November 18, 2013  |  Issue 13- 34


In This Issue


Save the Dates for 2014 Public Health Summit and 2014 Annual Consumer Conference



Millions Could be Saved by Supporting Medicare-Like Rates for IHS


World Diabetes Day - Raising Awareness of Diabetes Treatment and Prevention

  • SAVE THE DATE -  5th Annual NIHB Tribal Public Health Summit, Holiday Inn Grand Montana, Billings, MT, April 1-3, 2014.


  • SAVE THE DATE - 31st NIHB Annual Consumer Conference (ACC), Albuquerque, NM, September 22-25, 2014. The National ACC will be hosted by the Navajo Area Indian Health Board.  



Stay tuned to in the coming weeks for updates on the Public Health Summit and the Annual Consumer Conference. We hope to see you there. 


On November 13, over 300 Tribal leaders from the 566 federally-recognized Tribes from across Indian Country gathered in Washington, D.C. at the Department of the Interior to meet with President Obama and members of his Cabinet as well as other key Administration leaders. The Tribal leaders in attendance also participated in a variety of "breakout sessions" on several key topics, including health. During the Tribal Nations Conference, Secretary of the Department of Health and Human Services, Kathleen Sebelius, reconfirmed that the Department is committed to working to reduce health disparities in Indian Country. Secretary Sebelius also highlighted special benefits for AI/ANs in the Affordable Care Act, the success of the Indian Health Service/ Veterans' Administration reimbursement agreement and the injustice of sequestration to Indian Country.


During his remarks, the President recommitted his support for American Indians and Alaska Natives (AI/ANs). He said, "I promised that Tribal nations would have a stronger voice in Washington ... And for the past five years, my administration has worked hard to keep that promise -- to build a new relationship with you based on trust and respect."


President Obama articulated four key areas for focus - strengthening justice and sovereignty; increasing economic opportunity; expanding quality health care; and protecting native homelands. The President reiterated his support for strong implementation of the Affordable Care Act in Indian Country. "We've got to keep our covenant strong by making sure Native Americans have access to quality, affordable health care just like everybody else," he said. "That's one of the reasons we fought hard to pass the Affordable Care Act...For Native Americans, this means more access to comprehensive, affordable coverage." He also addressed contract support costs by saying, "We've heard loud and clear your frustrations when it comes to the problem of being fully reimbursed by the federal government for the contracted services you provide, so we're going to keep working with you and Congress to find a solution."


NIHB Chairperson Cathy Abramson said: "Since President Obama has been in office, we have come a long way. We still have a long way to go but I still have hope can improve health care access to our people across the nation. This was the first time the President talked about Contract support costs so that was hopeful. I hope the president's words are reflected in the actions of the Administration."


To view the Conference in its entirety, CLICK HERE. To view the President's remarks to Tribal leaders, CLICK HERE.


On Thursday, November 14, the Senate Committee on Indian Affairs held a hearing titled: "Contract Support Costs and Sequestration: Fiscal Crisis in Indian Country." The hearing featured both Tribal leaders and Obama Administration officials. Testifying for the Administration were Acting Director of the Indian Health Service, Dr. Yvette Roubideax and Assistant Secretary for Indian Affairs, Kevin Washburn. The Tribal leaders testifying were, President Brian Cladoosby with the National Congress of American Indians; Chairwoman Karen Diver of the Fond du Lac Band of Lake Superior Chippewa; Vice Chairman Alfred "Bud" Lane of the Confederated Tribes of Siletz Indians; Chief Phyliss Anderson of the Mississippi Band of Choctaw Indians; Lieutenant Governor Jefferson Keel of the Chickasaw Nation; and Chairman Aaron Payment with the Sault Ste. Marie Tribe of Chippewa Indians.


During the hearing. the Senators spoke against the harmful sequestration cuts and advocated for an exemption for Tribal communities. "Our country's financial troubles are not really stemming from our obligations to Indian Country, and frankly, we're not doing a good job in fulfilling those obligations" said Chairwoman Maria Cantwell (D-WA). Senator Tom Udall (D-NM) noted that "Tribal programs should be exempted from sequestration, especially the Indian Health Service. It is shameful that IHS is the only direct federal medical service agency not exempted in some way from sequestration."


Chief Phyliss Anderson with the Mississippi Band of Choctaw Indians testified that sequestration has affected over 60 programs on their reservation and that sequestration has had a "significant impact on patient care, hospital services, and public health on the reservation." Chairwoman Karen Diver of the Fond du Lac Band noted, "Because of these cuts, the Fond du Lac Band has been compelled to lay off staff, and reduce some services, and eliminate others all together."


Regarding Contract Support Costs, the Committee members expressed bipartisan support for Indian Country on the resolution of this issue. Senator Lisa Murkowski (R-AK) said, "The Supreme Court decision in Ramah is... unequivocal. The fact that we are continuing to bring this up before members of the Administration, I find very, very frustrating." When questioned by Senator Jon Tester (D-MT) Assistant Secretary for the Bureau of Indian Affairs Kevin Washburn, said that the Administration's proposal to put individual caps on contract support costs is "not something that makes a lot of sense in many respects..."


Lieutenant Governor Jefferson Keel of the Chickasaw Nation stated that, "The Contract support cost issue is truly a 'crisis' for the Chickasaw Nation, both when it comes to the status of our claims... and when it comes to the continuing annual shortfalls, we suffer and which we must therefore subsidize year in and year out. To close the hearing, Committee Chairwoman Cantwell said, "Hopefully we can now move forward in resolving both of these issues. Getting some parity as it relates to health services in sequestration and dealing with contract support..."


You can view the Committee's Press Release of the committee hearing HERE. You can view a webcast of the hearing HERE


If you have any questions or would like more information regarding this hearing, please contact Caitrin Shuy, NIHB's Manager of Congressional Relations at (202) 507-4085 or



g Millions Could be Saved by Supporting Medicare-Like Rates for IHS 

In April 2013, the Government Accountability Office (GAO) found that the Indian Health Service (IHS) could save $32 million annually if payments made for nonhospital Contract Health Services (CHS) care were paid at Medicare-like Rates (MLR). NIHB and its partners in Indian Country are working with Congress to enact this change.


In 2003, Congress enacted legislation to require hospital services under CHS to pay Medicare-Like Rates. CHS non-hospital visits are the only federal health care programs that continue to pay full billed charges for non-hospital services. On average, full billed charges are nearly 70 percent more than negotiated rates. The GAO report estimates that by expanding the MLR to non-hospital services, IHS and Tribal CHS programs would be able to save millions of dollars and dramatically increase the care they are able to provide. As discretionary spending grows scarce, this is a common-sense solution that would use federal dollars more efficiently. The Veteran's Administration and the Department of Defense have already capped their rates for non-hospital providers and CHS programs should be authorized to do so as well.


The GAO report found that this pricing mechanism would have little impact on access to providers, which is already a chronic need in Indian Country. The proposed legislation would require that any provider accepting Medicare to also accept MLR for payments billed to CHS programs. As the GAO report points out, most providers and suppliers already participate in Medicare, and are used to paying Medicare rates for services.


Click HERE to read the full GAO report. Click HERE to send a sample letter to Congress in support of this issue.


If you have any questions or would like more information about this issue please contact Caitrin Shuy, NIHB's Manager of Congressional Relations at (202) 507-4085 or



h World Diabetes Day - Raising Awareness of Diabetes Treatment and Prevention  

November 14 - World Diabetes Day - was a great opportunity for Indian Country to help raise awareness of diabetes treatment and prevention as well as encourage people in Tribal communities to take control of their health. On World Diabetes Day, the National Indian Health Board (NIHB) urged supporters to join NIHB and Tribal Communities in an SDPI National Call-In Day Event and ask their Senators and Representatives to support renewal of the Special Diabetes Program for Indians (SDPI). The SDPI provides critical funding to programs that are helping our Tribal communities address complications and burdens of Type 2 diabetes.


Also on World Diabetes Day, Native America Calling (NAC) hosted a national radio broadcast titled "Speaking Out Against Diabetes." The focus of the broadcast was to raise awareness of the high rate of diabetes in Indian Country, discuss with program listeners key information about what NIHB is doing on a national level to get the SDPI renewed by Congress this year and insights on incorporating healthy daily eating habits. NIHB continues to collaborate with SDPI stakeholders and other supporters on educating Congressional Members about the tremendous impact SDPI is having in changing the diabetes landscape in Indian Country. Guests on the show included Jeremy Marshall, NIHB Senior Legislative Associate, and Dr. Kendall Shumway, Diabetes Program Manager, of the Riverside San Bernardino County Indian Health, Inc. Diabetes Program. Please visit the NAC website to listen to the audio portion of the broadcast.


For more information about the SDPI, please contact Jeremy Marshall, NIHB Senior Legislative Associate, at or at (202) 507-4078. Stay tuned to the SDPI Resource Center websites for updates on the SDPI renewal campaign and how you can become involved.  

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