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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Questions? For more information, please contact: Geoff Strommer