Indian Health Service Considers Ending Funding for Clinics That Charge Copayments for Certain Services, MedicationsIndian Health Service is considering severing financial partnerships with clinics that charge eligible beneficiaries copayments for health services and prescription drugs, according to an agency official, Indian Country Today reports. A provision in the 1975 Indian Self-Determination and Education Assistance Act states that IHS is prohibited from charging eligible beneficiaries copayments for health services. Since the act, many tribes have taken over IHS health programs, but it has been interpreted that the rule still remains as long as they receive IHS funding. In recent years, "some tribal officials have tried to skirt the provision," claiming that a lack of funding from IHS has forced them to impose fees to care for beneficiaries.
Some tribal leaders have questioned why IHS is raising the issue when agency officials agree that IHS has funding problems, according to Indian Country Today. In addition, some tribal leaders have said they feel tribes should be able to craft their own health contract rules in order to offer quality care to their members.
A recent court decision involving the Susanville Rancheria tribe in California "found that while IHS is bound by Congress from requesting copays, tribes are not explicitly prohibited," Indian Country Today reports. IHS officials did not appeal the court's decision and instead viewed it as exclusive to that district in California.
Ronald Demaray, acting director of the agency's Office of Tribal Programs, said, "Indian Health Service believes that tribes should not be" charging copays, adding, "It is inappropriate for tribes to be doing so." According to Demaray, Robert McSwain, newly confirmed as director of IHS, has stated that the agency by law does not have to support clinics that engage in the practice and is considering ending partnerships with such clinics.
The Senate version of the Indian Health Care Improvement Act (S 1200) contains language that would legalize copays. IHS opposes the provision.
IHS has been consulting with tribes since April to try to quantify how many tribes charge copays and will continue its investigation through June. The agency also is trying to clarify the interpretation of the law (Capriccioso, Indian Country Today, 6/20). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.