In This Issue

Congressional Leaders have reached a deal on an FY 2015 "omnibus" appropriations package which would fund the federal government for the remainder of the fiscal year.  The package includes spending until September 30 for all federal agencies with the exception of the Department of Homeland Security.  That agency has been given only short-term funding so that Republicans in Congress can revisit immigration issues next year when they will control both the House and Senate.

Details of the legislation are expected to be released later on Monday.  Politico newspaper reports that most of the domestic funding will remain flat for FY 2015. Lawmakers must pass the bill by December 11 in order to avoid a government shutdown.  

Please stay tuned to NIHB in the coming days for specific details on the FY 2015 Indian Health Service budget. 

On December 2, 2014, the House of Representatives passed the Native American Housing Assistance and Self-Determination Reauthorization Act (NAHASDA) of 2014 by a voice vote. This legislation authorizes the Native American Housing and Self-Determination Act at $650 million through 2018.  The bill includes a new program, the HUD-Veterans Affairs Supportive Housing Program (HUD-VASH) which makes Indian Tribes eligible to participate in a program that addresses homelessness of Native American veterans by providing housing and rental assistance program, and appropriates a 5 percent set aside.

It now awaits consideration by the U.S. Senate.  If the Senate does not pass before the end of 2014, the House-passed bill will not become law, and the process for reauthorization will start over in 2015. To find out how to contact your Senators on this important bill please click here.

On Friday, December 5, 2014, Department of Health and Human Services released a proposed rule on a Medicare Like Rate for non-hospital services.  This proposed rule would amend Indian Health Service (IHS) Purchased and Referred Care (PRC), (formerly known as the Contract Health Services) regulations to apply Medicare payment methodologies to all physician and other health care professional services and non-hospital-based services.  (IHS referrals currently use a Medicare Like Rate for hospital-based services.) 

Specifically, it proposes that the health programs operated by IHS, Tribe, Tribal organization, or urban Indian organization (collectively, I/T/U programs) will pay the lowest of the amount provided for under the applicable Medicare fee schedule, prospective payment system, or Medicare waiver; the amount negotiated by a repricing agent, if available; or the usual and customary billing rate.

The proposed rule states that enacting Medicare Like Rates for referred non-hospital services at IHS could save the agency could save millions per year for the purchased/referred care program.  The IHS is seeking  comments on if there should be exceptions incorporated into the rule to permit an I/T/U to retain more flexibility over the payment rate. 

The rule follows a report released by the Government Accountability Office (GAO) in 2013 that recommended this important change.  You can view that report here. NIHB has also been working with Members of Congress to enact this important change.  In June 2014, the Native CARE Act (H.R. 4843) was introduced by Congresswoman Betty McCollum (D-MN) and Congressman Tom Cole (R-OK) which would enact Medicare Like Rates for non-hospital services at IHS.

On December 3, 2014, Tribal leaders from across Indian Country attended the annual White House Tribal Nations Conference in Washington, DC.  In his address to Tribal leaders, the President addressed his comments largely on youth-related issues.  He stated: "We're going to make sure that children and families get the support they need to stay secure and healthy. And we are going to keep fighting to meet our obligations to your nations."  Vice President Biden also addressed the conference by giving a poignant speech on domestic violence issues in Indian Country.

In addition to hearing from the President and Vice President, the conference attendees heard remarks from a wide variety of Cabinet-level officials.  HHS Secretary Sylvia Mathews Burwell reaffirmed her commitment to work collaboratively with Indian Country by stating: "I am fully committed to a strong government-to-government relationship with the Tribes. It is important to me that you continue to be full partners during the design and implementation of the policies, programs, and initiatives that we fund and advance at the Department of Health & Human Services."

You can watch the video of the conference here.  

You can read President Obama's full remarks here. 

You can read Secretary Burwell's full remarks here. 
The White House Fact Sheet for the conference is available here.  

Also last week, the White House Released its 2014 Native Youth Report.  The report details some of the barriers Native youth face when compared with other Americans.  It says, "Native youth continue to face education, socioeconomic, health, and other barriers. This is nothing short of a national crisis. All of us, including the federal government, have an important role in helping to improve the lives of Native youth."

The report makes several recommendations for improving the lives of young people in Indian Country.  These include: 

• Strengthening Tribal control of education
• Providing comprehensive, community-based student supports
• Strengthening the integration of Native cultures and languages into school climate and classrooms
• Supporting highly effective teachers and school leaders
• Promoting 21st century technology for tribal education
• Strengthening and expanding efforts that target suicide prevention
• Improving community systems of care to better address the behavioral health needs of Native youth.