Transcript Legislative Update NPAIHB Quarterly Board Meeting Thunder

Legislative & Policy Update
NW Portland Area Indian Health Board
Quarterly Board Meeting
April 23, 2014
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Report Overview
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SDPI Update
Senate Committee on Indian Affairs
Indian Bills
FY 2014 & FY 2015 Budget Updates
CSC Update
DTLLs
ACA Exemptions
SDPI Extended thru FY 2015
• H.R. 4302 Protecting Access to Medicare Act
– Commonly referred to as the Sustainable Growth
Rate bill -- SGR fix
– Sec. 204 Extends the Special Diabetes Program for
Indians thru FY 2015
– Sec. 210 Delays implementation of ICD-10 to Oct.
1, 2015
• SDPI thru September 30, 2015
– Maintains $150 million per year less sequestered
amount
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
– Other Tribe specific and education, children
related bills
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?
FY 2014 Budget Highlights
• FY 2014 budget $303 million increase over FY
2013 Operating Plan***
– ***Caution: Only $78 million over the FY 2014
Pre-Sequester Amount – Loss of $175 million
• Program Increases for (Detail of changes):
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$42.4 million for CHS
$24.9 million for facilities accounts
$71.9 million for staffing new facilities
$35 million for medical Inflation
$129.6 million for CSC
FY 2014 & CSC Funding
• IHS and BIA will fully fund CSC payments in FY
2014 and President’s FY 2015 budget proposes
same
– IHS estimated 2014 need: $587.4 million
– FY 2013 Amt + 2014 Increase = $577.4
– IHS needed additional $10 million to cover CSC
funding; consulted with Tribes about where to make
the cuts
• Reductions total $10 million made as follows:
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$3 million IHS Directors Fund
$5 million from Indian Health Professions
$1 million from Self-Governance
$1 million from Tribal Management
FY 2015 & CSC Funding
• President’s Request includes $29.6 million CSC increase
• IHS proposes to continue to fully fund CSC payments to
tribes into the future
• IHS Contract Support Cost Workgroup has reconvened to
address substantive policy issues
– Develop FY 2014 Payout Plan (Refer to Handout)
– Develop Standard AFA language to deal with IHS AntiDeficiency Act concerns
– Develop two-year appropriation authority
– Develop strategies to deal with new/expanded programs and
changing IDC rates following payout
– Analyze data to better estimate CSC need for appropriations
– Develop process to better estiamate CSC need; pass-throughs
and exclusions
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 Detail of Changes –
$199,662 mil. increase
FY 2014 Enacted Budget
$ 4,434,515
CURRENT SERVICES:
Adjustments for CSC
$ 10,000
Medical Inflation
$ 63,000
Pay Costs
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Staffing New Facilities
$ 70,818
Sub-total Current Services
2,572
$ 146,390
PROGRAM INCREASES:
New Tribes Funding
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Purchased/Referred Care
$ 15,428
Contract Support Costs
$ 29,829
Sub-total Program Increases
FY 2015 PRESIDENT’S REQUEST
8,015
$ 53,272
$ 4,634,177
FY 2016 Budget Formulation
• National IHS Budget Formulation - Feb. 26-27,
2014 in Washington DC
– Representatives Andy Joseph & Steve Kutz
• Recommended $779 million increase; 18%
increase
– $188 mil. for current services
– $191 mil. for binding obligations (CSC, HFCPS, Staffing,
New Tribes)
– $337 mil. for program expansion (CHS, H&C, Mental
Health, A/SA, Health Facilities other authorities)
– $62 mil for other priorities (UIHP, facilities, dental, )
Dear Tribal Leader Letters
• April 2, 2014: DTLL on CSCs as it relates to the FY 2014
Consolidated Appropriations Act & Announcing on-going
Consultation
• March 6, 2014: DTLL IHS Director Listening Sessions
• February 27, 2014: DTLL seeking input on MSPI & DVPI
• February 18, 2014: DTLL update on the IHS Consultation &
follow-up to the August 2, 2012 letter
• February 12, 2014: DTLL Initiating consultation on CSC issues
required in FY 2014 Consolidated Appropriations Act
• January 13, 2014: DTLL changing Aberdeen Area IHS to the
Great Plains Area
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 Proposed Rule including Minimum QHP Certification
Standards
Revising the CMS Tribal Consultation Policy
Evaluation of CMS Strategic Plan & Updates
Alternatives for Medicaid Expansion: Arkansas Model and UCC
Waivers
Indian definition issues
IRS/CMS Resource Exemptions
Extending Medicare Like Rates to non-hospital based services
ACA Educational materials
Data projects and studies
Affordable Care Act
Individual Mandate & Exemption
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What is the ACA Tax Penalty?
What is the I/T/U Hardship Exemption and who is eligible?
How to apply for the Indian Exemption or I/T/U Hardship
Exemption?
Additional Information related to exemptions and the application:
– HHS instruction are forthcoming, tax filing information,
– Do you need to reapply for the exemption?
– What can you do to help Tribal members?
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Education Tribal members and program beneficiaries
Make sure Tribal members understand the difference between Indian Exemption and
the Hardship Exemption
Prepare to offer eligibility letters
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Provide tax filing assistance
2014 Penalty = 1% household income; $95/adult
2015 Penalty = 2% household income; $325/adult
2016 Penalty = 2.5% household income; $695/adult
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
Discussion?