2. Indian Health Care Improvement Fund Workgroup
Jim Roberts, Senior Executive Liaison
Inter-Governmental Affairs
April 24, 2018

3. Indian Health Care Improvement Fund Workgroup Formation
November 13, 2017 Dear Tribal Leader Letter
Charge to Workgroup is to review IHCIF formula and recommend changes to improve allocation of funding
Initiated in response to Congressional action to provide funding $130 million; final Omnibus provides $72 million
Congress has requested review of formula in light of changes in health care environment (Medicaid expansion, Affordable Care Act)

4. Past Workgroup Decisions
FY 2011 Data Workgroup convened to revisit IHCIF data elements and formula
2011 Findings and Recommendations
User Counts
Alternative Health Status Index
Per User Cost Benchmark
Adjusting Benchmark for sites
New Guidance for Area Collection of Data
Index of CMS Spending
Forwarded CHS Topics
IHS Director decided not to change IHCIF until all operating units reach 55% of their level of need

5. 2018 IHCIF Workgroup Activities
Began with a technical review of all the data elements included in the IHCIF Formula
Identifying which issues to address that were received through the Tribal Consultation process
User population issues: workload, eligibility, quality reporting
Benchmark: IHCIA services, wrap-around, insurance model
Local Factors: price variation, TSA, travel distances, facility factors
Alternate Resources: revisit 25% default, better data, Congressional and GAO concerns

7. 2018 Decision Points
Following wide range of discussion on previous issues, four sub-workgroups formed:
Per Person Benchmark
User Counts
PRC Dependency
Alternate Resources

8. Per Person Benchmark
Assess the rationale and impact of replacing the Federal Employee Health Plans (FEHP) per user cost benchmark with a benchmark based on national health care expenditures (personal health care services)
Decision/Recommendation: move from an insurance model benchmark to the FEHP
The FEHP is more representative of IHCIA services
Takes into consideration dental and vision
Other public health factors

9. User Counts Workgroup
Assess the rationale and impact for modifying and/or augmenting user population now used in the methodology. List any implications if any of switching from an insurance plan benchmark to the national health care expenditure benchmark
Consideration of non-CHSDA users among 263 operating units
Evaluation Service Population, American Community Survey, or other population related data
Decision/Recommendation: Continue to use User Population with addition on non-CHSDA users
Continue discussion related to “fractionalization” of users

10. Access to Care: PRC Dependency
Assess the rationale and impact for adding PRC Dependency type indicator to the LNF methodology. The workgroup expressed some concern that existing “location based cost adjustments” insufficiently reflect true needs where hospitals are inaccessible
Restrict access to private hospital providers
Two bucket approach to allocating IHCIF
HRSA health professional shortage designation scores
Access to health facility construction system
Interim Action: (1) Develop a measure based on Priority One denials. (2) Increase weight on tribal size measure in current formula.

11. Alternate Resources Workgroup (non-IHS funding)
Sec requires counting ...”health resources available to an Indian tribe or tribal organization include health resources provided by the Service as well as health resources used by the Indian tribe or tribal organization, including services and financing systems provided by any Federal programs, private insurance, and programs of State or local governments.”
Review data sources of alternate resources related to Medicare, Medicaid, private insurance, etc.
Consider the feasibility of adopting or not adopting a new measure to replace the current 25% default for alternate resoureces
Workgroup has determined that there may be sufficient data to develop an alternate measure but is still working through limitations of the data
Responds to Congressional and GAO inquiries and concerns