May 31, 2016 |  Issue 16-17

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

Tribal Publich Health Accreditation Advisory Board Meeting
June 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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In This Issue

NIHB Updates

Capitol Hill Updates
NIHB Updates
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. In the meantime, to reserve your room call (866) 877-9897 and reference NIHB Group Number 10677.
NIHB Presents at Enroll America!

The National Indian Health Board's Director of Tribal Health Care Reform, Dawn Coley, presented on a panel alongside Mary Smith, Principal Deputy Director of the Indian Health Service, on Thursday May, 12, at the Enroll America Conference. The panel session was titled "Enrolling Indian Country: Building Capacity to Reach Tribal Communities." The workshop was aimed at building assister capacity to effectively engage Tribal members in outreach and education on the Patient Protection and Affordable Care Act (ACA). Specifically, the panel focused on educating the audience of over 30 participants on special provisions within the ACA for American Indian and Alaska Natives (AI/AN), highlighted best practices around relationship development in Tribal communities, provided detail on strategies to improve the enrollment of AI/ANs, and provided context on the barriers to accessing health care on and off Tribal reservations for AI/ANs. This was a first for Indian Country to have the opportunity to present at Enroll America, and NIHB looks forward to inviting Tribal partners to participate in the next event.
Don't forget that American Indians and Alaska Natives can enroll in the federal health insurance Marketplace at any time. Explore your options now by visiting you have any questions, please contact Dawn Coley at
Tribal Input Needed on Tribal Behavioral Health Agenda
The highlights from the first draft of a Tribal Behavioral Health Agenda have been Posted Here and comments are currently being accepted on the content. This document is not the final version, but contains the defining foundation elements and recommended strategies that are at the heart of the TBHA.  Please send comments to NIHB by sending an email to Jackie Engebretson, NIHB Public Health Project Coordinator, at
Capitol Hill Updates
Senators Take Action on IHS Shortfalls
U.S. Senator John Barrasso (R-WY), chairman of the Senate Committee on Indian Affairs, and Senator John Thune (R-SD) introduced the Indian Health Service Accountability Act of 2016 (S. 2953). This legislation arrives in the wake of multiple closures of IHS facilities and persistent issues with IHS services throughout Indian Country. The bill aims to, ultimately, improve the safety and care of American Indians and Alaska Natives (AI/ANs) who rely on the IHS for healthcare services by increasing transparency and accountability within the agency. The bill includes language that would:
  • Allow for the removal or demotion of an IHS employee based on performance or misconduct.
  • Improve hiring practices and provide incentives for recruitment and retention of quality employees.
  • Enact protections for current employees against retaliation.
  • Promote fiscal responsibility within the agency.
The bill provides a starting point for lawmakers and Tribal members to find a path forward for a better Indian health system. The Senate Committee on Indian Affairs will hosting a field hearing in Rapid City, SD, on June 17, 2016 at 10:30AM MT. All Tribal members, leaders and advocates are welcome to participate in the event where the conversation on "improving the accountability and quality of care of the Indian Health Service" will continue. The National Indian Health Board will be present for the event and will provide updates as they become available. Please visit the Committee's website for more details.

Senate Committee on Indian Affairs OversightLegislative FIELD Hearing on "Improving Accountability and Quality of Care at the Indian Health Service Through S. 2953"
Date: 06/17/2016 
Time: 10:30AM MT
Location: Central High School Auditorium
Address: 433 Mt. Rushmore Road, Rapid City, SD 55701
Zika Funding Negotiations Continue
The House and Senate passed vastly different measures that would only partially fund the President's request for supplemental Zika funding of ~$1.9 billion. As you may know, the Zika virus is responsible for causing thousands of severe birth defects in South America over the past year.  It also appears likely that Zika is causing miscarriages and less severe birth defects to an as-yet-unknown extent. The House passed a bill (H.R. 5243) that would fund the Zika virus response and prevention efforts at $622 million through the end of FY 2016. While House spokespersons say that this funding will be supplemented by further appropriations in FY 2017, this legislation alone grossly under funds the crisis while also using offsets from the Department of Health and Human Services budget that could be harmful to the Indian Health Service. The Senate bill (H.R. 2577would fund efforts at ~$1.1 billion with emergency funding, still falling short of the President's request, but without offsetting those costs with other funding sources.

The National Indian Health Board (NIHB) believes that a robust federal, state, Tribal, and territorial public health response are critical to our ability to respond to Zika and prevent the terrible birth defects it causes. NIHB has been working with a coalition of over 60 national and regional organizations to encourage both the House and Senate to provide emergency supplemental funding to combat Zika virus at or near the President's requested levels, and to reject proposals that fall far short of those amounts, particularly those that would fund efforts against Zika by cutting other vital domestic or global public health programs and priorities (like H.R. 5243). Since both chambers have passed their respective versions of legislation, the next step will be to negotiate a version that both chambers agree upon that can be sent to the President for approval. NIHB is doing targeted outreach to policymakers to ensure that whatever funding level is enacted, is enacted quickly and will hold Tribes and Tribal organizations eligible for direct funding, in parity with states and territories. Additionally, it is crucial that Congress uphold the federal trust responsibility by holding harmless the Indian Health Service budget from being used as an offset to fund this public health emergency. Read more about the crisis and NIHB's efforts on this important public health issue here.
Appropriations for Indian Country
The House Appropriations Committee released the fiscal year (FY) 2017 Interior and Environment Appropriations bill last week, which was considered in a subcommittee hearing last Wednesday. This legislation includes funding for the Department of Interior, including the Bureaus of Indian Affairs (BIA) and Education (BIE), the Environmental Protection Agency, the Forest Service, the Indian Health Service (IHS), and other independent and related agencies. Overall, the bill represents a $1 billion reduction from the President's FY 2017 budget request, but would provide the BIA, BIE and IHS with increases above their 2016 enacted budget levels. Among other important provisions in the bill, the Indian Health Service is set to be funded at $5.1 billion - an increase of $271 million above the FY 2016 enacted level and the largest increase of any agency within the bill. This includes operating costs for staffing at new facilities, and increases for rising contract support costs, medical inflation, and a growing and aging population.

Watch the Subcommittee Markup - FY 2017 Interior and Environmental Appropriations Bill from Wednesday, May 25 at 11:00AM ET. 
Native Children's Act is Taken Up in the House

U.S. Senators Heidi Heitkamp (D-ND) and Lisa Murkowski's (R-AK) introduced a bipartisan bill in 2013 to improve the lives of Native American children. This bill was considered last week in the U.S. House Committee on Natural Resources Subcommittee on Indian, Insular, and Alaska Native Affairs - bringing it one step closer to a final vote in the U.S. House of Representatives. Heitkamp and Murkowski's bill S.1622which unanimously passed in the U.S. Senate, would create a Commission on Native Children to identify the complex challenges faced by Native youth across the United States and making recommendations on how to make sure these children get the protections, as well as economic and educational tools they need to thrive. As NIHB Chairperson, Lester Secatero, has stated, "This legislation will be an important contributor to bringing light to issues and breaking down some of the administrative and bureaucratic barriers we face when working to better the lives of our children." Click here to watch Sen. Heitkamp's comments from last week's hearing.
Administration and Organizational Updates
Movement to Improve Health Care Quality and Access in Great Plains
The National Indian Health Board (NIHB) passed a motion at the end of January that would call for our organization to form a special task force that will investigate the situation at Indian Health Service (IHS) facilities across Indian Country, and embark on a path toward finding real, sustainable change at the IHS. As a part of these efforts, NIHB will work to provide updates on the issues of health care quality and access in the Great Plains IHS Service Area. Most recently:
  • Centers for Medicare and Medicaid Services (CMS) Flagged 3
    rd IHS Facility This Week
CMS has reported the Sioux San Indian Health Service (IHS) Hospital, located in Rapid City, SD, is in "immediate jeopardy" after an investigation revealed problems that pose serious threats to patients. The hospital was given five days to submit a plan of correction or risk losing its ability to bill to Medicare. This threat comes just days after South Dakota Congresswoman, Rep. Kristi Noem (R-SD), announced plans to bring forth legislation to address issues within the Indian Health Service including contracting, recruitment and billing. More specifically, included are provisions aimed to:

o Improve IHS's ability to secure long-term contracts for hospitals in emergency conditions.
o   Address recruitment issues for medical and administrative staff.
o   Require IHS to develop a new formula for allocating Purchased/Referred Care (PRC) Program.
o   Require IHS to negotiate Medicare-like rates for services it pays for with private providers.
o   Require IHS to address the backlog of PRC payments to private providers.

This legislation is expected to be introduced in the coming weeks. NIHB will provide further analysis upon its release. Click Here to watch a video of Rep. Noem discussing the planned legislation.
The IHS and the Centers for Medicare & Medicaid Services (CMS) entered into Systems Improvement Agreements for the IHS Rosebud Hospital and the IHS Pine Ridge Hospital. These agreements are important steps forward for the hospitals in ensuring quality health care and that the improvements made in coming months will be sustainable over time. 

On May 5, 2016, the Indian Health Service issued a Request for Proposal (RFP) to provide telehealth services at its seven hospitals and many health centers. The South Dakota Health Care Solutions Coalition is a partnership between South Dakota Tribes, IHS, Medicaid service providers, South Dakota Legislators and State agencies developed to create a strategy on how to improve healthcare access and outcomes in American Indians. This coalition recommended that the use of telehealth services be increased in the Great Plains IHS Service Area to support emergency departments and support increased access to primary and specialty care consultation and treatment in IHS and Tribal Programs.

CMS Medicare Program Quality Payment Program Proposed Rule 
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule around The Medicare Access and CHIP Reauthorization Act (MACRA).  The MACRA proposed rule eliminates the sustainable growth formula for updates to the physician fee schedule (PFS) and replaces it with a .5% annual rate increase through 2019, after which eligible physicians who serve Medicare beneficiaries will shift  to one of two Quality Payment Programs: 1) Merit-based Incentive Payment System (MIPS) or 2) Alternative Payment Model (APM). MIPS would streamline and consolidate components of three existing programs, 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).
CMS plans to finalize the rule by November 1, 2016 with reporting beginning January 1, 2017. More information can be found here.

Comments on the proposed rule are due June 27 and can be submitted hereContact Sarah Freeman, NIHB Policy Associate at to join the Medicare, Medicaid, and Health Reform Policy Committee (MMPC) MACRA Quality Payment Program Workgroup for open Tribal discussions around the proposed rule as well as to receive a Tribal template comment.
FUNDING OPPORTUNITY: Defending Childhood American Indian/Alaska Native Policy Initiative: Supporting Trauma-Informed Juvenile Justice Systems for Tribes 
Funding is now available through the U.S. Department of Justice Office of Juvenile Justice and Delinquency Prevention to support Tribes and Tribal organizations in addressing several recommendations included in the Ending Violence So Children Can Thrive report, from the Attorney General's Advisory Committee on AI/AN Children Exposed to Violence. The recommendations call for Tribal alternatives to detention, including use of facilities where children and youth can find safety and easily access services (safe houses); development or revision of Tribal juvenile codes to promote trauma-informed, culturally specific and individually tailored cared for youth; and wider application of culturally adapted, evidence-based, trauma-informed screening, assessment, and treatment services in Tribal juvenile justice and related systems.
Upcoming Events, Calls and Webinars
CDC Hosts Zika Action Plan Teleconference Series
As a follow up to the April 1 Zika Action Plan (ZAP) Summit in Atlanta, GA, CDC will host a series of teleconferences to address the most common challenges that jurisdictions are facing in implementing Zika Action Plans.  

Time (EDT)
Thursday, June 2 
2:00 - 3:00 pm 
Sexual Transmission / Pregnancy Planning
Wednesday, June 8 
2:00 - 3:00 pm 
Monday, June 13
1:00 - 2:00 pm 
Diagnostics: Laboratory Capacity / Testing Interpretation 

There will be an opportunity for questions following the presentations. Questions can be sent in advance to
A link to a PowerPoint presentation will be provided prior to the teleconference. Audio from the call will also be recorded and available online post-conference for those not able to participate live. Continuing education (CE) is available for a variety of professions. Instructions for CE units will be provided during teleconference.
Audio Conference Access Information:
1-800-593-0370 (Toll Free)
Passcode: 5112757
The TALC (Tribal Accreditation Learning Community) is a free, monthly webinar series held the second Friday of every month. TALC is open to all who are interested in sharing and learning about public health accreditation in Tribal communities.  

June TALC:  Friday, June 10, 2016, 2:00-3:00pm ET

Public Health Accreditation Board (PHAB) Update

Robin Wilcox, MPA, Chief Program Officer, PHAB

TRIBAL PRESENTATION: Northern Cheyenne Tribe

Janet Wolfname, Director of Public Health Nursing

For more information and to view past webinars, please visit:

Follow this link to join the webinar:

Contact Karrie Joseph, or 202-507-4079 for more information.
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
Upcoming CMS Medicare Program Quality Payment Program Webinars

Wednesday, June 15, 2016 

12:00-1:00 pm EST

Friday, June 17, 2016
12:00-1:00 pm EST

Wednesday, June 22, 2016
12:00-1:00 pm EST

Friday, June 24, 2016
12:00-1:30 pm EST
910 Pennsylvania Avenue, SE
Washington, DC 20003
Main Phone: 202-507-4070
Fax: 202-507-4071
Thank you for visiting the Washington Report!