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North Dakota and South Dakota PRC Study Consultation

On October 18, The Indian Health Service (IHS) Office of Resource Access and Partnerships (ORAP) hosted an online Tribal consultation session to solicit feedback on a study investigating the feasibility of a Purchased/Referred Care Delivery Area (PRCDA) in North Dakota and South Dakota. The Purchased/Referred Care program can pay for medical or dental services delivered outside of IHS and Tribal health facilities if a Tribal member can meet requirements relating to residency, notification, medical priority, and alternate resources. The consultation is IHS’s response to provisions in the Indian Health Care Improvement Act (IHCIA), 25 U.S.C. § 1678a(a), which provides for the designation of the states of North Dakota and South Dakota as “a contract health service delivery area.”

Jim Lyon, Director of the Division of Contract Care, shared details on information they plan to collect in the study. The draft analysis requirements were broken up into three sections: 1) PRC implications in the states of North Dakota and South Dakota, 2) cost implications of an expansion to a statewide PRCDA, 3) preparation of a map for each state showing PRCDAs and American Indian/Alaska Native (AI/AN) population in each county. One piece of feedback ORAP received requested they include a quantitative positive impact of the potential PRCDA for North Dakota and South Dakota PRC.

The September 11 Dear Tribal Leader Letter from IHS sharing information on the consultation clarifies that IHICIA “prohibits the designation from decreasing health care services to Indians.” IHS’s proposed study requested feedback on the “feasibility” of expanding the PRCDA to North Dakota and South Dakota. If the study finds that this expansion will decrease health care services, the PRCDA expansion cannot proceed. Multiple Tribal consultation participants raised questions inquiring if the proposed PRCDA would come with additional funding to support newly eligible people. IHS representatives replied, stating that there is no additional funding for the proposed PRCDA.

It is a potentially long road to the creation of a PRCDA in North Dakota and South Dakota. IHCIA similarly directed the IHS to designate the state of Arizona as a PRCDA. IHS began the process of designing a study to investigate the impacts and feasibility of such a PRCDA back in 2018. IHS acknowledged at the call that they are still in the process of making a decision on the PRCDA for Arizona.

To learn more about previous expansions of PRCDAs, check out this Washington Report Article.