Legislative & Policy Update

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

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

3. 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

4. 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

5. 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

6. 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

7. 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’sallocation 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

8. Summary of GAO Findings • 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 • GAO recommends IHS use actual counts of CHS users in methods for allocating CHS funds • CHS Workgroup discussed these recommendations at length in Denver

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

10. Discussion?