Welcome everyone The CMS Tribal Affairs office has developed this video to
provide an overview of the important role CMS plays in improving the health care
of American Indians and Alaska Natives.
CMS Tribal Affairs serves as the primary liaison between CMS and the American
Indian and Alaska Native communities. Tribal Affairs, along with designated
Native American Contacts in each Regional Office, are there to assist and
support CMS components and other federal partners on Indian health issues, both
at the national and regional level.
There are over five million American Indians and Alaska Natives living in the
United States. Many are eligible for and are enrolled in Medicare, Medicaid, the
Children's Health Insurance Program, and the Marketplace. When American Indians
and Alaska Natives enroll in CMS programs, they have greater access to health
services and tribal communities benefit by enhanced resources to Indian health
care providers in their communities.
American Indians and Alaska Natives are an ethnically diverse population. There
are 567 Federally Recognized Tribes and over 250 languages actively spoken.
American Indians and Alaska Natives call the entire continent home, from the
everglades of Florida to the northern reaches of Alaska.
The Federal government entered into nearly 400 treaties with Indian Tribes in
the 18th and 19th centuries. Indian tribes ceded millions of acres of land to
the federal government for certain rights and benefits, including the provision
of health care.
The U.S. Constitution establishes the basis for the "government to government
relationship" and that relationship has been upheld by U.S. Supreme Court
decisions, federal law and regulations. This government-to-government
relationship distinguishes American Indians and Alaska Natives from all other
ethnic groups in the United States.
The federal government's responsibility for Indian health care has changed over
the years:
Initially the responsibility was in the War Department, and then was was
transferred to the Department of the Interior in 1849, then in 1954 to the
Indian Health Service, a sister agency within the Department of Health and Human
Services.
The Indian Health Service is the primary federal agency responsible for
providing health care to American Indians and Alaska Natives. The Indian Health
Service delivery system is comprised of health programs operated by the Indian
Health Service, tribes and tribal organizations under the Indian
Self-Determination Act (sometimes called "638" tribes), and urban Indian
organizations under title V of the Indian Health Care Improvement Act (these are
referred to as "urban Indian clinics").
The Indian Health Service, along with its tribal and urban partners, is a
comprehensive delivery system that provides culturally appropriate health care
to over 2 million American Indians and Alaska Natives.
In 1976, Congress enacted the Indian Healthcare Improvement Act and amended
titles 18 and 19 of the Social Security Act to authorize Indian Health Service
to receive reimbursement for services provided to Medicare and Medicaid
beneficiaries. Revenues from Medicare and Medicaid are used to meet compliance
and accreditation standards, to reduce health resource deficiencies and can in
most instances, represent approximately 25 50% of local Indian health budgets.
As you can see, CMS plays a key role in fulfilling the federal government's
responsibility to provide health care to American Indians and Alaska Natives and
any changes in CMS policies and programs can have a significant impact on Indian
health providers and beneficiary access to care.
Executive Order 13175 Consultation and Coordination with Indian Tribal
Governments, affirmed the federal government's commitment to work with tribal
governments on a government-to-government basis and required each federal agency
to consult with tribal governments. Subsequent presidential memoranda have
reaffirmed this commitment
The CMS Tribal Consultation Policy requires the agency to consult on any policy
that will significantly impact Indian Tribes. Although determined on a
case-by-case basis, such issues could arise in any policy area for which CMS has
responsibility, such as program eligibility standards, changes in provider
payment and reimbursement methodologies, or changes in services covered by CMS
programs.
An easy way to determine whether CMS needs to consult is to see if your policy
uses the words, "Indian," "Tribe," "Tribal," or "Native American."
However, that's not the only time consultation may be required. Other policies,
such as those implementing general policies applicable to hospitals, clinics,
and other health providers, could significantly impact Indian health providers
and may require consultation.
CMS Tribal Affairs is available to help you determine whether something you're
working on triggers consultation.
Tribal consultation is unique to the government-to-government relationship
between Indian tribes and the federal government. Consultation is defined as an
enhanced form of communication that emphasizes trust, respect, and is intended
to be an open and free exchange of information resulting in mutual
understanding.
Consultation can be invoked by CMS or the tribes at any stage of policy
development or decision making. Over the years, we have found that many issues
can usually be resolved more effectively if consultation occurs in the early
stages of policy development.
A copy of the CMS Tribal Consultation Policy can be found at go.cms.gov/AIAN,
scroll down to Tribal Consultation.
Please also visit this webpage to find more information about CMS Tribal Affairs
and to learn more about Indian health through other learning opportunities, such
as webinars, All Tribes' Calls, power point presentations and outreach and
educational materials.
CMS Tribal Affairs wants to thank you for all of the work you do every day that
has a significant impact on the health and daily lives of all American Indians
and Alaska Natives.