1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting April 17, 2013

Overview IHS Budget Updates Covered Uncompensated Care Updates Review Legislative Plan Priorities CHS Workgroup Meeting Discussion

Oregon Uncompensated Care OR Uncompensated Care Project is Moving Concept “paper” Finalized & Shared with State/CMS States in discussion with CMS about how to proceed Key elements include: – Provides all Services available in state Medicaid Plan – No sunset date (AZ & CA have end dates) – Services must be provided to all Medicaid clients eligible to be served by Tribal health program – 100% FMAP only for eligible AI/ANs – Expand up to 133% FPL – Tribes must provide non-federal share of state match for non-AI/ANs – CPE model will be developed

WA Uncompensated Care Washington Uncompensated Care Waiver is on hold: – No Tribal Liaison to work on waiver – Workgroup has been inactive Karol Dixon has been hired as Medicaid Tribal Liaison Recommend the waiver as a discussion issue at AIHC meeting

2013 Legislative Plan Two lobbying trips to D.C. & new Legislative Plan presented to Members Legislative Priorities include: – Indian Definition Fix – CSC Oversight hearing – Reauthorize SDPI – ACA technical fixes: QHP contracting, payments IHS Appropriations: CHS, CSC, EpiCenter, YRTC Administrative Issues: Medicaid, ACA Implementation

Contract Health Services Workgroup CHS Workgroup has reconvened to address the CHS Formula equity issues Denver meeting on February 20-21, 2013 – First meetings focused on CHS best practices – Consistent process to document denied/deferred care – Punted on CHS formula issues June 2012 GAO Report issued, “Action Needed to Ensure Equitable Allocation of Resources for the Contract Health Service Program” IHCIA provision required completion of report and IHS to address equity issues as a result of the findings

GAO Report Summary Analyzed 2000 –2010 CHS base budgets and user population data Data used to calculate per capita estimates for CHS and Direct Care – Findings presented how IHS’s allocation of CHS funding varied across IHS areas – What steps IHS has taken to address funding variation within the CHS program Report included two key recommendations

Summary of GAO Findings 1.GAO “suggests” Congress consider requiring IHS to develop and use a new method to allocate all CHS program funds to account for variations across areas 2.GAO recommends IHS use actual counts of CHS users in methods for allocating CHS funds CHS Workgroup discussed these recommendations at length in Denver

CHS Denver Meeting Summary 1.Recommend current formula remain the same until additional data is available to evaluate 2.Resource Disparity Report due to Congress (IHCIA, FDI requirement) 3.Once report is available than CHS workgroup to reconvene to evaluate findings and how it correlates to CHS formula? 4.CHS formula discussion issues: – Program increases based on CHS Users vs. All Users – Expand “Access to Care” (Hospital) Component: mileage, driving time, tiered system, 5.Other Issues: ND/SD CHSDA expansion, MLR non- hospital services, CHEF threshold

Discussion?