H.R. 2954 – The Health Equity and Accountability Act

Over the past few months, NCUIH has been working with Congressional staff to achieve the goal of 100% FMAP for Urban Indian Health Programs. 100% FMAP would provide UIHPs with 100% federal reimbursement for services billed to Medicaid and Medicare. Tribal programs already enjoy 100% FMAP, and Trust Responsibility dictates that urban programs should also receive this treatment.

Today we can announce that legislative language providing 100% FMAP for UIHPs has been included in H.R. 2954, the Health Equity and Accountability Act of 2011 (HEAA). NCUIH notes that many advocates have been working for a very long time to achieve the goal of 100% FMAP, and we thank you for your past and present advocacy on this very important issue. NCUIH urges our programs and our communities to contact your elected representatives and urge them to support HEAA. It will take a great effort of outreach and advocacy to ensure the success of HEAA, and NCUIH will be meeting with Congressional staff in the coming days and weeks to urge support of this critical legislation.

NCUIH also worked with Congressional staff to include language in HEAA that would standardize the definition of “Indian” throughout the Affordable Care Act. This single definition, based on the American Recovery and Reinvestment Act (ARRA) regulations issued by HHS and endorsed by the CMS Tribal Technical Advisory Group, would ensure that exchange cost-sharing protections, special monthly enrollment periods, and the individual mandate exemption would not be limited only to members of federally-recognized tribes. The definition NCUIH has proposed is the same as that currently used to determine eligibility for Medicaid cost-sharing exemptions under ARRA, and this definition has broad and deep support throughout Indian Country.

The goal of the Health Equity and Accountability Act is to eliminate racial and ethnic health disparities. Introduced into the House of Representatives by the Congressional Tri-Caucus (comprised of the Congressional Asian Pacific American Caucus, the Congressional Black Caucus and the Congressional Hispanic Caucus), other goals of HEAA include: improvements to data collection and reporting; the provision of cultural and linguistically appropriate health care; health workforce diversity; improvements in health outcomes for women, children, and families; HIV/AIDS prevention; improving Health Information Technology; improvements in mental health care; and reducing the impact of diabetes on racial and ethnic minorities.

Update on Definition of Indian Issue

On August 29th, Director Roubideaux posted an update on the “Director’s Blog” regarding the various definitions of Indian within the Affordable Care Act. As you may be aware, the Affordable Care Act uses three different legal definitions of Indian. While these definitions are similar, the lack of a consistent definition could cause administrative confusion and hardship during the implementation of health care reform.

NCUIH has been in regular discussion with the Senate Committee on Indian Affairs, as well as the Senate Finance Committee, to seek a legislative solution to this problem. Earlier this week, NCUIH discussed with Indian Affairs staff strategies for moving forward with a legislative fix to the definition of Indian issue. A legislative solution would eliminate the need to move forward with regulatory fixes to this issue. We regard this issue as a very high priority and will continue to work closely with Congress to resolve this problem.

Simultaneously, NIHB and the CMS Tribal Technical Advisory Group (TTAG) continue to explore ways to resolve this issue from an administrative vantage point. NIHB is currently devising a formal response to the issues raised in Dr. Roubideaux’s blog and will be releasing it shortly. NCUIH will distribute this document to you as soon as it is released.

Comment Today on Proposed HHS Standards for Data Collection on Minorities

Deadline for Public Comments is August 1

HHS is seeking public comments on draft standards for data collection on race, ethnicity, sex, primary language and disability status, as required by Section 4302 of the Affordable Care Act   The Affordable Care Act contains multiple provisions aimed at eliminating health disparities.  Establishing data collection standards is a critical first step in addressing the health disparities faced in AI/AN communities.  The proposed data collection standards will be required to be used in any federally sponsored, federally conducted, or supported health care or public health program, activity, or survey.  An example of the types of questions posed in the proposed standards are:

 

What is your race? (One or more categories may be marked)
a. ____White*
b. ____Black or African American*
c. ____American Indian or Alaska Native*

d. ____Asian Indian**
e. ____Chinese**
f. ____Filipino**
g. ____Japanese**
h. ____Korean**
i. ____Vietnamese**
j. ____Other Asian**

k. ____Native Hawaiian***
l. ____Guamanian or Chamorro***
m. ____Samoan***
n. ____Other Pacific Islander***

 

To view the complete list of proposed standards, please click here.  To comment on the proposed standards, please follow the directions available at this link.  Comments on these proposed data collection standards must be received by August 1, 2011.  Comments may be submitted via www.regulations.gov under docket number HHS-OMH-2011-0013.  They can also be submitted by mail.

Medicare Proposes Coverage for Screening and Counseling for Alcohol Misuse and Screening for Depression

The Centers for Medicare & Medicaid Services (CMS) today proposed to add alcohol screening and behavioral counseling, and screening for depression, to the comprehensive package of preventive services now covered by Medicare.  These proposed national coverage determinations (NCDs) are issued under authority granted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which allows CMS to add coverage of new preventive benefits that are recommended by the U.S. Preventive Services Task Force and are appropriate for Medicare beneficiaries.

Under the new proposals, Medicare would cover an annual alcohol misuse screening by a beneficiary’s primary care provider.  The benefit would also include four behavioral counseling sessions per year if a beneficiary screens positive for alcohol misuse.  Medicare would also cover an annual screening for depression in primary care settings that offer staff-assisted depression care, so beneficiaries can receive an  accurate diagnosis, effective treatment, and follow-up.

 Public comments are invited on today’s proposed decisions for 30 days.  CMS will issue final coverage decisions later this year.  The proposal for screening and counseling for alcohol misuse is available on the CMS website at this link.

The proposal for screening and counseling for depression is available on the CMS website at this link.

Update on House Appropriations Committee Mark-up

Yesterday the House Appropriations Committee met to mark up the FY2012 Interior and Environment Appropriations Bill.  The Committee approved the bill by a vote of 28-18.  This bill provides $4.46 billion for the Indian Health Service – an increase of $392 million over FY11 enacted levels, and $162 million less than President Obama’s FY12 request.  The bill also provides $45.5 million for Title V Urban Indian Health Programs.  This is an increase of $2.47 million over FY11 enacted levels, and $1.22 million below the President’s request.  The bill sets aside $944,000 to improve UIHP third-party billing.

NCUIH, with the support of the IHS Tribal Budget Consultation Workgroup, submitted a request to congressional appropriators for a $9 million increase to the UIHP line item.  While the proposed increase of $2.47 million is far below the amount needed to address years of underfunding, medical inflation, and federal neglect, NCUIH appreciates the Committee’s modest increase in UIHP funding during this extremely contentious budgetary atmosphere.  In particular, NCUIH again thanks Congressman Mike Simpson for his leadership on this issue, as well as the many Committee staff who have helped us educate newer members of Congress about the need to honor the federal government’s Trust Responsibility to AI/AN people.

Our efforts to secure UIHP funding for the 2012 fiscal year will continue in the Senate, where members will have the option of drafting changes to the House bill.  Any changes made by the Senate must be reconciled with the House bill before being submitted to the President for signature.  It is too early to tell if Congress will submit a budget to the President before the current fiscal year ends on September 30^th.  The funding increase included in this House bill will not take effect until signed into law by the President.

House Interior Appropriations Mark-up

Today the House Interior Appropriations Subcommittee met to mark up the FY2012 Interior and Environment Appropriations Budget. The Subcommittee approved, without changes, the budget which was made public yesterday. This budget provides $4.46 billion for the Indian Health Service – an increase of $392 million over FY11 enacted levels, and $162 million less than President Obama’s FY12 request.

While IHS funding has seen an increase, the bill contains cuts to many other programs and agencies, including the Environmental Protection Agency, conservation and environmental protection programs, grant funds under the Clean and Safe Drinking Water Act, and funding for the Endangered Species Act. Overall, the Interior and Environment Appropriations bill contains $2.1 billion in cuts, 7% below the FY11 enacted level and $3.8 billion, or 12%, below the President’s budget request.
Congressman Mike Simpson, who previously stated his commitment to “hold harmless” IHS funding while seeking deep cuts in other areas, remarked that,

“…this bill makes critical investments in Indian Country—an area of particular interest to Members of this subcommittee. Building upon efforts begun by Mr. Dicks and Mr. Moran, this bill continues to make investments in human health and wellness programs in Indian Country affecting health care, education, and Self-Determination.”

NCUIH offers our thanks to Congressman Simpson and his staff for keeping their promise to Indian Country, and for finding a way to increase the IHS budget even as other agencies faced severe cuts. Back in May, NCUIH staff met with Congressman Simpson to personally thank him for his continued support for IHS/UIHP funding, and we presented him with the NCUIH Congressional Leadership Award in gratitude for his strong commitment to Indian Health. NCUIH will continue to build good relationships with members of Congress in both parties who are willing to support improved health care for AI/AN people.

The Subcommittee’s budget will next move to the full House Appropriations Committee, where it will again be marked up and voted on. The exact funding level of IHS programs, including Urban Indian Health Programs, will not be known until this mark-up occurs, typically in September. NCUIH will be working with our allies in the Senate to build strong support for an increase in funding for Urban Indian Health Programs. There is still much work to be done before this bill is enacted into law, and NCUIH will continue to educate Congress about the critical role played by UIHPs.

IHS Tribal Consultation Summit July 6-7, 2011

The IHS Tribal Consultation Summit will be held July 6-7, 2011, in Bethesda, Maryland.  Please click this link to download a detailed agenda.

Urgent Action Needed: Health Centers National Call-In day

ACT NOW: Health Centers National Mobilization Call-In Day is TODAY
Step Up For America’s Health Centers – Make Your Calls Now!
Health Centers National Mobilization Call-In Day Is TODAY Step Up For America’s Health Centers – Make Your Calls NOW! Today’s the day for EVERY HEALTH CENTER ADVOCATE TO ACT! The President and Congressional leaders are RIGHT NOW considering proposals to address federal spending, some of which could literally zero out funding for the Health Centers Program or drastically cut critically important programs like Medicaid.  Today, as the first step in the Campaign to Save America’s Health Centers we are holding the first national health center mobilization call-in day. We need you to do two things to make sure Congress and the White House get a message they can’t ignore: Take Action: 1)      Call Your Members of Congress: Use the toll free NACHC Advocacy Hotline at 1-866-456-3949 and tell Your Representative AND BOTH Senators: Do not undermine the successful Health Centers program as you negotiate Medicaid changes and cuts to the federal budget. The health and lives of our families and our neighbors should not be negotiated away. I am counting on your support for my Health Center. a.       You only need to call the Advocacy Hotline ONE TIME – stay on the line at the end of each conversation to be automatically connected to your next policymaker. THEN 2)      Call the White House Comment Line at 1-202-456-1111 and leave a message for the President saying:  Do not undermine the successful Health Centers program as you negotiate Medicaid changes and cuts to the federal budget. The health and lives of our families and our neighbors should not be negotiated away. I am counting on your support for my Health Center. a.       When you call the White House Comment line it may take a few moments to be connected to a LIVE OPERATOR, but you WILL be connected and be able to leave a message with a LIVE person. Make sure to call the White House BEFORE the Comment Line CLOSES at 5:00pm EST. Be Aware: when you call your Congressional offices and the White House the line might be busy because SO MANY health center advocates are calling -  DON’T GIVE UP – Keep calling until you get through! Never before have the threats to health centers been so serious or our advocacy efforts more important.  Never before has the timing of your action been so critical. Negotiations that will impact the future of your health center are going on RIGHT NOW and only tens of thousands of calls from health center advocates across the country will make it clear how much we oppose these potentially devastating proposals.  Make your advocacy calls NOW and ask your friends, family, colleagues and partners to the do the same. For more information about the threats facing health centers and more detailed instructions on how to take action visit the NACHC Grassroots  Action Center.  To download and print a one page version of this alert visit the Campaign for America’s Health Center’s webpage. If you have questions or need additional information you can contact the NACHC Mobilization Information line at 1-202-331-4608.

Affordable Care Act Delivers Cheaper Prescription Drugs to Nearly 500,000 People

MEDICARE NEWS

FOR IMMEDIATE RELEASE                                                         Contact: CMS Media Relations Group

June 28, 2011                                                                                                               (202) 690-6145

 

Affordable Care Act Delivers Cheaper Prescription Drugs to Nearly 500,000 People

 

Law Has Already Saved $260 Million, Averaging $545 for People in Donut Hole

 

Thanks to the Affordable Care Act, nearly 500,000 people with Medicare Part D who reached the gap in coverage know as the “donut hole” have received an automatic 50 percent discount on their covered brand name prescription drugs.  The Centers for Medicare & Medicaid Services (CMS) posted data today that shows 478,272 Medicare beneficiaries have benefitted from the 50 percent discount in the first five months of 2011. These beneficiaries saved a total of $260,534,102, or an average savings of $545 per beneficiary.

 

The number of seniors benefiting from this discount continues to grow.  In the month of May alone, the total number of beneficiaries who received the discount rose by over 76 percent, while the dollar amount of savings rose by over 56 percent.  Based on data from past years, CMS expects that as many as 4 million additional beneficiaries will fall into the coverage gap later this year and benefit from these discounts.

 

Most of these discounts are helping Americans with serious medical conditions – nearly 14 percent of the benefits provided to date – more than $36 million – are for cancer drugs, more than 8 percent or $21 million for drugs to help control high blood pressure and cholesterol, and another more than 7 percent – about $20 million – are for drugs provides to diabetic patients.

 

For more information on how the prescription drug discount and other provisions of the Affordable Care Act benefits seniors and people with disabilities, visit www.HealthCare.gov.

 

People with Medicare can learn more about these new benefits, including new free preventive benefits and other helpful information by contacting customer service representatives at 1-800-MEDICARE (1-800-633-4227 toll free) or by visiting www.Medicare.gov

 

A blog and state-by-state numbers are up on healthcare.gov now at:  http://www.healthcare.gov/news/blog/Seniors06282011a.html

To read the entire CMS press release issued today (6/28) click here: http://www.cms.gov/apps/media/press/release.asp?Counter=3996

 

Important NACHC Advocacy Teleforum Call – June 29th

Health Centers Are Facing Very Real And Very Serious Threats Find Out How You Can Help Save America’s Health Centers And Why You Need Step Up NOW On Wednesday, June 29th at 2:00PM EST the National Association of Community Health Centers will be hosting perhaps its most important advocacy update ever. During this national Teleforum, the NACHC Leadership and Policy Team will brief everyone on the serious and multiple threats now facing Health Centers and the patients they serve. We will announce a Campaign to Save America’s Health Centers and tell you what you can do to help stop potentially devastating changes and cuts to the Health Center Program. Be a part of the NACHC National Mobilization Teleforum on June 29th at 2:00PM EST AND make a commitment to participate in our Medicaid Mobilization Call In Day on Thursday, June 30th. If you thought the $1 billion cut in Health Center Funding that passed the U.S House and the $600 billion cut that Congress and the President eventually agreed on was bad news for Health Centers and our patients, you should know those changes could be just the beginning. The House has also passed a budget that calls for block granting the Medicaid program and cutting it by $1.4 trillion over the next ten years. If that were to be enacted into law, Health Centers could see their Medicaid revenue cut by 50% or more immediately.  Even more ”moderate” proposals could have nearly the same devastating effect. We simply CAN NOT let that happen, but to stop it, we will need a grassroots effort on a scale we have not seen before. This mobilization is the first chance for us to demonstrate that we can make that happen. Being a part of our National Medicaid Mobilization will be easy and free. In addition to the Teleforum briefing, you will receive a call to action on June 30th as the signal to start calling. Instructions on how respond when the call to action comes are posted on the NACHC Grassroots Action Center. There has never been a more important time for Health Centers to have a unified, overwhelming advocacy effort. We need EVERY health center supporter to participate in the Teleforum on June 29th and then step up and call during the National Medicaid Mobilization Day on June 30th.  We all need to act to save America’s Health Centers. Joining us on the Teleforum is FREE of charge, in fact, we’ll call you! But, you MUST have a direct phone number where we can reach you at 2:00 next Wednesday entered in your profile in our Advocacy Network in the ‘Tele-Town Hall Phone Number’ field. Update your profile TODAY to make sure you are able to participate in this essential call! If you do not have a direct phone number at which you can be reached on Monday in your profile, you may also join the call by dialing: 1-877-229-8493 and entering PIN: 15035. There are a limited number of call-in slots available and we cannot guarantee that you will be able to participate on the call unless you have entered a direct phone number into your advocate profile.  The call will be recorded and available on the NACHC website on Thursday morning. Join us live Wednesday, June 29th at 2:00PM EST. Your advocacy has NEVER been more important!