May 3, 2016 |  Issue 16-16
MMPC Monthly Call
May 4, 2016
2:00 PM EDT

Treasury Consultation Call: ACA Employer Mandate
May 13, 2016
3:00 PM EDT

Nurse Leaders in Native Care Conference
May 17-19, 2016
Glendale, AZ

CMS All Tribes Call: Medicaid Managed Care Final Rule
May 23, 2016
12:30PM EDT

Direct Service Tribal Advisory Committee Quarterly Meeting
June 1-2, 2016
Rockville, MD
HHS Secretary's Tribal Advisory Committee Meeting
June 7-8, 2016
Washington, DC

MMPC Annual Spring Retreat
June 13-14, 2016
Nashville, TN

NIHB Annual Tribal Youth Health Summit
August 1-5, 2016
Location: TBD

National AI/AN Behavioral Health Conference
August 9-11, 2016
Portland, OR

Direct Service Tribes Annual Meeting 
August 30 - September 1, 2016
Rapid City, SD

HHS Secretary's Tribal Advisory Committee Meeting
September 13-14, 2016
Washington, DC

33rd NIHB Annual Consumer Conference

September 19-22, 2016
Phoenix, AZ

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NIHB Updates
2016 MMPC Retreat- June 13 and 14 in Nashville, Tennessee

The Medicare, Medicaid, and Health Reform Policy Committee (MMPC) Retreat is scheduled for Monday, June 13 to Tuesday, June 14. The Retreat will be held at the
Downtown Nashville Holiday Inn Express.
The MMPC is a standing committee of the National Indian Health Board (NIHB), comprised of Tribal leaders, Tribal representatives, and technical advisers dedicated to effecting solutions surrounding the delivery of health care for American Indians and Alaska Natives.  The MMPC works on issues revolving around the Affordable Care Act (ACA) and the Indian Health Care Improvement Act (IHCIA), regulation review, and other health policy issues.  The MMPC also provides technical support to the Tribal Technical Advisory Group (TTAG) to the Centers for Medicare and Medicaid Services (CMS).
The purpose of the MMPC Retreat is to strategize, debrief, and set priority items and issues for the last year of the Obama Administration.  The draft agenda (here
includes the following priority issues: the ACA Employer Mandate,the Medicaid Managed Care Final Rule, 100% Federal Medical Assistance Percentage (FMAP), Medicare-like Rates, and the Medicare Access and CHIP Reauthorization Act proposed regulations.  The Retreat is also an opportunity to streamline our process and deliberate on how the MMPC will operate for the coming year. 

When making a hotel reservation (prior to May 13) at the Holiday Inn Express, you will be prompted to input the June 13th arrival date and then taken to the discounted group rate.  For reservations, call 877.HIE.STAY (443.7829) and request the "National Indian Health Board" block to make reservations over the phone.

Please contact Sarah Freeman, NIHB Policy Associate at or call (202) 507-4077 with any questions or comments you may have regarding the MMPC Retreat or to join the MMPC listserv.

Click here to make a reservation at the Holiday Inn Express for the MMPC 2016 Retreat. 
SAVE the DATE:  NIHB Annual Consumer Conference
The National Indian Health Board's 33rd Annual Consumer Conference will be held from September 19-22, 2016 at the Talking Stick Resort in Scottsdale, Arizona. 
The Conference will provide the most up-to-date and important information Tribal leaders, health directors and consumers will need as they work toward reducing American Indian and Alaska Native health disparities through continued advancement of the Tribal health care system. In addition to an in-depth, special focus on federal policy, conference attendees will have an opportunity to learn about best practices and share their community's concerns with key federal decision-makers. 
Information on registration, award nominations and workshop proposals will be available in the coming weeks. 
To reserve your room call (866) 877-9897 and reference NIHB Group Number 10677.
Capitol Hill Updates
Opioid Legislation Advances in the House
Last week, the House Energy and Commerce Committee and the House Judiciary Committee advanced over a dozen pieces of legislation that would target several issues related to opioid abuse throughout the country.  The bills address a range of issues, mostly by authorizing new federal grants to expand access to treatment and overdose-reversal drugs.  NIHB worked closely with Congressman Markwayne Mullin's office to make sure that Indian health programs were included as part of a report on opioid treatment access.  You can read more on that here.

The Comprehensive Opioid Abuse Reduction Act (H.R. 5046), passed last week by the Senate Judiciary Committee, contains authorization of a comprehensive opioid abuse grant program that encompasses a variety of new and existing programs, such as vital training and resources for first responders and law enforcement, criminal investigations for the unlawful distribution of opioids, drug courts, and residential substance abuse treatment.  NIHB also worked with Committee staff to ensure that Indian Country was included as part of this grant program.  It is expected that the full House of Representatives will consider a package of opioid legislation during the week of May 9.
In March, Senate passed the S. 524, the Comprehensive Addiction and Recovery Act, which also authorizes new grant programs and spending targeted at opioid treatment and prevention.  The House package differs from the Senate-passed version, so lawmakers will have to work out these various differences before the legislation can become law.  
Government Accountability Office Releases Report on IHS Wait Times
Last week the Government Accountability Office (GAO) released a report on patient wait times at the Indian Health Service (IHS).  As part of this report, GAO found that "IHS has not conducted any systematic, agency-wide oversight of the timeliness of primary care provided in its federally operated facilities."  It further found that the electronic health record system used by IHS noes not "provide complete information on patient wait times," making it harder for staff to track the wait times.
The GAO recommended that IHS "(1) communicate specific agency-wide standards for patient wait times, and (2) monitor patient wait times in its federally operated facilities, and ensure corrective actions are taken when standards are not met."
You can read the full report here.
Administration and Organizational Updates
CMS Releases new Medicaid Managed Care Final Rule
On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) Released its final rule modernizing the Medicaid Managed Care regulations to reflect changes in the usage of managed care delivery systems.  The rule is open for public inspection here and will be published in the Federal Register on May 6, 2016.  

The final rule aligns, where possible, many of the rules governing Medicaid managed care with those other major sources of coverage, including coverage through qualified health plans and Medicare Advantage plans; implements statutory provisions; strengthens actuarial soundness payment provisions to promote the accountability of Medicaid managed care program rates; and promotes the quality of care and strengthens efforts to reform delivery systems that serve Medicaid and Children's Health Insurance Program (CHIP) beneficiaries.  The rule also codifies the Indian managed care protections in section 5006 of the American Recovery and Reinvestment Act (ARRA), including those provisions that permit AI/ANs enrolled in Medicaid managed care plans to continue to receive services from an Indian health care provider and ensures Indian health care providers are reimbursed appropriately for services provided.  

The final rule also addresses Tribal comments that NIHB sent to CMS concerning network and payment requirements for managed care plans that serve Indians, contracts with Indian health care providers, state Tribal consultation requirements, and referral and prior authorization requirements.  CMS has committed to following up the regulation with additional sub-regulatory guidance.  They will be having an All-Tribes call where additional Tribal input is requested.  The information is below.


CMS All Tribes Call

Monday, May 23, 2016

12:30 - 2:00 PM ET

Conference Call: 1-866-901-6455

Participant Code: 361-333-070

NIHB will be providing further information on the final rule in the coming weeks.  For more information, please contact Devin Delrow, Director of Federal Relations, at
CMS Releases Medicare Access and CHIP Reauthorization Act (MACRA) Proposed Rule
On April 27, the Centers for Medicare and Medicaid Services (CMS) released highly anticipated changes to modernize Medicare physician payments for patient quality of care. The proposed regulations are focused on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) relating to the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) and how they apply to eligible Medicare clinicians.  In 2015, Congress passed a law to repeal the Medicare Sustainable Growth Rate and strengthen Medicare access.  In 2019, CMS will pay eligible Medicare clinicians participating in MIPS or APMs through the Quality Payment Program.  A Delivery System Reform video created by the U.S Department of Health and Human Services (HHS) can be viewed here.
MACRA streamlines the performance measure reporting by consolidating the current programs of the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs) into the MIPS program.  MACRA authorizes incentive payments for providers who participate in Alternative Payment Models (APMs).  It is designed to provide new ways to pay health care providers for the care of Medicare beneficiaries.  Examples of APMs include Accountable Care Organizations (ACOs), Patient-Centered Medical Homes, and bundled payment models.

The rule proposes Merit-based Incentive Payment System (MIPS) performance standards for all measures and activities applicable to the following four performance measures: quality, resource use, clinical practice improvement activities, and meaningful use of certified Electronic Health Record (EHR) technology.  The MIPS performance period begins in 2017 and will affect payments in 2019.

The comment period for the MACRA Proposed Rule is open until June 27, 2016.  The National Indian Health Board (NIHB) will be submitting comments and we welcome Tribes and Tribal organizations to contribute to our MACRA discussions before the comment period is closed.  Please contact Sarah Freeman, NIHB Policy Associate at to join the MACRA discussion and contribute with comments or questions regarding MACRA.

The Proposed Rule can be accessed here and a CMS MACRA PowerPoint presentation can be accessed here.  

CMS is providing multiple webinars for stakeholders to discuss and provide feedback on MACRA and MIPS. Please see below for webinar dates and times.


Overview of the Quality Payment Program Proposed Rule

Date: Tuesday, May 3, 2016

Time: 12:00pm-1:00pm ET

Register: To participate, visit the registration webpage


The Merit-Based Incentive Payment System (MIPS) in the Quality Payment Program

Date: Wednesday, May 4, 2016

Time: 12:00pm-1:00pm ET

Register: To participate, visit the registration webpage


MACRA Listening Session: Quality Payment Program

Date: Tuesday, May 10, 2016

Time: 2:00pm-3:00pm ET

Register: To participate, visit the MLN registration webpage

Tribal Management Grants Available for Tribes and Tribal Organizations
The Indian Health Service is now accepting applications for the Tribal Management Grant Program, a competitive grant for federally recognized Tribes and Tribal organizations that is administered by the IHS Office of Direct Service and Contracting Tribes (ODSCT).

The intent of the grant program is to prepare Tribes and Tribal organizations for assuming all or part of exiting IHS programs, functions, services and activities, and further develop and improve their health management capabilities. Read more here.

Important deadlines to remember:

Applications due: June 8, 2016

Review dates: June 20-24, 2016

Earliest anticipated start date: September 1, 2016

Upcoming Events, Calls and Webinars
IHS to Hold a Call on LGBT2S Health Issues - May 5, 2016
The Indian Health Service will hold a public teleconference call on May 5, 2016 from 3:00 to 5:00pm ET to seek broad input on efforts to advance and promote the health needs of the American Indian and Alaska Native Lesbian, Gay, Bisexual, Transgender and Two-Spirit communities. This is the first of a series of public teleconferences that will take place this year.  Themes that resulted from previous discussions included service and eligibility; clinical services; behavioral health; suicide; youth services; confidentiality and organization strategies.
Join the meeting by calling the toll free phone number at 800-857-9744, followed by the participant passcode number, 3618057. Please call at least 15 minutes prior to the meeting.
Treasury Consultation Call with Tribes on the ACA Employer Mandate - May 13, 2016
On Friday, May 13, 2016 at 3:00PM EDT the U.S. Department of Treasury will be holding a Tribal consultation conference call on the Affordable Care Act Employer Shared Responsibility Provisions.  The purpose of the consultation call is to engage Tribal leaders and their representatives in government-to-government consultation on the application of the employer shared responsibility provisions of the ACA to Tribal employees.

Date: Friday, May 13, 2016
Time: 3:00PM EDT
Call-In Number: 888-390-0682
Passcode: 6432
For more information on the ACA Employer Mandate or the Tribal consultation call with Treasury, please feel free to contact Devin Delrow, NIHB Director of Federal Relations at or 202-507-4072.
IHS to Hold Nurse Leaders in Native Care Conference - May 17-19, 2016
IHS announced the 2016 Indian Health Service, Nurse Leaders in Native Care Conference, Nurse Leadership: Promoting Quality Care, Ethical Practice and Patient Safety, May 17 - 19, 2016, in Glendale, Arizona to all Tribal and Urban Indian Health Systems on behalf of Headquarters (HQ), Division of Nursing Services (DNS).
HQ DNS welcomes and invites all Tribal and Urban nurses and nurse leaders to attend the conference.  There is no registration fee.  

Click here for more information.
For any questions, please contact: 
Celissa G. Stephens, MSN, BSN, RN
CAPT U.S. Public Health Service
Chief Nurse/Director, Division of Nursing Services
Tel.  301-443-5070
HRSA To Hold Tribal Consultation on June 15, 2016
The Health Resources and Services Administration (HRSA) will be holding its annual Tribal consultation (link in DTLL here) with Tribes on June 15, 2015, from 8:30 AM to 5:15 PM in Washington, DC, in partnership with the Administration for Children and Families (ACF).  HRSA is the Federal agency charged with improving access to health care through the health care workforce, building healthy communities and achieving health equity.  HRSA's programs specialize in providing health care to people in geographically isolated, economically or medically vulnerable communities.  The consultation will focus on three priority areas: Improving Access to Quality Health Care and Services; Strengthening the Health Workforce; and Building Healthy Communities.  Written testimony or questions for HRSA can be submitted no later than June 8, 2016 to  To register for the consultation, please go to (access code: ACFHRSAConsultation).  Please see below for further details regarding the consultation location.
When: June 15, 2016, 8:30 AM to 5:15 PM
Where: Residence Inn Marriot, Capitol Hill,
333 Street SW, 334
Washington, DC 20024
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071
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