Transcript Legislative Update NPAIHB Quarterly Board Meeting Thunder

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
FAAB Update
• April 29-30th Meeting; first meeting in over five years ~ 2007
Mtg in Rockville?
• Review of Enabling Legislation
• Facilities Needs Assessment Workgroup
– Improving Joint Venture Construction Program
– Improving Small Ambulatory Program
– Innovative Strategies for HCFC
– Improve Health Care Facilities Planning and Construction
• Overview of Current HCFC Priority List
– History of the Current Priority List
– Last Report to Congress
• July 24-25th in Sacramento; November 12-13 in Albuquerque
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?