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National Indian Health Board Supports House Bill to Require Veterans Health Administration to Reimburse Indian Health Providers
WASHINGTON, DC—July 22, 2020—The National Indian Health Board (NIHB) Acting Chairman William Smith testified today before the Subcommittee for Indigenous Peoples of the United States (SCIP) for a legislative hearing on the “PRC for Native Veterans Act” ( H.R. 6237 ). This critical bill would amend the Indian Health Care Improvement Act to clarify that the Veterans Health Administration (VHA) and the Department of Defense are required to reimburse the Indian Health Service (IHS) and Tribal health programs for healthcare services provided to Native veterans through an authorized referral. Acting Chairman Smith, who is a Vietnam veteran, stressed that third-party reimbursement adds funds to the IHS Purchase/Referred Care (PRC) system so specialty services can be purchased and reiterated that the government has a dual responsibility to Native veterans.   
“The United States federal government has a dual obligation to Native veterans – one obligation specific to the treaties and the other obligation specific to their service in our collective national defense,” said NIHB Acting Chairman Smith, who is a member of the Valdez Native Tribe of Alaska. “One way that Congress can close the gap between the Veterans Health Administration and the Indian Health Service is by passing H.R. 6237, that will ensure the VHA fully reimburses IHS and Tribes for healthcare services through Purchased/Referred Care. The chronic underfunding of the IHS and the strain of the COVID-19 pandemic makes those PRC dollars critical to the overall stability of the Indian health system.”

The PRC system is designed for IHS and Tribes to purchase care from outside providers to help make up for the lack of primary and specialty care providers within the Indian health system. However, the system is limited to only circumstances where the patient has first exhausted all other available forms of health coverage including private insurance, Medicare and Medicaid. Essentially, the PRC program is the payer of last resort. The “PRC for Native Veterans Act,” sponsored by Subcommittee Chair Congressman Ruben Gallego (D-AZ) emphasizes that IHS is indeed the payor of last resort, and the VHA must reimburse for services.

Tribal governments rely on third-party reimbursements from federal programs like Medicare, Medicaid and private insurance to supplement the underfunding from IHS and extend care to critical patients. For many self-governance Tribes, third-party collections make up nearly 60% of their healthcare operating budgets. Many Tribes have experienced third-party reimbursement shortfalls ranging from $800,000 to $5 million due to COVID-19 cancellations of non-emergent care. These funding shortfalls have forced Tribes across the country and Alaska to furlough hundreds of workers, curtail available healthcare services or close clinics entirely. 
“Congressman Gallego’s bill would guarantee that IHS and Tribes receive that third-party reimbursement from the VHA and finally settle the Veterans Affairs claims that they have no statutory obligation to pay IHS or Tribal health providers for specialty and referral services, despite repeated requests from Tribes,” said NIHB Acting Chairman Smith. “If a veteran wants to get care from an Indian health provider then that program should be reimbursed for the services even if the same service could have been done at a nearby VA facility. Native veterans should have the freedom to get care from either the VA or an Indian health program. This failure in the system creates greater care coordination issues and burdensome requirements for Native veterans.”

Read the complete testimony at

National Indian Health Board Mission Statement

Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.
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