A Resolution concerning 105(l) lease agreements

WHEREAS, the National Indian Health Board (NIHB), established in 1972, serves all Federally recognized American Indian/Alaska Native (AI/AN) Tribal governments by advocating for the improvement of health care delivery to AI/ANs, as well as upholding the Federal government’s trust responsibility to AI/AN Tribal governments; and

WHEREAS, the Indian health system has always been chronically underfunded, as documented by the U.S. Commission on Civil Rights, among others; and

WHEREAS, Tribes and Tribal organizations providing health care services through contracts and compacts with the Indian Health Service (IHS) under the Indian Self-Determination and Education Assistance Act (ISDEAA) have been able to supplement inadequate health care facilities funding by leasing Tribal facilities to IHS under the authority of section 105(l) of the ISDEAA, 25 U.S.C. § 5324(l); and

WHEREAS, Tribal governing bodies have the authority to determine to what extent a Tribe should provide such services, which are deemed as a matter of law by § 1680c(c)(2) to be provided under the Tribe’s ISDEAA agreement with IHS; and

WHEREAS, Tribes are required to charge for those services and may bill third parties such as health insurance, Medicare, Medicaid, and the Children’s Health Insurance Program, for the services; and

WHEREAS, it is essential that Congress continue funding 105(l) leases and Contract Support Costs (CSC), as these are contractual obligations to sovereign Tribal governments, but without meaningful impacts to funding for medical services, facilities, sanitation, and other needs, that are vital to the Indian health system and effectively reduce AI/AN health disparities; and

WHEREAS, a recent court decision involving the Jamestown S’Klallam Tribe threatens to undermine the increasingly beneficial interaction between sections 105(l) and 813.

NOW THEREFORE BE IT RESOLVED, that Congress should amend Section 105(l) of ISDEAA to further reinforce congressional intent regarding the intersection of Sections 105(l) and 813 by clarifying that all facility space used to provide healthcare services under ISDEAA agreements – including to non-IHS beneficiaries, be compensable under Section 105(l); and