Transcript Legislative Update NPAIHB Quarterly Board Meeting Thunder

Legislative & Policy Update
NW Portland Area Indian Health Board
Quarterly Board Meeting
October 21, 2014
1
Report Overview
1.
2.
3.
4.
5.
6.
7.
IHS Budget Update
ACA Updates
HHS STAC Meeting
IHS Director Listening Session
Contact Support Cost Recap
HRSA 340B Regulation
Indian Health Legislation
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
• House & Senate have pending Interior
Appropriations bills
• House bill is $96 million more than the
Senate bill
• Senate bill requests only $2.5 million
increase for CHS, while the House request is
$50 million
• Senate bill includes small increases for H&C
items
Sub-Sub Activity
FY 2014
Final Operating
Plan
Senate
S. 000
Change
over
FY 2014
Percent
of
Change
$ 1,838,665
$47,761
2.7%
SERVICES
Hospitals & Health Clinics
$
1,790,904
Dental Services
$
165,290
$
173,982
$8,692
5.3%
Mental Health
$
77,980
$
81,145
$3,165
4.1%
Alcohol & Substance Abuse
$
186,378
$
190,981
$4,603
2.5%
Contract Health Services
$
878,575
$
881,147
$2,572
0.3%
$
3,099,127
$ 3,165,920
$66,793
2.2%
Public Health Nursing
$
70,909
$
75,640
$4,731
6.7%
Health Education
$
17,001
$
18,026
$1,025
6.0%
Comm. Health Reps
$
58,345
$
58,469
$124
0.2%
Immunization AK
$
1,826
$
1,826
$0
0.0%
$
148,081
$
153,961
$5,880
4.0%
Urban Health
$
40,729
$
40,729
$0
0.0%
Indian Health Professions
$
33,466
$
33,466
$0
0.0%
Tribal Management
$
1,442
$
1,442
$0
0.0%
Direct Operations
$
67,894
$
68,065
$171
0.3%
Self-Governance
$
4,727
$
4,727
$0
0.0%
Contract Support Cost
$
587,376
$
617,205
$29,829
5.1%
$
735,634
$
765,634
$30,000
4.1%
$
3,982,842
$ 4,085,515
$102,673
2.6%
Subotal, Clinical Services
Subtotal, Preventive Health
Subtotal, Other Services
TOTAL, SERVICES
House Bill vs. FY 2014
Sub-Sub Activity
SERVICES
Hospitals & Health Clinics
Dental Services
Mental Health
Alcohol & Substance Abuse
Contract Health Services
FY 2014
Final Operating
Plan
H.R. 5016
Change
over
FY 2014
Percent
of
Change
$66,721
$10,864
$4,045
$7,446
$50,466
3.7%
6.6%
5.2%
4.0%
5.7%
$
$
$
$
$
1,790,904
165,290
77,980
186,378
878,575
$
$
$
$
$
1,857,625
176,154
82,025
193,824
929,041
Subotal, Clinical Services $
3,099,127
$
3,238,669
$
$
$
$
70,909
17,001
58,345
1,826
$
$
$
$
76,353
18,263
59,386
1,855
148,081
$
155,857
40,729
33,466
1,442
67,894
4,727
587,376
$
$
$
$
$
$
44,250
48,342
2,442
67,894
5,727
617,205
735,634
$
785,860
$50,226
6.8%
3,982,842
$
4,180,386
$197,544
5.0%
Public Health Nursing
Health Education
Comm. Health Reps
Immunization AK
Subtotal, Preventive Health $
Urban Health
Indian Health Professions
Tribal Management
Direct Operations
Self-Governance
Contract Support Cost
$
$
$
$
$
$
Subtotal, Other Services $
TOTAL, SERVICES
$
$139,542
4.5%
$5,444
$1,262
$1,041
$29
7.7%
7.4%
1.8%
1.6%
$7,776
$3,521
$14,876
$1,000
$0
$1,000
$29,829
5.3%
8.6%
44.5%
69.3%
0.0%
21.2%
5.1%
ACA Updates
• HHS & IRS report AI/ANs may claim Hardship
Exemption from Individual Responsibility
payment when filing taxes
– Simplifies the exemption claiming process
– Previous process required filing form with HHS to
await Exemption Certification Number
– IRS Form 8965 allows members of Tribes and IHS
eligible individuals to claim exemption by checking
box “E” on form
– 12 page instructions and form may be
complicated and require training
Marketplace Updates
• Redetermination letters being sent by FFM and SBE in
October
• 2nd Open Enrollment period begins November 15 –
February 15th
• FFM 76 screens down to 16 for basic application
• Phone capacity improved
• FFM will allow “Window shopping”
• IRS reconciliation of subsidies
• Enrollment expected to peak ~ 13 million. Six million
enrolled in CY 2014
• Personal responsibility payment $95 grows to $325 in
2015
Redetermination Updates
• Oregon – Medicaid & Exchange differences
–
–
–
–
Cover Oregon issuers sending renewal notices
Expedited Renewal – SNAP match option – short expedited form
Fast Track Renewal Letter and full application
Renewal [redetermination] Letters – (46,000 people)
• Washington
– Renewal notices sent this week by QHP issuers
– Approximately ~100K are eligible to auto renew in plan available
– 47,000 will need to change plans and/or provide additional income
informaiton
– Washington Apple clients will receive redetermination information
@60 days before the month they enrolled
• Idaho
– Transferring eligibility from FFM to Your Health Idaho
– www.YourHealthIdaho.org/renewals
STAC Meeting Update
• First STAC meeting with Sec. Burwell –
Priorities & Issues
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–
–
–
–
–
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G2G relationship & Tribal consultation
Implementation of Affordable Care Act
Indian Child Welfare Act Implementation
477 Implementation
IHS Advance Appropriations
Expand Self-Governance in HHS
Contract Support Cost – Long Term solutions
Other STAC Meeting Issues
• IHS Director Roubideaux Updates on Contract Support
Costs
• OMB presentation by Julian Harris, Associate Director for
Health Programs
– Working to find “balanced approach” and long-term
solution to CSC funding
– Recognizes unfairness of sequestration and Administration
seeking higher discretionary caps for Indian funding
– Committed to continuing to work with Tribal leaders thru
the STAC
• CCIIO Report from Lisa Wilson
– Cost Sharing issue for AI/ANs <100% FPL
– Data to evaluate implementation
• ACF and Early Childhood education evaluation & funding
issues
IHS Director Listening Session
for Portland Area
• Held August 27th at Embassy Suites Portland
Airport Hotel
• Attendance was not very good: only 5-6
tribes attending. Issues included:
– Tribal Consultation and FACA
– Contract Support Costs: Mandatory funding and
long term solutions
– IHS Advance Appropriations
– Facilities Funding and Staffing Issues
– Regional Referral Specialty Care Center
– CHS, LNF, and Resource Equity
– SDPI restructuring
Contract Support Costs
• 3 Supreme Court Cases, Congressional Directives, and
Administration policy for “full CSC payments”
– Mar/Apr: IHS reports need to reprogram $10 million
– Aug: IHS updates need to reprogram $48 million
– Sept: IHS reports final reprogram of $25.1 million
• Changing amount “questions” IHS ability to project and
monitor CSC needs?
• Changes due to ongoing reconciliation, pending
negotiations on direct CSC and indirect costs, and
resolution of new & expanded programs
• These issues will continue to plague the IHS for the next
couple of years
• IHS Contract Support Cost Workgroup has proposed
changes that should improve & stabilize the process
Veteran Access Choice &
Accountability Act of 2014
• August 7th, President Obama signed Veterans
Choice & Accountability Act (VACCA)
– Intended to improve veterans access and choice
to health care
– Passes in wake of VA scandals involving lengthy
wait times for appointments & falsified records
– Act allows eligible Veterans to seek care at non-VA
facilities
– This includes IHS and Tribal facilities
– Provides $10 billion in appropriations
– Get your VA-IHS reimbursement agreements!
HRSA 340B Update
• Recent Court Decision in DC Circuit may have effect on
340B Drug Discount Program – HRSA in process of issuing
Mega-regulation
• Regulation will redefine relationship between a patient and
prescriber of drugs (provider) and now require that all
prescriptions must be issued by a staff provider at a tribal
clinic
• Unless Indian programs are exempt from such a rule, it will
make prescriptions issued by providers serving patients of
tribal health programs outside tribal clinic facilities under
referral or contractual arrangements, or under tribal health
plans contracting with provider networks, ineligible for
340B pricing
• This would vastly curtail tribal access to 340B pricing under
the current system and add to the expense of providing
health care to AI/ANs
CMS Tribal Consultation Policy
is being revised
• August 20th, CMS issues Dear Tribal Leader Letter that it
intends to revise its Tribal Consultation Policy
• It is outdated due to ARRA, Transparency Regulations,
Affordable Care Act and other changes
• DTLL seeks input from Tribes and State Medicaid Programs
• Board assisted to develop TTAG Comments and submitted
Board comments
• TTAG Subcommittee chaired by Ron Allen has already met
to review and begin revising the policy
• Important changes will include section on State/Tribal
review of waivers, demonstration projects, and
Transparency Regulations
NIHB Annual Consumer Conference
• Held in Albuquerque, NM – Sept 8-12th
• There were a series of Listening Sessions
– IHS, HRSA, VA, STAC, and CMS
• HRSA Tribal Consultation Policy Update
• Dental Health Aide Therapist (DHATs) and Oral
Health Issues were big on the agenda
• SDPI special session and luncheon with TLDC
• Affordable Care Act Issues
• CMS Day
• Very good event!
Indian Health Legislation
• H.R. 4843 Extending Medicare-like Rates
for all CHS Services
– Sponsored by Rep. Betty McCollum (MN)
– Sen. Thune (SD) expected to introduce
Senate bill has met some complications from
AMA and Hospital Associations
– Issues out of Aberdeen Area about certain
hospitals not getting paid out of the CHS
program
• Other Section 506 issues – Board Letter
has been prepared
Indian Health Legislation
• H.R. 3229 & S. 1570: IHS Advance
Appropriations
– July 15th House hearing on H.R. 3229
– Witnesses were Liz Fowler, IHS Finance; Cathy
Abramson, NIHB Chair; Tim Schuerch, CEO Maniilaq
Association
– IHS position did not support nor opposed. Testimony
explained it would benefit Tribes but IHS and didn’t
address timlieness or inadequacy of appropriations
– NIHB testimony explained strong Tribal support by
every Area Health Board and national organizations
– Maniilaq testified about improvements in
administration of health programs
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)
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
Discussion?