2017- TSGAC Letter: Request to Delay Catastrophic Health Emergency Fund Final Rule

Excerpt: “On October 31, 2016, the TSGAC recommended that any Final Rule only include provisions to set the CHEF threshold at $19,000 and raised several issues important to SelfGovernance Tribes. One of the primary issues discussed was the “Definition of Alternate Resources.” We opposed the inclusion of “Tribal” as part of the list of primary payers in the “alternate resource” definition. As you are aware, the IHS denied several CHEF claims submitted by Redding Rancheria (Redding), in part, on the grounds that Redding’s self-insurance plan was an “alternate resource” that should have paid for the care. The IHS then rejected a compact amendment proposed by Redding to clarify that Redding had a right to coordinate care between its Purchased/Referred Care program and Tribal self-insurance programs without impacting its eligibility for CHEF coverage. A lawsuit was filed by Redding shortly thereafter (Redding Rancheria v. Burwell, Civ. No. 14-2035) and litigation is ongoing.