Indian Health Service reform efforts gaining steam on Capitol Hill

Sen. John Thune (R-South Dakota), second from right, is seen here meeting with leaders of the Rosebud Sioux Tribe in February 2016. Photo from Facebook

Update: This post includes more information about the original sponsor of S.2953, the Indian Health Service Accountability Act, and a new co-sponsor.

Lawmakers from South Dakota continue to press for major changes at the Indian Health Service in response to long-standing problems in the region.

Last week, Sen. John Thune (R-South Dakota) introduced S.2953, the Indian Health Service Accountability Act. The bill is the first comprehensive attempt to fix deficiencies in the troubled Great Plains Area and in other parts of Indian Country.

The election-year effort is gaining some steam on Capitol Hill. The Senate Committee on Indian Affairs will hold a field hearing in South Dakota next month on the bill, Thune said on Wednesday.

"There's no better place to learn about the challenges facing tribal members than in an area that's been plagued by one, literally, IHS disaster after another," Thune said on a conference call with reporters.

More details about the hearing will be released in the coming days, Thune said. The committee's chairman, Sen. John Barrasso (R-Wyoming), introduced the bill with Thune on May 19.

In February, Thune participated in a hearing in Washington, D.C., that drew a large delegation from the Great Plains. By going to South Dakota, he said the committee will be able to hear directly from more tribal leaders and tribal members.


Indianz.Com SoundCloud: Sen. John Thune (R-South Dakota) discusses S.2953, the Indian Health Service Accountability Act, May 25, 2016

"We're going to keep pressing forward," Thune said.

Thune said his bill focuses on accountability and transparency at the IHS. It includes provisions to address the removal and discipline of "problem" employees, including senior officials.

"Leadership does start at the top," Thune said. "If the people in the agency are a barrier to delivering quality care, then they ought to look for a new job."

Thune said the IHS typically shuffles under-performing leaders around -- something that happened in the Great Plains on the eve of the February hearing -- rather than fire them. He believes his bill gives the agency, as well as the Department of Health and Human Services, greater authority to make changes.

Thune acknowledged that his bill does not add more money to the beleaguered agency. But he said tribes are more worried about how funds are spent and whether they are consulted about hiring decisions, another issue that's addressed in S.2953.

"They don't generally raise funding as being the principal concern," Thune said.

President Barack Obama requested a record $6.6 billion for the IHS for fiscal year 2017. Since he took office in 2009, the agency's budget has grown 53 percent.


YouTube: Sen. John Thune (R-South Dakota) discusses IHS reform bill on the Senate floor May 24, 2016

The fiscal year 2017 Interior and Environment Appropriations bill that was released on Tuesday includes additional funds to address what Rep. Kristi Noem (R-South Dakota) said was a "crisis" at the IHS. Some $6 million will be directed to "accreditation emergencies" like the ones affecting an unprecedented four facilities in the Great Plains.

“The added funding will not solve IHS’s deep-rooted problems, but I’m hopeful it will help as we work to put real reforms in place,” Noem said in a press release on Wednesday.

S.2953 does not have a companion in the House at this point. But Noem confirmed that she is working on her own IHS reform package, an effort Thune welcomed during his conference call.

"We need to fundamentally change how this agency is run and how it delivers care" Noem said.

Sen. Mike Rounds (R-South Dakota), a first-term member of Congress who's also pushing for reform at the IHS, signed onto Thune's bill on Tuesday.

Republicans aren't the only ones focusing on the IHS. Democrats in South Dakota say the lawmakers haven't done enough to resolve issues that have been festering for years.

"Senator Thune has been in the Congress for 18 of the last 20 years, and it is unfortunate that it is not until he faces an election in which he has an opponent that Senator Thune has decided to take some action," Jay Williams, a Democratic candidate for Senate, said on Wednesday.


The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo by Colorado National Guard Medical Detachment / Flickr

Paula Hawks, another Democratic candidate, has voiced similar concerns. She is challenging Noem for South Dakota's lone seat in the House,

"After six years of warning signs, unless we are prepared to provide sufficient resources immediately, whatever plan proposed won't be worth the weight of the paper it's printed on," Hawks said in a statement to The Sioux Falls Argus Leader.

Tribes in the Great Plains have indeed suffered through years of inadequate care and management woes. Last summer, the Centers for Medicaid and Medicare Service withdrew certification to the Winnebago Service Unit in Nebraska, which serves the Omaha Tribe and the Winnebago Tribe.

The hospital can no longer bill for Medicaid and Medicare so it has lost a key source of revenue. The IHS hasn't said publicly what it is doing to restore certification.

Similar threats were directed at the Rosebud Service Unit and the Pine Ridge Service Unit, both in South Dakota. But the IHS averted a cut-off after reaching agreements with the CMS earlier this month.

The emergency room at the Rosebud Hospital, however, remains closed after being placed on diversion in December. Since then, six members of the Rosebud Sioux Tribe have died while being transported to urgent care facilities up to 55 miles away.

Just this Monday, a fourth facility was hit with a termination letter. Deficiencies at the Sioux San Hospital in Rapid City, South Dakota, pose an "immediate threat to the health and safety" of tribal members, the CMS said.

The IHS has been given until May 28 to come up with a corrective plan. Unless changes are made, Sioux San will lose its ability to bill for Medicaid and Medicare on June 15, according to the letter.

The facility serves a large urban Indian population in Rapid City. Tribal members from other parts of South Dakota and from neighboring states also go there for services that may not available in their communities.

Additional Coverage:
Sen. Thune pushes for IHS accountability (The Mitchell Daily Republic 5/25)
Thune: Government failing treaty requirement to tribes (The Sioux Falls Argus Leader 5/25)

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)

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