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The Indian Health System SHIP Conference June 10,2007

The Indian Health System SHIP Conference June 10,2007. Dorothy, Dupree Director, Tribal Affairs Group Office of External Affairs, CMS. Presentation Purpose. General Understanding of Indian Health System CMS and the American Indian/Alaska Native (AI/AN) Health System Your Questions

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The Indian Health System SHIP Conference June 10,2007

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  1. The Indian Health SystemSHIP Conference June 10,2007 Dorothy, Dupree Director, Tribal Affairs Group Office of External Affairs, CMS

  2. Presentation Purpose • General Understanding of Indian Health System • CMS and the American Indian/Alaska Native (AI/AN) Health System • Your Questions • CMS AI/AN Health Office

  3. American Indians and Alaska Natives in the United States • 2.4 million American Indians and Alaska Natives • 2050 estimated 4.3 million • 1/3 under 15 years old • ~ 40% Reservation and Rural • ~ 60% Urban • Unemployment 2 x US population • 1/3 live below poverty level

  4. American Indians/Alaska Natives Unique Status Sovereign Nations • 562 Federally Recognized Tribes • Government • Judicial System / Tribal Courts • Culture • Traditional Medicine Government to Government Relationship w/ USA Healthcare is a Treaty Obligation Caddoan Indian Treaty of Cession, July 1, 1835. Mural in Louisiana. State Exhibit Museum, Shreveport. Photograph by Al Goody. Indian Chiefs who counseled with Gen. Miles and settled the Indian war. Photograph by J. C. H. Grabill, 1891. Reproduction number: LC-DIG-ppmsc-02513 (color copy scan)

  5. History / Key Legislation 1832 Congress appropriated funds for Indian Health care 1921 Snyder Act - US trust responsibility to AI include health care 1975 Indian Self-Determination and Educational Assistance Act (ISDEA) • Contracting • Compacting 1976 Indian Healthcare Improvement Act (IHCIA) • Indian Health Service

  6. Title XVIIIMEDICARE Section 1880 • Indian Health Care Improvement Act (IHCIA)AmendmentPayment to a hospital or skilled nursing facility of the Indian Health Service and placed in a special fund • Benefits Improvement and Protection Act (BIPA 432)-FY 2000Payment for the professional component of part B to a hospital or an ambulatory care clinic • Medicare Modernization Act (MMA 630)-FY 2003 During the 5-year period beginning on 1/1/2005, payment for all items and services may be made under part B

  7. Title XIXMEDICAID Sec. 1905b “The Federal medical assistance percentage shall be 100 per centum with respect to amounts expended as medical assistance for services which are received through an Indian Health Service facility” 1996 Memorandum of Agreement between IHS and CMS to pay States 100% FMAP for Medicaid payments for services provided by facilities operated by tribes/tribal organizations under self-determination authorities.

  8. Title XXI: State Children’s Health Insurance Program • Waives cost sharing for children Photo Courtesy of the Indian Health Service/U.S. Department of    Health and Human Services.

  9. Health Disparities of AI/AN Indians experience disproportionately high mortality compared to other Americans from - 627% 533% 249% 204% 72% 63%

  10. IHS Only 17% Private Insurance Other Public Coverage 28% 55% Health Coverage • IHS is the only source of health care coverage for 55% of Indians • Only 28% had employment related insurance

  11. IHS – Unlike Any Other • Bill another Federal agency • Tribes and Tribal Organizations administer IHS programs and carry many Federal authorities • States receive 100 % FMAP • IHS is payer of last resort • Medicare and Medicaid important funding stream for IHS programs

  12. Facilities of the Indian Health Service • Owned and Operated by the IHS • Owned by IHS and Operated by Tribes or Tribal Organizations • Owned and Operated by Tribes or Tribal Organizations

  13. Accessing Healthcare I/T/U Indian Health Service Tribes and Tribal Organizations Urban Indian Health Programs National Organizations • National Indian Health Board (NIHB) • National Congress of American Indians (NCAI) • National Council of Urban Indian Health (NCUIH) • Tribal Self-Governance Advisory Committee(TSGAC)

  14. Indian Health Service (IHS) HEADQUARTERS Rockville, MD TRIBAL GOVERNMENTS 12 IHS AREA OFFICES 34 URBAN INDIAN PROGRAMS 85 Service Unites 66 Service Unites Health Centers 10 Hospitals 37 Hospitals 2 Hospitals Outreach & Referral Extended Care Facilities 247 Health Centers 394 Health Clinics Other Clinics

  15. n Hospital l Ambulatory Center l l l l l l l l l l n l l l n l n l l l l l n l l l l l l l l n l l l l l l n l n l l l l l n l n l l l n l l l l l l l l l n l n n l n l l l l l l n l l l l l l l l l l l l l l l l l l l l l l l l l n l n l l n l l n l l l l l n l n l n n l l l l n l l l n n l n n l n l l l n l l l n l l l l n l l n n l l l l l l l n l n l n n n n n l l n l l l l l l l n n l l n n l l l l l n n l l n l l l l l n l l l IHS Health Facility Locations 60% of IHS hospitals and clinics are in remote areas

  16. URBAN INDIAN HEALTH • 34 Urban Indian Health Programs in 7 urban Indian Regions • Over half the AI/AN population lives in urban communities • < 1% of the IHS budget under Title V • Extreme health disparities

  17. THE CREATION OF URBAN INDIAN COMMUNITIES • BIA relocation program relocated 160,000 Indians to cities between 1953 and 1962 • Failure of Federal economic policies on reservations forced many Indians to cities • Termination of Tribes • General Allotment Act • Indian service in the U.S. military • Court sanctioned adoption of Indian children by non-Indian families • Boarding schools

  18. Partnerships and Consultation Tribal Technical Advisory Group (TTAG) Native American Regional Contacts (NAC) CMS/IHS Joint Steering Committee (JSC)

  19. Outreach and Education • Partnerships • Campaign with in the Campaign • Materials • Trainings • 1-800 Medicare

  20. Culturally Competent Outreach

  21. Culturally Competent Outreach

  22. Take Away Messages • Indian Healthcare is a unique system established to address the federal trust responsibility of the Federal Government to provide healthcare to enrolled members of federally recognized tribes. • AI/AN Healthcare relies heavily on Medicare and Medicaid payments • You have a role to play! • CMS has an AI/AN health team to help you!

  23. Native American Contacts • Main point of contact for tribes in that region • Each CMS Region has a Native American Contact (NAC) • Region 1 Boston Irv Rich Region 2 New York Julie Rand Region 3 Philadelphia Tamara McCloy Region 4 Atlanta Pamela Carson Region 6 Dallas Dorsey Sandongei Region 7 Kansas Nancy Rios Region 8 Denver Cynthia Gillaspie Region 9 San Francisco Rosella Norris Region 10 Seattle Theresa Cumpton

  24. CMS Headquaters Contacts Central Office – Tribal Affairs Group Dorothy Dupree Dorothy.Dupree@cms.hhs.gov Priya Helweg Priya.Helweg@cms.hhs.gov Capt. Michael Lyman Michael.Lyman@cmslhhs.gov Robert Inzer Robert.Inzer@cms.hhs.gov Rodger Goodacre Rodger.Goodacre@cms.hhs.gov

  25. For more information • CMS websites -http://www.cms.hhs.gov/AIAN/ - http://www.cms.hhs.gov/center/ir.asp THANK YOU

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