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Responses to Questions from Rep. Westerman for Hon. Jarred-Michael Erickson, Chairman, Colville Tribes

Summary

Responses to Questions from Rep. Westerman for Hon. Jarred-Michael Erickson, Chairman, Confederated Tribes of the Colville Reservation. In answer to the first question, the response says that for the past three years there has been a spike in instances where tribal members received notices from collection agencies for unpaid bills for services from private medical providers under the Purchased/Referred Care program (PRC). It says that for PRC patients in the Colville Service Unit, IHS is responsible for ensuring that these providers are paid, and that collection notices mean IHS has failed to do the administrative work needed. In answer to the second question, the response says the Colville Service Unit serves a rural area with limited housing options and shares the challenges other rural providers have in attracting and retaining health providers.

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“Responses to Questions from Rep. Westerman for Hon. Jarred-Michael Erickson, Chairman, Colville Tribes.” Original at docs.house.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/hhrg-117-ii24-20220728-qfr200-75de93ebeb7c-2b90bd2849/, SHA-256 75de93ebeb7cdf694e06c614eb2d1439e884d66c734d0869facf58466b13d749.

Full text

     Responses to Questions from Rep. Westerman for Hon. Jarred-Michael Erickson,
               Chairman, Confederated Tribes of the Colville Reservation


1. `Please further elaborate on your answer and document further stories about instances
of tribal members being referred to collection agencies because IHS did not pay provider
bills.
ANSWER: As noted in my written testimony, for the past three years we have seen a spike in
instances where tribal members have received notices from collection agencies for unpaid bills
for services tribal members receive from private medical providers under the Purchased/Referred
Care program (PRC). As the Committee is aware, under the PRC program, the Indian Health
Service (IHS) contracts with private medical providers to enable patients to receive care from
those providers that IHS is unable to provide.
The PRC program is carried out through arrangements between IHS and private health providers.
For PRC patients in the Colville Service Unit, IHS is responsible for ensuring that these private
providers are paid, not tribal employees. As such, when individual patients receive collection
notices, this means that IHS has failed to do the administrative work necessary to ensure those
providers are paid in a timely manner. Because the contractual arrangement for PRC is between
IHS and the health provider, the Colville Tribes questions why Colville tribal patients—and not
IHS—are receiving collection notices in any event.
2. Please further elaborate on the issues regarding recruitment and retention of health
providers.
ANSWER: The Colville Service Unit serves a rural area with limited housing options. It shares
the challenges that other rural health care providers have in attracting and retaining health
providers. The Colville Tribes has, on its own, worked to establish housing for professional staff
and medical providers in communities on the Colville Reservation. IHS has funding available for
staffing quarters but, based on our experience, IHS has been reticent to share details of how that
funding is allocated or how Service Units can utilize it.
       a. How would advance appropriations prevent the kind of disruptions the Colville Service
Unit has experienced in trying to hire providers?
       ANSWER: If IHS were to be funded a year in advance, it would not have to stop
administrative hiring processes, scheduling interviews, and other disruptions associated with
government shutdowns.
        b. What ideas or thoughts do you have on how IHS can improve recruitment and
retention generally?
        ANSWER: As noted in my written testimony, IHS should establish a residency program
for medical students to locate them in rural areas. IHS currently does not have its own residency
program. Studies and data have shown that doctors are much more likely to permanently locate
in areas where they train.

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