1. Indian Health Service Portland Area Director’s Update
Dean M Seyler - Area Director
April 16, 2019
Swinomish Casino Resort
NPAIHB Quarterly Board Meeting

2. Indian Health Service Portland Area
The Accreditation Association for Ambulatory Health Care (AAAHC)
All six Federal service units achieved re-accreditation
Continuous Quality Improvement
All six are Patient Center Medical Home certified

3. Indian Health Service Portland Area
Procedures for Title AFA
Annual Funding Agreements (AFA’s) should be done each year. (no successors)
120-days prior to expiration a package will be sent to Tribe to review AFA (FY2019).
Tribe reviews and determines if update are needed along with SOW.
Draft CSC template will also be provided with package, to calculate initial Direct and Indirect for coming FY/CY period.
Unilateral vs. Bilateral amendments – Recommend tribes adopt Unilateral for a majority to speed up payments.

4. Indian Health Service Portland Area
Model Agreement/Contracts
Portland Area staff would like to review model contracts and Scopes of Work (SOW) with Tribes to ensure they are fully covered for:
Tort Claims – SOW should corresponded to services being delivered
CMS billing – Facilities should be listed in SOW and all services that are billed should be included
Partner Agencies – Terms of the Model Agreement ensures access to other services (GSA-Fleet Management, Federal Supply or VA contracts for Medical providers)

5. Indian Health Service Portland Area
Based on CSC policy IHS and Tribes must fully reconcile amounts once final actuals are determined.
Actuals from the Rate Agreement will be used to finalize amounts
Draft 2014 & 2015 Reconciliations are being prepared now and will start going out to Tribes.
Please review quickly and provide any follow-up information that could impact your calculations
Once agreement is reached a final Amendment for the FA or AFA will be issued to close out the reconciliation for that period.

6. Indian Health Service Portland Area
The Office of Tribal and Service Unit Operations is now fully staffed
Rena Macy, ISDEAA Specialist
Responsible for T1/TV negotiations
LCDR Jason Davis, Financial Analyst
CSC calculations, payment processing
Waleeska Knifechief, Program Assistant
Administrative support & tracking/distribution of AFA/FA and amendments

7. Indian Health Service Portland Area
Consolidated Appropriations Act, 2019
The total FY 2019 discretionary budget authority for IHS is $5.8 billion, which is a $266 million increase over the FY 2018 enacted funding level.
The bill includes a 1.9% pay raise for federal civilian employees.
Funds previously available for one fiscal year will now be available for two years (FY 2019 funds will expire on September 30, 2020).
Previously specified no year funding (e.g. facilities, collections, etc.) remains available until expended.

8. Indian Health Service Portland Area
FY 2021 National Tribal Budget Formulation Work Session
March 14-15, 2019, Crystal City/Arlington, Virginia
Tribal Representatives for Portland
Andrew Joseph, The Confederated Tribes of the Colville Reservation
Steve Kutz, Cowlitz Indian Tribe
Technical Support Team
Joe Finkbonner, NPAIHB, Executive Director
Laura Platero, NPAIHB, Policy Analyst
CAPT Ann Arnett, PAIHS, Executive Officer
Nichole Swanberg, PAIHS, Director, Division of Financial Management

9. Indian Health Service Portland Area
Indian Health Care Improvement Fund Workgroup
March 12-13, 2019, Crystal City/Arlington, Virginia
Tribal Representatives for Portland
Steve Kutz, Cowlitz Indian Tribe
Gail Hatcher, Klamath Tribes
Technical Support Team
Laura Platero, NPAIHB, Policy Analyst
CAPT Ann Arnett, PAIHS, Executive Officer
Nichole Swanberg, PAIHS, Director, Division of Financial Management

10. Part 2, Chapter 3, "Purchase/Referred Care"
Indian Health Service
Portland Area
Indian Health Manual
Part 2, Chapter 3, "Purchase/Referred Care"
Signed by the Principal Deputy Director on February 28, 2019.
Some key changes were made to the following:
Management of Purchased/Referred Care Funds
Deferred Services
Persons to Whom PRC Will Be Provided
Exception to the IHS Payor of Last Resort
Tribal Self-Insurance Plans.

11. FY18 Catastrophic Health Emergency Fund
Indian Health Service
Portland Area
FY18 Catastrophic Health Emergency Fund
Status as of March 27, 2019
76 total cases
51 amendments
$3,313, in reimbursements
$127, pending reimbursements
96% Reimbursed

12. FY19 Catastrophic Health Emergency Fund
Indian Health Service
Portland Area
FY19 Catastrophic Health Emergency Fund
Status as of March 27, 2019
5 total cases
1 amendment
$158, in reimbursements
$0.00 pending reimbursement
100% reimbursed to date
Online CHEF tool

13. Indian Health Service Portland Area
Office of Clinical Support – Pharmacy & EHR Consultant
Meetings & Trainings
IHS-HIM Quarterly Meeting – April 1-5
IHS National Council of Informatics – Monthly
IHS SW Pharmacy Conference – April 12-14
EHR Advanced TIU Training – April 15-19
IHS Antimicrobial Stewardship Program – Monthly
EHR Clinical Reminders Training – May 13-17
IHS Partnership Conference – June 11-13
EHR Integrated Behavioral Health Training (tentative) – June 24-28
RPMS-EHR
Windows 10 issues
Sexual Orientation Gender Identification Project
Electronic Prescribing of Controlled Substances
Pharmacy Drug Disposal Program
Naloxone Co-Prescribing
IHS Adverse Event Reporting System (WebCident) Replacement

14. Indian Health Service Portland Area
Office of Clinical Support – Upcoming Trainings
Working Together to Create Healthier Communities for Native Youth: An Action Planning Session
April 23, 2019
2019 American Indian and Alaska Native National Behavioral Health Conference
May in Albuquerque, NM
May 14th-17th - Annual Portland Area Dental Meeting

15. Indian Health Service Portland Area
Office of Clinical Support – Upcoming Trainings
May 29th-30th - OSAP/ IHS Infection Control Workshop
Link to Registration:
June 10th- 13th - National Biannual IHS Dental Updates
Kalispel Tribe’s “Spring 2019 Physical Activity Challenge” – April 8 – June 16
Burns Paiute Tribe will be Hosting:
Adult Mental Health First Aid Workshop – May 5
Tobacco Cessation Training – May 6-7

16. Indian Health Service Portland Area
Office of Clinical Support – Diabetes Consultant
SDPI FY 2019 Data Infrastructure Funding
Has been distributed directly to SDPI grantees
Contact LCDR Kathi Murray for information or questions
Nutrition Services Clinic at Western Oregon SU
Diabetes Prevention Program Lifestyle Coach Training – April 30th - May 1st
Hosted by the Cowlitz Indian Tribe
Free to attend; to register, contact Alyssa Fine
IHS Division of Diabetes, 2019 Diabetes in Indian Country Conference
August 6-9 in Oklahoma City, OK
Free to attend; additional details and registration at:
LCDR Kathi Murray – last day at Portland Area Office, April 30th.

17. Indian Health Service Portland Area Division of Health Facilities Engineering (DHFE)
FY 19 Facilities Appropriation Update
Backlog of Essential Maintenance, Alteration, and Repair (BEMAR)
Includes Another Special Appropriation to be Applied to BEMAR
Portland Area Share is $2.766M
DHFE Will Send Request for Tribal Project Proposals in May
Only Previously Reported Facility Deficiencies Are Eligible
Portland Area Facilities Advisory Committee (PAFAC) Will Be Requested to Assist with Tribal Project Prioritization
Supportable Space Data Call
24 of 43 Tribal Programs Replied and Updated Information

18. Indian Health Service Portland Area Division of Health Facilities Engineering (DHFE)
FY 19 Facilities Appropriation Update
Small Ambulatory Program (SAP)
Approximately $15M Allocated for 2019
Request for Proposals in April

19. Indian Health Service Portland Area
2019 IHS Funding for Sanitation Facilities Construction
2019 Consolidated appropriation resulted in 0.54% increase in construction funding over last year.
The Tribe’s needs continue to exceed available funding.
The Law reiterated that funds must be obligated* through signed MOAs. *Please help us help you by returning MOAs in a timely manner.
Preparation for 2020 SFC Funding:
Identification of potential 2020 projects.
Housing Developments
Sanitation Deficiencies (existing water/sewer infrastructure)
The Tribes should be hearing from District Engineers and staff over the next three months.

20. Indian Health Service Portland Area
Indian Health Service Announces New Office of Quality
Will provide leadership and promote consistency in health care quality across the agency by consolidating and enhancing oversight of these efforts at IHS headquarters.
Implementing a centralized credentialing software system
Creating a National Accountability Dashboard for Quality
Establishing patient wait time standards
Developing a Patient Experience of Care Survey
Developing the Partnership to Advance Tribal Health, in collaboration with the Centers for Medicare & Medicaid Service

21. Indian Health Service Portland Area
Tribal Leader Letters
March 12, 2019
March 15, 2019
February 27, 2019

22. IHS Strategic Plan FY
2019
IHS Strategic Plan FY

23. What’s New? Timeline Additional Content related to:
IHS Strategic Plan FY
2019
What’s New?
Timeline FY
Additional Content related to:
Introduction / Background
Performance
Strategic Plan Development
Minor language updates:
Goals
Objectives
Strategies
Appendices
Crosswalks

24. Management and Operations
IHS Strategic Plan FY
2019
IHS Strategic Plan FY
Mission: To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
Vision: Healthy communities and quality health care systems through strong partnerships and culturally responsive practices.
Access
Goal 1: To ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people.
Quality
Goal 2: To promote excellence and quality through innovation of the Indian health system into an optimally performing organization.
Management and Operations
Goal 3: To strengthen IHS program management and operations.

25. IHS Strategic Plan FY
2019
Goal 1 - Access
To ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people.
Objective 1.1: Recruit, develop, and retain a dedicated, competent, and caring workforce.
12 Strategies
Objective 1.2: Build, strengthen, and sustain collaborative relationships.
5 Strategies
Objective 1.3: Increase access to quality health care services.
14 Strategies

26. IHS Strategic Plan FY
2019
Goal 2 - Quality
To promote excellence and quality through innovation of the Indian health system into an optimally performing organization.
Objective 2.1: Create quality improvement capability at all levels of the organization.
8 Strategies
Objective 2.2: Provide care to better meet the health care needs of American Indian and Alaska Native communities.
6 Strategies

27. Goal 3 – Management and Operations
IHS Strategic Plan FY
2019
Goal 3 – Management and Operations
To strengthen IHS program management and operations.
Objective 3.1: Improve communication within the organization with Tribes, Urban Indian Organizations, and other stakeholders, and with the general public.
6 Strategies
Objective 3.2: Secure and effectively manage the assets and resources.
10 Strategies
Objective 3.3: Modernize information technology and information systems to support data driven decisions.
9 Strategies

28. Implementation of the Strategic Plan
IHS Strategic Plan FY
2019
Implementation of the Strategic Plan
Road map that will guide IHS forward over the next five years.
Implementation is no small task and requires input from across IHS.
Everyone has a role and stake in its success.
IHS employees are expected to identify how their work contributes to the IHS Strategic Plan.
Anyone can provide feedback on the plan and ideas for implementation by ing:

29. Resources IHS Strategic Plan web site Questions or comments?
IHS Strategic Plan FY
2019
Resources
IHS Strategic Plan web site
Download a PDF version
DTLL/UIOLL link
Download Response to Comments
Questions or comments?

30. Indian Health Service Portland Area
Spring 2019 Portland Area Clinical Director’s Meeting
April 25-26, 2019
World Trade Center, Portland OR
Contact Dr. Rudd for details/agenda
Follows the Northwest Clinicians Cancer Update- April 24, 2019 at Residence Inn Downtown/River Place

31. Indian Health Service Portland Area
HRSA- Shortage Designation Modernization Project: Auto-HPSAs
HPSA= Health Profession Shortage Area
Score assigned in three realms:
Primary Care
Dental Care
Mental Health
Used in targeting resources for:
National Health Service Corps (NHSC)
NURSE Corps
IHS Loan Repayment Program
Auto-HPSA- HRSA devising approach to automate updating of HPSA scores from available data sources.

32. Indian Health Service Portland Area
National Update of Auto-HPSAs
Tentatively planned for this Spring/Summer
Series of Auto-HPSA preview reports in advance
Raise awareness of Auto-HPSAs
Provide scoring transparency
Enable HRSA to provide technical assistance
Submit supplemental data to change Auto-HPSA scores
facility-specific data
fluoridation status, alcohol misuse rate and substance misuse rate data.
Work with State Primary Care Offices (PCOs) to ensure provider data are correct and identify appropriate Nearest Sources of Care

33. Indian Health Service Portland Area
Shortage Designation Modernization Project Summary
No changes to HPSA scores have occurred at this time.
Current participants will not be impacted.
National update is tentatively planned for spring/summer 2019.
There are things that organizations can do to change their scores.
Before the update takes place:
Collect facility-specific
Collect supplemental data
Work with State Primary Care Offices on the provider data
Contact with questions or requests for briefings.

34. Questions or Comments
Our Mission... to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.
Our Foundation... to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.