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Indian Nations Update - April 2010

April 13, 2010

Health Care Reform Becomes Law, Indian Health Care Improvement Act is Reauthorized
On March 23rd, President Obama signed into law H.R. 3560, the "Patient Protection and Affordable Care Act," Pub. L. 111-148 (the "Act"). On March 26th, H.R. 4872, the "Health Care and Education Reconciliation Act," including amendments to the Act agreed upon by both chambers of Congress, was sent to the President for signature. The Act, which is intended to extend health insurance coverage to an additional 32 million persons, provides extensive consumer protections intended to prevent loss of health insurance, mandates that individuals maintain health insurance beginning in 2014, establishes insurance exchanges intended to expand insurance availability, provides subsidies to individuals and small business to encourage coverage and makes many other changes to the American health. The Act includes the Indian Health Care Improvement Reauthorization and Extension Act which:

  • permanently authorizes appropriations to fund the Indian health programs set forth in the Indian Health Care Improvement Act of 1976, as amended ("IHCIA");
  • expands permissible uses of funds appropriated under the IHCIA to include behavioral, mental, youth, hospice, long-term care, assisted living, and community-based care;
  • permits tribes to directly bill Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) for health care provided by the Tribe;
  • requires a federal health care program (e.g., Medicare and Medicaid) to accept an Indian Health Service (IHS), tribe, tribal organization, or urban Indian organization entity as a provider eligible to receive payment under the program for services furnished to an Indian on the same basis as any other qualified provider;
  • provides for negotiation of regulations to establish a disbursement formula for contract health service funds;
  • authorizes demonstration programs for modular component health care facilities and mobile mental health stations in Indian communities;
  • provides grants to assist tribes in establishing and administering programs to help members enroll in Medicare, Medicaid and CHIP and to pay premiums where applicable for such programs based on financial need, as determined by the tribe;
  • permits a tribe or tribal organization carrying out programs under the Indian Self-Determination and Education Assistance Act or an urban Indian organization carrying out programs under Title V (Health Services for Urban Indians) of that Act to purchase insurance under the Federal Employee Health Benefit (FEHB) for the employees of such Indian tribe, tribal organization, or urban Indian organization;
  • provides for the designation of specified areas as contract health service delivery areas;
  • authorizes programs to increase the recruitment and retention of health care professionals, such as updates to the scholarship program and demonstration programs which promote new, innovative models of health care, in order to improve access to health care for Indians and Alaska Natives;
  • establishes mental and behavioral health programs beyond those for alcohol and substance abuse, such as fetal alcohol spectrum disorders, and domestic violence prevention programs;
  • amends Section 813 of the IHCIA to clarify eligibility of non-member minor children and spouses; and
  • improves youth suicide prevention programs, including streamlining the process by which Indian tribes apply for youth suicide prevention grants.

Godfrey & Kahn's Indian Nations and Health Law teams have prepared an Alert that describes in greater detail the Patient Protection and Affordable Care Act and the numerous provisions that affect Indian country. The Alert also proposes an action plan for tribes to adopt to take full advantage of the Act. For more information, contact Brian Pierson at 414.287.9456 or

G&K Labor and Employment Law CLE
G&K's Labor and Employment Team will offer a complimentary seminar for executives, in-house counsel, human resource professionals and front-line supervisors. The focus will be practical approaches to preventing and managing employment law problems, recent changes in labor and employment law and strategies to address these changes. Agenda topics include:

  • Labor & Employment Law Update, including the numerous employment law provisions of the Patient Protection and Affordable Health Care Act signed into law March 23rd.
  • Social Networking: The Good, The Bad and The Ugly: Ensure your organization is able to secure the greatest advantage from the effective use of social media for recruiting and communication and learn how to craft and communicate a solid social media policy to assist in preventing and dealing with any negative ramifications of uncontrolled use of social media by employees.
  • The Americans with Disabilities Act as Amended - How to Understand and Implement it Effectively: This law made a number of significant changes to the definition of "disability" by rejecting the holdings in several Supreme Court decisions and portions of the U.S. Equal Opportunity Commission's (EEOC) ADA regulations. On September 23, 2009, the EEOC published a Notice of Proposed Rule Making detailing its proposed regulation changes in response to the enactment of the amendments. This session will focus on these recent changes in disability law as well as the practical consequences in order to aid in employer understanding and compliance.
  • Wellness Programs: Explore the impact wellness programs have on employee health and health care costs and the limits imposed by Health Insurance Portability and Accountability Act (HIPAA), the ADA and GINA on the ability to take advantage of these programs.

Seminars will be held at the following locations and on the following dates:

  • Tuesday, April 13: Madison (Monona Terrace)
  • Tuesday, April 20: Green Bay (Hotel Sierra)
  • Thursday, April 22: Milwaukee (Sheraton Brookfield)

The firm has applied for 3 recertification credit hours toward PHR, SPHR and HPHR recertification through the Human Resource Certification Institute (HRCI). To register contact Katelin Botsford at 414.287.9269 or

Prevent All Cigarette Trafficking Act
President Obama signed the Prevent All Cigarette Trafficking Act ("PACT Act") of 2009 into law on March 31, 2010. The PACT Act amends the Jenkins Act, 15 U.S.C. 375 et seq., and will impact the sale and distribution of cigarettes and smokeless tobacco by certain Indian nations and their membership. Among other things, the PACT Act regulates the ability of common carriers and the United States Postal Service to deliver cigarettes to customers. In addition, the new law requires tribes selling cigarettes or smokeless tobacco through Internet or mail-order channels to 1) pay all federal, state, local, and tribal taxes and affix applicable tax-stamps before delivering these products to customers; 2) comply with tribal, state, and local laws as if the sellers were located in the same jurisdiction as their end-user customers; and 3) register with the state and make periodic reports to state officials.

Please contact Godfrey & Kahn's Indian Nation Law Team if you have additional questions about the PACT Act, its implications for your tribal tobacco sales and distributions operations, or its impact on current law regarding the same. Please contact Carl Artman at (414) 287.9624 or

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