U.S. Senator John Thune (R-S.D.) today sent the following letter to U.S. Secretary of Veterans Affairs (VA) Eric Shinseki and Director of Indian Health Services (IHS) Dr. Yvette Roubideaux. The letter outlines Senator Thune’s concerns with a recent service agreement reached by the VA and IHS. The reauthorization of the Indian Health Care Improvement Act (IHCIA), which was signed into law in March of 2010, required IHS and the VA to establish guidelines for the payment of services incurred by “eligible Indian veterans” and to promote sharing arrangements for medical facilities between federal agencies.
The agreement reached by the VA and IHS this past August does not provide assistance to ensure tribal health care programs can meet the VA required claims processing standards. Additionally, Senator Thune expressed concerns that the agreement does not address IHS Contract Health Service referrals and payments, the sharing of electronic patient records, and test results between the VA and IHS.
Finally, the letter questions IHS’ recent decision to suspend the Memorandum of Understanding established in June of 2012 by the VA and IHS to standardize the process for payment of eligible tribal veterans’ first party copayments at VA Midwest Health Care Network facilities.
The text of the Senator’s letter is below.
September 18, 2012
Secretary Eric K. Shinseki
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington D.C. 20420
Dr. Yvette Roubideaux
Indian Health Service
801 Thompson Avenue, Ste. 400
Rockville, MD 20852
Dear Secretary Shinseki and Director Roubideaux,
I write again regarding provisions included in the reauthorization of the Indian Healthcare Improvement Act (IHCIA) enacted as part of the Patient Protection and Affordable Care Act (P.L. 111-148) related to improving health care for Native American veterans. As you know, the IHCIA provides for collaboration between the Secretary of Health and Human Services and the Secretary of Veterans Affairs to establish guidelines to provide for the payment of services incurred by “eligible Indian veterans” and to promote sharing arrangements for medical facilities between federal agencies.
I was pleased to see the Department of Veterans Affairs (VA) and the Indian Health Service (IHS) announcement in August that the VA would begin working on local implementation plans with individual tribal health programs to provide reimbursement for direct services. While understandable that tribal health programs must meet certain claims processing site standards before an agreement between the VA and an individual tribal health program can be finalized, I am concerned that nothing in the VA and IHS agreement provides for any assistance to ensure tribal health programs can meet these standards. Many of South Dakota’s tribal health programs already struggle to maintain enough trained claims staff to collect all the third party dollars they are due. What, if anything, is IHS doing to ensure that tribes will qualify to enter into an agreement with the VA?
I am also extremely concerned that the agreement does not address IHS Contract Health Service (CHS) referrals and payments, or the sharing of electronic patient records and test results between the VA and IHS. CHS provides tribal members, including tribal veterans, with health care services not available at IHS facilities and are often the most complex and life-sustaining care they receive. That is why I believe it is imperative that any VA and IHS agreements include ways in which tribal veterans can take their IHS CHS referrals to the VA for treatment. Additionally, no matter which facility a tribal veteran begins care at, I believe there must be a way for the IHS and VA to share patient records and test results to ensure that care is not slowed and federal funds wasted by repetitive and unnecessary tests.
Finally, I am confounded why the IHS has decided to suddenly suspend the Memorandum of Understanding (MOU) establish in June 2012 by the VA and IHS to standardize the process for payment of eligible tribal veterans’ first party copayments at VA Midwest Health Care Network facilities. I have received only positive feedback on the MOU, and understood that some tribal veterans have already benefited from the agreement. The MOU’s suspension so that the rest of the VA and IHS service units can sign similar MOU’s is unacceptable and seems to be in direct contradiction to the direct service agreement, which is moving forward in a piecemeal manner. I respectfully request an immediate reinstatement of the MOU.
I believe our nation’s tribal veterans deserve access to first-rate health care and I applaud the VA and IHS for the work they have done to improve tribal veteran health care services. However, there is much more work to be done and I look forward to hearing updates from you both on how you will address these concerns. Thank you for your attention to these important matters.
Senator John Thune