Legislative Update NPAIHB Quarterly Board Meeting Thunder ...

Legislative Update NPAIHB Quarterly Board Meeting Thunder ...

Legislative/Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting June 20, 2012 1 Overview FY 2013 IHS Appropriation CSC Supreme Court Decision GAO CHS Funding Study Insurance Exchanges TTAG Updates

Questions FY 2013 Appropriations Twelve Appropriations bills House and/or Senate Action on 11 bill bills; none have been passed full chamber Interior & Environment is one bill that House or Senate have not taken action June 20th, 1:00 PM mark up scheduled Witness Hearings March 27-29th Andy Joseph was witness Discretionary Budget Caps Subcommittee FY 2012 FY 2013 Agriculture

$17,250 $19,405 Homeland Security Interior & Environment $40,592 $27,473 $39,117 $28,000 Labor, HHS & Education $139,218 $150,002 Defense

$530,025 $519,220 Commerce, Justice, Science $50,237 $51,129 IHS FY 2013 Presidents Request Presidents Request $115.9 million increase; 2.7% NPAIHB analysis estimates $403 million to maintain current services Inflation: $213.5 million Population Growth: $90.4 million CSC Shortfall: $99.3 million IHS CJ explains Detail of Changes: Current Services: $85.6 million for Federal Pay costs, medical inflation, staffing new facilities

Program Expansion: $30.3 million for CHS, Health IT (ICD10), Direct Ops, CSC, M&I Program Decrease in Facilities Construction $3.5 million IHS FY 2013 Presidents Request Current Services: $85.6 million Federal Pay Costs $2.4 million Medical Inflation $33.9 million Staffing new facilities $49.3 million Program Increases (Reprogramming) CHS increase $20 million HIT ICD-10 $6 million Direct Operations $1.1 million Contract Support Costs $5 million Maintenance & Improvement $1.5 million Health Facilities Construction $3.6 million Contract Support Cost Update New interest in CSC issues driven by funding FY 2010 $116 million increase; 41% increase FY 2012 $74 million increase; 19% increase

FY 2013 $5 million; will drive up shortfall IHS Director reconvened the Contract Support Cost Workgroup Andy Joseph, Jr., Chairperson First Workgroup Meeting Mar. 31-Feb. 1, 2012 Charged to evaluate changes for new/expanded programs Impasse with the IHS Director about data Second Workgroup Meeting May 3-4, 2012 Same issues continue CSC Workgroup Issues CSC Workgroup requests the following: IHS Disclosure of CSC data to analyze impact of CSC policy change for new & expanded programs Data provides basis of developing recommendations IHS Redline of CSC Policy changes Concerns about application of FACA

Next meeting date? CSC Supreme Court Decision Supreme Court reached decision in Salazar v. Ramah Navajo Chapter (Zuni) case Case brought by Federal Government (BIA) arguing that notwithstanding the CSC "cap" language in the annual appropriations, it is not obligated to fully fund CSCs Case decided by narrow margin 5-4 This means that IHS/BIA must pay full CSC costs if Agencies have enough appropriated funds and does not matter if they do not have adequate CSC funding GAO Study on CHS Funding IHCIA requires GAO review of CHS allocation and make recommendations to address funding inequity GAO reviewed: 1. CHS base funding (FY 2001 FY 2010) 2. Annual Inflation and population adjustments

3. Program increases GAO attempted to examine these issues: 1. The extent to which IHSs allocation of CHS funding varied across IHS areas, and 2. What steps IHS has taken to address funding variation within the CHS program. GAO analyzed IHS funding data, reviewed agency documents and interviewed IHS and area office officials. GAO Method Examined FY 2001 FY 2010 CHS base budgets and user population Data used to calculate per capita estimates for CHS and Direct Care GAO Recommendations 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 3. HHS/IHS did not concur with the GAO recommendation to use CHS users 4. GAO believes that its recommendation would provide a more accurate count of CHS users. Items of interest in GAO Report IHS found substantial differences using its own FDI: In fiscal year 2010, the index estimated that resources available in the most well-resourced of its 12 areas, relative to their need, were nearly 50 percent higher than in the leastresourced area and that the most well-resourced individual CHS programs had resources more than three times greater than that of the programs with the least resources. GAO CHS Study Total CHS Funds Allocated to IHS Area Offices, Fiscal Years 2001 through 2010

Funds allocated to area offices, in dollars, for fiscal year 2010 Area Base Funding Base funding Total adjustmentsa $75,827,291 $3,323,888 Navajo 69,437,474 3,090,855 12,458,000

Phoenix 51,570,656 2,278,464 Albuquerque 29,830,959 Bemidji Oklahoma Program increase capita Total IHS active Pertotal

CHS funding user count CHSfunding $16,114,000 $95,265,179 318,923 $299 84,986,329 242,331 351 9,200,000 63,049,120 159,166 396

1,327,724 6,023,000 37,181,683 85,946 433 41,868,282 1,865,264 8,631,000 52,364,546 102,782

509 California 31,420,785 1,400,292 7,952,000 40,773,077 78,682 518 Alaska 63,065,563 2,808,647

9,907,000 75,781,210 138,298 548 Nashville 24,243,805 2,012,527 3,899,000 30,155,332 51,491

586 Aberdeen 67,932,811 3,026,350 7,949,000 78,908,161 121,903 647 Tucson 14,805,851 658,487

1,522,000 16,986,338 25,562 665 Portland 69,230,127 3,001,723 10,985,000 83,216,850 104,097

799 Billings 49,214,400 2,193,163 5,360,000 56,767,563 70,863 801 Federal Facilitated Exchange State Exchange Work Exchange Analysis Papers Exchange Impact Analysis on Tribal Health Programs

Justification for QHPs to Contract with Tribal Health Programs Tribes as Navigators Tribal Sponsorship of Premiums & Group Payer Arrangements CO-OP Analysis & Tribes Exchange IT Assessment, Tribal identification and documentation Indian Definition & Documentation Reference Guide to Federal Indian Laws & Regulations for Exchange Planning Questions/Discussion Jim Roberts, Policy Analyst Northwest Portland Area Indian Health Board [email protected] 19

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