/T/U in funding for SAMHSA

$125,000,000

  1. : “That from within the amount appropriated under this heading in this Act in the previous provisos, a total of not less than $125,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health or behavioral health service providers to tribes”

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

$11,000,000

  1. “Medication-Assisted Treatment for Prescription Drug and Opioid Addiction.- Within the amount, the agreement includes $11,000,000 for grants to Indian Tribes, Tribal Organizations, or consortia. The agreement directs SAMHSA to ensure grants allow the use of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.”

Public Health and Social Services Emergency Fund  

IHS to I/T/U for testing, contact tracing, surveillance, containment, and mitigation

$790,000,000

  1. : “That of the amount appropriated under this paragraph in this Act, $790,000,000, shall be transferred to the ‘Department of Health and Human Services—Indian Health Service—Indian Health Services’ to be allocated at the discretion of the Director of the Indian Health Service and distributed through Indian Health Service directly operated programs and to tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act and through contracts or grants with urban Indian organizations under title V of the Indian Health Care Improvement Act”   Pg. 1840: “That funds an entity receives from amounts described in the first proviso in this paragraph may also be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability at the State and local level”

 

Special Diabetes Program for Indians (SDPI)

SDPI

Extends SDPI through FY2023 at current levels

  1. : “(a) TYPE I.—Section 330B(b)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’. (b) INDIANS. —Section 330C(c)(2)(D) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)(D)) is amended by striking ‘2020, and $32,465,753 for the period beginning on October 1, 2020, and ending on December 18, 2020’ and inserting ‘2023’.”

 

Guide on Evidence-Based Strategies for Public Health Department Obesity Prevention Programs  

Obesity prevention and reduction programs in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations  

Creation of a guide of evidence-based strategies  

  1. : “The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’), acting through the Director of the Centers for Disease Control and Prevention, not later than 2 years after the date of enactment of this Act, may— develop a guide on evidence-based strategies for State, territorial, and local health departments to use to build and maintain effective obesity prevention and reduction programs, and, in consultation with Indian Tribes, Tribal organizations, and urban Indian organizations”

 

Broadband Connectivity Grants

Tribal Broadband

$1,000,000,000

  1. : “There is appropriated to the Assistant Secretary, out of amounts in the Treasury not otherwise appropriated, for the fiscal year ending September 30, 2021, to remain available until expended— (1) $1,000,000,000 for grants under subsection 15 (c)” […] “(c) TRIBAL BROADBAND CONNECTIVITY PROGRAM.— (1) TRIBAL BROADBAND CONNECTIVITY GRANTS.—The Assistant Secretary shall use the funds made available under subsection (b)(1) to implement a program to make grants to eligible entities to expand access to and adoption of— (A) broadband service on Tribal land; (B) remote learning, telework, or telehealth resources during the COVID–19 pandemic.”

 

Public Health Provisions

Title 3 of the Public Health Service Act is amended by inserting Sec. 330N

$10,000,000

  1. : “Title III of the Public Health Service Act is amended by inserting after section 330M (42 U.S.C. 254c–19) the following: SEC. 330N. EXPANDING CAPACITY FOR HEALTH OUTCOMES. (a) DEFINITIONS. —In this section: (1) ELIGIBLE ENTITY. —The term ‘eligible entity’ means an entity that provides, or supports the provision of, health care services in rural areas, frontier areas, health professional shortage areas, or medically underserved areas, or to medically underserved populations or Native Americans, including Indian Tribes, Tribal organizations, and urban Indian organizations […] (b) PROGRAM ESTABLISHED.—The Secretary shall, as appropriate, award grants to evaluate, develop, and, as appropriate, expand the use of technology-enabled collaborative learning and capacity building models, to improve retention of health care providers and increase access to health care services, such as those to address chronic diseases and conditions, infectious diseases, mental health, substance use disorders, prenatal and maternal health, pediatric care, pain management, palliative care, and other specialty care in rural areas, frontier areas, health professional shortage areas, or medically underserved areas and for medically underserved populations or Native Americans. […] (k) AUTHORIZATION OF APPROPRIATIONS. —There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2022 through 2026.’’

 

 

By NCUIH, posted on Wednesday January 13, 2021
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