[House Report 117-168]
[From the U.S. Government Publishing Office]
117th Congress } { Rept. 117-168
HOUSE OF REPRESENTATIVES
1st Session } { Part 1
======================================================================
URBAN INDIAN HEALTH CONFER ACT
_______
November 1, 2021.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Grijalva, from the Committee on Natural Resources, submitted the
following
R E P O R T
[To accompany H.R. 5221]
[Including cost estimate of the Congressional Budget Office]
The Committee on Natural Resources, to whom was referred
the bill (H.R. 5221) to amend the Indian Health Care
Improvement Act to establish an urban Indian organization
confer policy for the Department of Health and Human Services,
having considered the same, reports favorably thereon without
amendment and recommends that the bill do pass.
Purpose of the Bill
The purpose of H.R. 5221 is to amend the Indian Health Care
Improvement Act to establish an urban Indian organization
confer policy for the Department of Health and Human Services.
Background and Need for Legislation
The Indian Health Service (IHS) supports contracts and
grants to 41 Urban Indian Organization programs. These programs
offer medical services ranging from dental services, optometry
services, pharmacy services to community services, alcohol, and
drug abuse prevention, nutrition education, and counseling
services. The Indian Health Care Improvement Act established
the Urban Indian Organizations (UIOs) in response to the 70% of
American Indians and Alaska Natives living and seeking
healthcare outside tribal lands throughout the United States.
Currently, only IHS maintains a legal obligation to confer
with UIOs. An Urban Confer policy at HHS will serve as the
preferred method of dialogue between the agency and UIOs. HHS's
Urban Confer policy's limited scope is a barrier for UIOs
communication with other agencies and offices. The harms caused
by this limited confer policy were highlighted throughout the
COVID-19 pandemic when HHS began its vaccine allocations. HHS
refrained from initiating communications with UIOs. As a
result, UIOs were unable to provide input on the vaccine
rollout allocations until the day of the deadline, which
delayed the vaccine's distribution to many urban American
Indians and Alaska Natives.
The failure to communicate with UIOs about healthcare
policies that impact urban Indian communities is inconsistent
with the federal trust responsibility and contrary to sound
public health policy. H.R. 5221 will establish direct lines of
communication for UIOs across the entire Department and ensure
that urban American Indians and Alaska Natives are aware of
significant healthcare policy changes.
H.R. 5221 will require agencies and offices within the U.S.
Department of Health and Human Services to confer with urban
Indian organizations on policies and initiatives related to
healthcare for urban American Indians and Alaska Natives.
Committee Action
H.R. 5221 was introduced on September 10, 2021, by Chair
Raul M. Grijalva (D-AZ). The bill was referred to the Committee
on Natural Resources, and in addition to the Committee on
Education and Labor. Within the former committee, the bill was
referred to the Subcommittee for Indigenous Peoples of the
United States. On October 5, 2021, the Subcommittee held a
hearing on the bill. On October 13, 2021, the Natural Resources
Committee met to consider the bill. The Subcommittee was
discharged by unanimous consent. No amendments were offered.
The bill was adopted and ordered favorably reported to the
House of Representatives by unanimous consent.
Hearings
For the purposes of clause 3(c)(6) of House rule XIII, the
following hearing was used to develop or consider this measure:
hearing by the Subcommittee for Indigenous Peoples of the
United States held on October 5, 2021.
Committee Oversight Findings and Recommendations
Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII of the Rules of the House of Representatives, the
Committee on Natural Resources' oversight findings and
recommendations are reflected in the body of this report.
Compliance With House Rule XIII and Congressional Budget Act
1. Cost of Legislation and the Congressional Budget Act.
With respect to the requirements of clause 3(c)(2) and (3) of
rule XIII of the Rules of the House of Representatives and
sections 308(a) and 402 of the Congressional Budget Act of
1974, the Committee has received the following estimate for the
bill from the Director of the Congressional Budget Office:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
H.R. 5221 would require the Secretary of Health and Human
Services (HHS) to ensure that the Indian Health Service (IHS)
and other agencies within HHS confer with Urban Indian Health
Programs (UIHPs), to the maximum extent practicable, on matters
relating to carrying out the Indian Health Care Improvement Act
and other provisions of law relating to Indian health care.
UIHPs are health care organizations that are grantees of IHS
but are not considered federal entities nor part of the IHS
system. There are currently 41 UIHP clinics that provide
primary care services to a mix of Indian and non-Indian
patients. CBO estimates that enacting H.R. 5221 would not
affect direct spending or revenues and would have an
insignificant effect on spending subject to appropriation for
IHS and other agencies' staff to confer with representatives of
UIHPs as needed.
The CBO staff contact for this estimate is Robert Stewart.
The estimate was reviewed by Leo Lex, Deputy Director for
Budget Analysis.
General Performance Goals and Objectives. As required by
clause 3(c)(4) of rule XIII, the general performance goals and
objectives of this bill are to amend the Indian Health Care
Improvement Act to establish an urban Indian organization
confer policy for the Department of Health and Human Services.
Earmark Statement
This bill does not contain any Congressional earmarks,
limited tax benefits, or limited tariff benefits as defined
under clause 9(e), 9(f), and 9(g) of rule XXI of the Rules of
the House of Representatives.
Unfunded Mandates Reform Act Statement
This bill contains no unfunded mandates.
Existing Programs
This bill does not establish or reauthorize a program of
the federal government known to be duplicative of another
program.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Preemption of State, Local, or Tribal Law
Any preemptive effect of this bill over state, local, or
tribal law is intended to be consistent with the bill's
purposes and text and the Supremacy Clause of Article VI of the
U.S. Constitution.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
INDIAN HEALTH CARE IMPROVEMENT ACT
* * * * * * *
TITLE V--HEALTH SERVICES FOR URBAN INDIANS
* * * * * * *
SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.
(a) Definition of Confer.--In this section, the term
``confer'' means to engage in an open and free exchange of
information and opinions that--
(1) leads to mutual understanding and comprehension;
and
(2) emphasizes trust, respect, and shared
responsibility.
[(b) Requirement.--The Secretary shall ensure that the
Service confers, to the maximum extent practicable, with urban
Indian organizations in carrying out this Act.]
(b) Requirement.--The Secretary shall ensure that the Service
and the other agencies and offices of the Department confer, to
the maximum extent practicable, with urban Indian organizations
in carrying out--
(1) this Act; and
(2) other provisions of law relating to Indian health
care.
* * * * * * *
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Supplemental, Minority, Additional, or Dissenting Views
None.
[all]