Current Health Policy Issues and Tribal Consultation Accordion

The current policy areas of concern monitored by the Steering Committee include the following:

Public Law 111-148 contains numerous policy provisions that impact American Indians that are served at tribal, urban and Indian health care programs. The national health care reform legislation in which IHCIA was merged was signed into law on March 23, 2010 and will be implemented over a multi-year period. Updates are provided intermittently to the tribal leaders, tribal health directors and other key staff. Tribal leaders serving on various national advisory committees and workgroups oversee the development of tribal comment on ACA and IHCIA guidance and regulations. Click here for the document.

Tribal leaders were requested to provide recommendations on implementation of ACA Indian specific provisions and IHCIA by Yvette Roubideaux, MD, IHS Director during the IHS 2013 budget consultation process. Tribes in the Phoenix Area identified several priorities. Click here to download.

Click here to download

The passage of these laws resulted in numerous changes affecting the Indian health care system.  Regulations development by the Centers for Medicare and Medicaid Services (CMS) to implement CHIPRA and ARRA has required input by tribal leaders at the Federal and State level.  CHIPRA clarified CMS tribal consultation requirements and funds were made available for outreach and enrollment activities to be carried out in Indian communities. ARRA provided stimulus funding to construct one hospital in Alaska and one clinic in Montana and several water and sanitation projects, plus medical and information technology equipment was provided at many locations. As a part of ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 makes available Medicare and Medicaid incentive payments to eligible health care professionals and hospitals when they adopt certified EHR technology.

Public Law 110-161, the Consolidated Appropriations Act of 2008, established the national Methamphetamine Suicide Prevention Initiative (MSPI) in the Indian Health Service and that year $14 million was initially appropriated for this purpose.  The IHS National Tribal Advisory Committee (NTAC) on Behavioral Health Services comprised of tribal leaders to represent all IHS Areas provided recommendations to Yvette Roubideaux, IHS Director, on the utilization of the 2008 available funds to which 2009 appropriations were added for a total of $24.6 million. In the Phoenix Area, a consultation meeting was held in May 2009 to discuss the distribution of $2.6 million to Tribes and Service Units in the region.  The primary requirement is to initiate community-focused responses that use evidence based practices for meth and/or suicide prevention, additional treatment services and education programming and to respond to any local meth and/or suicide crises.  Following a competitive review process, awards were made to nine tribal and IHS entities in the Phoenix Area.

  • Washoe
  • Gila River
  • White Mountain
  • PIMC
  • Desert Visions Regional Treatment Center
  • Pyramid Lake
  • Reno Sparks
  • San Carlos
  • Salt River

Public Law 111-8, the Omnibus Appropriations Act of 2009 provided a total of $10 million to address domestic violence and sexual assault within the AI/AN communities. Three year competitive funding was announced in May 2010 to provide tribal or IHS programming in a broad range of activities – outreach, victim advocacy, intervention, policy development, community response teams, and community and school education programs. The following locations received funding in the Phoenix Area:

  • Salt River Pima Maricopa Indian Community
  • Hualapai Tribe
  • Ute Indian Tribe

Tribal leaders met with Dr. Yvette Roubideaux during a listening session on 3/26/10 in Phoenix, Arizona. At the meeting Dorothy Dupree was introduced as the new Acting Director for the Phoenix Area. Ms. Dupree held met with the Steering Committee on 5/7/10 and 9/28/10. The major purpose of these meetings was to discuss current policy and budgetary concerns to be addressed and to develop agendas for the Phoenix Area tribal consultation meetings.

A tribal consultation session demonstrate Meaningful Use by held on 5/25/10 on the implementation of the Phoenix Area 2015 Master Plan that identifies local, regional and Area (PIMC) service delivery recommendations and needed Contract Health Services expansion and to discuss opportunities thru Title III Facilities of the IHCIA.  Another topic that tribes focused on was the utilization and effectiveness of telehealth technology by IHS and tribal health programs. Tribal leaders noted that advancing telehealth services is extremely important in terms of strategic planning for the future regional health care delivery system in the Phoenix Area.

A consultation meeting held on 11/4-5/10 was on the Nevada Area Office plan that is to be developed per Section 173 of IHCIA.  Concerns regarding the needed health services and the additional funding that would be required to establish a 13th IHS Area office along with the impact on shares and residual funding were identified. A short term comment period on the draft plan was provided to the tribes by the Phoenix Area IHS.

The annual consultation meeting on the formulation of the IHS budget request was held on 12/9-10/10 to develop tribal recommendation for fiscal year 2013..  At this meeting IHS asked the tribes to develop an agreed upon list of health priorities and identify the funding that would be needed to address these issues. IHS also asked tribes to identify their top IHCIA priorities in terms of implementation and needed appropriations in FY 2013. See IHS budget consultation section.

Per the national Presidential Memorandum on tribal consultation the U.S, Department of Health and Human Services (HHS) conducts annual national consultation meetings with tribal leaders In accordance with its tribal consultation policy. The most recent session was held on March 3-4, 2011 in Washington D.C.  Region VIII and IX of the U.S. HHS also conducted its annual tribal consultation session with tribal leaders in Arizona, Nevada, Utah and California on March 10, 2011.

The ITCA Behavioral Health/Involuntary Commitment Work Group comprised of tribal, IHS, and state officials in Arizona developed and implemented training on the legal and clinical process associated with the Arizona Revised Statute (ARS) 12-136. Tribal court orders for involuntary commitment may be issued under the auspices of tribal law and order, public health and/or mental health codes. The state statute, which tribes advocated for several years ago, created a process so that the tribes’ court orders are then domesticated in State Superior Courts. This is the legal process created so that members of tribes that reside on an Indian reservation would be served at the Arizona State Hospital as long as the proposed patient is diagnosed by a licensed physician as a danger to self, a danger to others, persistently or acutely disabled and/or gravely disabled.  Per a tribal court order they would also be able to obtain services following discharge through the state’s Regional Behavioral Health System.  Significant progress was made in 2010 with the involvement of tribal and IHS behavioral health staff, tribal and state court and health officials to improve timeliness of the process so that American Indians are better served.


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