Rep. Kristi Noem’s Helping Ensuring Accountability, Leadership, and Trust in Tribal Healthcare (HEALTTH) Act was debated today before the House Natural Resources Subcommittee on Indian, Insular, and Alaska Native Affairs.  The hearing brought tribal members and organizations as well as IHS leadership before the Subcommittee to discuss Noem’s proposed Indian Health Service (IHS) reforms.

“The Indian Health Service is beyond broken and fixing it is literally a matter of life and death,” said Noem.  “The HEALTTH Act reforms an agency in desperate need of change by giving tribes a seat at the table, addressing recruitment and retention problems, and ensuring we can get more services out of every dollar, among many other things. All in all, it takes a step toward getting IHS out of the hospital business, which is ultimately what tribal communities want and deserve.”


“Adequate healthcare is one of the most important issues to American Indian and Alaska Natives; however the system is deficient, inadequate, and is simply failing areas of the country that need help the most,” said Chairman of the House Natural Resources Subcommittee on Indian, Insular, and Alaska Native Affairs Don Young.  “H.R. 5406, the HEALTTH Act, is intended to make reforms to the Indian Health Service to help their broken direct care system. It is a step in the right direction for Indian Country.”

Today’s hearing served as a necessary next step in moving the HEALTTH Act forward.  Leaders from the Rosebud Sioux Tribal Health Board, Great Plains Tribal Chairmen’s Health Board, and National Indian Health Board, among others, were able to weigh in on the legislation. IHS Principal Deputy Director Mary Smith was also questioned by the Members of Congress.  A video of the hearing in full and copies of the written testimonies are available here.

Introduced in June 2016, Noem’s legislation:

+ Gives tribes a seat at the table to encourage better, longer-term contracts by allowing for a partnership among IHS, tribal communities and healthcare stakeholders to collaborate throughout the contract negotiating process, rather than leaving those decisions solely to IHS.

+ Addresses the current recruitment problem – for both medical staff and hospital leadership – by putting provisions in place to:

  • Allow for faster hiring.
  • Make the existing student loan repayment program tax free, as an added incentive for high-quality employees.
  • Provide incentives to attract competent and well-trained hospital administrators as well as medical staff.

+ Reforms the Purchased/Referred Care (PRC) Program by, among other things:

  • Requiring IHS to develop a new formula for allocating PRC dollars.  Under Noem’s bill, IHS would be required to develop a formula based on need, population size, and health status to ensure those areas that have the greatest need receive a greater portion of the funding.
  • Requiring IHS to negotiate Medicare-like rates for services it pays for with private providers.  IHS currently pays a premium for PRC services.  Noem’s proposal would bring payments in line with what Medicare pays to stretch every dollar further.
  • Requiring IHS to address the backlog of PRC payments to private providers.  Private hospitals in the Great Plains Area have long expressed concern because IHS has failed to pay their bills.  Noem would require IHS to put a strategy in place to get these hospitals paid what they are due.

+ Restores accountability through strategies, such as:

  • Require IHS to be accountable for providing timely care.
  • Require the Government Accountability Office to report on the financial stability of IHS hospitals that are threatened with sanction from the Centers for Medicare and Medicaid Services.

The legislation has been endorsed by the Rosebud Sioux Tribe, the National Indian Health Board, Avera, Rapid City Regional Health, Sanford Health, the South Dakota Association of Healthcare Organizations, the South Dakota State Medical Association, the South Dakota Dental Association and others.

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