[Federal Register Volume 87, Number 170 (Friday, September 2, 2022)]
[Notices]
[Pages 54219-54220]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-19085]



[[Page 54219]]

-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Analyses, Research, and Studies To Assess the Impact of Centers 
for Medicare & Medicaid Services Programs on American Indians/Alaska 
Natives and the Indian Health Care System Serving American Indians/
Alaska Natives Beneficiaries

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of a single source award.

-----------------------------------------------------------------------

SUMMARY: Through a Notice of Funding Opportunity, ``Analyses, Research, 
and Studies to Assess the Impact of Centers for Medicare & Medicaid 
Services (CMS) Programs on American Indians/Alaska Natives (AI/ANs) and 
the Indian Health Care System Serving AI/AN Beneficiaries,'' CMS has 
sought an application from the National Indian Health Board (NIHB)for a 
single source cooperative agreement. The funding CMS anticipates 
awarding under this single source cooperative agreement will support 
research to assess the impact of CMS programs that affect AI/ANs and 
the Indian Health Care System.

DATES: The NIHB's application is due on September 1, 2022, and if the 
application is approved, CMS anticipates awarding a single source 
cooperative agreement by September 28, 2022. The anticipated period of 
performance for the cooperative agreement would be from September 29, 
2022, through September 28, 2027, subject to the availability of funds 
and satisfactory performance.

FOR FURTHER INFORMATION CONTACT: Rhonda Martinez-McFarland, Project 
Officer (206) 615-2267.

SUPPLEMENTARY INFORMATION:

I. Background

    Through a Notice of Funding Opportunity (NOFO), ``Analyses, 
Research, and Studies to Assess the Impact of Centers for Medicare & 
Medicaid Services (CMS) Programs on American Indians/Alaska Natives 
(AI/ANs) and the Indian Health Care System Serving AI/AN 
Beneficiaries,'' CMS has sought an application from the National Indian 
Health Board (NIHB) for a single source cooperative agreement. The 
funding CMS anticipates awarding under this single source cooperative 
agreement will support research to assess the impact of CMS programs 
that affect AI/ANs and the Indian Health Care System, composed of 
Indian Health Service (IHS) providers, providers that are Tribally 
operated under the Indian Self Determination and Education Assistance 
Act (ISDEAA), and providers operated by Urban Indian organizations 
(collectively referred to as ITU providers). This cooperative agreement 
is authorized under Section 1110 of the Social Security Act, codified 
at 42 U.S.C. 1310, which authorizes federal funding for analyses, 
research, and studies which will help improve the administration and 
effectiveness of programs carried on or assisted under the Social 
Security Act and programs related thereto.
    CMS anticipates that the research conducted under this award will 
help CMS to develop more effective and efficient ways to increase 
access to health services and coverage for the AI/AN population, 
including by improving and increasing the enrollment of AI/AN 
individuals and Indian Health Care System providers in Medicare, 
Medicaid, the Children's Health Insurance Program (CHIP), and Health 
Insurance Marketplace[supreg] \1\ coverage. CMS also anticipates that 
the research conducted under this award might help CMS develop policies 
to reduce health inequities experienced by AI/AN communities.
---------------------------------------------------------------------------

    \1\ Health Insurance Marketplace[supreg] is a registered service 
mark of the U.S. Department of Health & Human Services.
---------------------------------------------------------------------------

    The scope of the work under the anticipated award builds on NIHB's 
past experience and knowledge and is expected to help CMS better serve 
AI/AN communities. NIHB was established by federally recognized Tribes 
to advocate as their united voice. NIHB seeks to reinforce Tribal 
sovereignty, strengthen Tribal health care systems, secure resources, 
and build capacity to achieve the highest level of health and well-
being for AI/ANs. NIHB provides culturally appropriate outreach and 
education to Tribal communities to encourage enrollment of AI/ANs in 
CMS programs. Data analysis conducted by NIHB is shared with Tribal 
leaders to increase their knowledge of the important role CMS plays in 
providing greater access to health coverage in Tribal communities. In 
the past, NIHB has conducted extensive analysis of AI/AN enrollment in 
Medicare, which resulted in several data symposiums and reports. More 
recently, NIHB analyzed data from the American Community Survey (ACS) 
to demonstrate an increase in AI/AN enrollment in Medicare and 
Medicaid. NIHB's initial analysis of Medicaid enrollment noted an 
increase of AI/ANs enrolled in Medicaid from 1.4 million in 2012 to 1.7 
million in 2016. Through the work of NIHB, Tribal leaders and Tribal 
health directors have gained a better understanding of CMS policies and 
programs and their impact on the Indian Health Care System and Tribal 
communities.

II. Provisions of the Notice

    CMS has solicited a proposal from the NIHB to undertake analysis, 
research, and studies to assess the impact of CMS programs on AI/AN 
beneficiaries and the Indian Health Care System serving those 
beneficiaries. The project consists of five principal tasks:
     Research and analysis of impact of CMS Regulations/
Policies on AI/ANs and on the Indian Health Care System: Assess the 
ongoing impact of CMS programs through an analysis of CMS regulations, 
policies, and initiatives that have a potential impact or effect on the 
Indian Health Care System and on AI/ANs. The objective is to determine 
the level of Tribal input in the CMS regulatory and policy formulation 
process and assess whether such input was effectively considered in the 
final development of CMS regulations and policies that impact AI/ANs 
and the Indian Health Care System.
     Data Research and Analysis: Analysis of AI/AN demographic, 
enrollment, and utilization data by reviewing CMS, IHS, Social Security 
Administration (SSA), United States Census, and other data resources in 
order to develop strategies that make CMS data systems capable of 
reporting on AI/AN enrollment. Determine service utilization, health 
status, and payment data from Medicare, Medicaid, CHIP, and Health 
Insurance Marketplace[supreg] coverage. The results of this data 
analysis are expected to help facilitate CMS program planning, 
evaluation, performance measurement, health status monitoring, and 
targeted enrollment efforts. In addition, the data analysis will 
include a review of data to help address health inequities experienced 
by Tribal communities in a coordinated continuous effort with CMS and 
Tribal partners.
     Research & Strategic Priority Planning: Review, revise, 
and provide updates to the CMS Tribal Technical Advisory Group (TTAG) 
strategic plan activities to reflect the views of all federally 
recognized Tribal leaders on changes to Medicare, Medicaid, CHIP, and 
Health Insurance Marketplace[supreg] coverage that impact AI/ANs and 
the Indian Health Care System, including changes to CMS programs 
resulting from legislation, regulations, policy guidance, and new 
initiatives or priorities of the agency.

[[Page 54220]]

     Consultation Policy: Provide research support on the use 
and effectiveness of the CMS Tribal Consultation Policy, national 
consultations and listening sessions with Tribes on CMS program issues, 
and annual HHS National and Regional Consultation Sessions with Tribes. 
Track issues raised at Tribal consultation/listening sessions and 
develop an executive summary on key issues and recommended actions for 
resolution and/or further analysis.
     Enrollment and Outreach: Evaluate the effectiveness of CMS 
outreach and enrollment efforts to AI/ANs enrolled in CMS-regulated 
programs by conducting quarterly trainings on these programs for Tribal 
enrollment assisters, ITU providers, ITU third-party resource staff, 
and AI/ANs. NIHB will complete an assessment and compile best practices 
to increase AI/AN enrollment in Medicare, Medicaid, CHIP, and Health 
Insurance Marketplace[supreg] coverage. In addition, NIHB, in 
collaboration with CMS, will develop culturally appropriate Tribal 
outreach materials. The information NIHB uses to evaluate CMS outreach 
and enrollment efforts will be collected based on feedback from CMS 
annual ITU trainings, AI/AN outreach events, and other data sources. 
NIHB, in collaboration with Tribal leadership and CMS, will summarize 
lessons learned and make recommendations on how CMS could improve AI/AN 
outreach efforts in Indian Country.

Amount of the Award

    The total amount of funding available over a 5-year period will be 
up to $4,000,000 pending availability of funds and satisfactory 
performance by the recipient. The cooperative agreement will be awarded 
consistent with the overall quality of the proposal and the applicant's 
ability to meet project goals. The amount of funding awarded will be no 
more than $800,000 per 12-month budget period, subject to availability 
of funds, and there will be five 12-month budget periods under this 
award. Funding for budget periods 2-5 is non-competitive and is subject 
to the availability of funds as well as satisfactory performance of the 
recipient. The total award will not exceed $4,000,000.

Justification for Single Source Award

    In 2012, CMS awarded a five-year single-source cooperative 
agreement to NIHB under Section 1110 of the Social Security Act and in 
2017, CMS awarded a second five-year single source cooperative 
agreement to NIHB under the same authority. With this NOFO, CMS has 
sought an application from NIHB for a third five-year single source 
award, under the same authority.
    Through its two previous cooperative agreements, since 2012, NIHB 
has provided analysis and research on the potential and actual impact 
of CMS policies and guidance on AI/ANs and the Indian Health Care 
System. The work has included analysis and research on Medicare and 
Medicaid enrollment of AI/ANs in order to gain a better understanding 
of AI/AN utilization of CMS programs.
    In addition, NIHB has been instrumental in tracking CMS regulation 
and policy changes, and has provided a better understanding of the 
implications that CMS regulations and guidance have had for Indian 
Health Care System providers and AI/AN individuals. This includes 
evaluating the impact of effective and meaningful Tribal consultation. 
NIHB has a long history of providing unique forums for showcasing how 
CMS works within Indian Country to promote enrollment of AI/ANs and 
Indian Health Care System providers in CMS programs.
    Based on this past experience, NIHB is the only entity capable of 
carrying out the scope of activities in Fiscal Years (FY) 2022-2027 
because the scope of the work that would be performed under this award 
builds on past experience and knowledge. Any other source would not 
have all of the knowledge and experience NIHB has gained in the last 
ten years.

Project Period

    The anticipated period of performance for this cooperative 
agreement is September 29, 2022 through September 28, 2027 with funding 
awarded in 12-month budget increments subject to the availability of 
funds and satisfactory performance.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping, or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Evell Barco Holland, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.
    Authority: Social Security Act section 1110.

    Dated: August 30, 2022.
Evell Barco Holland,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2022-19085 Filed 9-1-22; 8:45 am]
BILLING CODE 4120-01-P