1. 1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting June 20, 2014

2. Report Overview 1.SDPI Extended 2.GAO Report on Veterans Health 3.FY 2015 Appropriations Update 4.Dental Health Aide Therapists 5.Health IT Updates 6.Contract Support Cost Update 7.Navajo Nation Medicaid Study

3. 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

4. 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

5. 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

6. 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 26 th – S. 1570 amend IHCIA for Advanced Appropriations – S. 919 amend ISDEAA to expand self- governance

7. DateBIll #Title 03/31/2014S.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. 03/26/2014S.2160Native American Children's Safety Act 03/13/2014S.2132 Indian Tribal Energy Development and Self- Determination Act Amendments of 2014 02/25/2014S.2040Blackfoot River Land Exchange Act of 2014 02/25/2014S.2041May 31, 1918 Act Repeal Act 02/06/2014S.1998Native Adult Education and Literacy Act of 2014 01/16/2014S.1948Native Language Immersion Student Achievement Act

8. 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 (D- MT), Tom Udall (D-NM), Brian Schatz (D-HI), Al Franken (D- MN) Medicare-like Rates (Contract Rate Expenditure) - H.R. 4843 Rep. Betty McCollum (D-MN) and Rep. Tom Cole (R-OK)

9. 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

10. 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 7-8 th House Public Witness Hearings; April 30 th Senate Hearing Senate considering “mini-bus” bill for some Departments – Sign that headed for a long haul

12. TTAG/MMPC Updates 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

13. TTAG/MMPC Resources https://www.dropbox.com/home/Delegates/Temp%2 0Folder%20created%20by%20Jim 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

14. Navajo State Medicaid Agency Study CMS release Navajo Medicaid Study – 51 st state concept for Medicaid Report Concludes it is feasible for Navajo to administer a Medicaid Agency but many challenges: – 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 non- Indians – Report estimates Navajo could generate required 17% for non-federal share – May be statutory barriers and legislative action needed

15. Discussion?