1. 1 Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting Thunder Valley, CA July 6, 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 IHS Budget House & Senate Marks Both House & Senate have completed action – Bills will now move to conference President Requested $460 million increase – House bill is $315 less than President’s Request – 3.1% – Senate bill is $324 million less than President’s Request – 2.9% – $8.6 million difference with House mark higher Key differences in the bills are Senate provides significantly less in H&C accounts and greater increases for Facilities accounts Senate provides $17 million increase for H&C accounts while House provides $78 million Senate provides $61 million for Facilities accounts, while House provides $6 million

4. Comparing House & Senate Marks Sub-Sub AccountFY 2015HouseSenate Services (H&C)$3,197,036$3,275,000$3,214,662 Preventive Hlth$153,961$160,256$154,681 Other Services$831,150$886,283$888,150 Facilities$460,234$466,329$521,818 Total, IHS Budget$4,642,381$4,787,868$4,779,311

5. FY 2016 Budget Highlights (Refer to Funding Table) House provides $22 million for CHS (2.4% increase); Senate provides $1.2 million (0.1% increase) Senate provides less than a 1% increase for H&C and Dental Services Both House & Senate request similar amounts for Behavioral health programs Both bills provide funding for CSC at amount of President Request - $718 million (8.3% increase) Funding for UIHPs is a concern; President did not request an increase, House request $806,000 increase; Senate 0% President Request $185 million for Facilities Construction; House provided no increase, Senate provides $20 million increase

6. May 27, 2015 IHS Director Call Overtime Settlements IHS Director reported that it has settled over $80 million in outstanding overtime wage claims, taxes and social security of employees in Federally-operated hospitals and clinics, consisting of some twenty thousand claimants from 2008-2013 IHS will pay $60 million ($9 million from prior year funding and $50-51 million from prior year 3rd party health insurance collections) An additional $20 million in administrative and [union] attorney fees, will be reprogrammed from the 2015 Facilities Account (Navajo Staffing package) Expected that average claimant will receive $33,000 IHS reported that Unions have not provided a list of claimants TSGAC and other elected Tribal leadership have expressed outrage and have called for others to express disapproval of IHS leadership and management over this issue (See TSGAC letter)

7. IHS Overtime Settlements – STAC Meeting Issues at hand This is egregious issue and reflects poor personnel mismanagement. The fact that its happened is now irrelevant, what IHS doing to ensure it does not happen in the future? How will Navajo’s staffing package be replenished and how will this impact other JV projects? Where are the third party reimbursements coming from, which Area and what Tribes? Is this complicit with the IHCIA provision that requires collections to be returned to the operating unit that generates them? Why isn’t this settlement being paid out of the Judgement Fund as previous settlements have been? Why doesn’t IHS go to Congress for a special appropriation to handle this matter? This action to use tribal resources without consultation sets a bad precedent to do similar unilateral related action in the future. Why does IHS have $9 million in unspent funding from past year’s This confounds the reprogramming of program dollars a year ago to cover additional CSC need?

8. SDPI DTLL Announces IHS Director’s Decision from Tribal Consultation June 29, 2015 DTLL announcing IHS Director’s decisions re: SDPI – Data set-aside will be merged into C-D program – New Funding Announcement will allow new Tribes to compete – No change to weighting in national formula – More recent data (2012) will be used in funding formula – Competitive grant program (DP/HH) will be merged into C-D program – Explanation that combining above will hold Tribes harmless with any changes

9. MSPI/DVPI DTLL announces IHS Director decisions from consultation June 22, 2015 DTLL announces FY 2015 funding decisions – MSPI & DVPI national formula based on population, poverty, and disease burden will remain the same. – DVPI funding levels will remain the same in FY 2015; an additiona $600K will be provided to UIHP’s DVPI projects. Based on Behavioral Health NTAC. – New MSPI/DVPI grant program will used to prevent confusion regarding allowable costs, including indirect costs, to be included in the budget. A standard requirement for all federal financial assistance IHS facilities will continue to receive funding through program awards. – Additional details refer to DTLL attached.

10. Preparing for IHS Director’s Listening Session Listening Session set for July 23, 2015, Issaquah, WA from 10:00 a.m. to 12:00 noon Issues to develop talking points around: – Resource Equity – Regional Referral Specialty Care Center – RPMS, ICD-10, can IHS sustain RPMS or abandon ship? – SDPI funding and new tribes…what to do about how Portland Area funded new tribe in FY 2003 – Other???

11. Discussion?