Summary APPROVED by TLDC. Tribal Leaders Diabetes Committee. Teleconference Summary

Transcription

1 Summary APPROVED by TLDC Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016

2 Contents Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 TLDC Members Present... 1 TLDC Advisors Present... 1 Others in Attendance... 1 Speakers... 1 Abbreviations... 2 Summary of Motions... 3 Summary of Action Items... 3 Tribal Leaders Diabetes Committee Meeting Summary... 4 Welcome and Introductions... 4 Special Diabetes Program for Indians (SDPI) Legislative Update and Transition Planning... 4 TLDC Response to SDPI Legislative Update and Transition Planning... 7 Role of TLDC as a Tribal Advisory Group... 7 TLDC Response to Role of TLDC as a Tribal Advisory Group... 7 Plans for February 8 9, 2017, In-Person TLDC Meeting... 8 TLDC Response to Plans for February 8 9, 2017, In-Person TLDC Meeting... 8 Closing... 8 Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016

3 TLDC Members Present Connie Barker (Oklahoma City Area, Tribal Co-Chair) Dr. Ann Bullock (Indian Health Service [IHS], Federal Co-Chair) Rosemary Nelson (California Area) Cassandra Sellards-Reck (Portland Area) (Members not present: Alaska Area, Albuquerque Area, Bemidji Area, Billings Area, Great Plains Area, Nashville Area, Navajo Area, Phoenix Area, and Tucson Area) TLDC Advisors Present Tammie Cannady (Tribal Self-Governance Advisory Board) Patrick Marcellais (National Indian Health Board [NIHB]) Others in Attendance Dr. Richard Arakaki (Phoenix Area) Kelli Begay (IHS) Dr. Michael Bryer-Ash (Oklahoma City Area) Connie Brushbreaker (Great Plains Area) Michelle Castagne (National Indian Health Board [NIHB]) Randall Comb (Navajo Area) Carolyn Crowder (Port McDermitt Paiute and Shoshone Tribes) Victoria Davis (Navajo Area) Carmen Hardin (IHS) Nancy Haugen (Great Plains Area) Karrie Joseph (NIHB) Speakers Dr. Susan Karol (IHS) Akilah Kinnison (Hobbs, Straus) Melanie Knight (IHS) Helen Maldonado (California Area) Kathi Murray (Portland Area) Gordon Quam (Albuquerque Area) Dianna Richter (Nashville Area) Dee Sabbatus (United South and Eastern Tribes) Karen Sheff (IHS) Debra Smith (Bemidji Area) Dr. Sharon Stanphill (Portland Area) Judy Thompson (Alaska Area) Dominica Valencia (California Area) Dr. Ann Bullock Director Division of Diabetes Treatment and Prevention IHS Michelle Castagne Congressional Relations Manager NIHB Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 1

4 Abbreviations AI/AN... American Indian/Alaska Native CMS... Centers for Medicare & Medicaid Services FY... fiscal year IHS... Indian Health Service MDPP... Medicare Diabetes Prevention Program NIHB... National Indian Health Board SDPI... Special Diabetes Program for Indians TLDC... Tribal Leaders Diabetes Committee Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 2

5 Summary of Motions None Summary of Action Items Action Item Try to join in the Centers for Medicare & Medicaid Services All Tribes call on Wednesday, December 14, 2016, to discuss the Medicare Diabetes Prevention Program expansion (p. 4). Send a summary to the National Indian Health Board (NIHB) if they attend their Area FY 2019 budget formulation meeting (p. 5) Send out information on Hill Day, scheduled for February 7, 2017, shortly (p. 6) Contact NIHB if interested in participating in Hill day on February 7, 2017 (p. 6) Send reports on their budget formulation discussions to NIHB as soon as possible (p. 7) Take advantage of meetings in December and January for budget formulation conversations if they have not yet had them (p. 7) Send the Division of Diabetes Treatment and Prevention at the Indian Health Service suggestions for topics for the February 2017 meeting or another future meeting (p. 8) Schedule a telephone conversation to discuss ideas for future meeting discussions (p. 8) Person(s) Responsible TLDC TLDC NIHB TLDC Areas Areas TLDC Ms. Sellards- Reck, Dr. Bullock, and Ms. Barker Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 3

6 Tribal Leaders Diabetes Committee Meeting Summary Welcome and Introductions September 22, 2016 Ms. Barker welcomed members of the Tribal Leaders Diabetes Committee (TLDC) to this teleconference and offered an opening prayer. Ms. Barker asked the TLDC to review the save the date notice they had received about the All Tribes Call on Wednesday, December 14, 2016, at 1:00 to 2:00 pm ET. Dr. Bullock explained that the call will feature a brief overview from Centers for Medicare & Medicaid Services (CMS) staff of the Medicare Diabetes Prevention Program (MDPP) expansion. CMS staff would particularly like feedback from the TLDC as participants in and leaders of this discussion about the MDPP expansion. Action: TLDC members will try to join in the CMS All Tribes call on Wednesday, December 14, 2016, to discuss the MDPP expansion. Special Diabetes Program for Indians (SDPI) Legislative Update and Transition Planning Fiscal Year (FY) 2017 Appropriations Ms. Castagne reported that the National Indian Health Board (NIHB) has been preparing for the new administration and new Congress that will take office in January NIHB will host a transition planning meeting on December 8, 2016, in Washington, DC. Congress is likely to pass a continuation resolution to keep the federal government operating, giving the new Congress the opportunity to have input into the FY 2017 budget. FY 2018 and FY 2019 Budget Appropriation Planning The five main budget recommendations from the Indian Health Service (IHS) Budget Formulation Workgroup for FY 2018 are: $30.7 billion phased in over 12 years for the total Tribal needs budget 37% increase from the FY 2017 President s proposed budget ($7.1 billion new budget base, a $1.912 billion increase) $97 million for new Indian Healthcare Improvement Act Authorities Permanent exemption from sequestration Advance appropriations for IHS Several IHS Areas have completed their FY 2019 budget formulation meetings, and some others will complete their meetings this month. NIHB has not heard from the other Areas about the status of their budget formulation meetings. NIHB has not received updates to share with the IHS Budget Formulation Workgroup on many of the conversations that have taken place. Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 4

7 The types of information NIHB asks Areas to collect include the burden of type 2 diabetes in their communities, the funding needed for diabetes treatment and prevention based on the user population, and barriers preventing some individuals from receiving services. NIHB would also like to know which Tribes in each Area do not have an SDPI grant and how much additional funding would be needed to include them in the program. Stories of positive clinical outcomes from current SDPI programs are also valuable. This information helps NIHB determine how much money would be needed to enable all Tribes to offer the services provided through SDPI grants. Action: TLDC members who attend their Area FY 2019 budget formulation meeting will send a summary of these deliberations to NIHB. Indian Health Care Improvement Act An important priority is to keep the Indian Health Care Improvement Act intact, regardless of whatever health care reform changes occur. Many lawmakers have indicated support for upholding the act, and they say that any changes to the Affordable Care Act will not affect the Indian Health Care Improvement Act. NIHB is conducting in-depth analyses of several priority sections of the act and developing white papers on these sections. It will report on many of its findings at the December 8 event. NIHB is working on a congressional sign-on letter for this law, and it plans Capitol Hill visits for the NIHB board the week of January 23, First Kids 1 st First Kids 1 st, a new AI/AN children s policy agenda, focuses on physical activity and nutrition. NIHB is working with the National Congress of American Indians, National Indian Child Welfare Association, and National Indian Education Association to update the Native Children s Agenda. o Every year, these organizations develop this document to describe their policy and program priorities for the coming year for AI/AN youth. On August 24, 2016, NIHB cohosted a roundtable on AI/AN youth in health professions with the Senate Committee on Indian Affairs Office of the Vice-President and the American Academy of Pediatrics. NIHB and the Substance Abuse and Mental Health Services Administration released the Tribal Behavioral Health Agenda, a blueprint for Tribes and the federal government on behavioral health services, on December 6, Legislative Outlook for the Special Diabetes Program for Indians (SDPI) The current authorization for the SDPI, at $150 million a year, expires on September 30, NIHB is working to firm up the national Tribal ask with the goal of moving reauthorization legislation forward well before the September 2017 expiration date. Earlier reauthorization would give IHS time to prepare for the next round of grant funding. The legislative vehicle for the reauthorization is not known. Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 5

8 In the past, the reauthorization legislation was part of the annual doc fix bill designed to keep Medicare payments to physicians stable. However, Congress permanently repealed the doc fix in April The change in legislative vehicle could provide an opportunity to obtain long-term or increased funding for the SDPI if this is what Tribes request. NIHB, the American Diabetes Foundation, and JDRF have issued a sign-on letter supporting the SDPI reauthorization. The letter received signatures from 75 senators and 356 members of the House of Representatives. The SDPI has primarily been renewed in 1-year or 2-year increments, which makes staff retention challenging. NIHB is working to educate lawmakers about the need for long-term reauthorization. The timeline for the SDPI renewal process is as follows: November 2016: Work with Areas to determine financial needs for the SDPI December 2016/January 2017: Communicate Area SDPI funding needs to NIHB for Tribal ask to Congress January/February 2017: Coordinate a letter-writing campaign to members of Congress February 2017: Conduct Capitol Hill visits; TLDC in-person meeting Throughout this period, NIHB encourages Area SDPI sites to upload their local impact stories, host a visit by their members of Congress, and stay involved in TLDC workgroups. The day before the next in-person TLDC meeting on February 8 9, 2017, NIHB will organize a Hill day for Tribal leaders and advocates. Action: NIHB will send out information on Hill Day, scheduled for February 7, 2017, shortly. Action: TLDC members interested in participating in Hill day will contact NIHB. Budget Planning At any given time, federal agencies are working on the budgets for four different years. The budget formulation process for IHS often begins with an examination of what Tribes and national and Area organizations have done in the past and what they plan to do in the future. o This activity is underway now for the FY 2019 IHS budget. The Department of Health and Human Services and the Office of Management and Budget are working on the FY 2018 budget to present to the House and Senate appropriations committees. The SDPI is a mandatory program that does not need to be included in the President s budget request For FY 2017, President Obama s budget request did include permanent SDPI reauthorization at $150 million per year. Tribal leaders suggested that instead of a flat amount, the budget build in inflation increases or increases of a prespecified amount each year. Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 6

9 TLDC Response to SDPI Legislative Update and Transition Planning Dr. Stanphill asked whether the Portland Area should organize its budget formulation meeting now or wait until its board meeting in late January or the National Congress of American Indians meeting in February. Ms. Castagne said that these conversations are already happening in many Areas, often through the Area Indian Health Board. The Portland Area s board meeting in January would be a good time to have this discussion. The February meeting is a bit late. Ms. Castagne asked TLDC members to take advantage of conversations they have, as Tribal leaders, with other Tribal leaders or health directors to determine how much SDPI funding the Area needs. It is best to have these conversations sooner rather than later and to report back to the NIHB as soon as possible to help NIHB create the national ask. Dr. Stanphill asked whether Tribes would be consulted on the amount of funding to request for the SDPI. Ms. Castagne said that many Areas are determining how much money they need. NIHB can support these discussions. Action: Areas should send reports on their discussions to NIHB as soon as possible. Action: Areas that have not yet done so should take advantage of meetings in December or January to hold these conversations. Role of TLDC as a Tribal Advisory Group Ms. Barker explained that the role of TLDC members at committee meetings is to give guidance and recommendations to the IHS director about the programs that the TLDC represents. TLDC members may only advocate for SDPI funding in their roles as Tribal leaders, not as TLDC members. Dr. Bullock characterized the distinction between what Tribal leaders may do and what the TLDC may do as a group as a fine line. TLDC members may, as committee members, advise the IHS director on any issue related to the SDPI, including funding levels. Because the IHS budget is on the discretionary side of the federal budget, whereas the SDPI is on the mandatory side, only Congress, not the IHS director, can change the program s budget. TLDC Response to Role of TLDC as a Tribal Advisory Group Dr. Stanphill asked whether the TLDC will make recommendations to the IHS director about the SDPI budget. Dr. Bullock said that the TLDC does make recommendations to the IHS director about the SDPI, including the types of resources that the TLDC believes are required to accomplish the SDPI work. Ms. Crowder reported that due to a technical glitch, the Fort McDermitt Paiute and Shoshone Tribe was unable to submit its grant application for the SDPI to IHS. An appeal was denied. She asked for a list of unsuccessful SDPI applicants so that these communities can jointly advocate for SDPI grants during the next round of budget discussions. Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 7

10 Dr. Bullock explained that IHS presented the outcomes of the application process to the TLDC last December, and the TLDC does not discuss the specifics of Tribes with unsuccessful applications. The TLDC has heard about the number of applicants that were unsuccessful and the reasons why, and it is not possible to advocate for funding that is separate from the SDPI grants process. Dr. Bullock suggested that Ms. Crowder discuss her request with IHS after this meeting. Plans for February 8 9, 2017, In-Person TLDC Meeting Dr. Bullock said that the first day of the February 8 9, 2017, in-person TLDC meeting in the Washington, DC, area will focus on strategic planning. A skilled facilitator will lead this discussion in such a way as to develop a draft for the TLDC to finalize. The plan will then be sent to the IHS director for final approval. The meeting will also feature a presentation by an IHS attorney on the role of federal advisory committees and the release of a product from the Centers for Disease Control and Prevention in partnership with IHS about reductions in rates of end-stage kidney disease and kidney failure. Dr. Bullock asked for suggestions for meeting topics for the February meeting or another future meeting. Action: The TLDC will send the Division of Diabetes Treatment and Prevention at IHS suggestions for topics for the February 2017 meeting or another future meeting. TLDC Response to Plans for February 8 9, 2017, In-Person TLDC Meeting Ms. Sellards-Reck asked when the TLDC would discuss discuss advocacy and advise on the SDPI funding allocation, which is the purpose of TLDC meetings according to the committee s charter. Dr. Bullock said that the timing of these discussions depends on the SDPI funding cycle. The SDPI is currently funded through September 30, 2017, and the TLDC discussed the funding distribution and the national Tribal consultation soon after the current authorization was announced. Ms. Sellards-Reck pointed out that the charter does not mention the TLDC s strategic plan or spending time at in-person meetings on strategic planning. The TLDC needs to spend more time discussing policy and advocacy issues; ways to incorporate culture, traditions, and values; and the SDPI reauthorization and other issues that affect AI/AN communities. Dr. Bullock explained that the TLDC created its strategic plan to describe its approach to its work. The TLDC did not have a strategic plan in 2007, when the current TLDC charter was written. At the September 2016 meeting, the TLDC decided to spend a day on strategic planning because this is the committee s process for accomplishing its work. Dr. Bullock offered to schedule a time to discuss these other issues at the February meeting. Action: Ms. Sellards-Reck, Dr. Bullock, and Ms. Barker will schedule a telephone conversation to discuss ideas for future meeting discussions. Closing Ms. Barker thanked everyone for being on the call and wished them happy holidays. She then adjourned the meeting. Tribal Leaders Diabetes Committee Teleconference Summary December 6, 2016 Page 8