1. 1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting Hosted by Grand Ronde Tribe April 22, 2015

2. Report Overview 1.IHS Budget Updates 2.CHS Meeting & MLR Regs & CHEF 3.FAAB & CHS Workgroups 4.MLR for non-hospital based services 5.ACA Updates

3. FY 2016 Budget Update President’s FY 2016 budget provides BIG increase for IHS - $461 million increase (10%) – In FY 2010 $471 million increase – Dems in control Will Republican controlled Congress agree to provide such a large increase? Political grandstanding by the Administration recognizing Congress has tight purse strings? Great increase but there are some problems with the overall distribution to direct funds for construction, program increases & not enough for inflation/population growth

5. IHS Budget – Detail of Changes Overall Increase is $461 million Current Services - $147.3 million – Federal Pay Costs $7.7 million – Tribal Pay costs $11.7 million – Medical Inflation $71.2 million (3.8%) – Population Growth $56.7 million Program Increases - $313.3 million

6. IHS Budget – Detail of Changes Overall Increase $461 million Program Increases $313.3 million – Staffing new facilities $17.8 million – H&HC 3 rd Party Improvement $10 million – CHS/PRC increase $25.5 million – H&HC Health IT $10 million – ASA/Behavioral Health $25 million – Contract Support Costs $55 million – Facilities: M&I $35 million; SFC $35 million; Health Facilities Construction $100 million

7. NPAIHB Budget Analysis on FY 2016 President’s Request More Discussion on this tomorrow! Board has completed annual budget analysis and recommends $297 million needed for inflation and population growth. Additional $175 million is recommend for Program increases (based on FY 2016 Budget Formulation): – CHS/PRC – Dental Health – Mental Health – A/SA – Health Facilities: SFC, M&I – Urban Indian Health

9. House Interior Appropriations Subcommittee on Environment & Related Agencies Subcommittee conducted Native American Witness day March 24 th Andy Joseph, Jr, NPAIHB Chair testified on behalf of Board Budget Analysis Recommendations: – Reprogram President’s increase to adequately fund inflation, pop-growth – If Subcommittee funds Health Facilities than include funding for SAP, JV, and Area Distribution (Regional Referral Centers) – CHS/PRC increase to $100 million – Support for Administration’s proposal to make CSC a mandatory appropriation

10. Senate Committee on Indian Affairs New Chairman John Barrasso (R-WY); Vice-Chair Jon Tester (D-MT) Issues: – Address & find innovative solutions to reduce federal bureaucracy in Indian programs – Interior Self-governance amendments; HHS expansion – February 25 th hearing on FY 2016 budget; Yvette Roubideaux, Sr. Advisor to HHS Secretary, Administration’s witness – Support Self-Determination and contract support costs – March 4 Views and Estimates letter: http://www.indian.senate.gov/sites/default/files/upload/files/ FY%202016%20VE%20Letter.pdf http://www.indian.senate.gov/sites/default/files/upload/files/ FY%202016%20VE%20Letter.pdf – Facilities construction – Special Diabetes Program for Indians

11. Health Legislative Updates Special Diabetes Program for Indians – DTLL Tribal Consultation on FY 2016 funds – Medicare Access and CHIP Reauthorization Act of 2015 – “Doc-fix” bill – Includes extension of SDPI through FY 2018; S. 286, A bill to amend the ISDEAA to provide further self- governance by Indian tribes; Empowering Indian Country in the Republican Congress – SCIA Labor-HHS Committee holding hearing this week on Administration’s coordination with Tribes on health issues IHS Director Nomination? Likely to acting thru end of Administration Administration’s Proposal to make CSC a mandatory appropriation

12. FAAB Update FAAB Meeting, Rockville, MD, March 31 – April 2, 2015 – Recommendation on revised Health Facility Construction Priority System (HFCPS) – Preparation for IHCIA Facilities Report due to Congress March 23, 2016 – Area Master Planning criteria and process – Budget issues related to maintaining M&I and SFC – Consultation on new IHCIA authorities DTLL requesting input identifying Tribe’s top five health care facilities construction needs – new authorities in the IHCIA – June 1, 2015 Deadline – Discuss Process to develop comment and recommendations

13. Contract Support Costs Update President’s Budget includes proposal to make CSC funding mandatory – 3 year mandatory authorization – Tribes support a permanent authorization – Administration proposes caps “as necessary”; Tribes support no caps – 2% administration set-aside; relates to ongoing reconciliation process? – Process still being considered by Congress and has a ways to go

14. Discussion?