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:

Enclosure FY18 IHCIF AllocationsAugust 20, 20180.1 MiB25
Enclosure IHS VA CMOP Agreement-1January 10, 20170.3 MiB573
Faq11817January 20, 20170.2 MiB409
Federal Register Notice 38 CFR Pt 14 Recognition Of Tribal Organizations For Representation Of VA ClaimantsJuly 22, 20160.3 MiB627
Federal Register UpdatesApril 5, 201634 KiB379
FINAL 11-30-16 Letter To Administration On Dental Therapy IssuesDecember 1, 20160.2 MiB568
FINAL CHAP And CHRP BackgroundJuly 25, 20160.7 MiB593
GM 16-058 Status Of FY 2017 Continuing ResolutionSeptember 26, 201629 KiB696
IHS CHAP Letter TemplateOctober 19, 201628 KiB385
IHS Draft Policy Statement on the Expansion of CHAPJune 16, 201634 KiB750
IHS Letter To Tribal Leaders - CSC Policy Update - 10-27-2016October 27, 20160.6 MiB297
ISAC ACTIONS-RECOMMENDATIONS Jun 2017 FINAL-SIGNED 2017 07 11July 24, 20170.2 MiB560
Joint Letter Requesting Tribal Consultation 4May 1, 20180.5 MiB55
Letter To Tribal LeadersApril 19, 201959 KiB27
Letter-to-Governors-and-CommissionersFebruary 17, 20171.1 MiB526
NIHB Health Care Litigation Update (9-13-16)September 19, 20160.9 MiB413
NIHB HHS Budget Consultation Comments April 2012 FINALApril 5, 20161.0 MiB581
NPAIHB CHAP Interim Policy Comment FINAL SUBMITTEDJune 13, 20190.1 MiB29
NPAIHB Comment SDPI FY 19 Funding Distribution FinalMay 23, 20180.2 MiB33
NPAIHB Comments On MACRA QPR Rule 6 2016June 24, 20160.8 MiB361
NPAIHB IHS DHAT CHAP V2 7-25-16July 25, 20160.6 MiB805
NPAIHB Native Veterans Needs VA MISSION ACTJune 13, 20190.3 MiB24
NPAIHB ONC Health IT Strategy FINALJanuary 29, 20190.1 MiB28
O'Halleran Ltr To Leadership - ACA And IHCIAFebruary 1, 20170.1 MiB190
Policy Brief No 8 - SCIA Views Estimates - March 7, 2007April 5, 20162.0 MiB329

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:

Workgroups-external-roster-fullJune 9, 20160.1 MiB1534

The most recent policy issues for Idaho:

3April 6, 20168.1 MiB1118
5April 6, 201614.4 MiB914
A-D Waiver Amendment Tribal NoticeNovember 3, 20170.6 MiB338
Adult DD 1915i HCBS Tribal NoticeSeptember 28, 20170.4 MiB334
Agenda - July 31 2007 (2)April 6, 201668 KiB364
Agenda Tribes Nov 2017 DraftOctober 31, 201767 KiB341
Draft Agenda Tribal SR August 2017July 11, 20170.1 MiB360
Draft TribesState Agenda August 2017 Fort HallJuly 11, 20170.3 MiB595
Full Public Notice 7-3-19 Coverage Choice Waiver FinalJuly 8, 20190.2 MiB14
HCBS AD And Adult DD Reshab Tribal Notice 2November 28, 20171.0 MiB370
ID State-tribe Memo To ID Tribal LeadersApril 6, 20160.2 MiB398
ID13-006 Tribal LetterApril 6, 20160.4 MiB421
Idaho February Draft Agenda - 2-8-12April 6, 20160.2 MiB389
Idaho Quarterly State August FlyerApril 6, 201668 KiB482
Idaho State Tribes Meeting 6-15-07sbApril 6, 201642 KiB646
IdahoInsuranceExchangeApril 6, 20160.1 MiB283
Legal Notices PC Physician Codes & Rates 1-1-13April 6, 20160.4 MiB255
Letter To Debbie FieldApril 6, 20160.1 MiB400
MA1702 1915b Formal Policy StatementMay 24, 20170.1 MiB556
MMCP Servcie Area Reduction Tribal NoticeOctober 28, 20160.3 MiB361
Oregon Community PartnerApril 6, 20161.7 MiB691
Save The Date Flyerfor 2008April 6, 20160.1 MiB406
Save The Date FlyerNovApril 6, 20160.1 MiB424
SPA 13-004 Incentive Payments For Primary Care CodesApril 6, 20161.4 MiB337
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