23rd Biannual

CDC/ATSDR Tribal Advisory Committee

Meeting

Follow-Up Report

February 2–3, 2022 
Table of Contents 

2 

Introduction.................................................................................................................................................. 3 

Tribal Advisory Committee Charter............................................................................................................. 4 

Delegates .................................................................................................................................................. 4 

General Council......................................................................................................................................... 4 

Technical Assistance ................................................................................................................................. 4 

Follow-Up Reporting .................................................................................................................................... 5 

CDC Budget Update...................................................................................................................................... 5 

Equitable Access to Funding ..................................................................................................................... 5 

Budget Formulation Models ..................................................................................................................... 8 

Tribal Consultation Policy ............................................................................................................................ 8 

Tribal Public Health Infrastructure .............................................................................................................. 9 

Commission Study..................................................................................................................................... 9 

Communication......................................................................................................................................... 9 

CDC Director/ ATSDR Administrator Updates...........................................................................................10 

Self-Governance......................................................................................................................................10 

Communication.......................................................................................................................................11 

Appendix.....................................................................................................................................................12 

Acronym List ...........................................................................................................................................12 
Introduction 

The 23rd Biannual Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease 

Registry (CDC/ATSDR) Tribal Advisory Committee (TAC) meeting was held virtually February 2–3, 2022. 

The primary agenda topics were CDC budget updates, tribal public health infrastructure, and COVID-19 

response transition. In addition, CDC/ATSDR Director Dr. Rochelle Walensky provided agency updates 

and participated in a facilitated discussion with TAC members. 

During the meeting, TAC members provided input and recommendations and requested some areas of 

follow-up from agency leaders across CDC centers, institutes, and offices (CIOs). After the meeting, staff 

members from CDC’s Center for State, Tribal, Local, and Territorial Support (CSTLTS), Office of Tribal 

Affairs and Strategic Alliances (OTASA) collected, categorized, and tracked follow-up items using the 

following categories: “request,” “recommendation,” or “question,” and asked the applicable CDC CIOs 

to respond as needed. The report is organized by agenda topic area, with the TAC member input or 

questions received in each area ,followed by the applicable CIOs’ responses. 

For additional information about the meeting, please view the 23rd Biannual CDC/ATSDR TAC Meeting 

Minutes on the CDC Tribal Health website. 

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Requests/Recommendations/Questions

Tribal Advisory Committee Charter 

Delegates 

Request 

Tribal Advisory Committee (TAC) members requested CDC’s perspective on the role of an authorized 

representative. To obtain more valuable input during TAC meetings, tribal leadership is requesting to 

have authorized representatives from a different tribe within their represented area. 

Response 

Center for State, Tribal, Local, and Territorial Support (CSTLTS) – OTASA 

CDC will align the CDC/ATSDR TAC Charter with that of the Department of Health and Human 

Services (HHS) Secretary’s Tribal Advisory Committee (STAC) Charter, including clarification of 

the authorized representative role and eligibility. 

General Council 

Question 

TAC members asked to meet with the Office of General Counsel (OGC) to discuss the TAC Charter. 

Response 

CSTLTS – OTASA 

OTASA held a TAC conference call on March 30, 2022, to review and discuss the TAC’s suggested 

changes to the charter. OGC representatives were present on the call to hear comments. CSTLTS 

will continue to engage OGC to finalize changes to the charter and return it to TAC members for 

their approval this year. 

Technical Assistance 

Request 

TAC members requested to change the TAC Charter wording regarding technical assistance. The 

justification for the change was to have assistance to help guide their efforts in TAC work. 

Response 

CSTLTS – OTASA 

CDC agrees that structured technical assistance for TAC members is important and continues to 

work on that. CDC has increased its own technical assistance to the TAC this year by supporting 

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a TAC subcommittee to discuss issues such as technical assistance to tribes, providing a guide on 

CDC programs to TAC members, and aiding with other issues. Every CDC/ATSDR CIO presented 

an overview of their programs to this subcommittee. For example, prior to the February TAC 

meeting, CDC programs on the agenda met with the TAC to provide background on their 

sessions. CDC is also ready at any time to connect TAC members with CDC subject matter 

experts upon request. 

On March 30, 2022, during a TAC conference call, OTASA and TAC members reviewed and 

discussed wording for this section of the charter. CDC will include technical assistance language 

in a separate “Rules of Order” document, following the HHS STAC model. 

Follow-Up Reporting 

Request 

TAC members requested that recommendations/requests made during TAC meetings be tracked and 

reported back as “old business” during TAC meetings via a project matrix. 

Response 

CSTLTS – OTASA 

OTASA will incorporate a review of follow-up reporting as a standing item in future biannual TAC 

meeting agendas, as well as continue conversations on items during the regularly scheduled TAC 

conference calls. 

CDC Budget Update 

Equitable Access to Funding 

Request 

TAC members recommended that CDC partner with the Indian Health Service (IHS) through interagency 

agreements (IAA) for funding, which would allow tribes to compact and contract funding. They want to 

operate in an equitable process. 

Response 

CSTLTS – OTASA 

CDC has partnered with IHS through IAAs in the past and currently has some IAAs with IHS for a 

couple of small-scale projects. Contracting and compacting other public health activities and 

services versus clinical services is complex and needs further consideration at the agency level. 

CDC is taking this recommendation into consideration as it continues to explore with the TAC 

better ways to provide resources and other CDC support for tribal public health. 

Question 

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TAC members asked about CDC’s plans to ensure that funding opportunity eligibility criteria do not block 

tribes from essential funding. Some tribes are denied due to restrictive categories that are more 

favorable to larger tribes. 

Response 

CSTLTS – OTASA 

CDC will continue to support building, improving, and implementing tribal public health 

infrastructure and supporting surveys on the status and needs of tribal public health for decision 

making on supporting the system. This includes funding tribal-only cooperative agreements and 

grants. CDC will continue to fund national tribal organizations, regional organizations, and 

others who can sub-grant and sub-contract to smaller tribes, extending CDC’s reach and

reducing administrative burden on smaller tribes. CDC and will continue dialogue with Indian 

Country on how best to meet the needs of tribal public health departments that are being stood 

up to those further along in their journey. 

Request 

TAC members requested a minimum 5% of funding for chronic disease prevention and health 

promotion, set aside across CIOs to support public health infrastructure. When you look at the 

president’s fiscal year (FY) 2022 budget request at $160 million for the Preventive Health and Health 

Services (PHHS) Block Grant, it is the same funding as 2021. Of the 61 FY 2021 grantees, only 2 tribes 

were awarded funds totaling about $92,000. Of the $145 million awarded, that is roughly 0.64% of those 

total funds. We want to achieve equitable funding, given that American Indian/Alaska Native (AI/AN) 

makeup is roughly 2.9% of the total US population. 

Response 

CSTLTS – OTASA 

Intramural funding is spent on basic operational functions for the agency (e.g., salaries, benefits, 

rent, utilities, office supplies, management and administrative activities, and programs and 

services directly provided by CDC). CDC strives to maximize its extramural investments as much 

as possible; most CDC funding is provided to the field. Direct funding to tribal nations for tribal 

public health has increased in recent years. Setting aside 5% of every CIO budget for tribal 

nations may result in a disproportionate distribution among tribal nations because of the 

disparate status and variations of tribal health infrastructures across Indian Country. CDC’s 

current budget structure—which is primarily based on disease or public health issue areas and 

not specific populations—is directed by Congress. 

The answer to the 5% set aside has multiple components. One of the components is CDC’s budget and 

appropriations language that tells how funds will be distributed. The other component is that CDC’s 

budget does not work in isolation. It is a part of the HHS budget. For example, CDC received COVID-19 

funds to address social determinants of health and there was a specific appropriation that went to IHS. 

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There was a specific direction from the appropriators and from HHS that separated the funds and how 

they were portioned. 

Congress established the PHHS Block Grant in 1981. The original legislation combined several 

categorical grants covering emergency medical services, hypertension, home health services, 

health education and risk reduction, urban rodent control, and community water fluoridation 

into the PHHS Block Grant. Congress specified that the new grant would be given to the 61 

recipients of the prior categorial grants (all 50 states, the District of Columbia, 2 American Indian 

tribes, 5 US territories, and 3 freely associated states). Congress also set a funding formula 

based in part on the share of funding each grantee had in the prior categorical grants. The 

funding Congress has provided for the PHHS Block Grant has been level at $160 million per year 

for a number of years; therefore, the amount of funding per grantee also has not changed. 

Question 

TAC members asked what CDC is doing to provide more direct funding. They also noted that providing 

funding directly to tribes does not relieve CDC from its responsibility to provide training, technical 

assistance, and other support in the same manner that the agency would for grants. 

Response 

CSTLTS – OTASA 

CDC programs continue to work directly with the CDC/ATSDR TAC and tribal nations to get tribal 

input into CDC program and resource development through TAC meetings and listening sessions 

at national tribal meetings. CDC’s “Fiscal Year 2020 CDC Funding Profile for American Indian and 

Alaska Native Tribes and Tribal Organizations” shows general increases from FY 2016 to FY 2020 

in a) total funding to tribal recipients, b) number of grants and cooperative agreements directly 

funding tribal recipients, and c) number of unique AI/AN recipients. Visit the CDC Tribal Funding 

Profiles to find more information about tribal-specific funding information. 

CDC currently has five funding mechanisms exclusive to tribal nations and tribal organizations: 1) 

Good Health and Wellness in Indian Country (GHWIC), 2) Tribal Epidemiology Centers Public 

Health Infrastructure (TECPHI), 3) Tribal Practices for Wellness in Indian Country (TPWIC), 4) 

Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative 

Agreement, and 5) Supporting Tribal Public Health Capacity in Coronavirus Preparedness and 

Response. CDC created these programs as a direct result of input received from the TAC and 

other tribal recommendations for mechanisms with tribal eligibility only, and for mechanisms 

that allow for culturally appropriate activities. 

The Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative 

Agreement enables any CDC program to fund collaborations with tribal nations and regional 

tribally designated organizations to improve the tribal public health system. 

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CDC used several of these mechanisms to provide tribal nations and tribal organizations with the 

first funding to address the opioid epidemic in Indian Country and for COVID-19 response 

efforts. 

The National Indian Health Board (NIHB) and the National Council of Urban Indian Health 

(NCUIH) are funded through CDC’s national partnership umbrella cooperative agreement, 

Strengthening Public Health Systems and Services Through National Partnerships to Improve 

and Protect the Nation’s Health. Any CDC program can fund these national partners to provide 

technical assistance to tribal nations and tribal organizations, and these partners can subaward 

funding to other tribal entities, as appropriate to the work. 

Tribes, whether they have a fiscal relationship with CDC/ATSDR or not, can request technical 

assistance from CDC/ATSDR programs. Examples of the technical assistance available are 

featured in Centers for Disease Control and Prevention: Examples of Resources Available to 

State, Tribal, Local & Territorial Health Agencies and CDC Support to Health Officials: How CDC 

Can Help Respond to Emerging Local Health Concerns. 

Budget Formulation Models 

Question/Recommendation 

TAC members are asking if CDC has reviewed other budget formulation models. It was recommended 

for CDC to review the Special Diabetes Program for Indians (SDPI). There are three defining categories in 

that formula that you score distribution of the grant funds: 1) disease burden, 2) tribal size adjustment, 

and 3) user population. 

Response 

CSTLTS – OTASA 

On May 19, 2022, CDC held a briefing call with IHS SDPI colleagues on their funding formula and 

will look at how a similar approach could be used by CDC programs. 

Recommendation 

TAC members recommended that CDC send out a “Dear Tribal Leader Letter” and hold a consultation on

budget formulation models if changes are going to be made. 

Response 

CSTLTS – OTASA 

CDC will follow HHS’s and CDC’s tribal consultation policies and will hold consultation for future 

budget formulation models. 

Tribal Consultation Policy 

Request 

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TAC members requested adding rapid consultation to the CDC/ATSDR’s Tribal Consultation Policy for 

pressing issues. If CDC is receiving new funding for tribes, then tribes need to be involved. 

Response 

CSTLTS – OTASA 

CDC/ATSDR acknowledges that the timeline for tribal consultation may sometimes need to be 

shorter, such as during emergency responses or for deadlines for decisions outside the agency’s

control and plans to acknowledge this in the Tribal Consultation Policy update. CDC/ATSDR 

recognizes that there may be a need to have consultation with less than a 60-day Federal 

Register Notice to allow for adequate preparation time for tribal leaders. CDC/ATSDR will notify 

tribal leaders when a consultation date is set via all communications means possible (e.g., a 

Dear Tribal Leader Letter, emails, partner notifications, CDC website postings). CDC/ATSDR is in 

the process of updating its Tribal Consultation Policy and will complete this process once HHS 

revises the HHS Tribal consultation policy; it is expected that HHS will have a revised approved 

policy later in 2022. 

Tribal Public Health Infrastructure 

Commission Study 

Recommendation 

TAC members recommended that CDC commission a study to determine the amount of funding needed 

to ensure tribes can improve health and well-being in tribal communities. Items suggested to keep in 

mind when conducting a study: 

• Assess the needs for smaller and larger tribes equitably. 

• Determine the difference between clinical delivery services and building that foundational public 

health infrastructure. The funding for both is different. 

• Start with some type of a tiered system based on readiness and capacity for the tribes. 

• Determine who does and does not want a public health infrastructure. Some tribes do not have that 

capacity. 

Response 

CSTLTS – OTASA 

CDC will continue to work to identify and maximize funding opportunities for tribal nations and 

organizations to support tribal public health priorities and emerging needs. 

Communication 

Recommendation 

TAC members recommended that CDC engage with tribal leadership early when it comes to funding 

mechanisms and public health plans. 

Response 

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CSTLTS – OTASA 

CDC will continue to engage with the TAC and tribal leaders through regular TAC Conference 

Calls and Biannual Meetings, as well as through national listening sessions and tribal 

consultation when applicable. 

Recommendation 

TAC members recommend that CDC provide a public statement to tribal leadership that public health 

infrastructure is a priority. 

Response 

CSTLTS – OTASA 

CDC recognizes that public health infrastructure is a priority. The COVID-19 crisis highlighted 

weaknesses and gaps that threaten Americans’ health and has proven the need for sustained 

improvements in our nation’s public health infrastructure. While CDC is responding to this 

current public health emergency, it is also building capacity to ensure America is increasingly 

prepared to respond to future threats. CDC aims to build a sustainable and resilient public 

health system that can respond effectively to emerging threats and to ongoing public health 

needs to keep Americans safe and healthy. 

The tribal health cooperative agreements and grants listed under the “CDC Budget Update”

section above help build, improve, and implement public health infrastructure. 

CDC Director/ ATSDR Administrator Updates 

Self-Governance 

Request 

TAC members requested HHS’s partnership in expanding and strengthening self-governance across HHS 

agencies and programs. Under self-governance programs throughout HHS, HHS will be better 

coordinated to produce better health outcomes for our tribal citizens, our families, and our 

communities. Self-governance would reduce program administrative costs and eliminate duplicative 

reporting requirements, which pull valuable time away from servicing our clients. TAC members 

requested CDC’s commitment to partnering in moving these efforts forward to fulfill President Biden's 

commitment to working to empower tribal nations to govern their own communities and make their 

own decisions. 

Response 

CSTLTS – OTASA 

The “Expansion of Tribal Self-Governance within the Department of Health and Human Services”

White Paper was shared with CDC Director Dr. Rochelle Walensky following the February TAC 

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Biannual Meeting. CDC will work alongside HHS to further understand self-governance programs 

and proposed legislation on this matter. 

Communication 

Recommendation 

TAC members recommended that CDC improve communication regarding COVID-19 updates to tribal 

communities. There could be real-time and culturally appropriate messaging to ensure tribal laws are 

consistent with CDC. 

Response 

CSTLTS – Tribal Support Section of the CDC COVID-19 Response 

CDC has worked to improve communication regarding COVID-19 updates to tribal communities 

since the most recent CDC/ATSDR TAC meeting held February 2–3, 2022. CDC has updated 

the Tribal Communities landing page with new language about the CDC COVID-19 community 

levels. CDC has designated Dr. Seh Welch as a spokesperson for tribal media outlets. 

CDC continues to offer technical assistance consultations to tribal nations upon request. Most 

recently, CDC assisted a tribal nation to conduct a needs assessment on tailored messaging for 

different populations in their community. CDC remains available to help tribes answer questions 

about layered prevention strategies and general COVID-19 response and recovery activities. For 

any questions, please email eocevent362@cdc.gov. 

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Appendix 

Acronym List 

AI/AN American Indian/Alaska Native 

ATSDR Agency for Toxic Substances and Disease Registry 

CDC Centers for Disease Control and Prevention 

CIOs Centers, institutes, and offices 

COVID-19 2019 Novel Coronavirus Disease 

CSTLTS Center for State, Tribal, Local, and Territorial Support 

GHWIC Good Health and Wellness in Indian Country 

HHS US Department of Health and Human Services 

IAA Interagency Agreement 

IHS Indian Health Service 

NIHB National Indian Health Board 

OGC Office of General Counsel 

OTASA Office of Tribal Affairs and Strategic Alliances 

SDPI Special Diabetes Program for Indians 

STAC HHS Secretary Tribal Advisory Committee 

TAC Tribal Advisory Committee 

TECPHI Tribal Epidemiology Centers for Public Health Infrastructure 

TPWIC Tribal Practices for Wellness in Indian Country 

TSS Tribal Support Section of the CDC COVID-19 Response

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