Legislative Policy Update NW Portland Area Indian Health

Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting Hosted by Grand Ronde Tribe April 22, 2015 1

Report Overview 1. IHS Budget Updates 2. CHS Meeting & MLR Regs & CHEF 3. FAAB & CHS Workgroups 4. MLR for non-hospital based services 5. ACA Updates

FY 2016 Budget Update • President’s FY 2016 budget provides BIG increase for IHS - $461 million increase (10%) – In FY 2010 $471 million increase – Dems in control • Will Republican controlled Congress agree to provide such a large increase? • Political grandstanding by the Administration recognizing Congress has tight purse strings? • Great increase but there are some problems with the overall distribution to direct funds for construction, program increases & not enough for inflation/population growth

IHS Budget – Detail of Changes • Overall Increase is $461 million • Current Services - $147. 3 million – Federal Pay Costs $7. 7 million – Tribal Pay costs $11. 7 million – Medical Inflation $71. 2 million (3. 8%) – Population Growth $56. 7 million • Program Increases - $313. 3 million

IHS Budget – Detail of Changes • Overall Increase $461 million • Program Increases $313. 3 million – Staffing new facilities $17. 8 million – H&HC 3 rd Party Improvement $10 million – CHS/PRC increase $25. 5 million – H&HC Health IT $10 million – ASA/Behavioral Health $25 million – Contract Support Costs $55 million – Facilities: M&I $35 million; SFC $35 million; Health Facilities Construction $100 million

NPAIHB Budget Analysis on FY 2016 President’s Request • More Discussion on this tomorrow! • Board has completed annual budget analysis and recommends $297 million needed for inflation and population growth. • Additional $175 million is recommend for Program increases (based on FY 2016 Budget Formulation): – – – CHS/PRC Dental Health Mental Health A/SA Health Facilities: SFC, M&I Urban Indian Health

House Interior Appropriations Subcommittee on Environment & Related Agencies • Subcommittee conducted Native American Witness day March 24 th • Andy Joseph, Jr, NPAIHB Chair testified on behalf of Board • Budget Analysis Recommendations: – Reprogram President’s increase to adequately fund inflation, pop-growth – If Subcommittee funds Health Facilities than include funding for SAP, JV, and Area Distribution (Regional Referral Centers) – CHS/PRC increase to $100 million – Support for Administration’s proposal to make CSC a mandatory appropriation

Senate Committee on Indian Affairs • New Chairman John Barrasso (R-WY); Vice-Chair Jon Tester (D-MT) • Issues: – Address & find innovative solutions to reduce federal bureaucracy in Indian programs – Interior Self-governance amendments; HHS expansion – February 25 th hearing on FY 2016 budget; Yvette Roubideaux, Sr. Advisor to HHS Secretary, Administration’s witness – Support Self-Determination and contract support costs – March 4 Views and Estimates letter: http: //www. indian. senate. gov/sites/default/files/upload/files/ FY%202016%20 VE%20 Letter. pdf – Facilities construction – Special Diabetes Program for Indians

Health Legislative Updates • Special Diabetes Program for Indians – DTLL Tribal Consultation on FY 2016 funds – Medicare Access and CHIP Reauthorization Act of 2015 – “Doc-fix” bill – Includes extension of SDPI through FY 2018; • S. 286, A bill to amend the ISDEAA to provide further selfgovernance by Indian tribes; • Empowering Indian Country in the Republican Congress – SCIA • Labor-HHS Committee holding hearing this week on Administration’s coordination with Tribes on health issues • IHS Director Nomination? Likely to acting thru end of Administration • Administration’s Proposal to make CSC a mandatory appropriation

FAAB Update • FAAB Meeting, Rockville, MD, March 31 – April 2, 2015 – Recommendation on revised Health Facility Construction Priority System (HFCPS) – Preparation for IHCIA Facilities Report due to Congress March 23, 2016 – Area Master Planning criteria and process – Budget issues related to maintaining M&I and SFC – Consultation on new IHCIA authorities • DTLL requesting input identifying Tribe’s top five health care facilities construction needs – new authorities in the IHCIA – June 1, 2015 Deadline – Discuss Process to develop comment and recommendations

Contract Support Costs Update • President’s Budget includes proposal to make CSC funding mandatory – 3 year mandatory authorization – Tribes support a permanent authorization – Administration proposes caps “as necessary”; Tribes support no caps – 2% administration set-aside; relates to ongoing reconciliation process? – Process still being considered by Congress and has a ways to go

Discussion?