Legislative Policy Update NW Portland Area Indian Health

Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting June 20, 2014 1

Report Overview 1. 2. 3. 4. 5. 6. 7. SDPI Extended GAO Report on Veterans Health FY 2015 Appropriations Update Dental Health Aide Therapists Health IT Updates Contract Support Cost Update Navajo Nation Medicaid Study

FAAB Update • April 29 -30 th Meeting; first meeting in over five years ~ 2007 Mtg in Rockville? • Review of Enabling Legislation • Facilities Needs Assessment Workgroup – Improving Joint Venture Construction Program – Improving Small Ambulatory Program – Innovative Strategies for HCFC – Improve Health Care Facilities Planning and Construction • Overview of Current HCFC Priority List – History of the Current Priority List – Last Report to Congress • July 24 -25 th in Sacramento; November 12 -13 in Albuquerque

GAO Native American Veterans Report • HEALTH CARE ACCESS: Improved Oversight, Accountability, and Prioritization Can Improve Access for Native American Veterans – Reviewed IHS & VA actions under required MOU – Report found agencies face substantial implementation challenges – Oversight is inconsistent: In 2013, the officials tasked with oversight of the implementation of the MOU did not meet and did not systematically evaluate the progress of MOU implementation. – Written policies and guidance are lacking on implementation – Prioritization of MOU implementation is lacking: Leadership of VA and IHS have not made MOU implementation a priority, which threatens the ability of agencies to move forward

DHAT Preparation • If legislation in WA State is to be successful, WA Tribes must weigh in • Cody, Appleton, Mc. Coy will not rely on tribal organizations to carry support – AIHC, ATNI, NPAIHB • Board Proposal under consideration with Kellogg, Pew, and NW Washington Foundation • Two state and national strategy to address mid-levels

SDPI Extended thru FY 2015 • H. R. 4302 Protecting Access to Medicare Act – Sustainable Growth Rate bill (Sec. 204) Extends the Special Diabetes Program for Indians thru FY 2015 • SDPI thru September 30, 2015 – Maintains $150 million per year less sequestered amount – April TLDC meeting to discuss recommendations on distribution – NPAIHB comment letter provide recommendations – Concerns related to user pop calculations

Senate Committee on Indian Affairs • New Chair: Sen. Jon Tester (MT) – Senators Cantwell and Crapo still on Committee • Legislation & Hearings – FY 2015 President’s Budget – March 26 th – S. 1570 amend IHCIA for Advanced Appropriations – S. 919 amend ISDEAA to expand selfgovernance

Date BIll # Title 03/31/2014 S. 2188 A bill to amend the Act of June 18, 1934, to reaffirm the authority of the Secretary of the Interior to take land into trust for Indian tribes. 03/26/2014 S. 2160 Native American Children's Safety Act 03/13/2014 S. 2132 Indian Tribal Energy Development and Self. Determination Act Amendments of 2014 02/25/2014 S. 2040 Blackfoot River Land Exchange Act of 2014 02/25/2014 S. 2041 May 31, 1918 Act Repeal Act 02/06/2014 S. 1998 Native Adult Education and Literacy Act of 2014 01/16/2014 S. 1948 Native Language Immersion Student Achievement Act

Indian Health Legislation • Advance Appropriations Bills – H. R. 3229: Don Young & Ray Lujan – S. 1570: Begich, Udall, Murkowski • Special Diabetes Program for Indians – House and Senate Sign-on letters • Indian Definition Fix – S. 1575: Senators: Mark Begich (D-AK), Max Baucus (DMT), Tom Udall (D-NM), Brian Schatz (D-HI), Al Franken (DMN) • Medicare-like Rates (Contract Rate Expenditure) - H. R. 4843 Rep. Betty Mc. Collum (D-MN) and Rep. Tom Cole (R-OK)

FY 2015 President’s Request • $4. 634 billion for Indian Health Service – $199 million increase (4. 5%) is respectable? – Staffing & New Tribes funding $78. 8 million takes increase down to $120. 9 million (2. 7%) * – $29 million program increase for CSC * – $15. 4 million program increase for CHS – Adjustments of $10 million to restore 2014 reductions (CSC) • Adjusting the increase for earmarks* leaves a balance of $91. 9 million for current services (does not include CHS increase) • NPAIHB estimates at least $223 million is needed to maintain current services • President’s budget will be short by $131 million to fully fund inflation and population growth

FY 2015 Appropriations Update • Full Congress not agreed on budget resolution – House Resolution: “Path to Prosperity” – Senate agreed to use framework Budget Control Act – Murray/Ryan deal set spending caps in FY 2015 for discretionary spending • April 7 -8 th House Public Witness Hearings; April 30 th Senate Hearing • Senate considering “mini-bus” bill for some Departments – Sign that headed for a long haul

TTAG/MMPC Updates • • ACA Policy Subcommittee is very active – Tribal Exemption & I/T/U hardship exemption – Referrals and Cost Sharing Exemptions – CMS Final 2015 Letter to Issuers in FFM and Guidance FAQs Revising the CMS Tribal Consultation Policy Evaluation of CMS Strategic Plan & Updates Alternatives for Medicaid Expansion: Arkansas Model and UCC Waivers IRS/CMS Resource Exemptions Extending Medicare Like Rates to non-hospital based services ACA Educational materials Data projects and studies

TTAG/MMPC Resources • https: //www. dropbox. com/home/Delegates/Temp% 20 Folder%20 created%20 by%20 Jim • MMPC Action Items and Tracking List • TTAG Roster of Pending Regulations and Assignments

Navajo State Medicaid Agency Study • CMS release Navajo Medicaid Study – 51 st state concept for Medicaid • Report Concludes it is feasible for Navajo to administer a Medicaid Agency but many challenges: Start-up costs $134 - $243 million Operational budget $360 - $526 million State & Federal concerns related to costs CMS does not see Navajo serving non-Indians FMAP at 100% and Medicaid maximum of 83% for non. Indians – Report estimates Navajo could generate required 17% for non-federal share – May be statutory barriers and legislative action needed – – –

Discussion?