Transcript Reauthorization of the Indian Health Care Improvement Act

Sonosky, Chambers, Sachse,
Miller & Munson, LLP
IHCIA and Long-Term Care
National Indian Health Board
National Tribal Health Reform Implementation Summit
Washington D.C.
April 20, 2011
Myra M. Munson, J.D., M.S.W.
[email protected]
Washington, DC
Juneau, AK
Anchorage, AK
Albuquerque, NM
San Diego, CA
Authority and Policy
*Sec. 2 Findings – New provision: “(2) A major national goal
of the U.S. is to provide the resources, processes, and
structure that will enable Indian tribes and tribal members to
obtain the quantity of health care services and opportunities
that will eradicate the health disparities between Indians and
the general public of the U.S.”
*Sec. 3 Policy – Acknowledgement of “special trust
responsibility and legal obligations to Indians.”
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 2
Objectives
*For the first time they are the same as for the
rest of the Nation. Healthy People 2010 ( or
successor standards). See,
www.healthypeople.gov. 25 U.S.C. § 1603(2);
IHCIA Sec. 3(2)
* Applies to Urban Indian Health Programs
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 3
2020 Objectives Address
access; adolescent health; arthritis, osteoporosis & chronic
back conditions; blood disorders & blood safety; cancer;
chronic kidney diseases; diabetes; disability & secondary
conditions; early/middle childhood; education & communitybased programs; environmental health; family planning; food
safety; genomics; global health; health communication and IT;
health care associated infections; hearing & other sensory
communication disorders; heart disease & stroke; HIV;
immunizations & infectious diseases; injury & violence
prevention; maternal, infant & child health; medical product
safety; mental health; nutrition & weight status; occupational
safety & health; older adults; oral health; physical health &
fitness; public health infrastructure; quality of life & wellbeing; respiratory diseases; sexually transmitted diseases;
social determinants of health; substance abuse; tobacco;
vision
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 4
What Services Can Be Provided
by an Indian Health Program?
Any Service to Achieve the Objectives in §1602(2).
Health Promotion/Disease Prevention (25 U.S.C. §1603)
Traditional Health Care Practices. Expressly authorizes the
Secretary to promote traditional health care practices, but
limits liability of United States for provision of such services.
(25 U.S.C. § 1680u; IHCIA Sec. 831)
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 5
Other Supportive Services
25 U.S.C. § 1621d ; IHCIA Sec. 205
Assisted living service, as defined in 12 USC 1715w(b), except
need not be licensed, but must meet applicable standards for
licensure
Home- and community-based service means 1 or more
services specified in 42 USC 1396t(a)(1)-(9) that are or bill be
provided in accordance with applicable standards
Hospice care all items and services in 42 USC 1395x(dd)(1)(A)(H) and “such other services the THO determines are
necessary and appropriate in furtherance Of that care
Long-term care services as defined in section 7702B(c) of the
Internal Revenue Code of 1986
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Longterm Care
Slide 15
OTHER OPPORTUNITIES
Shared Services for Long-Term Care. 25 U.S.C. § 1680l;
IHCIA Sec. 822
Expressly authorizes sharing staff and other services between
IHS or tribal health program and tribally operated long term
care or related facility.
Indian Health Care Delivery Demo. 25 U.S.C. § 1637;
IHCIA Sec. 307
Encourages demonstration projects to test alternative means
of delivering health services to AI/ANs through facilities and
through alternative and innovative methods like community
health centers and cooperative agreements with other
community providers for sharing or coordinating use of
facilities, funding, and other resources
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 7
AI/ANs VETERANS
Streamlining and Opportunity
Sharing arrangements authorized between IHS, Tribes and
Tribal Organizations, and VA and DoD. 25 U.S.C. § 1645;
IHCIA Sec. 405(a)
Requires VA and DoD to reimburse IHS and Tribal health
programs for services provided to beneficiaries of VA or
DoD; 25 U.S.C. § 1645(c); IHCIA Sec. 405(c)
Collaborations authorized between VA and IHS/Tribal health
programs at Indian health program locations. 25 U.S.C. §
1647; IHCIA Sec. 407.
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 8
Other Options to Obtain Care
*Purchasing Health Care Coverage. 25 U.S.C. § 1642; IHCIA
Sec. 402.
• IHS funds made available to an I/T/U (including ISDEAA
funds) may be used to purchase health benefits coverage for
beneficiaries
• May consider need of beneficiaries
• May cover expenses for a self-insured plan, including
administration and insurance to limit financial risks
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 9
More Acknowledgement of the
Need for Long-Term Care
Indian Health Care Improvement Fund now includes longterm care in clinical care. 25 U.S.C. § 1621(a)(5)(A); IHCIA
Sec. 201
Report to Congress regarding facility needs now includes
specialized health care facilities, including long-term care
facilities. 25 U.S.C. § 1631; IHCIA Sec. 301.
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 10
SERVING NON-BENEFICIARIES
Authority and Opportunity
Health Services for Ineligible Persons. 25 U.S.C. § 1680c;
Sec. 813;
Eliminates requirement that Tribal health programs consider
whether there are alternative services and expressly extends
FTCA coverage
Does not allow IHS to serve non-beneficiaries without
approval of tribes in the Service Unit
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 11
Licensing and Fees
Non-Discrimination in Qualifications for Reimbursement. Provides for
payment of I/T/U programs by any Federal health care program without
regard to licensed status so long as meet other generally applicable
requirements for participation (with an exception for Sec. 221) (25
U.S.C. § 1647a; IHCIA Sec. 408).
Exemption from certain fees. Employees of tribal and urban health
programs are exempt from fees imposed by federal agencies to the
same extent that IHS employees and commissioned corps officers are
exempt. Eg., DEA registration fees. (25 U.S.C. § 1616q; IHCIA Sec. 124).
Unfortunately, this exemption does not expressly exempt the facilities
from fees.
Sonosky, Chambers, Sachse, Miller & Munson, LLP
4/20/11
IHCIA and Long-Term Care
Slide 12