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    TSGAC Letters and Policy

    TSGAC provides recommendations orally during regular quarterly meetings and in written communication to the IHS Director or other Department leaders. Below is an archive of recommendations provided since January 1, 2014.

    Many of these recommendations are related to Self-Governance priorities outlined in the National Strategic Plan.  You can find recent white papers and updates related to many of these issues here.

    2017 TSGAC Correspondence

    Date Sent/ReceivedAddressed ToTopic/Issue
    July 31, 2017Rear Admiral Michael Weahkee
    Acting Director,
    Indian Health Service
    TSGAC Recommendations for the IHS Scholarship and Loan Repayment Programs
    July 18, 2017Lynn Malerba,
    Chief, Mohegan Tribe of Connecticut,
    Chairwoman, IHS TSGAC
    IHS Follow Up to the March 2017 TSGAC Meeting
    June 22, 2017The Honorable Thomas E. Price
    Secretary
    Department of Health and Human Services
    Request for Tribal Consultation on HHS Reimagining Initiative and Invitation to the TSGAC Quarterly Meeting July 18-19, 2017
    June 11, 2017Lynn Malerba,
    Chief, Mohegan Tribe of Connecticut,
    Chairwoman, IHS TSGAC
    Response to April 11, 2017 TSGAC Recommendations for the Formation of the CHAP Workgroup
    May 26, 2017Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service
    TSGAC Request to Delay Catastrophic Health Emergency Fund Final Rule
    May 26, 2017Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service
    TSGAC request for additional educational training regarding the Indian Health Care Improvement Fund (IHCIF), Level of Need Funded (LNF) calculations, and plans to update information related to each
    May 24, 2017Seema Verma
    Administrator,
    Centers for Medicare & Medicaid Services
    TSGAC Comments on Medicaid Work Requirements for American Indians and Alaska Natives
    May 19, 2017Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service

    Rear Admiral Kevin Meeks
    Acting Deputy Director of Field Operations,
    Indian Health Service
    Request to Schedule a Joint TSGAC/DSTAC Call to discuss Tribal Participation in the Department of Health and Human Services plan to carry out Executive Order 13781
    May 1, 2017U.S. Department of Health and Human Services Written Testimony Submitted to the HHS 19th Annual Tribal Budget
    Consultation Session on the FY 2019 Budget Request
    April 30, 2017Jennifer Cooper
    Acting Director, Office of Tribal Self-Governance,
    Indian Health Service
    Transmittal of Final Report, “Self-Governance Health Reform National Outreach and Education Semi-Annual Report”
    April 11, 2017Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service
    TSGAC Recommendations for the Formation of the Community Health Aid Program (CHAP) Workgroup
    Response
    March 24, 2017Lynn Malerba,
    Chief, Mohegan Tribe of Connecticut,
    Chairwoman, IHS TSGAC
    Response to February 27, 2017 Letter and Several Other Recent Issues Raised by TSGAC During the January 2017 Quarterly Meeting
    March 7, 2017CMS via regulations.govTSGAC Formal Comments Regarding Market Stabilization Proposed Rule (CMS-9929-P)
    February 27, 2017Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service
    TSGAC Recommendations to Improve Self-Governance Negotiations and Create Agency Lead Negotiator Pilot Project
    Response
    January 27, 2017Norris Cochran
    Acting Secretary,
    Department of Health and Human Services

    Rear Admiral Chris Buchanan
    Acting Director,
    Indian Health Service
    Support for Broad Exemption of Indian Health Service from Federal Hiring Freeze



    January 6, 2017Lynn Malerba,
    Chief, Mohegan Tribe of Connecticut,
    Chairwoman, IHS TSGAC
    Reimbursement program to include reimbursement for PRC,
    Response from VA to April 18, 2016 and August 23, 2016 Letters

    2016 TSGAC Correspondence

    Date Sent/ReceivedAddressed ToTopic/Issue
    December 16, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Identification of Staff for Developing Level of Need Funded Data
    December 14, 2016Jennifer Cooper
    Acting Director, Office of Tribal Self-Governance
    Indian Health Service
    Department of Health and Human Services
    Transmittal of Final Report, “TSGAC Report Network on Adequacy in the Health Insurance Marketplace: Analysis of Two Tribal Sites”
    December 5, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Updated Contract Support Cost (CSC) Policy
    November 4, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    IHS Headquarters Realignment
    November 2, 2016Dr. Richard A. Stone
    Principal Deputy Under Secretary for Health
    Veterans Administration
    810 Vermont Avenue NW
    Washington, DC 20420
    Request for the Information about the Veterans Administration’s Co-Payment Policy
    November 2, 2016David J. Shulkin
    Under Secretary for Health
    Department of Veterans Affairs
    810 Vermont Avenue, NW
    Washington DC 20420
    Comments on Veteran Affairs’ Proposal to Consolidate Community Care Programs
    October 31, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Comments on Catastrophic Health Emergency Fund Proposed Rule (RIN 0905-AC97)
    October 31, 2016Jennifer Cooper
    Acting Director, Office of Tribal Self-Governance
    Indian Health Service
    Department of Health and Human Services
    Transmittal of FINAL Report for “Self-Governance National Indian Health
    Outreach and Education” (2015-2016)
    October 28, 2016Ms. Kitty Marx, Director
    Tribal Affairs Group, Office of External Affairs
    Centers for Medicare and Medicaid
    Tribal Technical Advisory Group (TTAG) Appointments
    October 28, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Comments on Purchasing Health Care Coverage (IHS Circular 2016-08)
    October 5, 2016CMS via regulations.govHHS Notice of Benefit and Payment Parameters for 2018
    (CMS-9934-P)
    September 27, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    FY 2015 Report to Congress on Administration of the Tribal Self-Governance Program
    September 16, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    IHS Draft Quality Framework
    August 26, 2016
    Enclosure
    Lynn Malerba, Chairwoman, TSGACResponse to March 29, 2016 Request
    August 23, 2016Dr. Baligh Yehia, MD
    Assistant Deputy Undersecretary for Health for Community Care
    Veterans Health Administration
    U.S. Department of Veterans Affairs
    Opportunities for Partnerships between Tribal Health Programs and the Veterans Administration
    Response
    August 16, 2016RIN 0991-AC06: Comments on Proposed Rule; Health and Human Services Grant Regulation: Published on July 13, 2016 (81 Federal Register 45270, et seq.TSGAC formal comments to proposed rule
    July 23, 2016Lynn Malerba, Chairwoman, TSGACFacilities, Response from IHS to April 18, 2016 Letter
    July 14, 2016Mr. Michael Fisher, Lead Contract Specialist, Indian Health ServiceComments on Solicitation Number 16-IHS-HQ-SS-0001
    July 8, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Request for Common Self-Governance Materials to be made Available Electronically
    June 9, 2016Mary Smith
    Principal Deputy Director, Indian Health Service
    Proposed IHS Contract Support Costs Policy
    June 3, 2016Lynn Malerba, Chief, Mohegan Tribe, TSGAC Co-ChairResponse to April 18, 2016 TSGAC Request to Withdraw CHEF Proposed Rule
    May 20, 2016Betty Gould, Regulations Officer
    Indian Health Service, Office of Management Services
    Payment for Physician and Other Health Care Professional Services Purchased by Indian Health Programs and Medical Charges Associated With Non-Hospital-Based Care Final Rule (RIN 0917-AA12)
    May 13, 2016TreasuryTSGAC Formal Request for Targeted Partial Administrative Relief from Employer Shared Responsibility Provisions
    May 10, 2016IHS Principal Deputy DirectorCatastrophic Health Emergency Fund Proposed Rule (RIN 0905-AC97)
    May 10, 2016IHS Principal Deputy DirectorTSGAC Comments on SASP Program Funding Distribution
    May 6, 2016Steve Petzinger, OMB Program ExaminerFollow up from March 2016 Tribal Self-Governance Advisory Committee Meeting
    May 5, 2016Centers for Medicare and Medicaid ServicesCMS-10458, “Consumer Research Supporting Outreach for Health Insurance Marketplace
    April 24, 2016IHS Principal Deputy Director
    OTSG Director
    ORAP Acting Director
    SG National Outreach and Education on ACA/IHCIA
    April 18, 2016The Honorable Sylvia Burwell, HHS Secretary

    The Honorable Robert A. McDonald, VA Secretary
    Reimbursement Agreement between the Indian Health Service and Veterans Affairs
    Response
    April 18, 2016Mary Smith, IHS Principal Deputy DirectorRequest to Withdraw Proposed Rule, conduct Tribal Consultation and then reissue the rule.
    Response
    April 18, 2016Recommendations for Health Care FacilitiesTSGAC Recommendations
    April 11, 2016Thomas West
    Kathryn Johnson
    Treasury Department
    Excise Tax on Certain Employer-Sponsored Health Benefits
    April 5, 2016Sylvia Matthews Burwell, Secretary,
    Andy Slavitt
    Acting Administrator, Centers for Medicare and Medicaid Services
    Oklahoma Section 1115 Waiver Amendment Request
    March 30, 2016TSGACResponse to TSGAC August 2015 Letter Regarding Quality Reporting Measures

    Referenced GPRA Analysis
    March 29, 2016Mary Smith, IHS Principal Deputy DirectorRequest for Service Unit Data on Health Insurance Status and 2016 Appropriation
    Response
    Requested Data
    February 29, 2016Office of Management and Budget, Office of Information and Regulatory Affairs, Attn: CMS Desk OfficerCMS–10519, Agency Information Collection Activities: Submission for OMB Review
    February 19, 2016Centers for Medicare & Medicaid ServicesComments on CMS-9936-N; Waivers for State Innovation
    February 2, 2016Dr. Debra Houry, MD, MPH, Director, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention CDC Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain; Docket CDC-2015-0112
    January 15, 2016Center for Consumer Information and Insurance Oversight, CMS, HHSComments on Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces
    January 5, 2016Jerry Menikoff, M.D., J.D. Office for Human Research Protections Department of Health and Human ServicesHHS-OPHS-2015-0008 – Proposed Revisions to the Federal Policy for the Protection of Human Subjects

    2015 TSGAC Correspondence

    Date Sent/ReceivedAddressed ToTopic/Issue
    December 21, 2015Centers for Medicare & Medicaid ServicesCMS-9937-P, Notice of Benefit and Payment Parameters for 2017
    November 17, 2015Kitty Marx, Director,
    CMCS Division of Tribal Affairs, Centers for Medicare and Medicaid Services
    Support for 100 Percent FMAP Proposal
    November 10, 2015Mr. Robert McSwain, Principal Deputy Director, IHSPayment of Settlements to Civil Service Employees
    November 9, 2015U.S. Department of Health and Human Services, Office for Civil RightsNondiscrimination in Health Programs and Activities (RIN 0945-AA02). 80 Fed. Reg. 54172 (Sep. 8, 2015).
    November 3, 2015Mr. Robert McSwain, Principal Deputy Director, IHS
    Ms. Mary Smith, Deputy Director, IHS
    Interpretation of Duplication Provision in 25 U.S.C. § 450j-1(a)(3)
    November 3, 2015Honorable Sylvia M. Burwell, Secretary, Department of Health and Human ServicesFinal Rule related to expand the Medicare-Like Rate
    October 27, 2015Honorable Robert A. McDonald, Secretary of Veterans AffairsComments on Veterans Access, Choice and Accountability Act of 2014 (Choice Act)
    October 26, 2015Dr. Elaine Buckberg, Deputy Assistant Secretary for Policy, Office of Economic Policy, Department of TreasuryRequest for Permanent Administrative Relief from Affordable Care Act’s Employer
    Mandate on Tribes for Tribal Member Employees
    October 23, 2015Dr. Elaine Buckberg
    Deputy Assistant Secretary for Policy
    Office of Economic Policy
    Department of Treasury
    Request for Extension of Transition Relief from the Employer Mandate
    October 21, 2015Dr. Elaine Buckberg
    Deputy Assistant Secretary for Policy
    Office of Economic Policy
    Department of Treasury
    Excise Tax on Certain Employer-Sponsored Health Benefits
    October 16, 2015Mr. Robert G. McSwain
    Mr. Ben Smith
    Mr. Carl Harper
    Transmittal of FINAL Self-Governance National ACA Education and Outreach Report
    October 14, 2015Internal Revenue Service
    P.O. Box 7604
    Ben Franklin Station, Room 5203
    Washington, DC 20044
    Notice 2015-52 on Section 4980I — Excise Tax on High Cost Employer
    Sponsored Health Coverage
    October 13, 2015CDR Mark Rives
    Chief Information Officer and Director
    Office of Information Technology
    Indian Health Service
    The Reyes Building
    801 Thompson Avenue
    Rockville MD, 20852
    TSGAC Representative to ISAC
    September 30, 2015Mr. Jeff Wu
    Deputy Director
    Center for Consumer Information and Insurance Oversight
    Centers for Medicare and Medicaid Services
    Response to Request for Tribal Consultation on Referrals for Limited Cost-Sharing
    Variation Plans
    August 28, 2015Mr. Robert G. McSwain, Principal Deputy Director
    Indian Health Service
    Fiscal Year 2014 Report to Congress on the Administration of the Tribal Self-Governance Program
    August 4, 2015Dr. Elaine Buckberg
    Deputy Assistant Secretary for Policy
    Office of Economic Policy
    Department of Treasury
    Exemption of Tribes from the ACA Employer Mandate
    August 4, 2015Mr. Robert G. McSwain, Principal Deputy Director
    Indian Health Service
    Quality Reporting Measures
    August 4, 2015Centers for Medicare and Medicaid Services
    Department of Health and Human Services
    Attn: CMS-10561
    Comments on CMS-10561, ECP Data Collection to Support Qualified Health Plan
    (QHP) Certification for PY 2017
    July 28, 2015Geoffrey M. Standing Bear, Chairman, Osage NationWelcome to Self-Governance
    July 27, 2015Mr. Robert G. McSwainMulti-Purpose Agreement and Joinder Agreement & ISAC Presentation
    July 27, 2015Centers for Medicare and Medicaid ServicesComments on CMS-2390-P, “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability: Proposed Rules
    July 10, 2015Vincent Armenta, Tribal Chairman, Santa Ynez Band of Chumash IndiansWelcome to Self-Governance
    July 10, 2015Dan Courtney, Chairman, Cow Creek Band of Umpqua Tribe of IndiansWelcome to Self-Governance
    July 10, 2015Carolina Manzano, Chief Executive Officer, Southern Indian Health Council, IncWelcome to Self-Governance
    June 29, 2015Mr. Robert G. McSwainContract Support Costs - Incurred Costs Methodology
    June 9, 2015Mr. Robert G. McSwain, Acting Director , IHSEmployee Settlement
    April 20, 2015Mr. Robert G. McSwain
    Mr. Ben Smith
    Mr. Carl Harper
    Affordable Care Act
    April 8, 2015Mr. Robert G. McSwain, Acting Director , IHSContract Support Costs MSPI & DVPI
    April 8, 2015Mr. Robert G. McSwain, Acting Director, IHSContract Support Costs
    February 9, 2015Chief Marilynn Malerba, Chairwoman, TSGACAffordable Care Act
    February 5, 2015Dr. Yvette Roubideaux, Acting Director, IHSContract Support Costs
    February 4, 2015Betty Gould, Regulations Officer, IHS and Carl Harper, Director ORAP,IHS Medicare Like Rates
    January 31, 2015Chief Marilynn Malerba, Chairwoman, TSGACEbola Crisis
    January 14, 2015Ms Tracy Parker Warren, Office of Public and Intergovernmental Affairs, VAVeterans
    January 12, 2015CCIIO-CMS-DHHSAffordable Care Act