August 9, 2022

Dear USET/USET SPF Family,

The Department of Health and Human Services (HHS) is seeking feedback from Tribal Nations on a Notice of Proposed Rulemaking (NPRM) revising regulations within Section 1557 of the Patient Protection and Affordable Care Act related to Nondiscrimination in Health Programs.

The proposed regulations would apply nondiscrimination standards to all health programs and activities receiving federal funding, including state and federally facilitated exchanges and the Indian Health Service (IHS). The proposed rule would address language access for those with disabilities or limited English proficiency. It would also require covered entities to have Section 1557 policies and staff training.

At present, the proposed rule does not appear to have any exemptions for Tribally operated facilities or IHS facilities. It is not clear how this proposed rule would affect the existing provision in HHS’s nondiscrimination policy that provides an exception for IHS/Tribal/Urban Indian Organizations limiting their services to IHS beneficiaries. Additionally, the proposed rule would require the creation/implementation of certain policies and procedures, but there are currently no available grants or federal funds to support complying with the new requirements.

HHS proposes adopting a process by which certain recipients of federal funds may inform HHS of their views that parts of the rule would violate federal conscience or religious freedom laws, such that HHS may determine that the recipient is exempt from or eligible for a modification of the rule.

HHS will hold a Tribal Consultation on the proposed rule on August 31, 2022, from 2:00 – 4:00 pm EDT. Tribal Nations are invited to share their views, concerns and civil rights priorities with the agency. You may register here for the Tribal Consultation.

Comments on this topic are due on October 2, 2022 and must be submitted through the Federal Rulemaking Portal (www.regulations.gov) or by mail.

For more information, please contact Ashton Martin, USET SPF Health Policy Analyst, at amartin@usetinc.org.

Established in 2014, the USET Sovereignty Protection Fund (USET SPF) is a non-profit, inter-Tribal organization advocating on behalf of thirty-three (33) federally recognized Tribal Nations from the Northeastern Woodlands to the Everglades and across the Gulf of Mexico. USET SPF is dedicated to promoting, protecting, and advancing the inherent sovereign rights and authorities of Tribal Nations and in assisting its membership in dealing effectively with public policy issues.