1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting Embassy Suites, Portland OR January 22, 2014

Report Overview 1.FY 2014 Budget Update 2.DTLL Tribal Consultation Issues a.Special Diabetes Program for Indians b.Medicare Like Rate c.Advance Appropriations* 3.Legislative Plan 113 th Congress, 2 nd Session 4.Q&A

FY 2014 Budget Update Recap 16 Day Government Shutdown – Furloughs of over 800,000 federal employees – IHS suspended meetings, grant & contract activity, payments, ISDEAA negotiations, and CDA claims – Issues: ACA financing; debt ceiling; ACA-PTC & cost-sharing verification – Continuing Resolution to Jan. 15, 2014 Bipartisan Budget Act of 2013– “Ryan/Murray Deal” H.R Omnibus Consolidated Appropriations Act – $1.012 Trillion bill funds government through end of September 30, 2014 – Funds IHS Appropriation $77.9 million above pre-sequester amount – Adopts most of the President’s recommendations on funding amounts

Bipartisan Budget Control Act of 2013 Informally known as the Ryan/Murray Deal reached in December Two year agreement that adds back $63 billion in discretionary spending in FY 2014 and FY 2015 – $45 billion in FY 2014; $18 billion in 2015 More $ for Congress to work with and should avoid sequester under the Budget Control Act Does not restore any sequestered funds Offset comes from federal pension plans, retirement contributions of government workers, reduced COLAs of future military retirees No offset from programs that directly affect Tribal governments BCA 2% sequester stays in place (SDPI)

H.R Omnibus and the IHS FY 2014 Budget Important footnotes: – Full details of spending plan are not available – treat this as preliminary estimates – Word of caution on presentation of FY 2014: final numbers can look better depending on baseline due to 203 sequester and recission – NPAIHB agrees to use FY 2013 pre-sequester amounts and reference that post-sequester was less than FY 2012 amounts. Never use FY 2013 post-sequester for comparisons!

Senate & House Budget Resolutions

Dear Tribal Leader Letters 12/20/2013 DTLL on SDPI Consultation: – Initiate consultation on FY 2015 SDPI distribution – Expires end of FY 2014 – Finance Committee proposed reauthorization for 5 $150 million/year – IHS Director anticipate continence of SDPI and want to develop recommendation in advance Consultation Issues: Refer to the letter Refer to NPAIHB recommendations on SDPI: – December 9, 2013 letter – February 11, 2011 FY 2015 Recommendations continue to put forward these as the Portland Area Recommendations

Dear Tribal Leader Letters 12/6/2013 DTLL on Medicare-like Rates – Director seeks input on expansion of Section 506 to non-hospital based charges, including physician fees, and other services not associated with a hospital – April 2013 GAO Study estimates IHS could save $32 million in FY 2012 had MLR been available – IHS is only federal purchaser of care that pays hospital full billed charges (VA, DOD, etc. do not) – May 2013 CHS Workgroup recommended IHS pursue MLR legislation for non- hospital based services – IHS Director requests comments/concerns on GAO findings and options to improve CHS payment rates NPAIHB supports legislation; been working with ANHB, USET & NIHB to get legislation passed Bingaman amendment history Refer to MLR whitepaper & draft bill language Recommend: NPAIHB support letter and Board resolution

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?

TTAG/MMPC Updates ACA Policy Subcommittee is very active – Tribal Exemption & I/T/U hardship exemption – Medicare PPS for Federally Qualified Health Centers: no more multiple encounters – November 18th – CMS-R-267 Medicare Advantage Program Requirements-Due November 17 th – HHS-OS D Survey of Providers for the Evaluation of the Regional Extension Center Program-Due November 18 th Revising the CMS Tribal Consultation Policy Evaluation of CMS Strategic Plan & Updates Alternatives for Medicaid Expansion: Arkansas Model and UCC Waivers Indian definition issues QHP contraction and payment issues related to IHCIA section 206 and 408 (Reimbursement Subcommittee) IRS/CMS Resource Exemptions Extending Medicare Like Rates to non-hospital based services ACA Educational materials Data projects and studies

TTAG/MMPC Resources 0Folder%20created%20by%20Jim 0Folder%20created%20by%20Jim MMPC Action Items and Tracking List TTAG Roster of Pending Regulations and Assignments

Discussion?