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The Catastrophic Health Emergency Fund (CHEF) pays for extraordinary medical costs associated with treatment of victims of disasters or catastrophic illnesses. CHEF is used to reimburse PRC programs for high cost cases (e.g., burn victims, motor vehicle accidents, high risk obstetrics, cardiology, etc.). The proposed rule establishes conditions and procedures for payment from the fund.  During the comment period for the NPRM, several Tribes and Tribal Organizations expressed concern about provisions in the NRPM related to coordination with Tribal self-insurance as an alternate resource.  In response to those concerns, the IHS engaged in additional Tribal consultation and decided to delay moving forward with the NPRM pending the resolution of relevant litigation.  IHS intends to proceed with developing the NPRM consistent with how Tribal self-insurance is currently recognized in agency policy at https://www.ihs.gov/ihm/pc/part-2/chapter-3-purchased-referred-care/ . On January 29, 2021, IHS issued a Dear Tribal Leader Letter to clarify that the proposed rule should not be relied upon and that IHS will be moving forward by publishing a new proposed rule in the near future. A copy of the Dear Tribal Leader Letter concerning next steps for the CHEF regulations is available on the IHS website at:

https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/2021_Letters/DTLL_01292021.pdf.

Statement of Need:

These regulations propose to (1) establish definitions governing CHEF, including definitions of disasters and catastrophic illnesses; (2) establish that a service unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost; (3) establish a procedure for reimbursement of the portion of the costs for authorized services that exceed such threshold costs; (4) establish a procedure for payment from CHEF for cases in which the exigencies of the medical circumstances warrant treatment prior to the authorization of such treatment; and (5) establish a procedure that will ensure no payment will be made from CHEF to a service unit to the extent that the provider of services is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible.

Summary of the Legal Basis:

Section 202(d) of the Indian Health Care Improvement Act (IHCIA), Public Law No. 94-437 (1976), as amended by the Patient Protection and Affordable Care Act, Public Law No. 111-148, section 10221 (2010) requires the Secretary of the Department of Health and Human Services, acting through the Indian Health Service (IHS), to promulgate regulations to implement section 202(d). Section 202(d) of the IHCIA amends the IHS Catastrophic Health Emergency Fund (CHEF) by establishing the CHEF threshold cost to the 2000 level of $19,000; maintains requirements in current law to promulgate regulations consistent with the provisions of the CHEF to establish a definition of disasters and catastrophic illnesses for which the cost of the treatment provided under contract would qualify for payment under CHEF; provides that a service unit shall not be eligible for reimbursement for the cost of treatment from CHEF until its cost of treating any victim of such catastrophic illness or disaster has reached a certain threshold cost which the Secretary shall establish at the 2000 level of $19,000; and for any subsequent year, not less than the threshold cost of the previous year increased by the percentage increase in medical care expenditure category of the consumer price index for all urban consumers; establish a procedure that will ensure no payment will be made from CHEF to a service unit to the extent that the provider of services is eligible to receive payment for the treatment from any other Federal, State, local, or private source of reimbursement for which the patient is eligible.

Alternatives:

None.

Anticipated Costs and Benefits:

Reducing the threshold to $19,000 will allow for more purchased/referred care cases to be eligible for CHEF. Tribal and Federal PRC programs with limited budgets would have more of an opportunity to access the CHEF.

Risks:

The increase in cases will deplete the CHEF earlier in the fiscal year unless CHEF funding is increased.