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Our firm defended a tribal absentee ballot law (denying absentee ballots to non-resident members) against constitutional attack in Jacobson v. Eastern Band of Cherokee Indians, No. CV-05-101 (Supreme Court of the Eastern Band of Cherokee Indians, Nov. 29, 2006).

General Memorandum 15-032

General Memorandum 15-032
Doc Fix Bill Enacted; SDPI and Other Programs Extended

On April 16, 2015, the President signed HR 2, the Medicare Access and CHIP Reauthorization bill (also referred to as the "Doc Fix" bill). The Senate approved the bill on April 14 and the House on March 26. In addition to addressing the problem of the otherwise imminent 21 percent decrease in Medicare payments to physicians, the legislation also extends several programs which provide significant funding to tribes: Special Diabetes Program for Indians; Children's Health Insurance Program; Maternal, Infant and Early Childhood Home Visiting Program; and mandatory funding for Community Health Centers. A summary of the bill as prepared by the House Energy and Commerce and the Ways and Means Committees is attached.

Medicare Doc Fix. HR 2 repeals the Sustainable Growth Rate (SGR) formula enacted in 1997 which required automatic reductions in Medicare reimbursement rates to physicians based on spending targets. Congress has seventeen times since then enacted legislation to provide temporary relief from the impending cuts. With the enactment of HR 2, there will no longer be the need for a periodic rush to stop the reductions. The cost of the Doc Fix legislation is not fully offset which was a big issue of contention. Instead, Congress exempted the legislation from the PAY-GO Act which otherwise would have required offsets from mandatory spending and/or revenue increases.

Special Diabetes Program for Indians (SDPI). The SDPI program was extended for two years – through FY 2017 at its current funding level of $150 million per year. Tribes and tribal advocates had urged that the program be permanently reauthorized at a funding level of
$200 million per year. Nevertheless, the extension is certainly welcome and it has happened five months prior to what would have been the end of its authorization period, thus allowing for planning for the upcoming fiscal year. The periodic Doc Fix extensions proved to be a useful "must pass" legislative vehicle for the SDPI and other programs in the past, and with the permanent Doc Fix now in place, the SDPI program will have to secure extensions through other means.

Children's Health Insurance Program (CHIP). CHIP provides health care assistance to children and pregnant women in households whose income is above the Medicaid eligibility level but not sufficient to purchase insurance. The program is of enormous assistance in providing health care to children in Indian Country. There are exemptions for American Indians and Alaska Natives regarding cost sharing and consideration of certain property and resources in determining eligibility. HR 2 extends funding for CHIP through FY 2017. There was significance interest in extending funding for CHIP for four, rather than two, years and that effort is expected to continue.

Maternal, Infant, and Childhood Home Visiting Program. The Affordable Care Act created an entitlement program under Title V of the Social Security Act for evidence-based programs of home visits to families with young children or families who are expecting children and live in communities at risk for poor maternal and child health. Three percent of funds are reserved for tribes, tribal organizations, and urban Indian organizations. Tribal funding over the first five years combined of the program under this allocation was $45 million. HR 2 extends funding for this program through FY 2017 at $400 million per year.

Funding for Community Health Centers. Mandatory funding for Community Health Centers – which is in addition to the discretionary funding they receive – was set to expire in September 2015. HR 2 extends funding for the Health Centers through FY 2017. It also extends funding for an additional two years for the National Health Service Corps and the Teaching Health Center Graduate Medical Education Payment Program.

Please let us know if we may provide additional information regarding the provisions of HR 2, the Medicare Access and CHIP Reauthorization Act.

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Inquiries may be directed to:
Geoff Strommer (gstrommer@hobbsstraus.com)
Elliott Milhollin (emilhollin@hobbsstraus.com)
Karen Funk (kfunk@hobbsstraus.com)

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