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A Good Plan Come Together The IHCIA: Expanding Authority, Parity, and Opportunity

A Good Plan Come Together The IHCIA: Expanding Authority, Parity, and Opportunity. Myra M. Munson Sonosky , Chambers, Sachse , Miller & Munson LLP. Enactment.

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A Good Plan Come Together The IHCIA: Expanding Authority, Parity, and Opportunity

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  1. A Good Plan Come TogetherThe IHCIA: Expanding Authority, Parity, and Opportunity Myra M. Munson Sonosky, Chambers, Sachse, Miller & Munson LLP

  2. Enactment Section 10221 of Pub. L. 111-148, the Patient Protection and Affordable Care Act, signed by the President March 23, 2010, enacted by reference S. 1790, as reported out of the Senate Committee on Indian Affairs in December 2009, with four amendments. The IHCIA: Expanding Authority, Parity & Opportunity

  3. What Resulted from 11 Years of Advocacy? • Authority • Parity • Opportunity • And, a few unexpected provisions The IHCIA: Expanding Authority, Parity & Opportunity

  4. AUTHORITY Sec. 2 Findings – New goal to eradicate disparities between Indians and general public Sec. 3 Policy – Acknowledgement of “special trust responsibility and legal obligations to Indians.” Objectives –Healthy People 2010 ( or successor standards). See, www.healthypeople.gov The IHCIA: Expanding Authority, Parity & Opportunity

  5. Authority (cont) Sec. 4 Definitions – (5) Contract health services: referral and payment (important for implementation of Pub. L. 111-5, American Recovery and Reinvestment Act of 2009 (ARRA), Sec. 5006(a) regarding cost sharing) (7) Disease prevention (11) Health promotion: comprehensive list, ending with “(xxix) such other activities identified by the Service, a tribal health program, or an urban Indian organization to promote achievement of any of the objectives referred to in section 3(2) [Healthy People 2010 (or its successor].” The IHCIA: Expanding Authority, Parity & Opportunity

  6. Authority (cont) Sec. 204 Diabetes Prevention, Treatment and Control. Dialysis, makes model programs permanent. Sec. 205 Other Authority for Provision of Services Assisted living service Home- and community-based service Hospice care Long-term care services Sec. 822 Shared Services for Long-Term Care. Expressly authorizes sharing staff and other services between IHS or tribal health program and tribally owned and operated long-term care or related facility. The IHCIA: Expanding Authority, Parity & Opportunity

  7. Authority (cont) Sec. 212 Mammography & Other Cancer Screening - includes other cancers. Sec. 213 Patient Travel Costs - includes escorts Sec. 218 Infectious Diseases - expanded beyond tuberculosis Sec. 704 Comprehensive Behavioral Health Authority Sec. 712 Fetal Alcohol Spectrum Disorders Programs Sec. 713 Child Sexual Abuse Prevention and Treatment Programs Sec. 714 Domestic and Sexual Violence Prevention and Treatment The IHCIA: Expanding Authority, Parity & Opportunity

  8. PARITY Sec. 106 Continuing education allowances. Extended to all health professionals serving in Indian health programs, including CHRs and EMTs. Sec. 119 Community Health Aide Program. Extend authority for program to tribes outside Alaska; allows tribes to use mid-level dental providers on same basis as authorized by the state. Sec. 124 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. The IHCIA: Expanding Authority, Parity & Opportunity

  9. Parity (cont) Sec. 206 Third-party recovery. Allows recovery of charges from every kind of insurer and provides tribal health programs with authority to recover from tort-feasors on the same basis as the IHS and other federal health care providers do. Sec. 221 Licensing. Exempts licensed and certified tribal health program employees from licensure in the state where they are practicing so long as they are licensed or certified in some state. Sec. 408 Non-Discrimination in Qualifications for Reimbursement.Provides for payment of I/T/U programs without regard to licensed status so long as meet other generally applicable requirements for participation The IHCIA: Expanding Authority, Parity & Opportunity

  10. Parity (cont) Sec. 309 Tribal Management of Federally Owned Quarters.Authorized tribal health programs to set their own rates. Sec. 409 Access to Federal Insurance. Allows a tribe or tribal organization carrying out programs under the ISDEAA, or an urban Indian organization with IHS funding, to buy federal health insurance for the employees of the tribe, tribal organization, or urban Indian organization. Sec. 805 Medical Quality Assurance Records & Qualified Immunity. Provides authority for peer review to occur without compromising confidentiality of medical records and the The IHCIA: Expanding Authority, Parity & Opportunity

  11. OPPORTUNITY Sec. 206 Third-Party Recovery. Broadened authority to recover from third-party payors Sec. 214 Epidemiology centers.Secretary must grant tribal epi centers access to “data, data sets, monitoring systems, delivery systems, and other protected health information in possession of the Secretary.” Sec. 311 Other Funding.Allows other agencies to transfer funds to IHS for health and sanitation facility construction and operation. The IHCIA: Expanding Authority, Parity & Opportunity

  12. Opportunity (cont) Sec. 401 Reimbursement from Medicare, Medicaid & CHIP. Authorizes recovery by I/T/U “programs” instead of “facilities”; expands allowable “use of funds,” including to achieve the objectives under Sec. 3 of the Act. Sec. 402 Purchasing Health Care Coverage.Authorizes tribes and urban Indian organizations to purchase health benefits coverage; allows such coverage to be based on need; allows funds to be used to support operation of self-insurance plan. Sec. 828 Tribal Health Program Option for Cost Sharing.Acknowledges authority of tribal health programs to charge Indians for services, but retains the limit on being required to do so. Sec. 411 Navajo Nation Medicaid Agency Feasibility Study. The IHCIA: Expanding Authority, Parity & Opportunity

  13. Opportunity (cont) Sec. 405 Sharing Arrangements with VA and Dept of Defense.Authorizes the Secretary to enter into agreements to share medical facilities and services between IHS or tribes and DOD and VA; requires DOD and VA to reimburse IHS and tribal health programs for services provided to beneficiaries of DOD or VA Sec. 407 Establish procedures for health services to eligible Indian veterans by IHS and VA. Facilitates agreements between VA and IHS for services to Indian veterans Sec. 813 Health Services for Ineligible Persons. Eliminates requirement that tribal health programs consider whether there are alternative services and expressly extends FTCA coverage The IHCIA: Expanding Authority, Parity & Opportunity

  14. And, a Few Unexpected Provisions Sec. 226 Contract Health Administration and Disbursement Formula.Requires GAO to submit the report requested March 2009 regarding CHS, including recommendation re: funding level; IHS/tribal consultation about whether there are inequities, inefficiencies, and other issues; then, if Secretary determines there are issues, authorizes negotiated rulemaking to develop a CHS formula. Sec. 830 Other GAO Reports. Study and evaluation of the effectiveness and coordination of health care services; study of CHS. The IHCIA: Expanding Authority, Parity & Opportunity

  15. Unexpected (cont) Sec. 603 Office of Direct Service Tribes. Relocated from the program level to the immediate office of the Director. Sec. 604 Nevada Area Office. Requires the Secretary to submit within one year a plan to create a Nevada Area Office; if not submitted, requires the Secretary to withhold funds from the IHS Director’s office. Sec. 806. Limitation on Use of Funds for Abortions.“Any limitation pursuant to other Federal laws on the use of Federal funds appropriated to the Service shall apply with respect to the performance or coverage of abortions. The IHCIA: Expanding Authority, Parity & Opportunity

  16. Unexpected (cont) Sec. 827 Prescription Drug Monitoring.Requires the Secretary to work with the Attorney General and Secretary of Interior to establish a prescription drug monitoring program and report to Congress within 18 months. Sec. 831 Traditional Health Care Practices. Excludes such practices from FTCA coverage. The IHCIA: Expanding Authority, Parity & Opportunity

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