WINDOW ROCK, Ariz. – The 21st Navajo Nation Council passed historic legislation on Tuesday, July 21st, 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.
With the support from HSSC, IGR, and Ethics and Rules Committee, legislation No. 0371-10, including four amendments, sponsored by Honorable Thomas Walker (Birdsprings/Leupp/Tolani Lake) 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.
Sally Pete, chief executive officer of Winslow Indian Health Care Center, Inc., informed the Council that passage of this legislation has historical significance. “You will pave a new trail to improve the health of our Navajo people,” she said.
Joe Engelken, chief executive officer of Tuba City Regional Health Care Corporation, expressed the importance for the Council to move healthcare to the next level. “Title V will let us build centers of excellence in cardiology, trauma, cancer care, and other specialty care,” he said.
The legislation was first introduced and passed on June 24 before the Health and Social Services Committee (HSSC) with a 6-0 vote.
The three non-profit hospitals are now in their eighth year under the Indian Self-Determination Act (Public Law 93-638), managing and operating medical services and programs for the Navajo, Hopi, and San Juan Paiute Tribes.
The Self-Determination Act gave these non-profit hospitals the authority to operate under a local board of directors, assuming the administration and operation of healthcare services for the communities they serve.
To be eligible for Title V under the Indian Self-Determination Act, the three non-profit 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 21st Navajo Nation Council, the legislation was presented to the Inter-Governmental Relations Committee (IGR) on June 30. The committee passed the legislation with a 7-1 vote.
Health and Social Services Committee (HSSC) and IGR authorization for Title V then gave the three non-profit hospitals authorization to present before the Ethics and Rules Committee on Wednesday, July 12. Again, the legislation passed.
After approval from the Ethics and Rules Committee, the legislation moved one step closer to allowing ‘638 hospitals’ to continue to channel and expand healthcare services through the PL 93-638 contract in areas such as specialty care, oncology, and other improved healthcare services.
“There is no reason to leave home, these services can grow here and prosper,” said Joe Engelken, chief executive officer for Tuba City Regional Health Care Corporation at the Navajo Nation Council chambers.
Thomas Walker, Council Delegate (Birdsprings/Leupp/Tolani Lake), was certain HSSC and the 21st Navajo Nation Council were in support for the 638 healthcare hospitals request to enter Title V, another level of Indian Self-Determination in the health arena.
The HSSC received this request about a year ago, and has carefully guided the non-profit hospitals to obtain proper authorization from the Navajo Nation and the federal government.
“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,” said Walker.
Walker, who is in favor of Title V designation, believes medical centers operating under the Self-Determination Act “are viable assets in Navajo healthcare.”
Evelyn Acothley, Gap/Bodaway Council Delegate, expressed, as a sovereign nation, it is time to go to the next level as a Tribal Nation to inherit the authority and control our own healthcare system. “We are ready,” she said.
“We have seen improvements made at the healthcare centers, seen the advancements of healthcare, and that the 638 corporations have met the requirements to enter Title V,” said Acothley.
“I feel the decision and the vote reflect that our Nation’s leaders recognize healthcare contractors are ready, and capable of contracting, in this case compacting with the federal government,” said Walker.
Walker understands the non-profit healthcare corporations are now positioned to administer funds and resources to provide quality healthcare. “But this come with more responsibilities, and being more accountable,” he said.
Walker emphasized that the HSSC has oversight responsibility and authority for 638 contracting. With certainty he said, “638 hospitals are ready to enter the next level of contracting, in this case it would be called compacting. An evolutionary process of contracting for how tribal organizations contract with the federal government for healthcare services.”
Walker added, “As a committee, we commend the 21st Navajo Nation council in passing the title.”
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.
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