Introduction Of The Indian Health Care Improvement Act Reauthorization In Fy 2003
Mr. Speaker, I rise today to introduce amendments to the Indian Health Care Improvement Act. I am pleased to be joined in the co-sponsorship of this measure by both Republican and Democratic members of the U.S. House of Representatives.…
Mr. Speaker, I rise today to introduce amendments to the Indian Health Care Improvement Act. I am pleased to be joined in the co-sponsorship of this measure by both Republican and Democratic members of the U.S. House of Representatives.
The Indian Health Care Improvement Act (IHCIA) became Public Law 94- 437 in the 94th Congress (September 30, 1976), and was amended by:
P.L. 96-537--December 17, 1980;
P.L. 100-579--October 31, 1988;
P.L. 100-690--November 18, 1988;
P.L. 100-713--November 23, 1988;
P.L. 101-630--November 28, 1990;
P.L. 102-573--October 29, 1992; and
P.L. 104-313--October 19, 1996.
The purpose of the Act is to implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging the maximum participation of American Indians and Alaska Natives in such programs, and other purposes.
The IHCIA provides for health care delivery to over 2 million American Indians and Alaska Natives. Congress enacted a one-year extension to extend the life of the Act through FY 2001 but efforts at further extensions were interrupted due to 9/11/01 events. Appropriations for Indian health have continued through authorization of the Snyder Act, a permanent law authorizing expenditures of funds for a variety of Indian programs, including health. For FY 2003, Congress appropriated $2.9 billion to help provide health care services to American Indians and Alaska Natives. The IHCIA requires Reauthorization this year.
Since 1998, the Indian Health Service (IHS) started the reauthorization process under the IHS's Tribal Consultation Policy by conveying
a Roundtable to begin the discussion of the reauthorization and to give guidance to the consultation process which included all stakeholders, I/T/U (Indian Health Service/Tribes/Urban).
Coordinators from the 12 IHS areas formed workgroups of I/T/U and National Indian Health Board (NIHB) representatives. These meetings were to inform the I/T/U's about the reauthorization process, and provide opportunities to discuss and reach consensus on recommendations for the Act.
Four regional consultation meetings were held to provide further opportunities for I/T/U's to provide input, share recommendations from the 12 IHS Areas, and build consensus among participants for a unified position. The final report entitled ``Speaking with One Voice'' identified areas of consensus and differences.
The IHS Director convened a National Steering Committee (NSC) to be responsible for the final drafting of the report on the IHCIA recommendations. The NSC is composed of one elected and one alternative tribal representative from each of the 12 IHS Areas, a representative from the National Indian Health Board, National Council of Urban Indian Health, and the Self-Governance Advisory Committee. During the course of the 4 meetings, this group's responsibility evolved from compiling a final report of recommendations to the drafting of the actual IHCIA reauthorization bill language.
During the last year and a half, House Resources Committee, Office of Native American and Insular Affairs Committee staff, Cynthia A. Ahwinona, has traveled to ``American Indian and Alaska Natives country'' to observe the work of the NSC of the tribal leaders comprised to propose IHCIA reauthorization revisions to Congress. The draft bill was drafted by dozens of tribal attorneys and had technical, legal citation errors and, in some instances, was drafted very poorly and did not accomplish what was intended by the NSC.
As consensus was arrived, House Resources Committee and several members of the NSC met with House Legislative Counsel, Lisa Daly, Edward Grossman and Pierre Poisson in person and via teleconference to start the redrafting of the bill. Invited participants included both the Republican and Democratic health staff of the House Resources Committee and the Senate Committee on Indian Affairs, a representative from the National Indian Health Board, representatives of the IHS, and tribal attorneys from the NSC.
I want to personally thank Lisa Daly, Edward Grossman and Pierre Poisson of the House Legislative Counsel, Myra Munson of Sonosky, Chambers, Sachse, Endrieson and Perry, LLP. and Carol Barbero of Hobbs, Straus, Dean and Walker for all their efforts in the drafting of this bill. Thank you all, you have done a wonderful job. Attached is brief summary of each Title of the Indian Health Care Improvement Act Reauthorization of FY 03.
Indian Health Care Improvement Act Reauthorization of FY 03
Section 1. Short Title.
Section 2. Findings. Sets forth the national goal of the
U.S. in providing the quantity and quality of health services
to bring the health status of Indians to the highest possible
level.
Section 3. Declaration of Health Objectives. Sets forth 6
Health Status Objectives to be reached by the year 2010.
Section 4. Definitions. States the definitions of terms
used throughout the Act.
title i. indian health manpower
The purpose of this title is to increase, to the maximum
extent feasible, the number of American Indians and Alaska
natives entering the health professions. It also seeks to
assure an adequate supply of health professionals to the
Service, Indian tribes, tribal organizations, and urban
Indian organizations involved in the delivery of health care
to American Indians and Alaska natives. This title covers
recruitment, scholarships, extern programs, continuing
education, community health representatives, loan repayment,
advanced training and research, nursing, tribal cultural and
history, inmed, health training, incentives, residency,
community health aide for Alaska, and a University of South
Dakota pilot project.
title ii. health services
The purpose of this title is to establish programs that
respond to the health needs of American Indians and Alaska
natives. For example, American Indians and Alaska natives
have a disproportionately high rate of diabetes (death rate
for this disease is more than 300% of the rate for the U.S.
population generally), so this title has a specific diabetes
provision. It also includes the Indian Health Care
Improvement Fund through which the Appropriation Acts supply
funds to eliminate health deficiencies and disparities in
resources made available to American Indians and Alaska
Native tribes and communities. This title contains
catastrophic health emergency fund; health promotion and
disease prevention services; diabetes prevention, treatment
and control; hospice feasibility; research; mental health;
managed care feasibility; Arizona, North Dakota, South
Dakota, Trenton and California contract health services
programs; mammography; patient travel; epidemiology; school
health education; Indian youth; psychology; tuberculosis;
environmental and nuclear health hazards and women's health.
title iii. facilities
The purpose of this title relates to the construction of
health facilities, including hospitals, clinics, and health
stations including necessary staff quarters, and of
sanitation facilities for Indian communities and homes. It
also would require the IHS to annually report on Indian
Health Service/Tribes/Urban (ITU's) needs for inpatient,
outpatient and specialized care facilities, including
renovation of existing facilities. It also would require
newly-constructed/renovated facilities, whenever practicable,
to meet the construction standards of any nationally
recognized accrediting bodies. There is also a provision to
waive the Davis-Bacon when a tribe has its own wage law and
performs the construction project instead of IHS.
title iv. access to health services
The purpose of this title is to address payments to the IHS
and tribes for services covered by Social Security Act Health
Care programs, and to enable Indian health programs to access
reimbursements from third party collections. This title
states that any payments received by a hospital or skilled
nursing facility of the IHS for services provided to American
Indians and Alaska Natives eligible for benefits under the
Social Security Act Health Care programs will not be
considered in determining appropriations for health care of
American Indians or Alaska Natives.
Requires the Secretary to enter into agreements with
tribes, tribal organizations and urban Indian organizations
to assist them in enrolling qualified Indians in Medicare,
Medicaid and SCHIP (State children's health insurance
program), and to enable tribes to pay premiums for coverage.
Authorizes the Secretary to enter into agreements with I/T/
U's for receipt/processing of Medicaid/Medicare/SCHIP
applications. Condition continuing approval of State Medicaid
plan on taking steps to provide for Medicaid enrollment on
reservations, and to obtain input from tribes in the State on
matters relating to impact of changes in the State plan on
Indian health programs. If tribe/tribal organizations
performs outreach, the agreement may provide for 100%
reimbursement of costs and assures that 100% FMAP (Federal
Medical Assistance Payment) continues to apply to Medicaid
and SCHIP services provided by tribes/tribal organizations
who directly bill for the services they provide. Ensures that
insurance companies must reimburse I/T/U's for the services
they provide. Ensure that managed care plans must reimburse
I/T/U's for the services they provide.
Authorize IHS and tribal programs to receive reimbursement
for all Medicare Part B services and eliminates ambiguity
about Medicaid coverage. Authorizes Federal/State/tribal
agreements for tribal operation of Indian SCHIP programs;
places a Medicare-like rate ceiling on hospital services
purchased under the IHS's Contract Health Service program;
directs the Secretary of HHS to study the Medicare and
Medicaid payment methodology for Indian health programs and
report to Congress; and directs the Secretary to establish a
National Indian Technical Advisory Group to assist the
Secretary in identifying and addressing issues regarding the
health care programs under the Social Security Act (including
medicare, medicaid and SCHIP) that have implications for
Indian Health Programs or Urban Indian Organizations.
title v. health services for urban indians
The purpose of this title is to establish programs in urban
centers to make health services more accessible to Indians
who live in urban areas rather than on reservations or Alaska
Native villages. The Secretary through the IHS is authorized
to enter into contracts or grants to urban Indian
organizations to help these agencies with establishing and
administering health programs which meet the requirements of
the IHCIA and will require evaluations renewals. Authorizes
the establishment of an Office of Urban Indian Health which
shall be responsible for carrying out the provisions of this
title, providing central oversight of the programs and
services authorized under this title and, providing technical
assistance to Urban Indian Organizations. The bill would also
extend FTCA (Federal Tort Claims Act) coverage to urban
Indian organizations (Federal law already extends FTCA
coverage to tribally-operated health programs).
title vi. organizational improvements
This title addresses the establishment of the IHS as an
agency of the PHS(Public Health Service). It covers the
appointment of the Director of IHS by the President and
confirmed by the Senate. This title also authorizes the
Secretary through the Director of IHS to establish an
automated management information system as well as other
duties as assigned by the Secretary for the IHS. Authorizes
appropriations to carry out this title.
title vii. behavioral health programs
This title is revised from current law (which only
addresses substance abuse programs) in order to focus on
behavioral health. It combines all substance abuse, mental
health and social service programs in one title and
integrates these programs to enhance performance and
efficiency. The title addresses the responsibilities of the
IHS as outlined by the Memorandum of Agreement pursuant to
the section 402 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986. The IHS will
determine the scope of the alcohol and substance abuse among
Indian people; they must assess the existing and needed
resources for prevention of alcohol and substance abuse and
the treatment of Indians affected. Finally, IHS must estimate
the funding necessary to adequately support a program of
prevention of alcohol and substance abuse and treatment of
Indians affected. The IHS will also provide a comprehensive
alcohol and substance abuse prevention and treatment
programs, a rehabilitation and aftercare services, IHS youth
program, and training and community education. In this
section demonstration projects are outlined as well as grants
focusing of Fetal Alcohol Syndrome and Fetal Alcohol effect.
It also expands the authorization to establish inpatient
mental health facilities in each Area. Authorizes funding for
development of innovative community-based behavioral health
services. The requirement of matching funds has been
eliminated here. Allows the Fetal Alcohol Disorder programs
to be funded under the ISDEAA (Indian Self-Determination and
Education Assistance Act). Provides for a program to treat
both the victims and the perpetrator of child sexual abuse.
And, has been expanded to allow Indian Tribes and Tribal
Organizations to obtain funding for behavioral health
research.
title vii. miscellaneous
The purpose of this title is to address various topics
including the President's reporting of the progress made in
meeting the objectives of this Act to Congress at the time of
submitting the budget. It also applies the Negotiated
Rulemaking Act to the development of IHCIA regulations. Other
provisions require the Secretary to develop a plan of
implementation to submit to Congress; describe the
eligibility of California Indians for IHS services and sets
out the conditions for the issue of Indian health funding as
an entitlement.
amendments to the social security act
Amendments to the Social Security Act appear at the end of
the bill. These provisions are necessary to reflect a number
of the objectives described above in the Title IV summary.