TSGAC provides recommendations and comments on a variety of topics to the Administration and the Congress. The products resulting from TSGAC discussions and meetings can be found below.

All TSGAC Correspondence

Date Sent/Received	Addressed To	Topic/Issue	Actions Needed
December 21, 2015	Centers for Medicare & Medicaid Services	CMS-9937-P, Notice of Benefit and Payment Parameters for 2017
November 17, 2015	Kitty Marx, Director, CMCS Division of Tribal Affairs, Centers for Medicare and Medicaid Services	Support for 100 Percent FMAP Proposal
November 10, 2015	Mr. Robert McSwain, Principal Deputy Director, IHS	Payment of Settlements to Civil Service Employees
November 9, 2015	U.S. Department of Health and Human Services, Office for Civil Rights	Nondiscrimination in Health Programs and Activities (RIN 0945-AA02). 80 Fed. Reg. 54172 (Sep. 8, 2015).
November 3, 2015	Mr. 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, 2015	Honorable Sylvia M. Burwell, Secretary, Department of Health and Human Services	Final Rule related to expand the Medicare-Like Rate
October 27, 2015	Honorable Robert A. McDonald, Secretary of Veterans Affairs	Comments on Veterans Access, Choice and Accountability Act of 2014 (Choice Act)
October 26, 2015	Dr. Elaine Buckberg, Deputy Assistant Secretary for Policy, Office of Economic Policy, Department of Treasury	Request for Permanent Administrative Relief from Affordable Care Act’s Employer Mandate on Tribes for Tribal Member Employees
October 23, 2015	Dr. 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, 2015	Dr. Elaine Buckberg Deputy Assistant Secretary for Policy Office of Economic Policy Department of Treasury	Excise Tax on Certain Employer-Sponsored Health Benefits
October 16, 2015	Mr. Robert G. McSwain Mr. Ben Smith Mr. Carl Harper	Transmittal of FINAL Self-Governance National ACA Education and Outreach Report
October 14, 2015	Internal 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, 2015	CDR 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, 2015	Mr. 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, 2015	Mr. 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, 2015	Dr. Elaine Buckberg Deputy Assistant Secretary for Policy Office of Economic Policy Department of Treasury	Exemption of Tribes from the ACA Employer Mandate
August 4, 2015	Mr. Robert G. McSwain, Principal Deputy Director Indian Health Service	Quality Reporting Measures
August 4, 2015	Centers 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, 2015	Geoffrey M. Standing Bear, Chairman, Osage Nation	Welcome to Self-Governance
July 27, 2015	Mr. Robert G. McSwain	Multi-Purpose Agreement and Joinder Agreement & ISAC Presentation
July 27, 2015	Centers for Medicare and Medicaid Services	Comments 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, 2015	Vincent Armenta, Tribal Chairman, Santa Ynez Band of Chumash Indians	Welcome to Self-Governance
July 10, 2015	Dan Courtney, Chairman, Cow Creek Band of Umpqua Tribe of Indians	Welcome to Self-Governance
July 10, 2015	Carolina Manzano, Chief Executive Officer, Southern Indian Health Council, Inc	Welcome to Self-Governance
June 29, 2015	Mr. Robert G. McSwain	Contract Support Costs - Incurred Costs Methodology
June 9, 2015	Mr. Robert G. McSwain, Acting Director , IHS	Employee Settlement
April 20, 2015	Mr. Robert G. McSwain Mr. Ben Smith Mr. Carl Harper	Affordable Care Act
April 8, 2015	Mr. Robert G. McSwain, Acting Director , IHS	Contract Support Costs MSPI & DVPI
April 8, 2015	Mr. Robert G. McSwain, Acting Director, IHS	Contract Support Costs
February 9, 2015	Chief Marilynn Malerba, Chairwoman, TSGAC	Affordable Care Act
February 5, 2015	Dr. Yvette Roubideaux, Acting Director, IHS	Contract Support Costs
February 4, 2015	Betty Gould, Regulations Officer, IHS and Carl Harper, Director ORAP,IHS	Medicare Like Rates
January 31, 2015	Chief Marilynn Malerba, Chairwoman, TSGAC	Ebola Crisis
January 14, 2015	Ms Tracy Parker Warren, Office of Public and Intergovernmental Affairs, VA	Veterans
January 12, 2015	CCIIO-CMS-DHHS	Affordable Care Act
December 16, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Identification of Staff for Developing Level of Need Funded Data
December 14, 2016	Jennifer 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, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Updated Contract Support Cost (CSC) Policy
November 4, 2016	Mary Smith Principal Deputy Director, Indian Health Service	IHS Headquarters Realignment
November 2, 2016	Dr. 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, 2016	David 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, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Comments on Catastrophic Health Emergency Fund Proposed Rule (RIN 0905-AC97)
October 31, 2016	Jennifer 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, 2016	Ms. Kitty Marx, Director Tribal Affairs Group, Office of External Affairs Centers for Medicare and Medicaid	Tribal Technical Advisory Group (TTAG) Appointments
October 28, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Comments on Purchasing Health Care Coverage (IHS Circular 2016-08)
October 5, 2016	CMS via regulations.gov	HHS Notice of Benefit and Payment Parameters for 2018 (CMS-9934-P)
September 27, 2016	Mary Smith Principal Deputy Director, Indian Health Service	FY 2015 Report to Congress on Administration of the Tribal Self-Governance Program
September 16, 2016	Mary Smith Principal Deputy Director, Indian Health Service	IHS Draft Quality Framework
August 26, 2016 Enclosure	Lynn Malerba, Chairwoman, TSGAC	Response to March 29, 2016 Request
August 23, 2016	Dr. 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, 2016	RIN 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, 2016	Lynn Malerba, Chairwoman, TSGAC	Facilities, Response from IHS to April 18, 2016 Letter
July 14, 2016	Mr. Michael Fisher, Lead Contract Specialist, Indian Health Service	Comments on Solicitation Number 16-IHS-HQ-SS-0001
July 8, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Request for Common Self-Governance Materials to be made Available Electronically
June 9, 2016	Mary Smith Principal Deputy Director, Indian Health Service	Proposed IHS Contract Support Costs Policy
June 3, 2016	Lynn Malerba, Chief, Mohegan Tribe, TSGAC Co-Chair	Response to April 18, 2016 TSGAC Request to Withdraw CHEF Proposed Rule
May 20, 2016	Betty 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, 2016	Treasury	TSGAC Formal Request for Targeted Partial Administrative Relief from Employer Shared Responsibility Provisions
May 10, 2016	IHS Principal Deputy Director	Catastrophic Health Emergency Fund Proposed Rule (RIN 0905-AC97)
May 10, 2016	IHS Principal Deputy Director	TSGAC Comments on SASP Program Funding Distribution
May 6, 2016	Steve Petzinger, OMB Program Examiner	Follow up from March 2016 Tribal Self-Governance Advisory Committee Meeting
May 5, 2016	Centers for Medicare and Medicaid Services	CMS-10458, “Consumer Research Supporting Outreach for Health Insurance Marketplace
April 24, 2016	IHS Principal Deputy Director OTSG Director ORAP Acting Director	SG National Outreach and Education on ACA/IHCIA
April 18, 2016	The 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, 2016	Mary Smith, IHS Principal Deputy Director	Request to Withdraw Proposed Rule, conduct Tribal Consultation and then reissue the rule. Response
April 18, 2016	Recommendations for Health Care Facilities	TSGAC Recommendations
April 11, 2016	Thomas West Kathryn Johnson Treasury Department	Excise Tax on Certain Employer-Sponsored Health Benefits
April 5, 2016	Sylvia Matthews Burwell, Secretary, Andy Slavitt Acting Administrator, Centers for Medicare and Medicaid Services	Oklahoma Section 1115 Waiver Amendment Request
March 30, 2016	TSGAC	Response to TSGAC August 2015 Letter Regarding Quality Reporting Measures Referenced GPRA Analysis
March 29, 2016	Mary Smith, IHS Principal Deputy Director	Request for Service Unit Data on Health Insurance Status and 2016 Appropriation Response Requested Data
February 29, 2016	Office of Management and Budget, Office of Information and Regulatory Affairs, Attn: CMS Desk Officer	CMS–10519, Agency Information Collection Activities: Submission for OMB Review
February 19, 2016	Centers for Medicare & Medicaid Services	Comments on CMS-9936-N; Waivers for State Innovation
February 2, 2016	Dr. 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, 2016	Center for Consumer Information and Insurance Oversight, CMS, HHS	Comments on Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces
January 5, 2016	Jerry Menikoff, M.D., J.D. Office for Human Research Protections Department of Health and Human Services	HHS-OPHS-2015-0008 – Proposed Revisions to the Federal Policy for the Protection of Human Subjects
July 31, 2017	Rear Admiral Michael Weahkee Acting Director, Indian Health Service	TSGAC Recommendations for the IHS Scholarship and Loan Repayment Programs
July 18, 2017	Lynn Malerba, Chief, Mohegan Tribe of Connecticut, Chairwoman, IHS TSGAC	IHS Follow Up to the March 2017 TSGAC Meeting
June 22, 2017	The 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, 2017	Lynn 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, 2017	Rear Admiral Chris Buchanan Acting Director, Indian Health Service	TSGAC Request to Delay Catastrophic Health Emergency Fund Final Rule
May 26, 2017	Rear 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, 2017	Seema Verma Administrator, Centers for Medicare & Medicaid Services	TSGAC Comments on Medicaid Work Requirements for American Indians and Alaska Natives
May 19, 2017	Rear 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, 2017	U.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, 2017	Jennifer 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, 2017	Rear Admiral Chris Buchanan Acting Director, Indian Health Service	TSGAC Recommendations for the Formation of the Community Health Aid Program (CHAP) Workgroup Response
March 24, 2017	Lynn 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, 2017	CMS via regulations.gov	TSGAC Formal Comments Regarding Market Stabilization Proposed Rule (CMS-9929-P)
February 27, 2017	Rear 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, 2017	Norris 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, 2017	Lynn 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
17-Oct-18		Request for Fiscal Year (FY) 2018 105(l) Leasing Expenditures and Estimates
3/18/2019	IHS Response	IHS response to issues discussed at the October 2018 TSGAC meeting.
July 27, 2016 - HHS ECP List Tip Sheet Click Here		New HHS ECP List Tip Sheet issued by the Center for Consumer Information and Insurance Oversight (CCIIO). This document outlines the steps to enter and update entries on the HHS ECP List.	HHS ECP List Tip Sheet
UPDATED! - 6/24/2016 CLICK HERE (PDF)	UPDATED! - TSGAC - All Tribes/Indian health care providers	UPDATED! Applicable Percentages and Thresholds: Indexing Adjustments Related to Certain Affordable Care Act Provisions for 2015, 2016, and 2017	UPDATED! Applicable Percentages and Thresholds: Indexing Adjustments Related to Certain Affordable Care Act Provisions for 2015, 2016, and 2017
3/18/2016 CLICK HERE (PDF)	TSGAC - All Tribes/Indian health care providers	Indian Health Service Reimbursement Rates (aka "OMB Rate") for 2016.	Indian Health Service Reimbursement Rates (aka "OMB Rate") for 2016.
3/18/2016 CLICK HERE (PDF)	TSGAC - All Tribes/Indian health care providers	Review of HHS ECP Lists for Coverage Years 2016, 2017, and 2018	Review of HHS ECP Lists for Coverage Years 2016, 2017, and 2018
1/28/2016 CLICK HERE (PDF)	TSGAC Memo - All Tribes/Indian health care providers	TSGAC Memo - Federal Poverty Levels for Medicaid and Marketplace Enrollment in 2016 and 2017	Federal Poverty Levels for Medicaid and Marketplace Enrollment in 2016 and 2017
TSGAC MEMO: Oct. 30, 2015 - CLICK HERE (PDF)	TSGAC Memo - All Tribes/Indian health care providers (IHCPs)	TSGAC Memo - HHS ECP List - Process for Updating Entries	TSGAC Memo - HHS ECP List - Process for Updating Entries
July 29, 2015: Webinar - Please Click Here for ROI Template (Instructions) July 29, 2015: Webinar: - Please Click Here for ROI Template (Excel File)	Resource for Tribes/THOs engaged in Tribal premium sponsorship	Tribal Premium Sponsorship, Calculation of Return on Investment, Template and Instructions	Resource for Tribes/THOs engaged in Tribal premium sponsorship
July 27, 2015 Click Here	Centers for Medicare and Medicaid Services	Comments 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	TSGAC provided a series of substantive comments (26 pages); along with accompanying attachments. The TSGAC comments mirror the model template developed by a team of health care experts from the MMPC/NIHB.
June 26, 2015 Click Here	TTAG to CCIIO-CMS-DHHS	Cost Sharing Protections	Identified barriers (and fixes) to AI/ANs accessing Indian-specific cost-sharing protections
May 15, 2015 Click Here	Internal Revenue Service	Notice 2015-16 on Section 4980I — Excise Tax on High Cost Employer-Sponsored Health Coverage	TSGAC Comments in Request to Notice from IRS.
January 14, 2015 Click Here	Ms Tracy Parker Warren Office of Public and Intergovernmental Affairs OTGR(075F)-VA	Comments Submitted Response to Notice of TC: Sec 102 © of the Veterans Access, Choice and Accountability Act of 2014	Urge the Reports enter into agreements for reimbursement also current agreements be used and expanded where possible to speed up implementation to eligible veterans
January 12, 2015 Click Here	CCIIO-CMS-DHHS	Comments on Draft 2016 Letter to Issuers in the Federally-Facilitated Marketplace	We are available to discuss any of the recommendations contained in the correspondence and attachment on CMS-9944-P
December 22, 2014 Click Here	DHHS/CMS- Regulations.gov	Comments on CMS-9944-P;Notice of Benefits and Payment Parameters for 2016
December 19, 2014 Click Here	Ms. Marilyn Tavenner, Administrator, CMS	TSGAC-TTAG letter of Request for Information on Contract Offers made by Issuers of Qualified Health Plans	Response received from Marilyn Tavenner, CMMS 2/2/15 to TSGAC letter dated 12/19/14
November 10, 2014 Click Here	IHS Director,Dr. Y. Roubideaux	Tribal Consultation on Medicare-like Rates (MLR) Regulations and/or Guidance	Request Tribal Consultation on MLR before the IHS or CMS publish any notices of proposed rule-making or any guidance on this topic.
November 7, 2014 Click Here	CMS, Director, Ms Kitty Marx	Reappointment of Primary & Alternate Representative to serve on CMS Tribal Technical Advisory Committee	Appreciate collective work of the TTAG provide advice and input to the CMS
October 16, 2014 Click Here	Sylvia Burwell, Secretary DHHS and Jacob Lew, Secretary Treasury	Appreciation for Recent Announcement on Exemption from Tax Penalty for American Indian/Alaska Natives	Continued partnership to improve health and welfare for Tribal citizens
September 19, 2014 Click Here	Dr. Elaine Buckberg, DAS for Policy, Dept of Treasury	Announcement Regarding Applying for Exemption through Tax Filing	Continued collaboration to improve health and welfare of all tribal members
August 28, 2014 Click Here	Sylvia Burwell, Secretary, DHHS	IHS Tribal Self-Governance Advisory Committee Priorities and Strategic Plan	Response received 12/8/14 from Sylvia Burwell, DHHS re: HHS supports efforts to increase AI/AN enrollment in Medicaid, CHIP and the Marketplace.re;CSC continue to make progress on resolving claims
August 25, 2014	Mary Wakefield, Ph.D. RN ,Administrator Health Resources & Services Administration, DHHS	Request for Tribal Consultation on 340B Drug Pricing Program	Considered attending Tribal Consultation on this matter
August 15, 2014	Dr. Caroyln Clancy, Interim Under Secretary Health-Veterans Affairs IHS Director, Dr. Y.Roubideaux	Request for VA and IHS to Revisit the VA-IHS Reimbursement Agreement	Considered attending TSGAC Quarterly meeting during Oct 8-9 and discuss recommendations in greater details.
May 23, 2014 Click Here	DHHS Secretary, The Honorable Kathleen Sebelius	Delaying Meaningful Use Electronic Health Record Program-Stage 3	Response received 9/12/14 from Marilynn Tavenner, CMS re: HER Incentive Programs, CMS updated the hardship exception application to add another option for extreme circumstances
May 20, 2014	Mandy Cohen	Request for Action on Outstanding Issues for AI/AN under ACA	Response received 6/13/14 from Mandy Cohen, MD MPH, letter sent by TSGAC dated 5/20/2014 re request for action on issues for AI/AN under ACA
May 20, 2014 Click Here	DHHS Secretary, The Honorable Kathleen Sebelius	Request for Action on Outstanding Issues for AI/AN under ACA	Appeal to reconsider an administrative fix for definition of Indian under ACA
April 15, 2014 Click Here	IHS Director, Dr. Y.Roubideaux	Response Ltr Interpreting Section 402 of the Indian Health Care Improvement Act	On-Going discussions and provide comments
March 31, 2014 Click Here	CMS-DHHS Attn: CMS Desk Officer	CMS-3178-P; Comment on Proposed Emergency Preparedness Rule	On-Going collaboration and recommendations provided
February 25, 2014 Click Here	CCIIO/CMS/DHHS	Comments on Draft 2015 CCIIO letter to issuers in the Federally-facilitated Marketplaces	On-Going collaboration and further discussions and recommendations
February 7, 2014 Click Here		Final Comments - TSGAC- CMS-9937-P Benefit and Payment Parameters 2015-...	Final Comments - TSGAC- CMS-9937-P Benefit and Payment Parameters 2015-...
January 31, 2014 Click Here	IHS Director, Dr. Y. Roubideaux	December 6, 2013 DTLL on Expanding the Medicare-Like Rate Cape to Non-Hospital Services	TSGAC Comments
January 29, 2014 Click Here	DOT, Office of Economic Policy, Dr.Elaine Buckberg	Follow-up from January 22,2014 IHS/TSGAC Quarterly Meeting	On-Going collaboration and participation in work groups establish to fashion approach implementing exemption
January 22, 2014 Click Here	CMS/DHHS Attn: CMS-3288-N	Comments on CMS-2380-PN; Basic Health Program Proposed Federal Funding Methodology for 2015	Recommend CMS modify proposed funding formula in determine amount of federal payment to states for AI/AN enrollees
Nov. 4, 2013 - Third Party Payments of Premiums..... - Click Here		Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces	Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces