President Trump Signs FY 2018 Omnibus  The Impact to Tribal Health:  Tribal Set Asides for Opioid Funding,  $500 Million Increase for IHS

March 23, 2018
President Trump announced today that, despite several objections to funding levels in the bill, he supported the Fiscal Year (FY) 2018 Omnibus. He signed the Omnibus into law shortly after 1:00 Eastern. This means that the government will be funded through September, the end of FY 2018.
Read below on the analysis conducted earlier by the National Indian Health Board regarding the Omnibus’s impact on Tribal health.
Last night, Congressional leaders unveiled a massive $1.3 trillion spending bill that will fund the federal government through the rest of FY 2018. The Consolidated Appropriations Act, 2018 (H.R. 1625) contains funding for most of the federal government agencies including Department of Health and Human Services (HHS), and the Indian Health Service (IHS). The bill passed the U.S. House of Representatives on a bipartisan vote of 266-167 on Thursday, March 22. The Senate passed the bill 65-32 early Friday morning.
In the agreement, HHS will receive a total of $88.1 billion, which is $10.1 billion over the FY 2017 level. The bill also contains $4 billion to fight the opioid crisis.IHS will receive a total of $5.5 billion, which is an increase of $500 million (10%) from the FY 2017 enacted level. The legislation contains an extra $1 billion for the state response to opioid grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Within this funding there is a$50 million for Tribes and Tribal organizations. NIHB has been advocating in Congress for Tribes to be directly funded by this important program. Additionally, the funding bill provides $84 million for the Medication-Assisted Treatment (MAT) for Prescription Drug and Opioid Addiction program, also administered by SAMHSA. Tribes and tribal organizations will receive a $5 million set-aside in this funding.
Legislation also provides funding for other Tribally-focused health programs such the Good Health and Wellness in Indian Country program, Tribal Behavioral Health Grants, and the Zero Suicide Prevention Initiative.
You can read the bill text here. You can read the Explanatory Statement detailing IHS funding in the bill here (IHS begins on page 75). You can read the explanatory statement for other HHS programs here.
Resources to Fight the Opioid Epidemic
The FY 2018 Omnibus contains $4 billion to treat the opioid epidemic across the nation. The funding is spread across agencies including HHS, Homeland Security, Justice, and Veterans Affairs for prevention, treatment and law enforcement. Under HHS, about $1 billion would go toward state and tribal grants created under the 21st Century Cures Act to respond to the crisis. Almost $500 million more is slated for the Centers for Disease Control and Prevention’s (CDC) prevention and surveillance activities, and another $500 million would go to the National Institutes of Health (NIH) for research on opioid addiction and new non-addictive pain therapies. An additional $130 million is carved out to address opioid addiction in rural areas and $94 million would help FDA expand its efforts to crack down on shipments of synthetic opioids at international mail facilities.
Tribal Specific Provisions
As noted above, the omnibus includes a $50 million set aside for Tribes and Tribal organizations under the State Targeted Response to opioid grants. Previously, this funding has only been available to states. NIHB has been advocating for Tribes to be included as part of this funding over the last several months. With the passage of the omnibus, $50 million will specifically go to Tribes and Tribal organizations under this program. The program aims to address the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids as well as illicit drugs such as heroin).
The appropriations bill also contains $84 million for the Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program. The purpose of this program is to expand/enhance access to medication-assisted treatment services for persons with an opioid use disorder seeking or receiving MAT. Out of the $84 million, $5 million is specifically targeted for Tribes and Tribal organizations. This will help provide vital funding to Tribes implementing MAT programs in order to provide treatment to the opioid crisis.
NIHB has been testifying before Congress over the last two weeks on the opioid crisis in Indian Country. To view NIHB’s testimony before the Senate Committee on Indian Affairs click here and to view the testimony before the Energy and Commerce Committee click here.
Indian Health Service Funding
In the FY 2018 Consolidated Appropriations Act, the Indian Health Service would receive $5.5 billion for IHS which is an increase of just under $500 million (10%) above the FY 2017 enacted level. The legislation allocates $3.9 billion for services, $867 million for facilities and $718 million for Contract Support Costs.
The Indian Health Care Improvement Fund (IHCIF) would receive $72.3 million in the legislation. This fund has been authorized by Congress to improve funding discrepancies across the IHS. This is the first time funding has been made available since FY 2012. The IHCIF Workgroup continues to meet to discuss the formula for distributing these funds.
The legislation also includes $ 58 million for IHS to address “accreditation emergencies” at Direct Service facilities. This includes those facilities who have or have the potential to lose the ability to bill the Centers for Medicare and Medicaid Services due to deficiencies in the system. It also encourages IHS to share information about these cases with the Tribes and with Congress.
Funding is also allocated for domestic violence prevention ($4 million); and $1,000,000 to continue prescription drug monitoring program (equal to FY 2017 ). Alcohol and Substance Abuse programs would see an $8 million increaseincluding $6.5 million for the Generation Indigenous Initiative; $1.8 million for the youth pilot project; and $2,000,000 to fund essential detoxification and related services provided by the Service’s public and private partners to IHS beneficiaries. Purchased/Referred Care would get an increase of $32 millionfor total funding of $962.7 million.
The agreement also directs IHS to report to Congress about the progress they are making on patient wait times as outlined in IHS Circular 17-11 within 90 days of enactment. The report should include how Health IT issues impact patient wait times. The legislation also requires the agency to report to Congress on detailed funding amounts it would take to fully implement the Indian Health Care Improvement Act. This was also requested in the FY 2017 appropriations bill, but IHS never provided the information to Congress.
Within 180 days, IHS is also required to report to Congress on “patient population and service growth over the past ten years and the funding sources used to provide for these medical services.” This report is to include funding sources which supplement appropriated dollars to cover the provision of medical services at IHS-operated facilities. The Appropriations Committee would like to understand how services have expanded over time due to additional funding available. Congress also requests an analysis of the different personnel hiring and recruitment authorities used by the Department of Veteran Affairs (VA) and the IHS and to report such findings to Congress.
The spending agreement also contains language that allows IHS to provide a housing subsidy for medical personnel at IHS operated sites. It also requires IHS to conduct additional training for all IHS personnel on how to improve quality of care, so that staff understand their obligations to improve quality of care.
Finally, the agreement also contains language that “encourages” IHS to provide funding for the Substance Abuse and Suicide Prevention Program, Domestic Violence Prevention Program, Zero Suicide Initiative, and aftercare pilots at Youth Regional Treatment Centers through contracts and compacts rather than through grant based programs to ensure that Contract Support Costs are available.
The spending agreement also contains a total of $867.5 million for facilities funding which is an increase of $303.4 million over FY 2017. This includes $243 million for Health Care Facilities Construction, which is 106% more than the FY 2017 enacted amount. Within that amount, there is $15,000,000 for small ambulatory clinics and $11,489,000 for staff quarters.
The spending agreement also directs the HHS Secretary to prioritize Indian Health Services facilities from the Nonrecurring Expenses Fund which include Indian Health Services facilities. This fund is comprised of unobligated appropriations at HHS since FY 2008.
Click here to view a chart of FY 2018 IHS Appropriations as outlined in the Consolidated Appropriations Act.
Other Public Health Programs for Indian Country
The legislation contains funding several other programs important to Indian health including:
  • Good Health and Wellness in Indian Country (CDC) – $16 million
    • Equal to FY 2017 Funding
  • Tribal Behavioral Health Grants (SAMHSA) – $15 million
    • Equal to FY 2017 Funding
  • American Indian and Alaskan Native Suicide Prevention Initiative (SAMHSA) –
    • Equal to FY 2017 Funding
  • Zero Suicide Initiative for American Indians and Alaska Natives (SAMHSA) – $2 million
    • Equal to FY 2017 Funding
If you have any questions about FY 2018 Appropriations please contact Caitrin Shuy, Director of Congressional Relations at cshuy@nihb.org or (202) 507-4085.

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