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