January 7, 2015 |  Issue 15-01




Affordable Care Act Mother's Tribal Day of Action 

January 13, 2015


IHS Tribal Self-Governance Advisory Committee 
January 27-28, 2015

Washington, DC


Affordable Care Act National Tribal Day of Action 

February 7, 2015


IHS FY 2017 National Budget Formulation Work Session

February 10-11, 2015

Washington, DC


Medicare, Medicaid Policy Committee Meeting

February 17, 2015

Washington, DC 


CMS Tribal Technical Advisory Group 

February 18-19, 2015

Washington, DC 


Direct Service Tribes Advisory Committee Meeting 

February 18-19, 2015

Nashville, TN


Secretary's Tribal Advisory Committee Meeting

March 17-18, 2015

Washington DC


NIHB Tribal Public Health Summit 

April 7-9, 2015

Palm Springs, CA


NIHB Annual Consumer Conference

September 21-24, 2015

Washington, DC

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In This Issue


Capitol Hill Updates

Yesterday marked the start of the 114th Congress.  It is the first time since 2006 where both chambers will be controlled by the Republican Party, but divisions remain within the party that might make passing legislation difficult.  The Senate will have 13 new members while the House will have 60 new Members of Congress.  


As we head into 2015, there are many deadlines and challenges that Congress must deal with and several of these will be important to Tribal communities.  Appropriations for FY 2016 will continue to be a sticking point in the new Congress.  The Budget Control Act of 2011 will provide for sequestration in FY 2016 unless a deal can be reached to ensure that federal spending remains below the statutory caps in the law. Republican leadership will have to decide if they will make an attempt to replace the cuts in part or in whole or write bills to the lower level. There is pressure to do both.  NIHB will be educating the Congress in the coming weeks and months on Tribal health priorities for FY 2016.  Tribes may also submit testimony to the House and Senate Appropriations Committees detailing your priorities.  For your information, NIHB will send updates when information on submitting testimony is available.


On March 31, 2015, the current patch for the "Sustainable Growth Rate" or "Doc Fix" will expire.  This is the legislation that governs the rates that physicians are paid by Medicare.  It is also typically the legislative vehicle for the renewal for the Special Diabetes Program for Indians (SDPI).  SDPI will expire on September 30, 2015 unless Congress acts.  NIHB will be working tirelessly to educate Congress on the success of the SDPI program.  Tribes across Indian Country have called for multi-year renewal to further sustainability of their programs.  As in past years, that will largely depend on the ability of Congress to agree on a long-term "Doc Fix."  Please visit www.nihb.org/sdpi for more information.


NIHB will also continue to educate Congress on key legislative priorities for Tribes in the new Congress.  These include advance appropriations for the Indian Health Service, achieving a Medicare Like Rate for non-hospital Purchased/Referred Care at the Indian Health Service, and a legislative fix for the Definition of Indian in the Affordable Care Act.


For a general article on some of the upcoming challenges facing the new Congress please click here

Administration Updates

New SAMHSA Grant Opportunities

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is accepting applications for fiscal year (FY) 2015 Strategic Prevention Framework Partnerships for Success cooperative agreements (SPF-PFS 2015). The SPF-PFS program is designed to address two of the nation's top substance abuse prevention priorities: 1) underage drinking among persons aged 12 to 20; and 2) prescription drug misuse and abuse among persons aged 12 to 25.


Application Due Date: Monday, March 16, 2015


Anticipated Award Amount: From $318,543 to $2,472,608 per year


Please click here for more information.



The Employer Shared Responsibility Rule, otherwise known as the Employer Mandate, states that all employers, who employ more than 50 people, must offer health insurance to their employees or pay a penalty.  Many Tribal governments are currently counted as large employers for application of this rule and cannot afford to offer insurance or pay a penalty.  As a result, many Tribes are very concerned about their ability to meet the mandate which went into effect January 1st.  There is transition relief for employers with 50-99 employees.


American Indians and Alaska Natives (AI/AN) are exempt from the Individual Mandate to purchase health insurance under the Affordable Care Act (ACA).  This is in recognition of the fact that AI/ANs should not be forced to purchase healthcare that the federal government is obligated to provide based on the federal government's trust responsibility, which is delivered, primarily, through the Indian Health Service (IHS).  By requiring Tribal employers to offer such coverage to AI/ANs, and penalizing them if they do not, the federal government is essentially invalidating the AI/AN exemption from the individual mandate by shifting the penalty from the individual to the Tribe itself and restricting health care coverage for AI/AN.  This is contrary to the intent of the ACA which was created to expand access to coverage, control health care costs, and improve health care quality and coordination. 


NIHB has heard from Tribes on this matter and is advocating on their behalf to the federal government.  NIHB is working closely with other organizations on finding a regulatory fix for this problem that all Tribes will be happy with. 


For more information, please contact Devin Delrow at 202-507-4072 or ddelrow@nihb.org.  


Other Updates
Kaiser Family Foundation Report: Disparities Persist for AI/ANs over 65

According to a report released by the Kaiser Family Foundation on December 18, 2014, disparities persist among those who are 65 or older and have disabilities.  Medicare provides coverage for most American Indians and Alaska Natives, but its relatively high cost-sharing and gaps in benefits can be problematic if individuals don't have additional supplemental coverage or can't access Indian Health Service providers.


You can view the full report here


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