March 2012 Blogs

Walter Reed Army Medical Center Transfers $1.2M Excess Medical Equipment to IHS

In March 2012, the Indian Health Service Project TransAm acquired over 400 “like-new” medical equipment items from the now-closed Walter Reed Army Medical Center in Washington, D.C. Since July 2009, Project TransAm has been monitoring the hospital’s closure and involved in intensive communications with Army property management program personnel to secure these highly desirable items.

The Project TransAm team was led by LCDR Allen Bollinger (Nashville Area, Office of Environmental Health and Engineering), who expertly arranged and negotiated the quick ownership transfer and transportation of the medical equipment “cache.” When the equipment arrives at the Tennessee-based warehouse, property specialists and biomedical engineers will inventory and provide condition assessments. After the assessments are completed, programs can select from the advertised listing (see below). The equipment is valued at over $1.2M (in acquisition value), and over half of the equipment was purchased within the past year.

Remarkably, the IHS received the third largest amount of equipment (next to Tripler and Fort Lewis) due to Project TransAm officials’ quick actions, giving IHS the distinction of being the only non-DoD entity to receive medical equipment transfers.

Medical Equipment acquired through Project TransAm is available for tribally-contracted and IHS health programs to select from Exit Disclaimer: You Are Leaving www.ihs.gov . Specific inquiries should be directed to LCDR Bollinger or Mr. Geoff Elliott.

Established in 1995, Project TransAm has screened and transferred millions of dollars in medical equipment deemed excess by DoD to meet health system needs at tribally-contracted and IHS health programs. This reutilization of government-owned equipment remains a vital program in supplying the medical equipment needs of clinics and hospitals serving  American Indian and Alaska Native communities.

---

National Indian Health Outreach and Education Initiative Hosts Kick-Off Meeting in Washington, D.C.

In early February, I met with fourteen Indian Health Service Area representatives and national tribal health organizations to kick off the National Indian Health Outreach and Education (NIHOE) Initiative. During the 2-day meeting, Area representatives leading NIHOE initiatives in their community worked to develop a national outreach plan, including the development of educational materials for use in our communities.

Together with the National Congress of American Indians and National Indian Health Board, the Area representatives and IHS headquarters staff plan to develop effective, streamlined, consumer-oriented materials to assist American Indian and Alaska Native people to better understand their opportunities under the Affordable Care Act and Indian Health Care Improvement Act.

In the coming months, Area representatives and national organizations will work to complete and implement several educational tools for use in the tribal communities of each Area. Many of the tools are in development now and will be available in April on a website specifically for tribal stakeholders. In addition, the partners are hosting a national conference to assist communities in planning health reform education and outreach campaigns, learn more about the laws’ impact in tribal communities, and share nationally developed outreach materials.

Below is a picture of me with the NIHOE Kick-Off Meeting attendees.

Click on the thumbnail for a larger image

To learn more about and register for the national meeting, click here. Exit Disclaimer: You Are Leaving www.ihs.gov  I have also attached the draft agenda. [PDF - 221KB]

---

Affordable Insurance Exchanges and Indian Country

This week, HHS published a final rule on the establishment of Affordable Insurance Exchanges, which are new State-based competitive marketplaces created under the Affordable Care Act to provide all Americans access to affordable health insurance. Establishing these Exchanges is an extension of the Federal government’s responsibility to American Indians and Alaska Natives and will offer new opportunities to improve the health of Indian Country.

The final rule includes details on provisions included in the Affordable Care Act that will improve health care in Indian Country and makes clear IHS, Tribal, and Urban Indian Health providers will be paid for services they provide to AI/AN individuals with insurance.

The final rule builds on over two years of consultations with States, tribes, small businesses, consumers, and health insurance plans.

I would like to point out three important issues for Indian Country:

1. The law ensures AI/AN are able to take advantage of the new health insurance coverage opportunities. The final rule implements section 1311(c)(6)(D) of the Affordable Care Act that directs an Exchange to provide for special monthly enrollment periods for Indians and eliminates cost-sharing in private insurance coverage purchased through an Exchange for eligible Indians under 300 percent of the federal poverty level. The law ensures that anyone in the Indian Health Service can access services at IHS facilities without spending a penny out of their own pocket.

2. Consultation indicated that there was a preference that all IHS, Tribal, and urban Indian health (I/T/U) facilities be explicitly designated as Essential Community Providers (ECP). The final rule reiterates the statutory language regarding designation of ECP. The law and this rule specify that providers eligible for the HRSA 340B program including outpatient, tribally operated, and Urban Indian health programs are designated as ECP. Exchanges have discretion to designate additional providers as Essential Community Providers.

Two of the primary reasons that Tribes indicated that it was important to be included in the ECP designation was to encourage insurers in the Exchanges to include I/T/U providers in their networks and to ensure that full payment is made to I/T/U providers.

3. The Indian Health Care Improvement Act, reauthorized under the Affordable Care Act, includes section 206 that provides that all Indian providers have the right to recover from insurers up to the reasonable charges billed for providing health services, or, if higher, the highest amount an insurer would pay to other providers to the extent that the patient or another provider would be eligible for such recoveries. Insurers offering coverage on an Exchange could benefit from contracting with Indian health providers to coordinate care more effectively. For these reasons, I/T/U facilities are likely to be a part of the network and the recipients of competitive payment rates from the insurers. Section 206 will be addressed in future rule making.

There are many more benefits and opportunities for improving the health and well-being of Indian Country made possible by the Affordable Care Act. We look forward to continuing dialogue and consultation as we move forward with implementation.

HHS will discuss Affordable Insurance Exchanges Exit Disclaimer: You Are Leaving www.ihs.gov  in upcoming Regional consultation sessions during which Tribes can learn more about this and other Affordable Care Act activities important to the health of Indian Country.

---

HHS Tribal Budget Consultation

For those attending the Department of Health and Human Services Annual Tribal Budget Consultation this week in Washington, D.C., here is a document [PDF - 198KB] that summarizes the Indian Health Service’s FY 2011 accomplishments. We missed the deadline for inclusion of this file on the USB drive for the meeting and wanted to provide the electronic copy. A paper copy will be available at the registration desk. I am looking forward to the meeting, especially the presentation on the tribal recommendations on the IHS budget for FY 2014 that were developed as a result of the recent IHS tribal budget formulation process. We are grateful for the increases we have received the past few years and will continue to work to ensure we include tribal priorities in our budget requests. I am also looking forward to hearing tribal input on the budget and programs for all HHS operating divisions.

---

Update: VA/IHS Consultation

The Department of Veterans Affairs (VA) and the Department of Health and Human Services (HHS)/Indian Health Service (IHS) are initiating consultation to facilitate VA reimbursement for services provided by IHS and Tribal health facilities to Eligible American Indian and Alaska Native Veterans. Comments are due in 30 days from the date of the letter and an in person session will be held at the IHS Tribal Consultation Summit scheduled for March 13-14, 2012. Here is the copy of the letter and its attachment sent to Tribes:

• Download the Dear Tribal Leader Letter [PDF - 107KB]
• Download the VA IHS Draft Agreement [PDF - 116KB]

More information about the IHS Tribal Consultation Summit.

---

Update: Contract Support Costs Consultation

I sent a letter today to Tribes requesting input on two issues related to Contract Support Costs. Here is a copy of the letter [PDF - 25KB].

---

United South Eastern Tribes, Inc. (USET) Impact Week/Listening Session

I met with the USET Health Committee during USET Impact Week in Washington, D.C. I provided an update on IHS reform activities, answered questions, and listened to input from tribal representatives. This was a part of the Department of Health and Human Services Regional Consultation Session, and members of the Secretary’s Tribal Advisory Committee helped facilitate the session. Here are pictures from the meeting:

Click on the thumbnails for larger images

---

Aberdeen Area Tribal Listening Session

I met with the Aberdeen Area Tribes in a listening session in Aberdeen, SD, in February. I provided an update on our activities to change and improve the IHS, answered questions, and listened to input from the Tribes. Here are pictures from the meeting:

Click on the thumbnails for larger images

---

Commonwealth Fund/Harvard University Fellowship in Minority Health Policy

The current Commonwealth Fund/Harvard University Fellows in Minority Health Policy stopped by IHS for a tour and an overview of our operations. The fellowship is for mid-career physicians and involves coursework leading to a masters of public health degree and additional training in minority health policy issues. Here is the picture from the Fellows’ visit to IHS:

Click on the thumbnail for a larger image

---

Tribal Self-Governance Advisory Committee Quarterly Meeting

I met with the Tribal Self-Governance Advisory Committee at their quarterly meeting in February. Here’s a picture from the meeting:

Click on the thumbnail for a larger image

---

Contract Support Costs Workgroup

The new IHS Contract Support Costs (CSC) Workgroup met in February and began the work of evaluating the 2007 CSC Policy. The workgroup discussed their initial thoughts about issues related to CSC. As a result of the meeting, I asked all IHS Area Directors to re-verify that Tribes did receive notice from the Areas on their 2011 CSC data and had an opportunity to review this data as we develop the 2012 CSC Report to Congress. The CSC workgroup will continue its evaluation of the 2007 CSC Policy at the next meeting. Here’s a picture of the workgroup:

Click on the thumbnail for a larger image

---

IHS Tribal Consultation Summit Update

The Indian Health Service (IHS) is hosting the IHS Tribal Consultation Summit on March 13-14, 2012, in Arlington, Virginia. The Summit's purpose is to provide Tribal Leaders a one-stop-shop opportunity to learn about current IHS Tribal Consultation activities and workgroups and to provide feedback and recommendations on current IHS consultation topics. Tribal leaders, administrators, health directors, federal staff, and other interested parties are encouraged to attend. More information is available on the IHS Tribal Consultation website, including the draft agenda and hotel information. We plan to hold another Tribal Consultation Summit in July in Denver, CO.