Title V status awarded to Title I contractors
WINDOW ROCK, Ariz. - The 21st Navajo Nation Council passed legislation on July 21, authorizing Tuba City Regional Health Care Corporation, Inc., Utah Navajo Health Systems, Inc. and Winslow Indian Health Care Center, Inc., to participate in Title V Self-Governance.
Sponsored by Thomas Walker (Birdsprings/Leupp/Tolani Lake), Legislation No. 0371-10, which included four amendments, passed with a unanimous vote of 67-0. This allows existing and qualifying Title I Indian Self-Determination contractors, to enter into Title V Self-Governance status, pursuant to the Indian Self-Determination Act, or P.L. 93-638.
The legislation was first introduced and passed on June 24 before the Health and Social Services Committee (HSSC) with a 6-0 vote.
Sally Pete, chief executive officer (CEO) of Winslow Indian Health Care Center (WIHCC), Inc. stated, "You will pave a new trail to improve the health of our Navajo people."
Joe Engelken, CEO of Tuba City Regional Health Care Corporation (TCRHCC) expressed the importance of moving health care to the next level, improving upon such services as specialty care, oncology, and other health care services.
"Title V will let us build centers of excellence in cardiology, trauma, cancer care, and other specialty care," he said.
The three non-profit hospitals are now in their eighth year under the Indian Self-Determination Act, managing and operating medical services and programs for the Navajo, Hopi, and San Juan Paiute Tribes.
The Act gave these hospitals the authority to operate under a local board of directors, assuming the administration and operation of health care services for the communities they serve.
To be eligible for Title V, the hospitals are required to meet and maintain three years of legal and financial standards with approval of the Navajo Nation, maintain eligibility with the Center for Medicare Services (CMS), and maintain standards of The Joint Commission - the premier healthcare accreditation organization in the U.S.
In order for the legislation to be considered by the Navajo Nation Council, the legislation was presented to the Intergovernmental Relations Committee (IGR) on June 30. The IGR passed the legislation with a 7-1 vote.
Health and Social Services Committee (HSSC) and IGR authorization for Title V then gave the hospitals authorization to present before the Ethics and Rules Committee on July 12. Again, the legislation passed.
"There is no reason to leave home, these services can grow here and prosper," Engelken stated to the Council.
Walker was certain that the HSSC and the Council were in support of the request to enter Title V status. "We realize 638 corporations have come a long way in the past several years and they have grown in maturity within the time it has involved," he stated.
Walker believes medical centers operating under the Self-Determination Act "are viable assets in Navajo healthcare."
Evelyn Acothley, council delegate for the Bodaway/Gap Chapter expressed that as a sovereign nation, it was time to go to the next level to inherit authority and control their own healthcare systems.
"We have seen improvements made at the health care centers, seen the advancements of health care, and that the 638 corporations have met the requirements to enter Title V," Acothley stated.
Walker added, "I feel the decision and the vote reflect[s] that our Nation's leaders recognize [that our non-profit] health care contractors are ready and capable of contracting ... but this comes with more responsibilities, and being more accountable."
Walker emphasized that the HSSC has oversight responsibility and authority for 638 contracting, stating, "[Our] 638 hospitals are ready to enter the next level of contracting ... called compacting, [which is the process] for how tribal organizations contract with the federal government for health care services."
"We are also grateful to the Indian Health Service administration for their support for the enactment of the Self-Determination Act Title V, which is critical to modernizing and improving the health care we provide to the Navajo, Hopi and San Juan Paiute Tribes," said Engelken.
Each of the '638 hospitals' have the ability to meet federal standards, and to even exceed federal levels for healthcare standards in some cases. HSSC support for Title V provides an opportunity for regional medical centers and the communities to build their own Navajo health care systems.
The three non-profit hospitals are required to maintain third party payments under Medicare and Medicaid, operate programs under and report to the HSSC, comply with Navajo Nation law, consult with the Navajo Division of Health (NDOH) on public health, establish an MOU with NDOH and Navajo Department of Emergency Services for the use of the Nation's healthcare facilities, and provide direct patient care to all Native American eligible users among other stipulations written in the legislation.
Title V status empowers the three non-profit hospitals with additional self-governance responsibilities that move the focus of decision-making for healthcare services more so to the community or local level, and enables the hospital boards and leadership to match program design and management with service delivery needs. This includes patient care, strategic planning, health policy, facility construction and other governance priorities.
The three non-profit hospitals have a collaborative alliance as members of the Association for Indian Self-Determination in Healthcare. The association has hosted several training sessions regarding Title V, including two "638 Title V Boot Camps." Each of the members of this association is committed to community-based, self-governance in healthcare.