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Senate Committee advances bill to reform tribal health care

April 17, 2018

By Jennifer Garvin

Washington — The Senate Committee on Indian Affairs on April 11 advanced legislation that calls for reforming the Indian Health Care Improvement Act.

S.1250, formally titled "The Restoring Accountability in the Indian Health Service Act of 2017," seeks to "improve the recruitment and retention of employees" and "restore accountability" in the Indian Health Service as well as introducing a centralized system to credential licensed health care professionals interested in providing services at Indian Health Services facilities — a provision supported by the ADA.

"Based on discussions with current and former IHS officials and a number of private sector dentists and state dental associations who have had experience with the credentialing process at various IHS facilities, the ADA believes a centralized credentialing system would benefit both practitioners and the IHS," Dr. Joseph P. Crowley, then ADA president elect, told the Senate committee in June 2017.

In last year's testimony, Dr. Crowley explained that the credentialing process for dentists takes "8-12 hours of staff time and costs the program about $1,000 per applicant," and also said the process could be intimidating for many applicants. For perspective, he shared a 2012 example from the South Dakota Dental Association, which actively recruited IHS volunteers only to find that out of 70 applicants, only two ultimately became credentialed to volunteer. This prompted the dental organization to partner instead with a private charity organization that was not subject to the same credentialing constraints as those placed on federal facilities.  

Dr. Crowley also testified that many other federal agencies, including all five branches of the U.S. military, use the Centralized Credentials & Quality Assurance System, a web-based worldwide credentialing, privileging, risk management and adverse actions application that supports medical personnel readiness. He also noted that the IHS itself has prioritized improving the credentialing process when it made quality improvement an agency priority last year.

In improving the oral health in tribal communities, the ADA is currently supporting the implementation of a 10 Year Health and Wellness Plan, which includes oral health and is designed to reduce oral disease by 50 percent among the Navajo tribal communities. The Navajo Nation is the largest reservation in the United States.

Centralizing the credentialing process and having more dentists available will enable greater community outreach, community education, and preventive services and will complement the ADA's efforts with the Community Dental Health Coordinator program, which currently has more than 135 graduates working in 21 states and more than 200 students enrolled.

S. 1250 is sponsored by Sen. John Hoeven, R-N.D., Senate Committee on Indian Affairs chair, and Senators John Barrasso, R-Wy., John Thune, R-S.D., and Steve Daines, R-Mont. The bill will next go to the full Senate.
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