April 19 Tribal Self-Governance Annual Consultation Conference Legislative Updates April 1, 2019 Geoffrey D. Strommer

IHS Advance Appropriations Initiative For many years tribes have sought advance appropriations for IHS funding to address negative impacts of CRs and government shutdowns Advance appropriations has applied to VA medical accounts for many years Legislation was previously introduced on House that would implement this initiative and House directed GAO to conduct a study on feasibility GAO issued study last year making it clear concepts can work Recent 35-day government shutdown increased interest in advance appropriations and led to introduction of new legislation

IHS Advance Appropriations Initiative (cont.) There are 3 pending bills HR 1135 by Rep. Don Young (R-AK). It would authorize advance appropriations for IHS Services and Facilities Accounts. There are 10 co-sponsors from both parties. HR 1128 by Rep. Betty McCollum (D-MN) who is Chair of the House Appropriations Subcommittee on Interior. It would authorize advance appropriations for IHS Services and Contract Support and some BIA/BIE programs. There are 10 co-sponsors from both parties. S. 229 by Sen. Tom Udall (D-NM) who is Ranking Member on the Senate Interior Appropriations Subcommittee. There are 7 co-sponsors, all Democrats. It is the same as HR 1128 and it was Referred to the Senate Budget Committee.

IHS Advance Appropriations Initiative (cont.) Numerous national and regional tribal organizations, as well as many tribes support this initiative The ABA is about to enact resolution in support of advance appropriations The Trump Administration is still not clearly on record as supporting this initiative yet Very happy to hear this morning that IHS will send DHHS Secretary a letter of support for the initiative Not clear when hearings will happen or when bills will move Including ask for extension of advance appropriations to BIA in addition to IHS complicates the landscape

SDPI Reauthorization and Funding Authorization for SDPI expires on 9/30/2019 SDPI has been level funded at $150 million per year since fiscal year 2004 NCAI and NIHB are advocating that Congress increase the annual appropriation for SDPI to $200 million for fiscal year 2020 to begin to address this unmet need

SDPI Reauthorization and Funding (cont.) Senator Alexander introduced a healthcare extenders bill (S. 192) that would reauthorize SDPI for an additional five years from 2019–2024 The bill was referred to the Senate Health, Education, Labor, and Pensions (HELP) Committee, where it remains under consideration Congressman O’Halleran is expected to introduce a similar bill in the House in April

SDPI Reauthorization and Funding (cont.) Hearings on SDPI reauthorization are expected to take place in either late spring or early summer The House Diabetes Caucus is circulating a sign-on letter of support in the House; a Senate companion letter is expected to be released soon NIHB is coordinating tribal outreach to Members of Congress

Section 105(l) Leasing: Background Chronic underfunding of tribal facilities used to provide services M&I funds inadequate to fully fund these needs Section 105(l)of ISDEAA: Tribally owned/leased Used for the purpose of providing PFSAs in FA Mandatory

Section 105(l) (Con’t) Maniilaq I: Lease may be part of funding agreement; lease proposal subject to final offer process; IHS failed to respond within 45 days Maniilaq II: Section 105(l) and the regulations require that IHS fully fund reasonable, non-duplicative lease costs

Section 105(l) (Con’t) Supplemental tribal clinics appropriation: Funds both VBC program increase and 105(l) lease compensation 105(l) leasing has spread throughout Indian Country In FY 2018, Congress appropriated $11 million to tribal clinics, but IHS had to reprogram $25 million more In FY 2019, Congress increased the tribal clinics appropriation by $25 million, to $36 million Recently IHS opened consultation on how to address a projected $45 million need in 2019

Section 105(l) (cont.) Section 105(l) leasing will continue to increase IHS needs to administer Section 105(l) leases in a manner that allows the agency to better anticipate and budget for this expansion IHS should drop its efforts to seek a legislative “fix” similar to the one proposed in the Administration’s last two budget proposals—that nullifies 105(l) The ideal solution: a separate, indefinite appropriation for 105(l) like that for contract support costs

Questions? For more information, please contact: Geoff Strommer gstrommer@hobbsstraus.com 503-242-1745