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Indian Health Service Portland Area Director’s Update

Read the latest update from the Indian Health Service (IHS) Portland Area Director, including information on re-accreditation, annual funding agreements, model contracts, reconciliation, and staffing updates.

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Indian Health Service Portland Area Director’s Update

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  1. Indian Health ServicePortland Area Director’s Update Dean M Seyler - Area Director April 16, 2019 Swinomish Casino Resort NPAIHB Quarterly Board Meeting

  2. Indian Health Service • Portland Area • The Accreditation Association for Ambulatory Health Care (AAAHC) • All six Federal service units achieved re-accreditation • Continuous Quality Improvement • All six are Patient Center Medical Home certified

  3. Indian Health Service • Portland Area • Procedures for Title 1 2020 AFA • Annual Funding Agreements (AFA’s) should be done each year. (no successors) • 120-days prior to expiration a package will be sent to Tribe to review AFA (FY2019). • Tribe reviews and determines if update are needed along with SOW. • Draft CSC template will also be provided with package, to calculate initial Direct and Indirect for coming FY/CY period. • Unilateral vs. Bilateral amendments – Recommend tribes adopt Unilateral for a majority to speed up payments.

  4. Indian Health Service • Portland Area • Model Agreement/Contracts • Portland Area staff would like to review model contracts and Scopes of Work (SOW) with Tribes to ensure they are fully covered for: • Tort Claims – SOW should corresponded to services being delivered • CMS billing – Facilities should be listed in SOW and all services that are billed should be included • Partner Agencies – Terms of the Model Agreement ensures access to other services (GSA-Fleet Management, Federal Supply or VA contracts for Medical providers)

  5. Indian Health Service • Portland Area • Based on CSC policy IHS and Tribes must fully reconcile amounts once final actuals are determined. • Actuals from the Rate Agreement will be used to finalize amounts • Draft 2014 & 2015 Reconciliations are being prepared now and will start going out to Tribes. • Please review quickly and provide any follow-up information that could impact your calculations • Once agreement is reached a final Amendment for the FA or AFA will be issued to close out the reconciliation for that period.

  6. Indian Health Service • Portland Area • The Office of Tribal and Service Unit Operations is now fully staffed • Rena Macy, ISDEAA Specialist • Responsible for T1/TV negotiations • LCDR Jason Davis, Financial Analyst • CSC calculations, payment processing • Waleeska Knifechief, Program Assistant • Administrative support & tracking/distribution of AFA/FA and amendments

  7. Indian Health Service • Portland Area • Consolidated Appropriations Act, 2019 • The total FY 2019 discretionary budget authority for IHS is $5.8 billion, which is a $266 million increase over the FY 2018 enacted funding level. • The bill includes a 1.9% pay raise for federal civilian employees. • Funds previously available for one fiscal year will now be available for two years (FY 2019 funds will expire on September 30, 2020). • Previously specified no year funding (e.g. facilities, collections, etc.) remains available until expended.

  8. Indian Health Service • Portland Area • FY 2021 National Tribal Budget Formulation Work Session • March 14-15, 2019, Crystal City/Arlington, Virginia • Tribal Representatives for Portland • Andrew Joseph, The Confederated Tribes of the Colville Reservation • Steve Kutz, Cowlitz Indian Tribe • Technical Support Team • Joe Finkbonner, NPAIHB, Executive Director • Laura Platero, NPAIHB, Policy Analyst • CAPT Ann Arnett, PAIHS, Executive Officer • Nichole Swanberg, PAIHS, Director, Division of Financial Management

  9. Indian Health Service • Portland Area • Indian Health Care Improvement Fund Workgroup • March 12-13, 2019, Crystal City/Arlington, Virginia • Tribal Representatives for Portland • Steve Kutz, Cowlitz Indian Tribe • Gail Hatcher, Klamath Tribes • Technical Support Team • Laura Platero, NPAIHB, Policy Analyst • CAPT Ann Arnett, PAIHS, Executive Officer • Nichole Swanberg, PAIHS, Director, Division of Financial Management

  10. Indian Health Service • Portland Area • Signed by the Principal Deputy Director on February 28, 2019. • Some key changes were made to the following: • 2-3.12 Management of Purchased/Referred Care Funds • 2-3.19 Deferred Services • 2-3.5 Persons to Whom PRC Will Be Provided • 2-3.8 Exception to the IHS Payor of Last Resort • Tribal Self-Insurance Plans. • Indian Health Manual • Part 2, Chapter 3, "Purchase/Referred Care"

  11. Indian Health Service • Portland Area • Status as of March 27, 2019 • 76 total cases • 51 amendments • $3,313,219.57 in reimbursements • $127,857.57 pending reimbursements • 96% Reimbursed FY18 Catastrophic Health Emergency Fund

  12. Indian Health Service • Portland Area FY19 Catastrophic Health Emergency Fund • Status as of March 27, 2019 • 5 total cases • 1 amendment • $158,317.29 in reimbursements • $0.00 pending reimbursement • 100% reimbursed to date • Online CHEF tool

  13. Indian Health ServicePortland Area • Office of Clinical Support – Pharmacy & EHR Consultant • Meetings & Trainings • IHS-HIM Quarterly Meeting – April 1-5 • IHS National Council of Informatics – Monthly • IHS SW Pharmacy Conference – April 12-14 • EHR Advanced TIU Training – April 15-19 • IHS Antimicrobial Stewardship Program – Monthly • EHR Clinical Reminders Training – May 13-17 • IHS Partnership Conference – June 11-13 • EHR Integrated Behavioral Health Training (tentative) – June 24-28 • RPMS-EHR • Windows 10 issues • Sexual Orientation Gender Identification Project • Electronic Prescribing of Controlled Substances • Pharmacy Drug Disposal Program • Naloxone Co-Prescribing • IHS Adverse Event Reporting System (WebCident) Replacement

  14. Indian Health ServicePortland Area • Office of Clinical Support – Upcoming Trainings • Working Together to Create Healthier Communities for Native Youth: An Action Planning Session • April 23, 2019 • 2019 American Indian and Alaska Native National Behavioral Health Conference • May 15-17 in Albuquerque, NM • May 14th-17th - Annual Portland Area Dental Meeting

  15. Indian Health ServicePortland Area • Office of Clinical Support – Upcoming Trainings • May 29th-30th - OSAP/ IHS Infection Control Workshop • Link to Registration: https://www.osap.org/page/2019AnnualConf#REGISTRATION • https://cdn.ymaws.com/www.osap.org/resource/resmgr/annual_conf_2019/preliminary_agenda_2.26_-_ih.pdf • June 10th- 13th - National Biannual IHS Dental Updates • Kalispel Tribe’s “Spring 2019 Physical Activity Challenge” – April 8 – June 16 • Burns Paiute Tribe will be Hosting: • Adult Mental Health First Aid Workshop – May 5 • Tobacco Cessation Training – May 6-7

  16. Indian Health ServicePortland Area • Office of Clinical Support – Diabetes Consultant • SDPI FY 2019 Data Infrastructure Funding • Has been distributed directly to SDPI grantees • Contact LCDR Kathi Murray (Kathi.murray@ihs.gov) for information or questions • Nutrition Services Clinic at Western Oregon SU • Diabetes Prevention Program Lifestyle Coach Training – April 30th - May 1st • Hosted by the Cowlitz Indian Tribe • Free to attend; to register, contact Alyssa Fine (Alyssa.fine@gmail.com) • IHS Division of Diabetes, 2019 Diabetes in Indian Country Conference • August 6-9 in Oklahoma City, OK • Free to attend; additional details and registration at: www.ihs.gov/sdpi/ • LCDR Kathi Murray – last day at Portland Area Office, April 30th.

  17. Indian Health ServicePortland AreaDivision of Health Facilities Engineering (DHFE) • FY 19 Facilities Appropriation Update • Backlog of Essential Maintenance, Alteration, and Repair (BEMAR) • Includes Another Special Appropriation to be Applied to BEMAR • Portland Area Share is $2.766M • DHFE Will Send Request for Tribal Project Proposals in May • Only Previously Reported Facility Deficiencies Are Eligible • Portland Area Facilities Advisory Committee (PAFAC) Will Be Requested to Assist with Tribal Project Prioritization • Supportable Space Data Call • 24 of 43 Tribal Programs Replied and Updated Information

  18. Indian Health ServicePortland AreaDivision of Health Facilities Engineering (DHFE) • FY 19 Facilities Appropriation Update • Small Ambulatory Program (SAP) • Approximately $15M Allocated for 2019 • Request for Proposals in April • https://www.fbo.gov/spg/HHS/IHS/AMB/SAP-2019/listing.html

  19. Indian Health ServicePortland Area • 2019 IHS Funding for Sanitation Facilities Construction • 2019 Consolidated appropriation resulted in 0.54% increase in construction funding over last year. • The Tribe’s needs continue to exceed available funding. • The Law reiterated that funds must be obligated* through signed MOAs. *Please help us help you by returning MOAs in a timely manner. • Preparation for 2020 SFC Funding: • Identification of potential 2020 projects. • Housing Developments • Sanitation Deficiencies (existing water/sewer infrastructure) • The Tribes should be hearing from District Engineers and staff over the next three months.

  20. Indian Health ServicePortland Area • Indian Health Service Announces New Office of Quality • Will provide leadership and promote consistency in health care quality across the agency by consolidating and enhancing oversight of these efforts at IHS headquarters. • Implementing a centralized credentialing software system • Creating a National Accountability Dashboard for Quality • Establishing patient wait time standards • Developing a Patient Experience of Care Survey • Developing the Partnership to Advance Tribal Health, in collaboration with the Centers for Medicare & Medicaid Service • https://www.ihs.gov/aboutihs/includes/themes/responsive2017/display_objects/documents/bios/JonathanMerrell.pdf • https://www.ihs.gov/newsroom/pressreleases/2018pressreleases/indian-health-service-announces-new-office-of-quality/

  21. Indian Health ServicePortland Area • Tribal Leader Letters • March 12, 2019 • March 15, 2019 • February 27, 2019 • https://www.ihs.gov/newsroom/triballeaderletters/

  22. IHS Strategic Plan FY 2019-2023

  23. What’s New? • Timeline • FY 2019-2023 • Additional Content related to: • Introduction / Background • Performance • Strategic Plan Development • Minor language updates: • Goals • Objectives • Strategies • Appendices • Crosswalks

  24. IHS Strategic Plan FY 2019-2023 • Mission: To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. • Vision: Healthy communities and quality health care systems through strong partnerships and culturally responsive practices. Management and Operations Goal 3: To strengthen IHS program management and operations. Access Goal 1: To ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people. Quality Goal 2: To promote excellence and quality through innovation of the Indian health system into an optimally performing organization.

  25. Goal 1 - Access • To ensure that comprehensive, culturally appropriate personal and public health services are available and accessible to American Indian and Alaska Native people. • Objective 1.1: Recruit, develop, and retain a dedicated, competent, and caring workforce. • 12 Strategies • Objective 1.2: Build, strengthen, and sustain collaborative relationships. • 5 Strategies • Objective 1.3: Increase access to quality health care services. • 14 Strategies

  26. Goal 2 - Quality • To promote excellence and quality through innovation of the Indian health system into an optimally performing organization. • Objective 2.1: Create quality improvement capability at all levels of the organization. • 8 Strategies • Objective 2.2: Provide care to better meet the health care needs of American Indian and Alaska Native communities. • 6 Strategies

  27. Goal 3 – Management and Operations • To strengthen IHS program management and operations. • Objective 3.1: Improve communication within the organization with Tribes, Urban Indian Organizations, and other stakeholders, and with the general public. • 6 Strategies • Objective 3.2: Secure and effectively manage the assets and resources. • 10 Strategies • Objective 3.3: Modernize information technology and information systems to support data driven decisions. • 9 Strategies

  28. Implementation of the Strategic Plan • Road map that will guide IHS forward over the next five years. • Implementation is no small task and requires input from across IHS. • Everyone has a role and stake in its success. • IHS employees are expected to identify how their work contributes to the IHS Strategic Plan. • Anyone can provide feedback on the plan and ideas for implementation by emailing: • IHSStrategicPlan@ihs.gov

  29. Resources • IHS Strategic Plan web site • Download a PDF version • DTLL/UIOLL link • Download Response to Comments • Questions or comments? • E-mail: IHSStrategicPlan@ihs.gov

  30. Indian Health ServicePortland Area • Spring 2019 Portland Area Clinical Director’s Meeting • April 25-26, 2019 • World Trade Center, Portland OR • Contact Dr. Rudd for details/agenda (Stephen.rudd@ihs.gov) • Follows the Northwest Clinicians Cancer Update- April 24, 2019 at Residence Inn Downtown/River Place

  31. Indian Health ServicePortland Area • HRSA- Shortage Designation Modernization Project: Auto-HPSAs • HPSA= Health Profession Shortage Area • Score assigned in three realms: • Primary Care • Dental Care • Mental Health • Used in targeting resources for: • National Health Service Corps (NHSC) • NURSE Corps • IHS Loan Repayment Program • Auto-HPSA- HRSA devising approach to automate updating of HPSA scores from available data sources.

  32. Indian Health ServicePortland Area • National Update of Auto-HPSAs • Tentatively planned for this Spring/Summer • Series of Auto-HPSA preview reports in advance • Raise awareness of Auto-HPSAs • Provide scoring transparency • Enable HRSA to provide technical assistance • Submit supplemental data to change Auto-HPSA scores • facility-specific data • fluoridation status, alcohol misuse rate and substance misuse rate data. • Work with State Primary Care Offices (PCOs) to ensure provider data are correct and identify appropriate Nearest Sources of Care

  33. Indian Health ServicePortland Area • Shortage Designation Modernization Project Summary • No changes to HPSA scores have occurred at this time. • Current participants will not be impacted. • National update is tentatively planned for spring/summer 2019. • There are things that organizations can do to change their scores. • Before the update takes place: • Collect facility-specific • Collect supplemental data • Work with State Primary Care Offices on the provider data • Contact SDMP@HRSA.gov with questions or requests for briefings.

  34. Questions or Comments Our Mission... to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Our Goal... to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people. Our Foundation... to uphold the Federal Government's obligation to promote healthy American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

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