The Northwest Portland Area Indian Health Board (NPAIHB) conducts health policy and legislative analysis on health care and budget issues affecting Indian health programs. The Board analyzes the Indian Health Service budget and other health care financing programs that impact Indian health care programs. NPAIHB also prepares Congressional testimony for health care financing and other important health policy issues at the federal and state levels. Click on the respective links to access detailed information about each aspect.

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There is a “legal and political relationship” between the United States and Indian Tribes, which establishes a federal responsibility to provide health services to Indian people.  This federal obligation is established in the US Constitution, through treaties and Presidential Executive Orders entered into between the United States and Indian Tribes.  This obligation has been affirmed through numerous court decisions, legislation, and policy declarations by Presidential Administrations.  This federal relationship forms the legal and moral foundation for the creation of health policies between the United States and Indian Tribes.

The Northwest Portland Area Indian Health Board is dedicated to upholding the responsibility of the United States to provide health services to Indian people under the federal trust relationship by:

  • Advocating and educating Congressional representatives on treaty rights and how such rights relate to health care in Indian Country.
  • Developing an Annual Legislative plan to provide recommendations on the President’s annual budget and other health care financing programs like Medicare and Medicaid.
  • Tracking legislation and other important health policy issues that affect the delivery of health care to American Indian and Alaska Native people.
  • Finally, facilitating consultation between state and federal agencies and Tribal leaders on health policy issues in order to understand respective concerns to make important decisions on programs and services that effect Indian people.

To learn about Senate Bills and House Reports that may affect American Indian and Alaska Native people in the Northwest read on, or visit Resolutions.

See the Senate Indian Affairs Committee and the House Resources SubCommittee on Indian and alaska Native Affairs for a list of legislation that impacts Indian programs. Pending legislation can be tracked using the Floor Activity weekly feature of Thomas.

The most recent Federal policy updates:

2007 Legislative Plan - February 14, 2007April 5, 201669 KiB364
uApril 5, 20160.3 MiB527
67249April 5, 20160.1 MiB345
Federal Register UpdatesApril 5, 201634 KiB374
NIHB HHS Budget Consultation Comments April 2012 FINALApril 5, 20161.0 MiB575
Portland OR× the House Resources Committee introduced a bill yesterday to reauthorize the IndianApril 5, 201689 KiB371
Policy Brief No 8 - SCIA Views Estimates - March 7, 2007April 5, 20162.0 MiB326
7 Jim Roberts Legislative Update - October 23 2015May 23, 20160.2 MiB1276
Save The Date DST GPTCHB National Meeting & Health SummitJune 13, 20160.3 MiB560
Dear Tribal Leader Letter CHAP ExpansionJune 16, 201678 KiB809
IHS Draft Policy Statement on the Expansion of CHAPJune 16, 201634 KiB741
NPAIHB Comments On MACRA QPR Rule 6 2016June 24, 20160.8 MiB360
55865-1 Draft IHSCircularNo2016-08 TribalPremiumSponsorshipJuly 19, 201653 KiB1224
55865-2 DTLLTribalPremiumSponsorship07182016July 19, 201639 KiB654
Federal Register Notice 38 CFR Pt 14 Recognition Of Tribal Organizations For Representation Of VA ClaimantsJuly 22, 20160.3 MiB626
NPAIHB IHS DHAT CHAP V2 7-25-16July 25, 20160.6 MiB804
DHAT Fact Sheets And Reports LinksJuly 25, 20161.4 MiB926
FINAL CHAP And CHRP BackgroundJuly 25, 20160.7 MiB585
TEMPLATE IHS DHAT CHAP LetterJuly 25, 201628 KiB673
VA DTLL 9-12-16September 15, 20161.5 MiB403
NIHB Health Care Litigation Update (9-13-16)September 19, 20160.9 MiB410
GM 16-058 Status Of FY 2017 Continuing ResolutionSeptember 26, 201629 KiB689
IHS CHAP Letter TemplateOctober 19, 201628 KiB380
IHS Letter To Tribal Leaders - CSC Policy Update - 10-27-2016October 27, 20160.6 MiB295
Quality Framework Authored By QF Steering Committee FINAL October 2016November 16, 20160.3 MiB614

The Northwest Portland Area Indian Health Board (NPAIHB or Board) understands the significance of tracking appropriations for the Indian Health Service (IHS) budget.  The IHS budget is the most important source of funding for Indian health programs, and is a recognized obligation of the federal government to provide health services to Indian people.

NPAIHB continues a long-standing tradition of close scrutiny of the IHS budget that began in the 1980s.  The federal trust responsibility and the relationship between Tribes and the federal government, by definition, require a partnership in developing the IHS budget.  Northwest Tribes are dedicated to this partnership by creating an Annual Budget Analysis and Recommendations Report as well as tracking appropriations to IHS programs.

The most recent IHS Budget updates:

FY 2008 Budget Analysis - FINAL April 15, 2007April 6, 20160.2 MiB590
The HHS Region 10April 6, 20160.1 MiB595
tax cuts estimated at $900 billion over five years will remove resources available to fund governmentApril 6, 201640 KiB364
tax cuts estimated at $900 billion over five years will remove resources available to fund governmentApril 6, 201640 KiB339
tax cuts estimated at $900 billion over five years will remove resources available to fund governmentApril 6, 201640 KiB492
NPAIHB POLICY BRIEFApril 6, 20160.1 MiB625
FY 2009 Budget Analysis - Final March 17, 2008April 6, 20160.8 MiB561
7 Jim Roberts Legislative Update - October 23 2015May 23, 20160.2 MiB1276
Final 15th Annual IHS Budget Analysis And RecommendationsJune 14, 20160.4 MiB629
2004 Legislative Plan - FINAL On March 6, 2004June 14, 20160.1 MiB700
55865-1 Draft IHSCircularNo2016-08 TribalPremiumSponsorshipJuly 19, 201653 KiB1224
55865-2 DTLLTribalPremiumSponsorship07182016July 19, 201639 KiB654
National Tribal Budget Workgroup Testimony - FY 2019 FINALJune 15, 20174.0 MiB1231
Portland Area - FY 2019 Budget Formulation Presentation HQJune 15, 20170.1 MiB529
Portland Area - FY2019 Budget NarrativeJune 15, 20170.1 MiB751
Portland Area - FY2019 Final Budget WorksheetJune 15, 201761 KiB892
2020 Budget Formulation DeliverablesNovember 1, 20170.1 MiB641
2020-Budget Formulation Support DocsNovember 1, 20170.7 MiB605
DTLL Signed LetterFebruary 16, 20180.2 MiB426
NPAIHB Letter To IHS On 97-3 Option 5-18-18 FinalMay 23, 20180.3 MiB43
Agenda - FY 2021 PAO IHS Budget Formulation MeetingOctober 24, 20182.4 MiB29
TAB 3 -National Budget Worksheets Guidance And Budget Line DescriptionsOctober 24, 20180.2 MiB24
FY 2020 PA Budget Submission Summary HANDOUTOctober 24, 201853 KiB21
TAB 2 - FY 2021 Area Instructions PackageOctober 24, 20180.8 MiB21
TAB 3 -National Budget Worksheets Guidance And Budget Line DescriptionsOctober 24, 20180.2 MiB22

The most recent Portland Area Facilities (PAFAC) updates:

9 RSRC - A Fact Sheet 2018 UpdateMay 11, 20180.1 MiB35
Pilot Study Interim PAFAC Report 30-Oct-09May 11, 20185.5 MiB43
Regional Center Fact Sheet And FAQs - September 2, 2010May 11, 20180.3 MiB34

The most recent policy issues for Oregon:

1115 Renewal-Tribal Consultation Letter-March 16, 2016April 6, 20161.5 MiB487
Consultation Summary 11-30-11June 9, 201698 KiB642
December 2011June 9, 20160.2 MiB617
Draft CCO Implementation Plan 12-09-11June 9, 20161.7 MiB1201
NPAIHB Comments On SB 99 - March 28 2011 (2)June 9, 20160.2 MiB492
OHA Budget-reductions2011-13June 9, 201657 KiB783
OR HIX Board Packet 12 9 11June 9, 20164.7 MiB684
Oregon Insurance Exchange Proposal Workplan - June 29 2011June 9, 201669 KiB503
Workgroup-cco-charterJune 9, 201679 KiB901
Workgroup-global-budget-charterJune 9, 20160.2 MiB539
Workgroup-medicare-medicaid-integration-charterJune 9, 201678 KiB802
Workgroup-outcomes-quality-efficiency-charterJune 9, 20160.1 MiB793
Workgroups-external-roster-fullJune 9, 20160.1 MiB1512
Copy Of OHA Contacts For Tribes 10-28-16November 1, 201634 KiB1941
Oregon Access Monitoring Review PlanNovember 1, 20160.7 MiB817
SB738March 14, 201757 KiB875
Oregon Tribal Leaders Letter to ODAJuly 28, 20170.4 MiB684
Tribal Consultation And Urban Indian Health Program Confer Policy-Signed 3March 2, 20183.5 MiB498
Health Care Agenda 9.7.18 FINALSeptember 13, 20180.2 MiB28
FW Oregon Dept Of Human Services - APD Rules Advisory Committee (RAC) UpdatesSeptember 13, 201862 KiB24
FW Oregon Health Authority To Present At OrOHC Fall ConferenceSeptember 13, 201876 KiB30
FW CCO RAC Stakeholders List Update RequestSeptember 13, 201861 KiB25
RAC Notification 10.4.18 TeledentistrySeptember 21, 201828 KiB24
Tele-dentistry Administrative Rules V5 9-12-18 KMSSeptember 21, 201820 KiB23
Governor Brown’s Health Care AgendaSeptember 25, 20180.2 MiB35

The most recent policy issues for Idaho:

ID State-tribe Memo To ID Tribal LeadersApril 6, 20160.2 MiB397
Idaho February Draft Agenda - 2-8-12April 6, 20160.2 MiB385
Letter To Debbie FieldApril 6, 20160.1 MiB397
Idaho Quarterly State August FlyerApril 6, 201668 KiB480
Save The Date Flyerfor 2008April 6, 20160.1 MiB405
Save The Date FlyerNovApril 6, 20160.1 MiB422
Agenda - July 31 2007 (2)April 6, 201668 KiB362
Idaho State Tribes Meeting 6-15-07sbApril 6, 201642 KiB643
16-090 Tribal Letter SPA 16-0006 PCSApril 6, 20160.3 MiB310
Oregon Community PartnerApril 6, 20161.7 MiB683
12-463 Tribal Soliciation - Primary Care Physician CodesApril 6, 20160.4 MiB352
13-116 Tribal Notice PRTF SPAApril 6, 201678 KiB452
13-123 1115 Demonstration Waiver AmendmentsApril 6, 20160.4 MiB323
ID13-006 Tribal LetterApril 6, 20160.4 MiB418
Legal Notices PC Physician Codes & Rates 1-1-13April 6, 20160.4 MiB252
SPA 13-004 Incentive Payments For Primary Care CodesApril 6, 20161.4 MiB336
12-293 Tribal Solicitation Health Care Acquired ConditionsApril 6, 20160.5 MiB369
IdahoInsuranceExchangeApril 6, 20160.1 MiB280
12-476 Tribal Solicitation -School Based ServicesApril 6, 20160.5 MiB472
3April 6, 20168.1 MiB1114
5April 6, 201614.4 MiB913
Wildhorse ResortApril 6, 201656 KiB604
Yellowhawk Tribal Health CenterApril 6, 201640 KiB544
16-167 Tribal Notice For RACJune 13, 20160.3 MiB473
MMCP Servcie Area Reduction Tribal NoticeOctober 28, 20160.3 MiB359

The most recent policy issues for Washington:

Nov 2007 AgendaDraftApril 5, 20160.1 MiB616
Sept 2007 MinutesDraftApril 5, 20160.1 MiB668
16-087 HCBS Transition Plan Tribal NoticeApril 5, 20160.3 MiB849
AIHC Dear Tribal Leaders OIC QHP Letter 4-10-14April 5, 20160.4 MiB1048
American Indian Health Commission for Washington StateApril 5, 20160.1 MiB903
Dear Interested Partners:April 5, 20160.6 MiB1977
AIHC CR 102 Redline Changes (Final-04-10-14)April 5, 201634 KiB641
Dental Proviso Report Follow Up 122016January 3, 20171.0 MiB393
Gov Inslee Finance Dem Medicaid LetterFebruary 17, 20170.5 MiB370
Letter-to-Governors-and-CommissionersFebruary 17, 20171.1 MiB522
Senate Finance Attachment, 02152017February 17, 20170.3 MiB557
Senate Finance Committee, Response Letter, 02152017February 17, 201757 KiB517
Final Washington Tribes SB 5079 Support LetterFebruary 22, 20170.4 MiB1049
5079-S SLMarch 14, 201764 KiB647
FAQ SSB 5079 FinalMarch 16, 20170.4 MiB2324

The Northwest Portland Area Indian Health Board’s (NPAIHB) resolution process is an important mechanism for policy making and is used to assist decision makers on Indian health matters. The usefulness and need of the Board’s resolution process and decision making are clear:
* Resolutions are used in the Board’s projects, programs, and policies.
* Resolutions assist in the development of Indian health policies.
* Resolutions are used to unite policies and people.
* Resolutions involve input from Tribal constituents (Tribal Leaders, Health Directors, Indian health policy experts, and other Indian health interests).
* Resolutions provide information about Tribal positions for decision makers.
* Resolution development is a proactive process that works toward positive outcomes.
Resolutions are introduced at NPAIHB Quarterly Board Meetings and carried on for introduction at the annual Affiliated Tribes of Northwest Indians (ATNI) conference.  A number of resolutions adopted by ATNI are later introduced at the National Congress of American Indians (NCAI) and form the basis of becoming national Indian health policy issues.  This process establishes an national Indian health policy agenda that becomes a focal point for Tribal leader and Congressional advocacy.
19-04-01 OHA and OHSU_HOWTO_Grant.pdf
19-04-02__334-08-19_Call to Congress to Support Advance Appropriations for IHS.pdf
19-04-03__335-08-19_Full Funding for IHS.pdf
19-04-04__336-08-19_Call Congress to Support Mandatory Appropriations for IHS.pdf
19-04-05__337-08-19_Call to Congress to Fully Fund Section 105i ISDEAA Lease.pdf
19-04-06__338-08-19 National Child Traumatic Stress Initiative.pdf
19-04-07__339-08-19_Ensure Medicaid Fulfills Federal Trust Responsibility to AI_AN
19-04-08__340-08-19_HHS OMH_AI-AN HRAC
19-04-09__341-08-19_Increase Funding for Special BH Program Title I_Title V.pdf
19-04-10__342-08-19_IHS to move the PRC Dependent Factor in the PRC Funding Formula.pdf
19-04-11__343-08-19_Support Legislation that Establishes VA_TAC.pdf
19-04-12__344-08-19_Support for Perment ReAuth SDPI.pdf
19-04-13__345-08-19_SAMSHA_Modernization Act Reporting Requirements for Opioid Tx.pdf
19-04-14_DHAT_Education Curricula North Sound Accountable Communities of Health (ACH) Revised.doc
19-04-14_DHAT_Education Curricula North Sound Accountable Communities of Health (ACH).pdf
19-04-15_RES RWJ_HER RESOLUTION_ 07-10-19.doc
19-04-16_CDC Supplement Resolution July2019.doc
19-04-16_CDC Supplement Resolution.pdf

19-02-05 State_Tribal Youth Suicide Prevention Grant.pdf

19.02.01 WE R NATIVE_TAM.pdf
19-02-02 Advance Appropriations for IHS.pdf
19-02-03 Tribal Youth Delegate Program.pdf
19-02-04 Establish a Food Sovereignty Sub-Committee.pdf


Resolutions FY 2016 – 2018
APRIL 2018
18-03-01 Support for NNACOE.pdf
18-03-02_NIJ_NWTribal Juvenile Justice Alliance.pdf
18-03-03_CDC_Tribal Public Health Capacity.pdf
18-03-04 Prevention Research Center PRC.pdf
18-03-05 SAMSHA Funding.pdf
18-03-06 Continued Support for Mandatory Funding for SDPI.pdf
18-03-07 IHP Funding Increase.pdf
18-03-08 CJR Tribal Management Health Ed Health Workforce Support.pdf
18-03-09 CHAP MTD DSRIP Funding.pdf
18-02-01 HCV Medication Access_State.pdf
18-02-02 HCV Medication Access_Federal.pdf
July 2018
18-04-01 Reserach to improve AI Health.pdf
18-04-03 SAMHSA MAT Initiative.pdf
18-01-01 DVPI Response Circles Project 08-30-2017 (00000002).pdf
18-01-02_NWTEC OHSU SEPA 2017.docx.pdf
18-01-03_ Addressing Suicide Research Gaps Understanding Mortality Outcomes.doc.pdf
18-01-04_Urging AMA to Adopt a Policy Statement on ACE and Toxic Stress.docx.pdf
18-01-05 Collaborative Minority Health and Health Disparities Research with Tribal Epidemiology Centers.pdf

Resolutions FY 2017
APRIL 2017
17-03-01 IHCIA.pdf
17-03-02 Supporting Native Expectant and Parenting Teens.pdf
17-03-03_OMH Partnership for Health Equity_IDEA-NW grant r.pdf
17-03-04 LOS Dr Grim and Resolution.pdf
17-03-04 Support for Dr. Grim for Director of IHS.pdf
12-03-05 NARCH.pdf
17-03-06 HSA Approval and Adoption.pdf
17-03-07_Opposition to FY2018 Budget Cuts to US HHS.pdf
17-02-01_Pathways into Health NW Native American Center of Excellence.pdf
17-02-02 National Indian Health Policy Education Foundation.pdf
17-02-03 Support submission of grant for CDC NTCCP.pdf
17-02-04 Background Check Policy.pdf
JULY 2017
17-04-01_Increased TEC Infrastucture.pdf
17-04-02_i-LEAD Grant.pdf
17-04-03_OMH Empowered Communities for a Healthier Nation Initiative Reso template1.doc.pdf
17-04-04_ Joint Resolution 100 Percent FMAP.docx
17-04-05 Joint Resolution ACA-IHCIA 2017.docx
17-04-06_Joint Resolution Adoption of CDC Opioid Guideline.docx
17-04-07 Joint Resolution ACA-IHCIA 2017.docx
17-04-07_Joint Resolution Budget 2017.docx
17-01-01 Supporting Standing Rock.pdf
17-01-02 Support of CHAP National Expansion.pdf
17-01-03 Support Engagement of Youth and Development of Youth Track.pdf
Resolutions FY 2016
APRIL 2016
16-03-01_Elder Falls Prevention Funding.pdf
16-03-02_Renewal of NW Tribal Epidemiology Center.pdf
16-03-03_NIH_New Digital Media R01.pdf
16-03-04_NIH U19 Collabroative Hubs to Reduce the Burden of Suicide among AIAN.pdf
16-03-05_Portland Area Could Be Treated As a State for the Purpose of Medicaid.pdf
16-04-01 NW NARCH 9 Program v3.pdf
16-04-01 NW NARCH 9 Program.pdf
16-04-02 Portland Area Fetal Alcohol Spectrum Disorders Funding.pdf
16-02-01_We R Native_Text 4 Sex Ed.pdf
16-01-01 Persons who Inject Drugs(PWID).pdf
16-01-02 Tribal Exemption from the ACA Employer Mandate.pdf
16-01-03 WTDP_SDPI.pdf

6) July 24  Assessing COVID-19 and the Broken Promises to Native Americans 

7) July 22  COVID-19 Provider Relief Funds for IHS and Tribal Programs Recommendations 

8) June 1- CMS Medicare and Medicaid Programs: Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency8) NPAIHB CMS Telehealth COVID19 Regulatory Changes_6.1

9) May 10- COVID-19 Provider Relief Fund and Paycheck Protection Program and Health Care Enhancement Act Funding Distribution Comments

10) NPAIHB CMS & HHS CARES Act Public Health and Social Services Emergency Fund- April 21

11) CMS Medicaid Fiscal Accountability – February 1

12) Medicare and State Healthcare Programs: Revisions to Safe Harbors Under the Anti-Kickback Statute (AKS), and Civil Monetary Penalty (CMP) Rules– December 23

13) Inclusion of Federally Operated Facilities (Direct Service Tribes) in the Community Health Aide Program (CHAP) Expansion – December 3

14) IHS Special Diabetes Program for Indians (SDPI) Distribution of Funding in Fiscal Year (FY) 2021 – November 27

15) IHS NTAC Behavioral Health Funding Mechanism Recommendations – October 1, 2019

14) HRSA Rural Access to Health Care Services Request for Information (RFI) – October 9, 2019

13) VA MISSION Act Strategic Plan Native Veteran Healthcare Needs – June 10, 2019

12) IHS CHAP Interim Policy Comments – June 7, 2019

11) HHS ONC Draft Strategy on Reducing Regulatory and Administrative Burdens Relating to the Use of Heath IT and EHRs – January 28

10) Comments on Arizona State-wide PRCDA Study Tribal Consultation – January 15

9) Request for Creation of a U.S. Department of Veterans Affairs Tribal Advisory Committee – January 18

8) CMS Medicaid and CHIP Managed Care Proposed Rule Comments January 14, 2019

7) IHS Draft Indian Health Service Strategic Plan Fiscal Year 2018-2022    August 23

6) IHS Funding Mechanism to Distribute Behavioral Health Initiatives Currently Distributed through Grants     August 1

5) IHS Section 105(l) Lease Funding “Dilemma” July 25

4) IHS Indian Health Care Improvement Fund Formula      July 13

3) IHS Tribal Consultation on Changes to the Indian Health Manual PRC Chapter, Part 2, Chapter 3 “Services to Indians and Others”     July 6

2) IHS Distribution of Funding for the Special Diabetes Program for Indians (SDPI) in Fiscal Year (FY) 2019     May 18

1) IHS Proposal to Amend “97/3 Method” for Determining Indirect Costs in Service Unit Shares     May 18