|June 12, 2014
CSKT Tribal Council files intent to compact IHS Contract Health Services
By B.L. Azure
ST. IGNATIUS — On May 15, the Tribal Health and Human Services Department director presented the recommendation to the Tribal Council to file for the resumption of the Indian Health Service Contract Health Services program that it retroceded in 2005. As a result of the recommendation the Tribal Council passed a resolution notifying IHS of the Tribes intent to reassume management of the Contract Health Service program.
“People are suffering because the healthcare on the reservation is fragmented,” THHS Director Kevin Howlett told the Tribal Council in May, adding that the effort, if successful, would result in a single health care entity — Tribal Health — that manages the healthcare system for eligible beneficiaries on and within the Flathead Indian Reservation service area. “We presently have no control over how the Contract Health Services program expends its funds.”
Bringing CHS under Tribal Health umbrella would result in increased funding for THHS but more importantly it would allow for local control of the last piece of the healthcare delivery puzzle on the reservation. The anticipated result, among other things, would mean quicker healthcare delivery decisions locally. When coupled with the Affordable Care Act and the Indian Health Care Improvement Act the result would mean increased healthcare options for THHS eligible beneficiaries.
“For the past year and a half the Indian Health Service’s Contract Health Services program has been operating on emergency-services care that only addresses life-threatening health conditions,” Howlett said Monday. “People have been routinely denied basic level healthcare services like diagnostics, referrals, surgeries and life-threatening preventive services.”
Howlett added that the result of IHS not paying medical bills in a timely manner for authorized medical services.
“The situation has created serious havoc in some people’s lives,” Howlett said. “With the compacting of Contract Health Services we have the opportunity to provide a higher level of quality care and increased health care services. It’s local control over the kinds of medical practices we can deliver. That’s why I recommended the action to the Tribal Council to reassume this part of the (IHS) health program for this reservation.”
Tribal Health Planning Director Anna Whiting-Sorrell concurred that the single healthcare delivery system on the Flathead would be more efficient than the segmented one that is presently in place with IHS CHS, as one healthcare related entity and Tribal Health as the other.
“The decision to consolidate a single healthcare delivery system under the direction of the Tribes is a good one,” Whiting-Sorrell said. “Local single system management would eliminate the duplicity of the effort to deliver healthcare that presently exists in the relationship. During tough fiscal times and tight resources it is essential to maximize the utilization of all resources, especially monetary resources. We can streamline the process to ensure that better services are delivered in a timely and succinct manner.”
Sorrell said the decision would not be made until the fall or later. Tribal Health presently operates the lion’s share of the IHS services on the Flathead Reservation under a PL-638 compact (Indian Self-determination and Education Act of 1975). Once Tribal Health submits its final plan through the negotiating process Indian Health Service has 90 days to respond positively or negatively. If yea, okay, if nay further discussions or negotiations. If IHS does nothing during that period the compact is — by default — approved.
“We have no intention under tribal management to operate Contact Health Services as it was managed in the past,” Whiting-Sorrell said. “The passing of the Affordable Care Act and the permanent reauthorization of the Indian Health Care Improvement Act has afforded us many opportunities to manage and deliver better comprehensive healthcare options — that includes CHS — that weren’t there in the past. That includes the purchasing of insurance for eligible beneficiaries to ensure their access to all the healthcare options available under the ACA and the IHCIA.”
“We will take advantage of the opportunities for tribal people under the Affordable Care Act,” Howlett said. “We will vigorously enroll our patients in alternative healthcare plans — including insurance — that they are eligible for.”
Howlett said there are unique mandates under the ACA specifically for tribal people, including enrolled and descendants.
“The ACA allows enrolled (federally recognized) Indian people to enroll in the program to gain access to insurance coverage anytime throughout the year,” he said. “That means there is no ‘open season’ for enrollment.”
Non-Indians have an enrollment period each year to enroll in the ACA. Non-enrolled Indian descendants can apply for waivers.
Howlett added that Tribal Health would also pursue every avenue available to enroll children in federal and state programs like CHIPS (Children Health Insurance Program), HMK (Healthy Montana Kids) and Medicaid.
“This will mean some additional paperwork and participation from parents to ensure the healthcare needs for their children are being met,” Howlett said. “The bottom line is to provide better and increased healthcare options and access to a wider scope of services under the Affordable Care Act.”
Howlett knows it will be a difficult task because tribal people have not had the experience of participation in many of the healthcare programs that are available.
“We will do whatever is needed to help our people access the healthcare they need,” Howlett said. “For this to be successful we will need the cooperation, participation and support of the patient base.”