Unified Delegation Demands Answers From the Indian Health Service

Delegation Demands Answers From the Indian Health Service
“We want to be helpful in this endeavor, but must also ensure that this approach is viable and responsive to the needs of impacted tribes.”

WASHINGTON — U.S. Sens. John Thune (R-S.D.) and Mike Rounds (R-S.D.) and U.S. Rep. Kristi Noem (R-S.D.) recently joined Sen. John Barrasso (R-Wyo.), chairman of the Senate Committee on Indian Affairs, in sending a letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell requesting that the Indian Health Service (IHS) provide answers regarding the recent system improvement agreements executed by the Centers for Medicare and Medicaid Services (CMS) and the IHS. These agreements were designed to avert the imminent loss of CMS reimbursement due to non-compliance at multiple IHS facilities in the Great Plains Area.

In the letter, the delegation and Barrasso pose several questions that have yet to be answered by IHS concerning the agreements, despite multiple requests from Indian tribes.

“During a recent briefing for congressional staff, the acting director of the IHS presented a system improvement agreement, which we understand is intended to improve the quality of care at IHS facilities in the Great Plains Area,” the members wrote. “We want to be helpful in this endeavor, but must also ensure that this approach is viable and responsive to the needs of impacted tribes. Unfortunately, during [a] recent briefing, more questions were raised than answered.”

The letter continues to pose seven questions to Secretary Burwell and requests the department’s prompt response. “The speed and efficacy with which your department and its agencies act directly impacts patient care and safety in the IHS system,” the members continued. “We look forward to your prompt response to these questions by June 1, 2016.”

In February, Chairman Barrasso, Thune, and Rounds participated in an oversight hearing and listening session on the substandard quality of care provided by the IHS to the Great Plains Area. Barrasso, Thune, Rounds, and Noem have continued to raise concerns about the quality of care at the IHS, particularly in the Great Plains Area, and remain committed to finding ways to improve the IHS.

Full text of the letter can be found below:

The Honorable Sylvia M. Burwell
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Secretary Burwell:

We write to ask for additional information regarding the recent system improvement agreements executed by the Centers for Medicare and Medicaid Services (CMS) and the Indian Health Service (IHS). As we understand, these agreements were designed to avert the imminent loss of CMS reimbursement due to non-compliance at multiple IHS facilities in the Great Plains Area.

As you are aware, in 2010, Senator Byron Dorgan (D-N.D.), then-Chairman of the Senate Committee on Indian Affairs, produced a report outlining many of the same issues identified this Congress through investigation by the Senate Committee on Indian Affairs. Recent congressional investigations made clear that despite significant examination and documentation of the systemic problems at IHS, the agency was still not providing tribal citizens access to safe, quality health care.

During a recent briefing for congressional staff, the Acting Director of the IHS presented a system improvement agreement, which we understand is intended to improve the quality of care at IHS facilities in the Great Plains Area. We want to be helpful in this endeavor, but must also ensure that this approach is viable and responsive to the needs of impacted tribes. Unfortunately, during this recent briefing, more questions were raised than answered.

So that we may assist the Department in its work to improve the quality of care in the Great Plains and be responsive to Indian tribes, we hope your staff can respond in writing to the following questions.

1. Please identify and provide the specific legal authority and legal opinion IHS has relied upon to implement the Rosebud system improvement agreement to contract with a hospital management firm and place federal employees under the direction of private hospital management.

2. What is the estimated cost associated with executing the Rosebud agreement? What is the estimated cost associated with executing the similar systems improvement agreement regarding the Pine Ridge facility? This is an essential piece of information for potential private partners to know when considering whether or not to bid.

3. Will tribes be consulted about the decision of whether to extend these agreements?

As you know, workforce recruitment and retention has been a significant challenge for IHS in the Great Plains Area and nationally, yet the system improvement agreements appear to provide little information about how the IHS plans to improve staff recruitment and retention. The new system improvement plan requires the IHS to “identify needs, barriers, and potential resources and actions to design and implement an effective long term workforce development strategy…”

4. Can you explain with specificity each workforce-related barrier identified by the IHS?

5. Please explain in detail this administration’s current strategy for IHS staff recruitment and retention. If a strategic plan exists, we would welcome a continuing dialogue on how to best address these issues.

Finally, we understand that IHS continues to suffer from significant vacancies, both in the Great Plains Area and nationally.

6. So that we may better understand the nature and scope of this problem, please identify the number and type of vacancies in each IHS Area.

7. Additionally, please identify the comparative cost of filling the same vacancies with full time equivalent employees.

The speed and efficacy with which your Department and its agencies act directly impacts patient care and safety in the IHS system. We look forward to your prompt response to these questions by June 1, 2016.

Sincerely,

John Barrasso
Chairman, Senate Committee on Indian Affairs

John Thune
U.S. Senator

Mike Rounds
U.S. Senator

Kristi Noem
Member of Congress

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