1. IHCIA and Long-Term Care
Sonosky, Chambers, Sachse,
Miller & Munson, LLP
IHCIA and Long-Term Care
National Indian Health Board
National Tribal Health Reform Implementation Summit
Washington D.C.
April 20, 2011
Myra M. Munson, J.D., M.S.W.
Washington, DC Juneau, AK Anchorage, AK Albuquerque, NM San Diego, CA

2. Sonosky, Chambers, Sachse, Miller & Munson, LLP
Authority and Policy
*Sec. 2 Findings – New provision: “(2) A major national goal of the U.S. is to provide the resources, processes, and structure that will enable Indian tribes and tribal members to obtain the quantity of health care services and opportunities that will eradicate the health disparities between Indians and the general public of the U.S.”
*Sec. 3 Policy – Acknowledgement of “special trust responsibility and legal obligations to Indians.”
Sonosky, Chambers, Sachse, Miller & Munson, LLP
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3. Sonosky, Chambers, Sachse, Miller & Munson, LLP
Objectives
*For the first time they are the same as for the rest of the Nation. Healthy People 2010 ( or successor standards). See, 25 U.S.C. § 1603(2); IHCIA Sec. 3(2)
* Applies to Urban Indian Health Programs
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4. Sonosky, Chambers, Sachse, Miller & Munson, LLP
2020 Objectives Address
access; adolescent health; arthritis, osteoporosis & chronic back conditions; blood disorders & blood safety; cancer; chronic kidney diseases; diabetes; disability & secondary conditions; early/middle childhood; education & community-based programs; environmental health; family planning; food safety; genomics; global health; health communication and IT; health care associated infections; hearing & other sensory communication disorders; heart disease & stroke; HIV; immunizations & infectious diseases; injury & violence prevention; maternal, infant & child health; medical product safety; mental health; nutrition & weight status; occupational safety & health; older adults; oral health; physical health & fitness; public health infrastructure; quality of life & well-being; respiratory diseases; sexually transmitted diseases; social determinants of health; substance abuse; tobacco; vision
Sonosky, Chambers, Sachse, Miller & Munson, LLP
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5. What Services Can Be Provided by an Indian Health Program?
Any Service to Achieve the Objectives in §1602(2).
Health Promotion/Disease Prevention (25 U.S.C. §1603)
Traditional Health Care Practices. Expressly authorizes the Secretary to promote traditional health care practices, but limits liability of United States for provision of such services. (25 U.S.C. § 1680u; IHCIA Sec. 831)
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6. Other Supportive Services 25 U.S.C. § 1621d ; IHCIA Sec. 205
Assisted living service, as defined in 12 USC 1715w(b), except need not be licensed, but must meet applicable standards for licensure
Home- and community-based service means 1 or more services specified in 42 USC 1396t(a)(1)-(9) that are or bill be provided in accordance with applicable standards
Hospice care all items and services in 42 USC 1395x(dd)(1)(A)-(H) and “such other services the THO determines are necessary and appropriate in furtherance Of that care
Long-term care services as defined in section 7702B(c) of the Internal Revenue Code of 1986
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7. Sonosky, Chambers, Sachse, Miller & Munson, LLP
OTHER OPPORTUNITIES
Shared Services for Long-Term Care. 25 U.S.C. § 1680l; IHCIA Sec. 822
Expressly authorizes sharing staff and other services between IHS or tribal health program and tribally operated long term care or related facility.
Indian Health Care Delivery Demo. 25 U.S.C. § 1637; IHCIA Sec. 307
Encourages demonstration projects to test alternative means of delivering health services to AI/ANs through facilities and through alternative and innovative methods like community health centers and cooperative agreements with other community providers for sharing or coordinating use of facilities, funding, and other resources
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8. AI/ANs VETERANS Streamlining and Opportunity
Sharing arrangements authorized between IHS, Tribes and Tribal Organizations, and VA and DoD. 25 U.S.C. § 1645; IHCIA Sec. 405(a)
Requires VA and DoD to reimburse IHS and Tribal health programs for services provided to beneficiaries of VA or DoD; 25 U.S.C. § 1645(c); IHCIA Sec. 405(c)
Collaborations authorized between VA and IHS/Tribal health programs at Indian health program locations. 25 U.S.C. § 1647; IHCIA Sec. 407.
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9. Other Options to Obtain Care
*Purchasing Health Care Coverage. 25 U.S.C. § 1642; IHCIA Sec. 402.
IHS funds made available to an I/T/U (including ISDEAA funds) may be used to purchase health benefits coverage for beneficiaries
May consider need of beneficiaries
May cover expenses for a self-insured plan, including administration and insurance to limit financial risks
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10. More Acknowledgement of the Need for Long-Term Care
Indian Health Care Improvement Fund now includes long-term care in clinical care. 25 U.S.C. § 1621(a)(5)(A); IHCIA Sec. 201
Report to Congress regarding facility needs now includes specialized health care facilities, including long-term care facilities. 25 U.S.C. § 1631; IHCIA Sec. 301.
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11. SERVING NON-BENEFICIARIES Authority and Opportunity
Health Services for Ineligible Persons. 25 U.S.C. § 1680c; Sec. 813;
Eliminates requirement that Tribal health programs consider whether there are alternative services and expressly extends FTCA coverage
Does not allow IHS to serve non-beneficiaries without approval of tribes in the Service Unit
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12. Sonosky, Chambers, Sachse, Miller & Munson, LLP
Licensing and Fees
Non-Discrimination in Qualifications for Reimbursement. Provides for payment of I/T/U programs by any Federal health care program without regard to licensed status so long as meet other generally applicable requirements for participation (with an exception for Sec. 221) (25 U.S.C. § 1647a; IHCIA Sec. 408).
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. (25 U.S.C. § 1616q; IHCIA Sec. 124). Unfortunately, this exemption does not expressly exempt the facilities from fees.
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