Legislation is critical to expanding Self-Governance and reaffirming its tenants throughout the Federal government. Self-Governance Tribes seek to further the self-determination across the spectrum of Tribal programs, while building local capacity to meet local needs. Self-Governance Tribes are interested in a vast number of legislative ideas, but identified the items below as their key priorities for the 115th Congress.
To learn more about each legislative initiative and other Self-Governance goals for this session download the National Tribal Self-Governance 2017-2019 Strategic Plan & Priorities.
Amend Title IV of the Indian Self-Determination and Education Assistance Act.
Amending Title IV of ISDEAA has been a top legislative priority for Self-Governance Tribes for over a decade. Over the past 35 years, ISDEAA has been one of the most successful mechanisms in allowing Tribes to develop the capacity for government-building activities. Self-Governance Tribes must continue to advance the vision of ISDEAA by working to amend Title IV of ISDEAA to create consistency between Title IV Self-Governance in the DOI and Title V Self-Governance in the Department of Health and Human Services (HHS), which would create administrative efficiencies for Self-Governance Tribes.
Enact legislation that strengthens and reaffirms the original tenants of the Indian Employment, Training and Related Services Act, Public Law 102-477.
The 477 Program provides Tribal governments with the flexibility to design employment, training, and economic development plans that utilize funding from several federal programs to best meet the needs of their local communities. While PL 102-477 is still technically a “demonstration project,” the 477 Program has existed for over two decades and more than 250 Tribes and Tribal organizations consolidate multiple programs into a single 477 Plan. Despite nearly two decades of success, the viability of the 477 Program was jeopardized by two recent Federal agency actions. Legislation is now necessary to make the 477 Program permanent and remove administrative burdens for Self-Governance Tribes.
Reauthorize the Native American Housing Assistance and Self-Determination Act.
The current authorization of the Native American Housing Assistance and Self-Determination Act of 1996 (NAHASDA) expired on September 30, 2013. NAHASDA is the main authorization of Tribal housing programs, which has been successful in allowing Tribes the self-determination necessary to provide effective programs for Tribal citizens. Tribes are now exercising their right to self-determination by designing and implementing their own housing and other community development infrastructure programs. Reauthorization of NAHASDA is critical to continue to support Tribal housing authorities that build keystone housing and community infrastructure in Tribal communities.
Protect modernizing health care delivery and quality provisions included in the Indian Health Care Improvement Act (IHCIA).
IHCIA has provided significant progress in the I/T/U health system. IHCIA updates and modernizes health delivery services, such as cancer screenings, home and community based services, hospice care, and long-term care for the elderly and disabled. It establishes a continuum of care through integrated behavioral health programs that address alcohol/substance abuse problems and the social service and mental health needs of Indian people. Additionally, there are many essential cost-saving provisions for IHS and Tribes, such as the authority for I/T/U health providers to be licensed in any state and practice at an I/T/U facility and the ability for Tribes to access the Federal Employee Health Benefits (FEHB) system. The law also authorizes IHS and Tribes to enter into arrangements with the Department of Veterans Affairs and Department of Defense to share medical facilities and services, which increases government efficiency and ensures that veterans receive the care they deserve. IHCIA allows I/T/U providers to be eligible for participation in any Federal health care program and for reimbursement from 3rd party payers, which is critical to increasing additional resources within the system.
Permanently reauthorize and provide full funding for the Special Diabetes Program for Indians.
Congress established the SDPI in 1997 as part of the Balanced Budget Act to address the growing epidemic of diabetes in American Indian and Alaska Native communities. SDPI programs have become the nation’s most strategic and comprehensive effort to combat diabetes. Self-Governance Tribes believe the success of these programs requires the permanent reauthorization and supporting funding for SDPI.
Enact Medicare-Like Rates for outpatient services for IHS, Tribal, and Urban facilities.
IHS, Tribes, and Tribal organizations currently cap the rates they will pay for hospital services to what the Medicare program would pay for the same service (the “Medicare-Like Rate” or “MLR”). Currently, this MLR cap applies only to hospital services, which represent only a fraction of the services provided through the Purchase/Referred Care (PRC) program. Proposed legislative fixes would amend Section 1866 of the Social Security Act to expand application of the MLR cap. It would direct the Secretary to issue new regulations to establish a payment rate cap applicable to medical and other health services in addition to the current law’s cap on services provided by hospitals. It would make the MLR cap apply to all Medicare-participating providers and suppliers. Self-Governance Tribes support this legislative fix to leverage the limited resources provided to I/T/Us.
Advance legislation to expand Self-Governance authority to other HHS agencies and programs.
Title VI of ISDEAA required the Secretary of HHS to conduct a study to determine the feasibility of a Tribal Self-Governance demonstration project for appropriate HHS PSFAs in agencies other than IHS. HHS submitted the required report to Congress in March of 2003. The report concluded that the demonstration project was feasible. Although Congress has considered legislation to authorize a Self-Governance demonstration project, to date, legislation has not been enacted. HHS has since convened a Self-Governance Tribal Federal Workgroup (SGTFW) and issued a final report in September 2014. After repeated attempts to reconstitute the SGTFW to continue working on the report recommendations, Self-Governance Tribes seek legislative proposals to implement recommendations outlined in the report.