Legislative & Policy Update
NW Portland Area Indian Health Board
Quarterly Board Meeting
June 20, 2014
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Report Overview
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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
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, McCoy 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 26th
– 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 SelfDetermination 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 McCollum (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 7-8th House Public Witness Hearings; April
30th Senate Hearing
• Senate considering “mini-bus” bill for some
Departments
– Sign that headed for a long haul
TTAG/MMPC Updates
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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%2
0Folder%20created%20by%20Jim
• MMPC Action Items and Tracking List
• TTAG Roster of Pending Regulations and Assignments
Navajo State Medicaid Agency Study
• CMS release Navajo Medicaid Study – 51st state
concept for Medicaid
• Report Concludes it is feasible for Navajo to
administer a Medicaid Agency but many challenges:
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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 nonIndians – Report estimates Navajo could generate required
17% for non-federal share
– May be statutory barriers and legislative action needed
Discussion?