Transcript Legislative Update NPAIHB Quarterly Board Meeting Thunder

Legislative & Policy
Update
NW Portland Area Indian Health Board
Quarterly Board Meeting
October 21, 2013
1
Budget Update
• 16 Day Government Shutdown
– Furloughs of over 800,000 federal employees
– Suspension of services not exempt by Anti-deficiency Act
– IHS suspended meetings, grant & contract activity,
payments, ISDEAA negotiations, and CDA claims
– Issues: ACA financing; debt ceiling; ACA-PTC & cost-sharing
verification
• What is in the anatomy of the CR Deal?
– Provides Continuing Resolution to Jan. 15, 2014
– Government back to work last Thursday, Oct. 17th
– Repayment for essential workers; Back pay for furloughed
workers
– New clock on debt-ceiling to February 7, 2014 (Ted Cruz)
H.R. 2775 Continuing
Appropriations Act 2014
•
•
•
•
•
•
•
•
Funds continuing operations, projects, or activities conducted in
FY2013 at the current levels.
Requires the rate for operations be calculated [reduced] based on
FY2013 requirements (Sequester)
Prohibits high rates or complete distribution of appropriations at
the beginning of FY2014 for some programs.
Provides compensation of federal employees furloughed as a result
of any lapse in appropriations
Directs agencies to pay for FY 2014 activities if they used their own
resources
ACA tax credit and cost-sharing verification and HHS-OIG issue
report to Congress on effectiveness
(Sec. 1002) Default Prevention Act of 2013
http://thomas.loc.gov/cgibin/bdquery/z?d113:HR02775:@@@D&summ2=m&
Appropriations Update
• H.R. 2775 CR thru January 15th
– H.J. Res. 80, American Indian and Alaska Native,
Health, Education, and Safety Act
• FY 2012 Final Amount = $4.306 billion
• FY 2013 Post Sequester = $4.131 billion
• President’s 2014 Request = $4.430 billion
– $124 million over FY 2012 level (2.9% increase)
• House FY 2014 = $4.130 billion
• Senate FY 2014 = $4.434 billion
Senate & House Budget Resolutions
Indian Health Service FY 2014 Budget
Comparing Enacted FY 2012, FY 2013, and President's FY 2014 Request;
And House & Senate Interior Apprpriaiton Marks
Prepared by: NW Portland Area Indian Health Board - 7/23/2013
President's Request
President's
FY 2014
Request
FY 2012
Budget
Sub-Sub Activity
FY 2013 Final Operating Plan
FY 2013
Operating
Plan
Change
Over
FY 2012
Pct of
Change
Hospitals & Health Clinics
$
1,810,966
$
1,865,630
$ 1,749,072
$
(61,894)
-3.4%
Dental Services
$
159,440
$
168,225
$
156,653
$
(2,787)
-1.7%
Mental Health
$
75,589
$
79,873
$
74,131
$
(1,458)
-1.9%
Alcohol & Substance Abuse
$
194,297
$
196,405
$
185,154
$
(9,143)
-4.7%
Contract Health Services
$
843,575
$
878,575
$
801,258
$
(42,317)
-5.0%
Total, Clinical Services $
3,083,867
$
3,188,708
$ 2,966,268
$ (117,599)
-3.8%
Public Health Nursing
$
66,632
$
71,194
$
66,282
$
(350)
-0.5%
Health Education
$
17,057
$
17,677
$
16,552
$
(505)
-3.0%
Comm. Health Reps
$
61,407
$
61,661
$
58,304
$
(3,103)
-5.1%
Immunization AK
$
1,927
$
1,931
$
1,826
$
(101)
-5.2%
Total, Preventive Health $
147,022
$
152,463
$
142,964
$
(4,058)
-2.8%
Urban Health
$
42,984
$
43,049
$
40,729
$
(2,255)
-5.2%
Indian Health Professions
$
40,596
$
40,602
$
38,467
$
(2,129)
-5.2%
Tribal Management
$
2,577
$
2,577
$
2,442
$
(135)
-5.2%
Direct Operations
$
71,653
$
71,845
$
67,894
$
(3,759)
-5.2%
Self-Governance
$
6,044
$
6,049
$
5,727
$
(317)
-5.2%
Contract Support Cost
$
471,437
$
477,205
$
447,788
$
(23,649)
-5.0%
Total, Other Services $
635,292
$
641,327
$
603,047
$
(32,245)
-5.1%
Total, Services $ 3,866,181 $ 3,982,498 $ 3,712,279 $ (153,902)
-4.0%
House
Interior
Mark-up
Senate
Interior
Bill 8-1-13
House
Subcomm.
Mark
House
Subcomm.
Mark
$ 878,575
$
843,237
$
36,000
$ 477,205
$
476,705
$ 3,712,486
$ 3,982,842
FACILITIES
Maintenance & Improvement
$
53,721
$
53,721
$
50,919
$
(2,802)
-5.2%
Sanitation Facilities Constr.
$
79,582
$
79,582
$
75,431
$
(4,151)
-5.2%
Health Care Fac. Constr.
$
85,048
$
85,048
$
77,238
$
(7,810)
-9.2%
Facil. & Envir. Hlth Supp.
$
199,413
$
207,206
$
193,578
$
(5,835)
-2.9%
Equipment
$
22,582
$
22,582
$
21,404
$
(1,178)
-5.2%
Total, Facilities $
440,346
$
448,139
$
418,570
$
(21,776)
-4.9%
$ 417,053
$
4,306,528
$
4,430,637
$ (175,679)
-4.1%
$ 4,129,539
$ 4,434,515
TOTAL, IHS
$
$ 4,130,849
451,673
Clinical Service Accounts
President's Request
President's
FY 2014
Request
FY 2012
Budget
Sub-Sub Activity
Hospitals & Health Clinics
$
1,810,966
$
1,865,630
Dental Services
$
159,440
$
Mental Health
$
75,589
Alcohol & Substance Abuse
$
Contract Health Services
FY 2013 Final Operating Plan
FY 2013
Operating
Plan
Change
Over
FY 2012
Pct of
Change
$ 1,749,072
$
(61,894)
-3.4%
168,225
$
156,653
$
(2,787)
-1.7%
$
79,873
$
74,131
$
(1,458)
-1.9%
194,297
$
196,405
$
185,154
$
(9,143)
-4.7%
$
843,575
$
878,575
$
801,258
$
(42,317)
-5.0%
Total, Clinical Services $
3,083,867
$
3,188,708
$ (117,599)
-3.8%
$ 2,966,268
House
Interior
Mark-up
Senate
Interior
Bill 8-1-13
House
Subcomm.
Mark
House
Subcomm.
Mark
$ 878,575
$
843,237
Preventive Health Accounts
President's Request
President's
FY 2014
Request
FY 2012
Budget
Sub-Sub Activity
FY 2013 Final Operating Plan
FY 2013
Operating
Plan
Change
Over
FY 2012
Pct of
Change
Public Health Nursing
$
66,632
$
71,194
$
66,282
$
(350)
-0.5%
Health Education
$
17,057
$
17,677
$
16,552
$
(505)
-3.0%
Comm. Health Reps
$
61,407
$
61,661
$
58,304
$
(3,103)
-5.1%
Immunization AK
$
1,927
$
1,931
$
1,826
$
(101)
-5.2%
Total, Preventive Health $
147,022
$
152,463
$
142,964
$
(4,058)
-2.8%
House
Interior
Mark-up
Senate
Interior
Bill 8-1-13
House
Subcomm.
Mark
House
Subcomm.
Mark
Other Services Accounts
President's Request
President's
FY 2014
Request
FY 2012
Budget
Sub-Sub Activity
FY 2013 Final Operating Plan
FY 2013
Operating
Plan
Change
Over
FY 2012
Pct of
Change
Urban Health
$
42,984
$
43,049
$
40,729
$
(2,255)
-5.2%
Indian Health Professions
$
40,596
$
40,602
$
38,467
$
(2,129)
-5.2%
Tribal Management
$
2,577
$
2,577
$
2,442
$
(135)
-5.2%
Direct Operations
$
71,653
$
71,845
$
67,894
$
(3,759)
-5.2%
Self-Governance
$
6,044
$
6,049
$
5,727
$
(317)
-5.2%
Contract Support Cost
$
471,437
$
477,205
$
447,788
$
(23,649)
-5.0%
Total, Other Services $
635,292
$
641,327
$
603,047
$
(32,245)
-5.1%
Total, Services $ 3,866,181 $ 3,982,498 $ 3,712,279 $ (153,902)
-4.0%
House
Interior
Mark-up
Senate
Interior
Bill 8-1-13
House
Subcomm.
Mark
House
Subcomm.
Mark
$
36,000
$ 477,205
$
476,705
$ 3,712,486
$ 3,982,842
Facilities Accounts
President's Request
President's
FY 2014
Request
FY 2012
Budget
Sub-Sub Activity
FY 2013 Final Operating Plan
FY 2013
Operating
Plan
Change
Over
FY 2012
Pct of
Change
House
Interior
Mark-up
Senate
Interior
Bill 8-1-13
House
Subcomm.
Mark
House
Subcomm.
Mark
FACILITIES
Maintenance & Improvement
$
53,721
$
53,721
$
50,919
$
(2,802)
-5.2%
Sanitation Facilities Constr.
$
79,582
$
79,582
$
75,431
$
(4,151)
-5.2%
Health Care Fac. Constr.
$
85,048
$
85,048
$
77,238
$
(7,810)
-9.2%
Facil. & Envir. Hlth Supp.
$
199,413
$
207,206
$
193,578
$
(5,835)
-2.9%
Equipment
$
22,582
$
22,582
$
21,404
$
(1,178)
-5.2%
Total, Facilities $
440,346
$
448,139
$
418,570
$
(21,776)
-4.9%
$ 417,053
$
4,306,528
$
4,430,637
$ (175,679)
-4.1%
$ 4,129,539
$ 4,434,515
TOTAL, IHS
$
$ 4,130,849
451,673
Ardmore OK - $8.9 million
Tishomingo OK - $5.3 million
Vinita OK - $1.8 million
Tazlina AK - $500K
Wasilla AK - $17.7 million
Kenai AK – $1 million
Fairbanks AK - $20 million
Barrow AK - $6.8 million
Nome AK - $13.6 million
San Carlos AZ - $1.3 million
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)
• IHCIA Technical Amendments
IHS Director Confirmation Hearing
• SCIA confirmation hearing June 12, 2013
• SCIA has placed a hold on IHS Director confirmation until
they are satisfied with received reports:
– Four IHS Areas has conveyed dissatisfaction on issues
– Aberdeen Investigation continues to plague IHS
– Area Office Reviews: SCIA wants reports of findings
– CHS formula: adding mortality and morbidity to formula
– Health Facilities construction & staffing issues
– CSC issues and Administration’s proposal in FY 2014
• SCIA and HHS-Secretary have received Tribal leaders letters
requesting Administration withdraw nomination or SCIA not
move forward with confirmation.
• STAC Meeting: HHS Secretary weighs in support of Directors
Contract Support Cost Update
• July 31-August 1: CSC Summit Hosted by ANHB, ANTHC,
CRIHB, NPAIHB, USET & NTCSCC
• 3 Supreme Court cases have affirmed Tribes right to be paid
full CSC payments
• Ramah decision requires federal government to pay Tribes
full CSC if the agency has sufficient appropriation
• Administration proposed statutory ‘amendment-byappropriation’
– Eliminate Tribes’ future contract recovery rights
– Proposal gives legal effect to amounts in a “table” provided to the
Appropriations Committees
– Since Tribal contract is “subject to the availability of
appropriations,” limits legal remedy of Tribes and skirts Supreme
Court decisions
– No Tribal consultation on the Administration’s proposal!
Tribal Contract Support Cost Summit
CSC Policy Landscape is changing: Cherokee and Ramah
court decisions, Administration & Agency policy changes,
settlement of past CSC Claims, and lack of CSC funding
Alaska Native
Health Board
Alaska Native Tribal
Health Consortium
California Rural
Indian Health Board
Northwest Portland
Area Indian Health
Board
United South and
Eastern Tribes, Inc.
National Tribal
Contract
Support Cost
Coalition
Members
Tribal Contract Support Cost
Summit – Objectives
• Legal, financial, and ISDEAA policy experts addressed
recent CSC policy developments
• Tribal only meeting did not include federal program
personnel provided open and candid discussion
• Agenda Issues over two days included:
1.
2.
3.
4.
5.
6.
Litigation Update and Agency responses
Settlement of past year’s claims & documentation
Administration’s FY 2014 CSC Proposal
Discussion of Ramah options
CSC Tribal Consultation Issues
Moving forward with CSC Issues
Tribal CSC Summit
Recommendations
1. Tribal Consultation
2. Reject the Administration’s FY 2014
Proposal
3. Supreme Court Option Explanations
4. IHS Settlement Process
TTAG/MMPC Updates
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•
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•
•
ACA Policy Subcommittee is very active
– Tribal Exemption & I/T/U hardship exemption
– Medicare PPS for Federally Qualified Health Centers: no more
multiple encounters – November 18th
– CMS-R-267 Medicare Advantage Program Requirements-Due
November 17th
– HHS-OS-20475-60D Survey of Providers for the Evaluation of the
Regional Extension Center Program-Due November 18th
Revising the CMS Tribal Consultation Policy
Evaluation of CMS Strategic Plan & Updates
Alternatives for Medicaid Expansion: Arkansas Model and UCC Waivers
Indian definition issues
QHP contraction and payment issues related to IHCIA section 206 and
408 (Reimbursement Subcommittee)
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
IHS Dear Tribal Leader Letters
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
DTLL on IHS Virtual Summit – September 25, 2013
DTLL on CSC Update – September 9, 2013
DTLL on CHR Training – August 8, 2013
DTLL on Special Diabetes Program for Indians – June 19, 2013.
DTLL on Contract Support Costs – June 12, 2013.
DTLL on Contract Health Services – May 6, 2013.
DTLL on MSPI & DVPI – May 6, 2013.
DTLL on CSC Follow-up 9/24/2012 – March 26, 2013.
DTLL on draft IHS Sexual Assault Policy, Part 3, Chap. 29 – March
22, 2013.
DTLL on CHS increases for referrals for prevention services in
follow-up to 8/2/2012 – January 15, 2013
DTLL on CSC Issues in follow-up to 9/24, 2012 letter – January 14,
2013.
DTLL on UIHP Conferring Policy – January 11, 2013.
DTLL on OIT PFSA and Tribal Shares – January 11, 2013.
What will Your Marketplace Look Like?
Medicaid Expansion for Indian Country
Discussion?