Tribal Self-Governance Conference, Presentation: The Role of Tribal Consultation 5/21/2018 2010 President Obama signed into law the Patient Protection and Affordable Act on March 23, 2010 The Affordable Care Act brings new options for health coverage. It is another way that the federal government meets its responsibility to provide health care for American Indians and Alaska Natives. The purpose of the Affordable Care Act is to increase access to quality health coverage for all Americans, including our First Americans. The benefits of the health care law for American Indians and Alaska Natives are significant whether they have insurance now, want to purchase affordable insurance through the Health Insurance Marketplace or take advantage of the States expanding Medicaid. Indian elders will benefit from a stronger Medicare with more affordable prescriptions and free preventive services no matter what provider they see. In addition, the Indian Health Care Improvement Act (IHCIA), was made permanent by the Affordable Care Act. Patient Protection and Affordable Care Act (ACA) – Indian Health Care Improvement Act Reauthorization and Extension Act (IHCIA)

Health Care & Federal Trust Responsibility ACA offers new opportunities to access health insurance for AI/AN individuals The government’s historical and unique legal relationship with tribes is based on treaties, laws, and Supreme Court decisions Indian Health Service is Made Permanent The government has a historical and unique legal relationship with tribes that is based on treaties, laws, and Supreme Court decisions. The ACA did not end this special relationship. The IHS will continue to provide healthcare to AI/ANs. The new Health reform law offers new opportunities to access health insurance for all AI/ANs and tribal employees

Strengthening the Indian Health Service Expanded Authority for IHS Service IHCIA prescribes the duties and responsibilities, which allows IHS to modernize its health care delivery systems & permit tribal governments to make technical changes in the future Greater Workforce by increasing clinician recruitment and retention in tribally-operated health programs ACA/IHCIA Expanded Authority for IHS services: The reauthorization of the IHCIA, which prescribes the duties, responsibilities, and authorities of the IHS, allows IHS to modernize its health care delivery systems and permit tribal governments to make technical changes in the future. New and expanded program authorities for: mental and behavioral health treatment and prevention; long-term care services, including home health care, assisted living and community-based care; development of health professional shortage demonstration programs; funding of patient travel costs; demonstration projects for innovative health care facility construction; the provision of dialysis services; Improvements in the Contract Health Services program, which pays for referrals; facilitation of care for Indian veterans; and urban Indian health programs. * The IHCIA does not provide additional funding for all the new authorities stated in the law. Additionally funding may be needed to implement provisions of the law. Greater Workforce: The ACA can expands the health care workforce through new resources that will boost the number of doctors, nurses and health care providers in American Indiana and Alaska Native communities. Health Resources and Services Administration (HRSA) designated all Indian Health Service, tribally-operated facilities, and urban Indian health programs as National Health Service Corps (NHSC) sites so vacancies can be filled in clinics. The NHSC and the IHS offer primary care providers and students financial support in the form of loan repayment and scholarships to cover the cost of their medical, dental, or mental and behavioral health education. Expanded Third Party Funding: An increase in Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and private insurance covered AI/AN populations will increase payments to IHS to support both direct care and PRC services. This will free up IHS funds for expanded service offerings and help improve services for all AI/ANs. More opportunities to bill outside the IHS system will help facilities and areas stretch the all-important contract health services dollars. Expanded Third Party Funding - Increase payments to IHS to support both direct care and contract health care services

10 Essential Health Benefits Ambulatory Patient Services Prescription Drugs Emergency services Rehabilitative & Habilitative Services and Devices Hospitalization Laboratory Services Maternity & Newborn Care Preventive & Wellness Services and Chronic Disease Management Mental Health & Substance Use Disorder Services, Including Behavioral Health Treatment Pediatric Services, including Oral & Vision Care All Qualified Health Plans Will Cover These 10 Essential Health Benefits. You’ll see that some of these benefits are those that are not available at every clinic – particularly behavioral health and pediatric oral and vision care.

Tribal Self-Governance Conference, Presentation: The Role of Tribal Consultation 5/21/2018 2010 Formation of the HHS Secretary’s Tribal Advisory Council (STAC) This was the first meeting of the group and was historic because it is the first Cabinet-level group of its kind. Formation of the U.S. Department of Health and Human Services (HHS) Secretary’s Tribal Advisory Council (STAC)

HHS Strategic Plan FY 2014-2018 Goal 1: Strengthen Health Care Objective E: Ensure access to quality, culturally competent care for vulnerable populations Measure: Implements at least 3 additional recommendations from Tribes to improve the Tribal consultation process each year HHS Strategic Plan and Strategic Initiatives FY 2014 – 2018 To renew and strengthen the Federal/Tribal partnership, it is essential that American Indian and Alaska Native Tribes and the Indian Health Service (IHS) engage in open, continuous, and meaningful Tribal consultation. The IHS lists the target of implementing at least three additional recommendations from Tribes to improve the Tribal consultation process each fiscal year. Tribal consultation is an ongoing process that leads to information exchange, respectful dialogue, mutual understanding, and informed decision making.   Consultation is a top priority of the IHS. Senior IHS leadership works closely with the IHS Director’s Tribal Advisory Workgroup on Consultation to report and to implement the recommendations from Tribes. To improve organizational customer service, the Director, IHS, provides updates to IHS staff at monthly general staff meetings and by e-mail updates to all IHS staff. Additionally, the Director requires all Chief Executive Officers to communicate updates on a quarterly basis to staff and Tribal leaders and include him on their communication. The IHS has convened a national Tribal Consultation Summits to engage all stakeholders. HHS Strategic Plan FY 2014-2018

Tribal Self-Governance Conference, Presentation: The Role of Tribal Consultation 5/21/2018 2013 Formation of the White House Council on Native American Affairs On June 26, 2013, President Obama issued an Executive Order: To honor treaties and recognize tribes' inherent sovereignty and right to self-government under U.S. law, it is the policy of the United States to promote the development of prosperous and resilient tribal communities Formation of the White House Council on Native American Affairs Greater Engagement and Meaningful Consultation

Challenges today Cultural dynamics Loss of tribal language Funding and infrastructure resources Environmental changes – loss of plants, loss of the sacred Administration/training of community

Relevant health issues ……..continued disparities and inequities Youth suicide and injuries Substance Abuse impacts Infant and children’s health Diabetes Asthma Cancer Access to care

Tribal Self-Governance Conference, Presentation: The Role of Tribal Consultation 5/21/2018 “ No right is more sacred to a nation, to a people, than the right to freely determine its social, economic, political, and cultural future without external interferences. The fullest expression of this right occurs when a nation freely governs itself.“ — Joseph B. DeLaCruz Quinault Indian Nation (1937-2000)

Thank you! Office of Tribal Self-Governance Office of the Director Tribal Self-Governance Conference, Presentation: The Role of Tribal Consultation 5/21/2018 Thank you! Office of Tribal Self-Governance Office of the Director Indian Health Service U.S. Department of Health and Human Services Benjamin.Smith@ihs.gov.