Posted on September 04, 2024
What It Is:
On September 4, 2024, the U.S. Department of Health and Human Services (HHS) announced two new policies on data access. One policy would be for Tribes, and one for Tribal Epidemiology Centers (TECs). According to HHS, “the revised documents reflect the input received from Tribal leaders in prior consultation, as well as internal HHS working group experts.”
• The Tribal Data Access policy can be found here.
• The TEC Data Access policy can be found here.
• The Dear Tribal leader letter on the policies is available here.
Posted on August 30, 2024
The legacy of colonialism has sustained ongoing cycles of violence and oppression, particularly evident in intimate partner violence (IPV) within American Indian and Alaska Natives (AI/AN) communities, rooted in themes of domination and control. Oppression refers to the unjust treatment of a group, often enforced by authorities, leading to shame—a tool of oppression, as described by Brené Brown. This "chronic shame" has deeply affected Indigenous peoples due to colonialism, which disrupted social structures and cultural practices through forced relocation, assimilation, and systemic discrimination. An example is the cultural genocide perpetrated by Federal Indian Boarding Schools, aiming to "kill the Indian."
Like colonialism, IPV is closely linked to shame, with abusers employing humiliation tactics that leave survivors feeling deeply ashamed of their experiences. This shame can be intensified by the reactions of others upon learning of the abuse. Understanding the connection between intergenerational trauma and IPV is vital, as both contribute to profound feelings of shame and hopelessness. This chronic sense of shame, passed down through generations, has numbed and normalized passive acceptance and silence surrounding IPV in Indian Country.
Posted on July 26, 2024
From July 16 to 18, 2024 the Centers for Medicare and Medicaid Services(CMS) Tribal Technical Advisory Group (TTAG)and the Medicare, Medicaid, and Health Care Reform Policy Committee (MMPC) held their face-to-face meetings in Washington, DC. These meetings gathered Tribal leaders, federal representatives, and Tribal health policy advocates to engage on current priorities and issues.
The TTAG meeting started with Dan Tsai, Deputy Administrator and Director of the Center for Medicaid and CHIP Services (CMCS), sharing key updates including the publication of a proposed rule that would resolve the longstanding “Four Walls Issue” for Tribes. The Hospital Outpatient Prospective Payment System proposed rule includes language that would “create exceptions to the Medicaid clinic services benefit four walls requirement, to authorize Medicaid payment for services provided outside the four walls of the clinic for IHS/Tribal clinics.” TTAG Chairman Ron Allen and other TTAG members shared appreciation with Tsai for CMS’s partnership in addressing this important issue.
Deputy Administrator Tsai also provided updates on the CMS framework for Medicaid coverage of traditional health care practices included in section 1115(a) demonstration waivers. The TTAG and NIHB submitted comments in early May of this year providing input on the framework. Tsai also announced that the agency intends to additionally include Urban Indian Organizations(UIOs) as facilities that are eligible for Medicaid reimbursement in the framework. The State Demonstrations Group within CMS aims to review all four pending waivers with traditional healing components from Arizona, New Mexico, California, and Oregon simultaneously.
TTAG Member and National Council of Urban Indian Health (NCUIH) Board President Walter Murillo discussed the ongoing Medicaid billing fraud in Arizona substance use disorder rehabilitation centers that have exploited American Indian and Alaska Native individuals (AI/AN). Murillo emphasized that this issue is about a lot more than financial crimes: for patients, this is about human trafficking. TTAG representatives have shared stories of these schemes targeting AI/ANs in many ways including transporting individuals to fraudulent centers that eventually close, leaving people without access to critical resources such as housing. Furthermore, Murillo pointed out the need to address oversights in Medicaid programs that allow these problems to occur and the need for CMS to provide resources for the people who have been a target of these crimes.
The July Face-to-Face meeting also featured several updates from CMS and TTAG member organizations. The National Indian Health Board (NIHB) staff presented updates on its traditional healing project, which seeks to provide foundational information necessary to illuminate the barriers that inhibit the utilization of traditional healing practices. NIHB also presented an update on its implementation of a TTAG strategic plan evaluation process and the future of the next TTAG strategic plan.
The next TTAG Face-to-Face Meeting will take place in November and will mark the last meeting of the Biden Administration.
Posted on July 24, 2024
Amber Torres, Interim Chief Operations Officer, Walker River Paiute Tribe of Nevada, National Indian Health Board (NIHB) testified before House Natural Resources Committee, Subcommittee on Indian and Insular Affairs, July 24, 2024. Torres’ testimony focused on three pieces of legislation, H.R. 8956, the Uniform Credentials for IHS Providers Act of 2024, H.R. 8942, the Improving Tribal Cultural Training for Providers Act of 2024, and H.R. 8955, the IHS Provider Integrity Act.
Healthcare workforce is the critical component of the Indian health system that directly meets the trust and treaty obligation to provide for the healthcare of the Tribes. The legislation before the committee today seeks to address several important components of the staffing and provider hiring and onboarding process.
While NIHB supports the goal the legislation to improve staffing at IHS-operated facilities, there is more work that needs to be done to ensure that the language would not inadvertently impact Tribally operated health systems, and would not have a negative impact on the efficiency of the IHS hiring process.
“The language of the proposed bills would benefit from deeper dialogue with Tribes and IHS to ensure they fully meet the intent of Congress to improve the hiring and onboarding process for providers and the healthcare experience and outcomes for Tribal citizens,” said Torres. “It is also important that the legislation is clear in its intent to improve the operations of the IHS, and that it does not infringe on the sovereignty of Tribes which operate their programs through agreements under the Indian Self-Determination and Education Assistance Act.”
Additionally, Torres encouraged the House Natural Resources Committee to support changes that would categorize CSC and 105(l) leases as mandatory funding.
“Contract support costs and 105(l) lease payments have been determined by the U.S. Supreme Court to be required costs, regardless of the appropriation levels. Therefore, Congress must essentially pay these costs first before other areas of the IHS and Bureau of Indian Affairs budgets can be considered. In recent years, increases to CSC and 105(l) leases limited growth in direct services, facilities, and other administrative support to the IHS budget that would have otherwise gone to support maintaining current staffing and service levels,” Torres said.
Read NIHB's written testimony here.
Posted on July 10, 2024
On July 9, the House Appropriations Committee passed out its version of the Interior, Environment, and Related Agencies FY 2025 appropriations bill which contained significant increases for Tribal programs. Upon passage of the legislation, Chairman Cole shared: “As the first Native American to lead this committee, I commend the strong investments that uphold our nation’s trust and treaty responsibilities to our tribal communities.”
National Indian Health Board
