Self-Governance Communication & Education Tribal Consortium

TSGAC Letters and Policy

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/ReceivedAddressed ToTopic/IssueActions Needed
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
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
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 ServicesWritten 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
17-Oct-18Request for Fiscal Year (FY) 2018 105(l) Leasing Expenditures and Estimates
3/18/2019IHS ResponseIHS 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 providersUPDATED!
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 providersIndian 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 providersReview of HHS ECP Lists for Coverage Years 2016, 2017, and 2018Review of HHS ECP Lists for Coverage Years 2016, 2017, and 2018
1/28/2016
CLICK HERE (PDF)
TSGAC Memo - All Tribes/Indian health care providersTSGAC 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 EntriesTSGAC 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 sponsorshipTribal Premium Sponsorship, Calculation of Return on Investment, Template and InstructionsResource for Tribes/THOs engaged in Tribal premium sponsorship
July 27, 2015
Click Here
Centers 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 RulesTSGAC 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-DHHSCost Sharing ProtectionsIdentified barriers (and fixes) to AI/ANs accessing Indian-specific cost-sharing protections
May 15, 2015
Click Here
Internal Revenue ServiceNotice 2015-16 on Section 4980I — Excise Tax on High Cost Employer-Sponsored Health CoverageTSGAC 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 2014Urge 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-DHHSComments on Draft 2016 Letter to Issuers in the Federally-Facilitated MarketplaceWe 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.govComments on CMS-9944-P;Notice of Benefits and Payment Parameters for 2016
December 19, 2014
Click Here
Ms. Marilyn Tavenner, Administrator, CMSTSGAC-TTAG letter of Request for Information on Contract Offers made by Issuers of Qualified Health PlansResponse received from Marilyn Tavenner, CMMS 2/2/15 to TSGAC letter dated 12/19/14
November 10, 2014
Click Here
IHS Director,Dr. Y. RoubideauxTribal Consultation on Medicare-like Rates (MLR) Regulations and/or GuidanceRequest 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 CommitteeAppreciate 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 TreasuryAppreciation for Recent Announcement on Exemption from Tax Penalty for American Indian/Alaska NativesContinued partnership to improve health and welfare for Tribal citizens
September 19, 2014
Click Here
Dr. Elaine Buckberg, DAS for Policy, Dept of TreasuryAnnouncement Regarding Applying for Exemption through Tax FilingContinued collaboration to improve health and welfare of all tribal members
August 28, 2014
Click Here
Sylvia Burwell, Secretary, DHHSIHS Tribal Self-Governance Advisory Committee Priorities and Strategic PlanResponse 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, 2014Mary Wakefield, Ph.D. RN ,Administrator
Health Resources & Services Administration,
DHHS
Request for Tribal Consultation on 340B Drug Pricing ProgramConsidered attending Tribal Consultation on this matter
August 15, 2014Dr. Caroyln Clancy, Interim Under Secretary Health-Veterans Affairs

IHS Director, Dr. Y.Roubideaux
Request for VA and IHS to Revisit the VA-IHS Reimbursement AgreementConsidered attending TSGAC Quarterly meeting during Oct 8-9 and discuss recommendations in greater details.
May 23, 2014
Click Here
DHHS Secretary, The Honorable Kathleen SebeliusDelaying Meaningful Use Electronic Health Record Program-Stage 3Response 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, 2014Mandy CohenRequest for Action on Outstanding Issues for AI/AN under ACAResponse 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 SebeliusRequest for Action on Outstanding Issues for AI/AN under ACAAppeal to reconsider an administrative fix for definition of Indian under ACA
April 15, 2014
Click Here
IHS Director, Dr. Y.RoubideauxResponse Ltr Interpreting Section 402 of the Indian Health Care Improvement ActOn-Going discussions and provide comments
March 31, 2014
Click Here
CMS-DHHS
Attn: CMS Desk Officer
CMS-3178-P; Comment on Proposed Emergency Preparedness RuleOn-Going collaboration and recommendations provided
February 25, 2014
Click Here
CCIIO/CMS/DHHSComments on Draft 2015 CCIIO letter to issuers in the Federally-facilitated MarketplacesOn-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. RoubideauxDecember 6, 2013 DTLL on Expanding the Medicare-Like Rate Cape to Non-Hospital ServicesTSGAC Comments
January 29, 2014
Click Here
DOT, Office of Economic Policy, Dr.Elaine BuckbergFollow-up from January 22,2014 IHS/TSGAC Quarterly MeetingOn-Going collaboration and participation in work groups establish to fashion approach implementing exemption
January 22, 2014
Click Here
CMS/DHHS Attn: CMS-3288-NComments on CMS-2380-PN; Basic Health Program Proposed Federal Funding Methodology for 2015Recommend 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 MarketplacesThird Party Payments of Premiums for Qualified Health Plans in the Marketplaces