Tribal SelfGovernance Annual Consultation Conference Legislative Updates April

Tribal Self-Governance Annual Consultation Conference Legislative Updates April 1, 2019 Geoffrey D. Strommer HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 1

IHS Advance Appropriations Initiative • For many years tribes have sought advance appropriations for IHS funding to address negative impacts of CRs and government shutdowns • Advance appropriations has applied to VA medical accounts for many years • Legislation was previously introduced on House that would implement this initiative and House directed GAO to conduct a study on feasibility • GAO issued study last year making it clear concepts can work • Recent 35 -day government shutdown increased interest in advance appropriations and led to introduction of new legislation HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 2

IHS Advance Appropriations Initiative (cont. ) • There are 3 pending bills o HR 1135 by Rep. Don Young (R-AK). It would authorize advance appropriations for IHS Services and Facilities Accounts. There are 10 co-sponsors from both parties. o HR 1128 by Rep. Betty Mc. Collum (D-MN) who is Chair of the House Appropriations Subcommittee on Interior. It would authorize advance appropriations for IHS Services and Contract Support and some BIA/BIE programs. There are 10 co-sponsors from both parties. o S. 229 by Sen. Tom Udall (D-NM) who is Ranking Member on the Senate Interior Appropriations Subcommittee. There are 7 co-sponsors, all Democrats. It is the same as HR 1128 and it was Referred to the Senate Budget Committee. HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 3

IHS Advance Appropriations Initiative (cont. ) • Numerous national and regional tribal organizations, as well as many tribes support this initiative • The ABA is about to enact resolution in support of advance appropriations • The Trump Administration is still not clearly on record as supporting • Not clear when hearings will happen or when bills will move • Including ask for extension of advance appropriations to BIA in addition to IHS complicates the landscape HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 4

SDPI Reauthorization and Funding • Authorization for SDPI expires on 9/30/2019 • SDPI has been level funded at $150 million per year since fiscal year 2004 • NCAI and NIHB are advocating that Congress increase the annual appropriation for SDPI to $200 million for fiscal year 2020 to begin to address this unmet need HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 5

SDPI Reauthorization and Funding (cont. ) • Senator Alexander introduced a healthcare extenders bill (S. 192) that would reauthorize SDPI for an additional five years from 2019– 2024 • The bill was referred to the Senate Health, Education, Labor, and Pensions (HELP) Committee, where it remains under consideration • Congressman O’Halleran is expected to introduce a similar bill in the House in April HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 6

SDPI Reauthorization and Funding (cont. ) • Hearings on SDPI reauthorization are expected to take place in either late spring or early summer • The House Diabetes Caucus is circulating a sign-on letter of support in the House; a Senate companion letter is expected to be released soon • NIHB is coordinating tribal outreach to Members of Congress HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 7

Section 105(l) Leasing: Background • Chronic underfunding of tribal facilities used to provide services • M&I funds inadequate to fully fund these needs • Section 105(l)of ISDEAA: – Tribally owned/leased – Used for the purpose of providing PFSAs in FA – Mandatory HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 8

Section 105(l) (Con’t) • Maniilaq I: Lease may be part of funding agreement; lease proposal subject to final offer process; IHS failed to respond within 45 days • Maniilaq II: Section 105(l) and the regulations require that IHS fully fund reasonable, non-duplicative lease costs HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 9

Section 105(l) (Con’t) • Supplemental tribal clinics appropriation: Funds both VBC program increase and 105(l) lease compensation • 105(l) leasing has spread throughout Indian Country • In FY 2018, Congress appropriated $11 million to tribal clinics, but IHS had to reprogram $25 million more • In FY 2019, Congress increased the tribal clinics appropriation by $25 million, to $36 million • Recently IHS opened consultation on how to address a projected $45 million need in 2019 HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 10

Section 105(l) (cont. ) • Section 105(l) leasing will continue to increase • IHS needs to administer Section 105(l) leases ina manner that allows the agency to better anticipate and budget for this expansion • IHS should drop its efforts to seek a legislative “fix” similar to the one proposed in the Administration’s last two budget proposals—that nullifies 105(l) • The ideal solution: a separate, indefinite appropriation for 105(l) like that for contract support costs HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 11

Questions? For more information, please contact: Geoff Strommer gstrommer@hobbsstraus. com 503 -242 -1745 HOBBS STRAUS DEAN & WALKER, LLP WASHINGTON, DC | PORTLAND, OR | OKLAHOMA CITY, OK | SACRAMENTO, CA | ANCHORAGE, AK 12