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1 Legislative Update Ocean Shores, WA April 17, 2012.

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1 1 Legislative Update Ocean Shores, WA April 17, 2012

2 Overview FY 2013 President’s Request Contract Support Cost Updates 112 th Congress & Legislation Oregon CCOs TTAG Issues Q&A

3 IHS FY 2013 President’s Request President’s Request $115.9 million increase; 2.7% NPAIHB Budget Analysis estimates $403 million to maintain current services – Inflation: $213.5 million – Population Growth: $90.4 million – CSC Shortfall: $99.3 million IHS CJ explains Detail of Changes: – Current Services: $85.6 million for Federal Pay costs, medical inflation, staffing new facilities – Program Expansion: $30.3 million for CHS, Health IT (ICD- 10), Direct Ops, CSC, M&I – Program Decrease in Facilities Construction $3.5 million

4 IHS FY 2013 President’s Request Current Services: $85.6 million – Federal Pay Costs $2.4 million – Medical Inflation $33.9 million – Staffing new facilities $49.3 million Program Increases (Reprogramming) – CHS increase $20 million – HIT ICD-10 $6 million – Direct Operations $1.1 million – Contract Support Costs $5 million – Maintenance & Improvement $1.5 million – Health Facilities Construction $3.6 million

5 Contract Support Cost Update New interest in CSC issues driven by funding – FY 2010 $116 million increase; 41% increase – FY 2012 $74 million increase; 19% increase – FY 2013 $5 million; will drive up shortfall IHS Director reconvened the Contract Support Cost Workgroup – Andy Joseph, Jr., Chairperson First Workgroup Meeting Mar. 31-Feb. 1, 2012 – Charged to evaluate Dr. Grim 2007 changes for “new/expanded programs”; and provide recommendations – Meeting met at an impasse with the IHS Director due to lack of CSC data – CSCWG position was grant access to data or absent data, Workgroup “cannot and will not, proceed with its assessment of the 2007 Manual.”

6 Contract Support Cost Update CSCWG/Andy Joseph Letter Feb. 22, 2012 letter requesting: – Access to data not the IHS CSC Report, information completion of reports, funding allocations from past years, redline of IHS recommended changes to CSC Manual Contention around preparation for March CSC Workgroup meeting resulted in IHS Director cancelling – March 2, 2012, Dear Tribal Leader...effectively by-passed the CSC Workgroup – DTLL request input on new/expanded funding in FY 2012; and Tribal concerns about access to Tribe’s CSC data NPAIHB Freedom of Information Act (FOIA) Request for items outlined in Feb. 22 nd letter – IHS denied and NPAIHB has appealed to the Secretary

7 NPAIHB CSC Letters February 22, 2012 Letter on “New/Expanded Programs” (sent March 16 th ) – 2007 change to CSC Policy by Dr. Grim – Portland Tribes support fairness & equity – Promotes self-determination opportunities for DST – NPAIHB supports up to $10 million for new/expanded programs; balance to shortfall March 30, 2012 Letter on Data Confidentiality – Discussion on history of CSC policy and Tribal consultation – Changes have to be respectful of Tribal leaders recommendations and past work – Transparency promotes trust with the Agency and among Tribes – fairness & equity – Public information via NBC, Single Audit Act, Congressional reports – Assist to advocate for IHS budget and CSC – Northwest Tribes supportive of sharing CSC data

8 OMB Proposal for developing Indirect Cost Rates OMB Federal Register Notice, Feb. 28, 2012 – Proposal will have an effect on Tribes – Concept proposal now, policy later, expect notice of proposed rule to follow – Changes for Single Audit Act – Multi-year IDC rates – Good & Bad NPAIHB Analysis sent to Tribes April 11 th – Board Comments, Analysis, and sample comment letter for Tribes – Make sure to get to your Finance/Mgmt staff responsible for developing IDC proposals

9 Senate Committee on Indian Affairs Update Focus on technical & Native Hawaiian issues – Blood quantum, land/reservation, water, gaming, and cultural and preservation Native Hawaiian Issues – Health care, home ownership – NH Health Care Improvement Act – NH Government Reorganization SCIA focus is building health record for 113 th Congress; awaiting Supreme Court Hearing on IHS Budget March 12, 2012

10 State Policy Issues Oregon’s Health Reform & Coordinated Care Organizations Tribal provisions included in legislation* – Global Budgets & Alternative Payment Methods* – Mandatory Enrollment* – Indian Health Benefit Package* – Options for providing specialty care – Tribal Consultation NPAIHB letter on CCO implementation recommendations NPAIHB file letter to preserve Tribes ability to become CCOs

11 State Exchange Work Exchange Analysis Papers – Exchange Impact Analysis on Tribal Health Programs – Justification for QHPs to Contract with Tribal Health Programs – Tribes as Navigators – Tribal Sponsorship of Premiums & Group Payer Arrangements – CO-OP Analysis & Tribes – Exchange IT Assessment, Tribal identification and documentation – Indian Definition & Documentation – Reference Guide to Federal Indian Laws & Regulations for Exchange Planning

12 Exchange Establishment Tribal Consultation: NPR requirement for Exchange Plans to have TCP Exchange Consumer Assistance Tools: – Website, Call Centers, Calculators, Navigators, Outreach & Education Payment of Premiums; Group Payers Indian Protections & definition of Indian Reimbursement, QHP participation, network adequacy Essential Community Providers Other comments on IHCIA

13 Questions/Discussion Jim Roberts, Policy Analyst Northwest Portland Area Indian Health Board 13

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