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:

Quality Framework DTLL UIOLL Signed 11-16-16November 16, 20160.7 MiB343
Quality Framework Implementation Plan Authored By QF Steering Committee ..November 16, 20160.6 MiB688
FINAL 11-30-16 Letter To Administration On Dental Therapy IssuesDecember 1, 20160.2 MiB568
CHAP DTLL 01042017January 10, 201797 KiB322
Enclosure IHS VA CMOP Agreement-1January 10, 20170.3 MiB573
56995-1-DTLL-IHS-VAInteragencyAgreement-1January 10, 20170.7 MiB516
Faq11817January 20, 20170.2 MiB409
O'Halleran Ltr To Leadership - ACA And IHCIAFebruary 1, 20170.1 MiB190
2016 12 09 ACA LetterFebruary 17, 20170.1 MiB271
Letter-to-Governors-and-CommissionersFebruary 17, 20171.1 MiB526
Senate Finance Attachment, 02152017February 17, 20170.3 MiB562
Senate Finance Committee, Response Letter, 02152017February 17, 201757 KiB523
TSGAC - Timeline Of Key ACA-Related Congressional Activities 2017-02-13b ..February 28, 20170.3 MiB239
TSGAC Brief - CMS Restrictions On Billing Medicaid For Services Outside ..February 28, 20170.3 MiB1324
TSGAC Memo - Applicable Percentages Thresholds And Payments For ACA Prov ..February 28, 20170.3 MiB211
TSGAC Memo - IHS Reimbursement Rates For CY 2017 - 2016-02-06bFebruary 28, 20170.2 MiB285
TSGAC Memo-ACA In 2017 And Trump-Ryan Health Care Plans - 2017-01-06aFebruary 28, 20170.3 MiB361
TSGAC Memo-Net Marketplace Premium Costs Hold Or Lower In 2017 2017-01-1 ..February 28, 20170.3 MiB278
TSGAC Memo-Tribal Sponsorship Of Medicare Part B D Premiums - 2016-11- . .February 28, 20170.3 MiB323
TSGAC Memo-Comparison House Repub Plan Vs Current Law-ACA As Of 2017-03- ..March 16, 20170.4 MiB534
DTLL And UIO Leader Letter On IHS Funds Final 3-28-17March 29, 20170.8 MiB298
DSTAC Draft Agenda May 2017April 11, 201742 KiB313
03 Aoki SUPPMay 4, 20170.2 MiB674
DTLL DUIOLL 05102017May 12, 20170.1 MiB582
CMS Emergency Preparedness Final Rule WebinarJune 19, 201764 KiB689

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 Portland Area Facilities (PAFAC) updates:


The most recent policy issues for Oregon:

333-010 Notice Of Rulemaking 09-25-18September 27, 20180.1 MiB46

The most recent policy issues for Idaho:

17-0001 Base Benchmark Plan Alignment Tribal NoticeJanuary 24, 20170.3 MiB262
11-3-2016 Tribal Medicaid DRAFT Minutes (3)January 25, 20170.4 MiB809
17-0002 Tribal Notice For 2017 COLAJanuary 26, 20170.3 MiB329
17-0003 Tribal Notice For Covered Outpatient DrugsFebruary 23, 20170.3 MiB306
17-066 Tribal Notice For A-D Adult DD Waiver RenewalsMarch 9, 20170.4 MiB351
17-088 Tribal Notice For Childrens DDMarch 31, 20170.4 MiB357
MA1702 1915b Formal Policy StatementMay 24, 20170.1 MiB556
1915bIBHPWorkgroup Tribal Ltr MWMay 24, 20170.3 MiB295
Draft TribesState Agenda August 2017 Fort HallJuly 11, 20170.3 MiB595
Draft Agenda Tribal SR August 2017July 11, 20170.1 MiB360
YHI Idaho Tribal Meeting Agenda August 2017July 26, 20170.2 MiB288
Adult DD 1915i HCBS Tribal NoticeSeptember 28, 20170.4 MiB334
17-226 Tribal Notice For IHS Four WallsOctober 30, 201741 KiB494
17-229 Tribal Notice 1915i HCBS Adult DD SPAOctober 30, 20170.6 MiB315
17-230 Tribal Notice 1915c Adult DD & A&D Waiver Amendments ReshabOctober 30, 20170.5 MiB237
Agenda Tribes Nov 2017 DraftOctober 31, 201767 KiB341
A-D Waiver Amendment Tribal NoticeNovember 3, 20170.6 MiB338
HCBS AD And Adult DD Reshab Tribal Notice 2November 28, 20171.0 MiB370
17-255 Tribal Notice DME SPAJanuary 2, 201833 KiB353
11-8-2017 Idaho Tribes DRAFT Minutes - RfbJanuary 29, 20180.3 MiB430
18-001 Tribal Notice IDEA ITP SPAJanuary 31, 201841 KiB385
2-22-2018 Idaho Tribes DRAFT MinutesMay 10, 201846 KiB109
Tribal Notice - SED Premiums SPA 09132018September 20, 201891 KiB92
18-0014 Medicaid Adult Expansion To ABP SPA Tribal Notice FINAL SignDecember 19, 20181.9 MiB24
Tribal Mtg Coordination 2019February 15, 201992 KiB17

The most recent policy issues for Washington:


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