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Legislative & Policy Update

Legislative & Policy Update. NW Portland Area Indian Health Board Quarterly Board Meeting April 23, 2014. Report Overview. SDPI Update Senate Committee on Indian Affairs Indian Bills FY 2014 & FY 2015 Budget Updates CSC Update DTLLs ACA Exemptions. SDPI Extended thru FY 2015.

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Legislative & Policy Update

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  1. Legislative & Policy Update NW Portland Area Indian Health Board Quarterly Board Meeting April 23, 2014

  2. Report Overview • SDPI Update • Senate Committee on Indian Affairs • Indian Bills • FY 2014 & FY 2015 Budget Updates • CSC Update • DTLLs • ACA Exemptions

  3. SDPI Extended thru FY 2015 • H.R. 4302 Protecting Access to Medicare Act • Commonly referred to as the Sustainable Growth Rate bill -- SGR fix • Sec. 204 Extends the Special Diabetes Program for Indians thru FY 2015 • Sec. 210 Delays implementation of ICD-10 to Oct. 1, 2015 • SDPI thru September 30, 2015 • Maintains $150 million per year less sequestered amount

  4. Senate Committee on Indian Affairs • New Chair: Sen. Jon Tester (MT) • Senators Cantwell and Crapo still on Committee • Legislation & Hearings • FY 2015 President’s Budget – March 26th • S. 1570 amend IHCIA for Advanced Appropriations • S. 919 amend ISDEAA to expand self-governance • Other Tribe specific and education, children related bills

  5. 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?

  6. FY 2014 Budget Highlights • FY 2014 budget $303 million increase over FY 2013 Operating Plan*** • ***Caution: Only $78 million over the FY 2014 Pre-Sequester Amount – Loss of $175 million • Program Increases for (Detail of changes): • $42.4 million for CHS • $24.9 million for facilities accounts • $71.9 million for staffing new facilities • $35 million for medical Inflation • $129.6 million for CSC

  7. FY 2014 & CSC Funding • IHS and BIA will fully fund CSC payments in FY 2014 and President’s FY 2015 budget proposes same • IHS estimated 2014 need: $587.4 million • FY 2013 Amt + 2014 Increase = $577.4 • IHS needed additional $10 million to cover CSC funding; consulted with Tribes about where to make the cuts • Reductions total $10 million made as follows: • $3 million IHS Directors Fund • $5 million from Indian Health Professions • $1 million from Self-Governance • $1 million from Tribal Management

  8. FY 2015 & CSC Funding • President’s Request includes $29.6 million CSC increase • IHS proposes to continue to fully fund CSC payments to tribes into the future • IHS Contract Support Cost Workgroup has reconvened to address substantive policy issues • Develop FY 2014 Payout Plan (Refer to Handout) • Develop Standard AFA language to deal with IHS Anti-Deficiency Act concerns • Develop two-year appropriation authority • Develop strategies to deal with new/expanded programs and changing IDC rates following payout • Analyze data to better estimate CSC need for appropriations • Develop process to better estiamate CSC need; pass-throughs and exclusions

  9. FY 2015 President’s Request • $4.634 billion for Indian Health Service • $199 million increase (4.5%) is respectable? • Staffing & New Tribes funding $78.8 million takes increase down to $120.9 million (2.7%) * • $29 million program increase for CSC * • $15.4 million program increase for CHS • Adjustments of $10 million to restore 2014 reductions (CSC) • Adjusting the increase for earmarks* leaves a balance of $91.9 million for current services (does not include CHS increase) • NPAIHB estimates at least $223 million is needed to maintain current services • President’s budget will be short by $131 million to fully fund inflation and population growth

  10. FY 2015 Detail of Changes – $199,662 mil. increase

  11. FY 2016 Budget Formulation • National IHS Budget Formulation - Feb. 26-27, 2014 in Washington DC • Representatives Andy Joseph & Steve Kutz • Recommended $779 million increase; 18% increase • $188 mil. for current services • $191 mil. for binding obligations (CSC, HFCPS, Staffing, New Tribes) • $337 mil. for program expansion (CHS, H&C, Mental Health, A/SA, Health Facilities other authorities) • $62 mil for other priorities (UIHP, facilities, dental, )

  12. Dear Tribal Leader Letters • April 2, 2014: DTLL on CSCs as it relates to the FY 2014 Consolidated Appropriations Act & Announcing on-going Consultation • March 6, 2014: DTLL IHS Director Listening Sessions • February 27, 2014: DTLL seeking input on MSPI& DVPI • February 18, 2014: DTLLupdate on the IHS Consultation & follow-up to the August 2, 2012 letter • February 12, 2014: DTLL Initiating consultation on CSC issues required in FY 2014 Consolidated Appropriations Act • January 13, 2014: DTLL changing Aberdeen Area IHS to the Great Plains Area

  13. TTAG/MMPC Updates • ACA Policy Subcommittee is very active • Tribal Exemption & I/T/U hardship exemption • Referrals and Cost Sharing Exemptions • CMS Final 2015 Letter to Issuers in FFM • and Proposed Rule including Minimum QHP Certification Standards • Revising the CMS Tribal Consultation Policy • Evaluation of CMS Strategic Plan & Updates • Alternatives for Medicaid Expansion: Arkansas Model and UCC Waivers • Indian definition issues • IRS/CMS Resource Exemptions • Extending Medicare Like Rates to non-hospital based services • ACA Educational materials • Data projects and studies

  14. Affordable Care Act Individual Mandate & Exemption • What is the ACA Tax Penalty? • What is the I/T/U Hardship Exemption and who is eligible? • How to apply for the Indian Exemption or I/T/U Hardship Exemption? • Additional Information related to exemptions and the application: • HHS instruction are forthcoming, tax filing information, • Do you need to reapply for the exemption? • What can you do to help Tribal members? • Education Tribal members and program beneficiaries • Make sure Tribal members understand the difference between Indian Exemption and the Hardship Exemption • Prepare to offer eligibility letters • Provide tax filing assistance • 2014 Penalty = 1% household income; $95/adult • 2015 Penalty = 2% household income; $325/adult • 2016 Penalty = 2.5% household income; $695/adult

  15. TTAG/MMPC Resources • https://www.dropbox.com/home/Delegates/Temp%20Folder%20created%20by%20Jim • MMPC Action Items and Tracking List • TTAG Roster of Pending Regulations and Assignments

  16. Discussion?

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