1. IHS Update Yvette Roubideaux, M.D., M.P.H. Acting Director, Indian Health Service National Council of Urban Indian Health Conference November 19, 2014

3. Confer Policy 2010: IHCIA Reauthorization –New requirement to confer 2012: FRN – Draft Policy 2013: Listening Session 2014: FRN – Final Policy on Conferring with Urban Indian Organizations –effective 9/22/2014; Indian Health Manual Implementation Updates

7. Indian Health Service Appropriations by Fiscal Year (FY)

8. Confer Activities Budget –Budget formulation process Tribal, urban –Urban line item budget Non-recurring funding –program support, technical assistance portions Recurring contract and grant funding –Base funding vs. increases

9. Confer Activities Evaluation, Reporting, Data –Requirements UDS GPRA Grant/Contract requirements –Three levels of programs Comprehensive/ambulatory Limited ambulatory Outreach and Referral

11. IHS Priorities Renew and strengthen our partnership with Urban Indian Organizations Reform the IHS Improve the quality of and access to care Ensure that our work is transparent, accountable, fair, and inclusive

14. IHS Priorities To Reform the IHS – Affordable Care Act  Insurance Reforms  Health Insurance Marketplace  Medicaid Expansion  Strengthening Medicare  IHCIA reauthorization - Things still to do  Monthly Enrollment for Tribal members  Medicaid Enrollment/Expansion  Exemption – individuals eligible for IHS services  Help patients understand how to use insurance  Open Enrollment - November 15 – February 15 14

15. Affordable Care Act – Requirements for Individuals ALL AMERICANSIHS ELIGIBLE INDIVIDUALS must have HEALTH INSURANCE COVERAGE Qualifying health insurance coverage includes:  Medicaid, CHIP, Medicare, VA, TRICARE  employer sponsored health insurance  Marketplace health insurance  other qualifying health coverage  The same health insurance coverage types apply  The IHS is not a type of coverage that meets this ACA requirement must get a COVERAGE EXEMPTION You may qualify for an Exemption if:  You are not required to file taxes  Cost of coverage would exceed 8% of your income  You are ineligible for Medicaid because your state did not expand eligibility  Certain other exemptions identified on healthcare.gov The same exemptions apply plus:  Individuals eligible for IHS can get an exemption by: o claiming this exemption on IRS tax forms or o Applying once through the Marketplace and filing the certificate # on annual IRS tax forms Otherwise, pay PENALTY when you file your 2014 taxes 1 2 or

17. IHS Priorities To Reform the IHS – Affordable Care Act – Things still to do  Reach those still uninsured  Open enrollment continues  National Tribal Day of Action 17

18. IHS Priorities To Reform the IHS – Affordable Care Act  Definition of Indian  Exemption filing  Medicaid expansion  Email: acainformation@ihs.govacainformation@ihs.gov  Website: www.ihs.gov/acawww.ihs.gov/aca

19. IHS Priorities To Reform the IHS – Internal Reform  Improve how we do business  Improving budget planning and financial management  More consistency in business practices  Improve how we lead and manage people

20. IHS Priorities Improve the Quality of and Access to Care – Improving Patient Care (IPC)  Patient-centered medical home  Plan to expand throughout IHS system  IPC Quality and Innovation Learning Network

22. IHS Priorities Improve the Quality of and Access to Care – Health Information Technology  Measuring outcomes/clinical measures  RPMS improvements ongoing  Electronic Health Records and Accomplishing Meaningful Use Stage 2 Certification

23. IHS Priorities Improve the Quality of and Access to Care – Health Information Technology  Electronic Health Records and Meaningful Use  27 Urban Programs are using RPMS; 21 sites have implemented the RPMS electronic health record system.  15 Urban Programs have signed up for Meaningful Use and have received CMS incentive payments.

24. IHS Priorities Improve the Quality of and Access to Care ‒ Special Diabetes Program for Indians  $150 million/year  Grants to prevent and treat diabetes  Over 400 IHS/Tribal/Urban grantees  SDPI Report to Congress – outcomes

25. Summary Moving forward together Policy for Conferring with Urban Indian Organizations Affordable Care Act IHS Priorities