142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

"638 Toolkit" Considerations for Tribes Regarding Contracting for Clinical Services from the IHS

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 9:30 AM - 9:50 AM

Donald Warne, MD, MPH , Master of Public Health Program, North Dakota State University, Fargo, ND
The "638 Toolkit" is intended to assist tribes in evaluating the feasibility of assuming the management of Indian Health Service (IHS) clinics under an Indian Self-Determination & Education Assistance Act (ISDEAA—PL 93-638) Contract or Compact.  Each tribe is unique and will therefore have unique considerations in this process.  The purpose of the toolkit is to provide an initial outline of factors to consider in beginning the feasibility analysis.  In this session, the toolkit will be described and made available to participants. Key components include:

Community Demographics

Health Status

Role of Medicaid and Third Party Revenue

Contract Health Services—basis for health services purchasing power.

Current ISDEAA Contracted Services—Current ISDEAA budget and management history.

Current IHS Budget—Previous three fiscal years form the basis for budget projections.

Contract Support Costs—The tribal Indirect Cost Rate (IDC) is used to calculate Contract Support Costs revenue.

New Tribal Revenues—Multiple funding streams are available to Tribes for which IHS is not eligible. 

Contractible Services Retained at IHS—Some services might be better left with the IHS to manage. 

Patient Protection and Affordable Care Act Opportunities

Facility Issues—A facilities analysis is needed to assess the current facility.

Title I v Title V Considerations—Tribal self-governance is founded on the government-to-government relationship and is designed to be more flexible for tribes than Title I contracting. 

Federally Qualified Health Center Opportunities

The Toolkit contains specific information tribes need to consider, including: Overview of Key Datasets; Community and Stakeholder Outreach; Determination of Available Funding; Current Health Policy Considerations; Title I Contracting v Title V Compacting; and Collaboration and New Revenue Opportunities.

Learning Areas:

Administration, management, leadership
Advocacy for health and health education
Program planning
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Discuss the advantages of tribal control in the delivery of health services. Describe the key considerations for tribes in the "638" process. Identify potential barriers in the conversion to tribal management of health services.

Keyword(s): Health Law, Native Americans

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of the Master of Public Health Program at North Dakota State University. I wrote the "638 Toolkit", and I have worked with numerous tribes in the 638 process. I completed a Fellowship in Minority Health Policy from Harvard Medical School as part of my MPH training, and I have my MD from Stanford University. I have worked as a clinician in both IHS and Tribal 638 facilities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.