[Senate Report 116-180]
[From the U.S. Government Publishing Office]
Calendar No. 388
116th Congress } { Report
SENATE
1st Session } { 116-180
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HEALTH CARE ACCESS FOR URBAN NATIVE VETERANS ACT OF 2019
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December 18, 2019.--Ordered to be printed
_______
Mr. Hoeven, from the Committee on Indian Affairs,
submitted the following
R E P O R T
[To accompany S. 2365]
[Including cost estimate of the Congressional Budget Office]
The Committee on Indian Affairs, to which referred the
bill, S. 2365, to amend the Indian Health Care Improvement Act
to authorize urban Indian organizations to enter into
arrangements for the sharing of medical services and
facilities, and for other purposes, having considered the same,
reports favorably thereon without amendment and recommends that
the bill do pass.
PURPOSE
The bill is intended to authorize the U.S. Departments of
Veterans Affairs (VA) and Defense (DOD) to enter into
reimbursement agreements with urban Indian organizations (UIOs)
for direct health care services provided to eligible
beneficiaries of either Department.
BACKGROUND AND NEED FOR LEGISLATION
The Indian Health Service (IHS) provides primary health
care and public health services to an estimated 2.6 million
American Indians and Alaska Natives through a network of 605
facilities located in 37 states. Operation of these facilities
fall into one of three categories of health care facilities:
federally-operated, Tribally-operated, and UIO-operated.\1\
UIOs operate 40 facilities and serve more than 75,000 IHS
patients each year.\2\ However, the three branches of IHS do
not have equal access to federal Indian health resources--
including reimbursements from the VA for direct health care
provided by IHS facilities to eligible beneficiaries.
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\1\Under the Indian Relocation Act of 1956, Native communities saw
federal policy push massive numbers of Tribal members off the
reservation to urban centers for the first time. By the 1970s, 45% of
AIANs lived in urban areas--up from a mere 8% in the 1940s. This forced
diaspora led tribal leaders to call for the establishment and inclusion
of UIOs within the IHS system in 1976.
\2\U.S. Dep't of Health and Human Services, Fiscal Year 2020 Indian
Health Service Justification of Estimates for Appropriations Committees
CJ-140 (2019) (https://www.ihs.gov/sites/budgetformulation/themes/
responsive2017/display_objects/documents/
FY2020CongressionalJustification.pdf).
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Section 405 of the Indian Health Care Improvement Act
(IHCIA) authorizes the VA to reimburse federally-operated and
Tribally-operated IHS facilities for any services they provide
to Native VA-eligible beneficiaries. VA has entered into one
national reimbursement agreement that covers 74 federally-
operated IHS facilities and 114 individual reimbursement
agreements with tribally-operated IHS sites using this
authority since 2012.\3\ Between August 2012 and September
2019, the Department reimbursed these IHS facilities over $104
million for services provided to 10,645 Native veterans.
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\3\Oversight/Legislative Hearing on ``Recognizing the Sacrifice:
Honoring a Nation's Promise to Native Veterans'' and to receive
testimony on S.1001 and S.2365 Before the S. Comm. on Indian Affairs,
116th Cong. (2019) (statement of Robert L. Wilkie, Sec'y, U.S. Dep't of
Veterans Affairs).
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However, because IHCIA Section 405 does not explicitly
reference UIO reimbursements, these facilities are legally
excluded from receiving them.\4\
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\4\Oversight/Legislative Hearing on ``Recognizing the Sacrifice:
Honoring a Nation's Promise to Native Veterans'' and to receive
testimony on S. 1001 and S. 2365 Before the S. Comm. on Indian Affairs,
116th Cong. (2019) (statements of Robert L. Wilkie, Sec'y, U.S. Dep't
of Veterans Affairs, & RADM Chris Buchanan, Dep. Director, Indian
Health Service, U.S. Dep't of Health and Human Services).
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SUMMARY OF THE BILL
The bill, S. 2365, amends IHCIA Section 405 to explicitly
reference UIOs. This amendment will make UIOs eligible to enter
into reimbursement agreements with the VA and DOD for health
care services provided by UIOs to eligible VA and DOD
beneficiaries. It will also authorize the VA and DOD to
reimburse UIOs through these reimbursement agreements.
LEGISLATIVE HISTORY
On July 31, 2019, Senators Udall, Tester, Moran, Rounds,
and Smith introduced S. 2365, the Health Care Access for Urban
Native Veterans Act. Senators Duckworth, Sinema, McSally joined
the bill as additional co-sponsors on October 30, November 20,
and December 10, 2019, respectively.
On November 20, 2019, the Committee on Indian Affairs held
a legislative hearing on S. 2365. At this legislative hearing,
the honorable Robert Wilkie, VA Secretary, testified in support
of the bill. Additionally, IHS Deputy Director RADM Chris
Buchanan testified to the need for the legislation.
On December 11, 2019, the Committee on Indian Affairs of
the Senate met at a duly called business meeting to consider
two bills, including S. 2365. No Committee Members filed
amendments to S. 2365. The Committee passed both bills,
including S. 2365, by voice vote and ordered the bills reported
favorably.
On August 2, 2019, Representatives Khanna, Gosar, Haaland,
Gianforte, Lujan, Young, Moore, Bacon, Tonko, and Estes
introduced a companion bill, H.R. 4135, the Health Care Access
for Urban Native Veterans Act, which the House of
Representatives referred to the Committees on Natural Resources
and Energy and Commerce. Representatives Gallego, Blumenauer,
Kilmer, Hastings, O'halleran, Cook, Roybal-Allard, Fitzpatrick,
Kirkpatrick, McMorris Rodgers, Cole, DeGette, Aguilar, Mullin,
Joyce, and Sewell have since joined the H.R. 4135 as additional
co-sponsors.
On August 21, 2019, the Committee on Natural Resources
referred the identical companion bill, H.R. 4153, to the
Subcommittee for Indigenous Peoples of the United States. The
Subcommittee held a hearing on the bill on September 19, 2019,
but has taken no further action since that time.
SECTION-BY-SECTION ANALYSIS
Section 1. Short title
Section 1 states S. 2365 may be cited as the ``Health Care
Access for Urban Native Veterans Act of 2019.''
Section. 2. Sharing agreements with Federal agencies
Section 2 amends IHCIA section 405 to insert ``urban Indian
organizations,'' ``an urban Indian organization,'' before ``and
tribal organizations''' in subsections (a)(1) and (c).
COST AND BUDGETARY CONSIDERATIONS
The following cost estimate, was provided by the
Congressional Budget Office via email dated December 17th,
2019.
To expedite the filing of the Committee report, CBO
Directors Robert Stewart and Ann Futrell, provided the
following statement. CBO estimates that the bill would have no
effect on direct spending or revenues.
REGULATORY AND PAPERWORK IMPACT STATEMENT
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires each report accompanying a bill to evaluate the
regulatory and paperwork impact that would be incurred in
carrying out the bill. The Committee believes that S. 2365 will
have minimal impact on regulatory or paperwork requirements.
EXECUTIVE COMMUNICATIONS
The Committee has received no communications from the
Executive Branch regarding S. 2365.
CHANGES IN EXISTING LAW
On February 6, 2019, the Committee unanimously approved a
motion to waive subsection 12 of rule XXVI of the Standing
Rules of the Senate. In the opinion of the Committee, it is
necessary to dispense with subsection 12 of rule XXVI of the
Standing Rules of the Senate to expedite the business of the
Senate.