U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Director's Blog

Affordable Care Act Update

HHS is conducting both tribal consultation sessions and listening sessions over the next few weeks on its Notices of Proposed Rulemaking (NPRM) related to Affordable Insurance Exchanges. During these sessions, Tribes raised the issue of different definitions of the term “Indian" in the Exchange-related provisions of the Affordable Care Act; the law cites three different existing statutory definitions of American Indians and Alaska Natives.

Tribes have expressed concern about the definitions of the term “Indian” when discussing various provisions that affect American Indians and Alaska Natives. Tribes have requested that HHS adopt a uniform definition of the term “Indian” for purposes of implementing the Affordable Care Act that is more closely aligned with that associated with eligibility for IHS programs.

HHS has thoroughly reviewed the varying definitions of the term “Indian” in the Affordable Care Act. The use of different definitions of Indians when it comes to the individual responsibility exemption, the cost sharing reductions, and Medicaid is cumbersome for individuals, Tribes, and Exchanges.

While we agree with Tribes that greater uniformity in definitions would help simplify enrollment in various coverage options and promote better efficiency in implementation, our options are limited by the statutory language.

Because the Affordable Care Act references specific statutory definitions of the term “Indian,” there is no administrative flexibility to align these definitions with existing regulation and policy. The solutions would need to be legislative rather than regulatory. The American Recovery and Reinvestment Act included the term “Indian” without references to specific definitions in the law, permitting HHS to apply its definition associated with eligibility for IHS programs. Recent NPRMs related to Affordable Insurance Exchanges reference the various definitions cited in law. Congress would need to pass an amendment to the Affordable Care Act that replaces the existing statutory definitions. HHS will work with tribal communities and Congress to identify a solution that simplifies eligibility standards for individuals, Tribes, and Exchanges.

SCIA Hearings

In July, IHS testified in two hearings held by the Senate Committee on Indian Affairs - pictures and links to testimony below:

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  • Thumbnail - clicking will open full size image - Randy Grinnell
  • Thumbnail - clicking will open full size image - SCIA Hearings Attendees
  • Thumbnail - clicking will open full size image - Rose Weahkee
  • Thumbnail - clicking will open full size image - SCIA Hearings Attendees

Tribal Self-Governance Advisory Committee

I met with the Tribal Self-Governance Advisory Committee in July. We discussed the budget, contract support costs, the Affordable Care Act, and planning activities for Self-Governance in HHS. Here are pictures from the meeting:

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  • Thumbnail - clicking will open full size image - Tribal Self Governance Advisory Committee
  • Thumbnail - clicking will open full size image - Tribal Self Governance Advisory Committee

IHS Annual National Combined Councils Meeting

We held the IHS Annual National Combined Councils Meeting in Bethesda, MD during the last week in July. The focus of this meeting was on leadership, management and IHS reforms. We had great attendance from IHS administrative and clinical leadership. While this meeting has traditionally been more of a federal meeting, we invited Tribal and urban Indian health program leadership to attend as well since they are a part of the Indian health system and are facing the same issues and challenges. The agenda included updates on how the Affordable Care Act and the Indian Health Care Improvement Act will require us to focus more on improving the way we do business and provide care, as well as information and updates on many IHS reform topics such as human resources and hiring reforms, the Contract Health Service program, accreditation and certification, Information technology, telemedicine, the problem of prescription drug abuse in Indian Country, and an overview of the Office of Inspector General. We also had a training session on "influence" to help our leadership as they go back to their facilities to work with their colleagues to make the changes and improvements we need to make over the next few years. Here are some pictures from the conference and the agenda [PDF - 225KB].

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  • Thumbnail - clicking will open full size image - IHS National Combined Councils Meeting
  • Thumbnail - clicking will open full size image - Rima Cohen, HHS - Affordable Care Act Presentation
  • Thumbnail - clicking will open full size image - National Council Leadership
  • Thumbnail - clicking will open full size image - National Council of CEOs
  • Thumbnail - clicking will open full size image - National Council of Clinical Directors
  • Thumbnail - clicking will open full size image - Area Executive Officers
  • Thumbnail - clicking will open full size image - National Nurse Leadership Council
  • Thumbnail - clicking will open full size image - Pharmacy Council
  • Thumbnail - clicking will open full size image - Oral Health Council
  • Thumbnail - clicking will open full size image - National Council of Chief Medical Officers
  • Thumbnail - clicking will open full size image - National Council of Chief Clinical Consultants

Notice of Proposed Rulemaking: Affordable Insurance Exchanges

HHS announced its Notice of Proposed Rulemaking (NPRM) on the Affordable Insurance Exchanges on July 11, 2011. The purpose of this Notice was to request comments on initial thoughts for regulations related to the planning of the State Exchanges where individuals and small businesses will have access to purchasing affordable private insurance and access to eligibility/enrollment for other public programs such as the Medicaid expansion starting in 2014. This NPRM includes a request for comments on some of the Special Provisions for Indians in the Affordable Care Act related to the State Exchanges. Comments must be received in writing by September 28, 2011 and the NRPM can be viewed at www.regulations.gov Exit Disclaimer: You Are Leaving www.ihs.gov - search for CMS-9989-P. HHS will announce upcoming consultation sessions during which Tribes can learn more about the NRPM and other Affordable Care Act activities important to the health of Indian Country. For more information, go to www.healthcare.gov Exit Disclaimer: You Are Leaving www.ihs.gov .

Tribal Delegation Meetings

We met with several Tribes in the month of July. Common topics in the meetings were related to the uncertainty around the budget, health care facilities, and other programmatic issues. Here are some pictures from the meetings.

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  • Thumbnail - clicking will open full size image - Northern Ute Tribe of Uintah and Ouray
  • Thumbnail - clicking will open full size image - Arctic Slope Native Association
  • Thumbnail - clicking will open full size image - Yocha Dehe Wintun Nation
  • Thumbnail - clicking will open full size image - Rosebud Sioux Tribe
  • Thumbnail - clicking will open full size image - Acoma and Laguna Pueblos
  • Thumbnail - clicking will open full size image - Hopi Tribe

IHS Tribal Consultation Summit

I hosted the first IHS Tribal Consultation Summit in the first week of July. The Summit was a recommendation from my Director's Advisory Workgroup on Tribal Consultation and the purpose was to create a "one stop shop" for Tribal leaders to learn about current consultation activities, including the work of our many workgroups and committees. The conference was well received and we will hold them at least annually from now on. Here are some pictures from the meeting and a link to the agenda. [PDF - 76KB]

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  • Thumbnail - clicking will open full size image - Tribal Consultation Summit General Session
  • Thumbnail - clicking will open full size image - Tribal Consultation Summit Audience
  • Thumbnail - clicking will open full size image - Chairman Leonard Harjo
  • Thumbnail - clicking will open full size image - Chief Lynn Malerba
  • Thumbnail - clicking will open full size image - Direct Service Tribes Advisory Committee
  • Thumbnail - clicking will open full size image - ulia Davis Wheeler
  • Thumbnail - clicking will open full size image - CHS Workgroup
  • Thumbnail - clicking will open full size image - Director's Advisory Workgroup on Tribal Consultation

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Dr. Yvette Roubideaux
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