Community Health Aide Program

Refer to: OCPS

1. PURPOSE.  To establish the organization and administration of the National Community Health Aide Program (CHAP).
2. SCOPE.  This policy implements the statutory requirements of the Indian Health Care Improvement Act (IHCIA) that apply to CHAPs operated by the Indian Health Service (IHS) or by Indian Self-Determination and Education Assistance Act (ISDEAA) contractors in the contiguous 48 states outside of Alaska.  This policy does not apply to Urban Indian Organizations (UIOs) because UIOs are not legally authorized to implement a CHAP.
3. BACKGROUND.  The CHAP was developed in Alaska in the 1960s in response to health concerns in remote rural Alaska Native communities, including the tuberculosis epidemic.  Formally recognized in 1968, the Alaska CHAP was codified in 1992 in the IHCIA.  Since then, it has evolved to provide primary and emergent medical care, dental care, and behavioral health care services.  In 2010, Congress authorized the IHS to nationalize the CHAP to advance the health status objectives of the IHCIA.
4. AUTHORITY.  The IHCIA, as amended, provides authority for the nationalization of the CHAP as well as program requirements and Federal responsibilities related thereto; Indian Health Care Improvement Act, 25 U.S.C. § 1616l.
5. DISCIPLINES.  Subject to the authority established herein, the CHAP shall consist of three health aide disciplines:  community health aides, dental health aides, and behavioral health aides.
6. POLICY.
   1. National CHAP implementation will honor the distinct Tribal-Federal partnership that makes the CHAP a unique response to the health care needs of Tribal communities.
   2. The National CHAP will be implemented with the Federal infrastructure necessary to support the implementation of CHAPs in the contiguous 48 states (including in CHAPs operated by ISDEAA contractors), with the mutual goal of promoting access to safe and quality patient care.
   3. The IHS Federal direct care programs in the contiguous 48 states may employ and utilize CHAP providers in all allowed disciplines as part of their existing health programs.  This would include those programs that employ dental health aide therapists (DHATs) in states authorizing the use of DHATs.  The IHS may not fill any Federal vacancy for a licensed dentist with a DHAT, in accordance with 25 U.S.C. § 1616l(d)(4), in the contiguous 48 states. 
   4. As established and recognized by the IHS Director in Area(s) with CHAP(s), Area Certification Boards (ACBs) are Federal Certification Boards authorized by the IHS Director and located in the 11 IHS Areas in the contiguous 48 states.  The ACBs operate under a charter proposed by the ACB members and approved by the IHS Area Director.  The ACBs will be comprised of Federal and Tribal representatives, and their membership must include one Federal representative appointed by the respective IHS Area Director.  The ACB charter defines board composition.  The ACBs may contract with a Tribe and/or Tribal Organization under the ISDEAA to carry out the program support for the operation and maintenance of the ACB.  As a Federal board, the ACBs must comply with Federal laws, including the Federal Records Act, where applicable.
   5. In accordance with the IHCIA, 25 U.S.C. § 1616l(d)(2)(A), the IHS shall not reduce funding amounts of the Alaska CHAP.
7. RESPONSIBILITIES. 
   1. Director, IHS.  Authorizes and establishes ACBs in accordance with the guidelines set forth in the IHCIA, 25 U.S.C. § 1616l, to ensure that health aides are equipped with the necessary qualifications and skills to provide high-quality care and support.
   2. IHS Chief Medical Officer (CMO).  Chairs the National Community Health Aide Program Board (NCHAPB).  Accepts nominations of Tribal representatives to serve on the NCHAPB.  Appoints members of the NCHAPB.  Ensures that NCHAPB members shall not represent the interest of any professional association and will be comprised of representatives from across IHS Areas.  The IHS CMO will make a good-faith effort to ensure that the membership of the Board reflects the diversity of the geographic areas served and includes Tribal practitioners and Tribal administrators with relevant expertise.
   3. IHS Area Directors.  Consults with Area Tribes for suggestions of individuals to appoint to the ACB Recommends an IHS employee to serve as the Federal representative to serve on the ACB. Makes recommendations of these individuals to the CMO for appointments to the NCHAPB.  Provides ACB members with direction to establish board composition in its charters and to develop the procedures of each respective board.  The IHS Area Directors, upon the recommendation of their recognized ACB (pursuant to 7.G.2), are hereby delegated authority to provide the Federal certification of CHAP health aides.  Approves and signs individual certification documents for CHAP providers.
   4. National CHAP Board.  The NCHAPB is a permanent national IHS board responsible for supporting Tribal and Federal CHAPs, establishing and maintaining minimum CHAP standards and procedures in the contiguous 48 states, and overseeing CHAP ACBs.
   5. Area Certification Board.  The ACB will adopt standards and procedures in compliance with the National CHAP standards and procedures (National S&Ps) to recommend certification of health aides within their respective disciplines.  The ACBs will recommend approved education and training programs and continuing education requirements within their respective disciplines to the NCHAPB Chair or their designee.
8. NATIONAL COMMUNITY HEALTH AIDE PROGRAM BOARD.
   1. The NCHAPB is a Federal board which serves under the authority of the IHS Director.  As a Federal board, the NCHAPB must comply with Federal laws, including the Federal Records Act.
   2. The NCHAPB may delegate authority to an ACB to represent another Area that is establishing or awaiting recognition of an ACB, or chooses not to establish an ACB.
   3. Membership and Officers.
      1. Officers.  The IHS CMO (or their designee) is the NCHAPB chair.  A Vice Chair shall be elected annually by the members of the NCHAPB and shall represent a Tribally operated program.
      2. Members.  In addition to the Chair, NCHAPB membership includes a representative from each of the 12 IHS Areas by either a Federally operated or Tribally operated program.  At no time shall the number of Area representatives from Federally operated programs exceed those from Tribally operated programs.  Upon the request of the Chair, prospective members are nominated by their respective IHS Area Director, and nominees selected by the NCHAPB officers shall be submitted for appointment by the IHS Director, or delegated to the CMO.  Appointed members serve a term of two years; however, upon re-nomination and selection, they may be appointed for multiple terms.
      3. Board Composition.  The officers shall ensure that the NCHAPB membership always includes at least one Area representative in each of the disciplines:  licensed physician, licensed dentist, and licensed behavioral health provider; preferably with knowledge and experience of the CHAP.
   4. Quorum.  A quorum shall consist of the Chair, Vice-Chair, and a majority of the remaining appointed members of the Board.
   5. Meetings.  The Board shall meet no less than three times annually and may hold special meetings at the call of the Chair or on the written request of five Board members.  Meetings may be held by teleconference when necessary.
   6. Duties and Powers of the NCHAPB in the contiguous 48 states:
      1. Develop, establish, and maintain minimum standards for training, education, continuing education, and supervision of health aides based on the accepted National CHAP standards and procedures;
      2. Upon the written request of an IHS Area Director, review eligibility, subject to the national standards and procedures, and make recommendations to the IHS Director regarding the establishment, scope, and recognition of an ACB;
      3. Provide oversight and assist ACBs regarding compliance with the National S&Ps;
      4. Approve forms for applications, certificates, and other records following applicable Federal statutes.  The ACBs may develop forms for internal use for the operation of the ACBs per applicable standards and procedures;
      5. Ensure support for reciprocity between IHS Areas for appropriately qualified health aides based on approved training;
      6. The ACBs are delegated to review the standards and procedures in the Areas they cover with proposed updates and modifications for the population served.  The NCHAPB must approve any revisions or proposed changes;
      7. The NCHAPB may deny the establishment of, or revoke or suspend the operations of, an ACB for failure to meet the minimum National S&Ps; and
      8. Representatives from each ACB should meet annually to review National S&Ps to recommend revisions and updates to National S&Ps.  This will include a designated subject matter expert from each discipline from each ACB.
9. AMENDMENTS.  Any recommendations for changes to this Circular require a majority vote by NCHAPB members.  Changes required to ensure compliance with Federal law or policy are not subject to the recommendations of the NCHAPB members.  Approval of changes is subject to approval by the IHS Director.
10. SUPERCEDURE.  This Circular supersedes IHS Circular 20-06, Community Health Aide Program, dated June 10, 2020.
11. EFFECTIVE DATE.  This Circular becomes effective on the date of signature.

Distribution: IHS-wide
Date:11/07/2024