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Recoup Your Healthcare Contract Support Costs (CSC)
In a victory for Tribal Nations that pursue Self-Determination under PL 93-638, a recent Supreme Court decision now ensures that those with 638 contracts/compacts can be reimbursed by the Indian Health Service (IHS) for certain contract support costs related to healthcare program administration.
The new ruling requires that IHS pay Tribes for the contract support costs they incur in collecting and spending income from third-party payors—including Medicare, Medicaid, and private insurers—on eligible programs, functions, services, and activities under the contract/compact.
Becerra v. San Carlos Apache Tribe
For 30 years, Tribal Nations have sought to recoup certain contract support costs related to the administration of health care programs under self-determination contracts — and on June 6, 2024, the Supreme Court agreed.
Ruling in favor of the San Carlos Apache and Northern Arapaho Tribes, the Supreme Court determined that covering these costs is ”necessary to prevent a funding gap,” effectively placing Tribal Nations on an equal footing with IHS in the delivery of healthcare services.
This landmark decision not only helps to secure critical healthcare resources in under-served communities, but also serves to affirm Tribal sovereignty.
Timely Filing of Claims is Critical
Self-determination agreements include a six-year statute of limitations on claims for additional compensation.
So to ensure your Tribe has the support it needs to file claims in a timely manner and in accordance with all requirements, it pays to retain REDW’s team of Tribal finance experts to:
- Review program accounts
- Compile contract support costs
- Collaborate with Tribal counsel
- Support claim submission
Don’t wait to recover vital healthcare dollars for your Tribal community — connect with us today!
Support for Tribes
Connect with Us Today for a 30-min Complimentary Consultation on the Tribal CSC Claims Process
What Tribes Need to Know
The Supreme Court ruling in favor of the San Carlos Apache Tribe is a pivotal development for Tribal sovereignty and healthcare management. By ensuring CSC reimbursements, Tribes can better manage their federally delegated programs, leading to enhanced services and improved financial stability.
Impact of Supreme Court Ruling
- Federal Accountability: The ruling mandates IHS to cover CSCs relating to third-party income, reinforcing the federal government’s trust obligations and ensuring that Tribes receive necessary administrative and overhead cost reimbursements.
- Operational and Financial Ramifications: The decision allows Tribes to reallocate previously used tribal funds, enhancing their capacity to expand health programs or other services, thereby offering greater flexibility and improving overall community well-being.
Eligibility and Documentation
- Eligible Costs: Tribes must segregate expenses into those covered under Program Function Services and Activities (PFSA) and those considered program expansions. Only costs directly associated with PFSA and funded by third-party revenues (Medicare, Medicaid, private insurers) are eligible for reimbursement.
- Documentation: Essential documents include indirect cost agreements, A133 audits, program agreements, amendments, modifications, and detailed ledgers of third-party revenues. Timely notifications of claims to the IHS and proper claim letters compliant with the Contract Disputes Act are crucial.
- Segregation: When mingling tribal funds with third-party revenues, clear allocation and expenditure documentation are necessary to support claims.
Strategic and Legal Framework
- Legal Strategy: Tribes need strong legal strategies to argue their claims effectively, as seen in previous cases like Navajo Health Foundation Sage Memorial Hospital and San Carlos Apache Tribe. Legal experts emphasize the importance of structured claims and the negotiation of indirect costs.
- Statutory Compliance: Understanding and aligning claims with statutory language is vital. For example, spending must further the general purposes of the contract, not merely specific expansions outside the originally agreed programs.
Practical Steps for Tribes
- Preparation: Tribes should review their health programs, identify eligible costs, and maintain thorough records. Legal and financial advisors should be consulted to ensure compliance and the structuring of effective claims.
- Fill out the form on this page for a complimentary 30-minute educational consultation with one our our National Tribal Practice Leaders.
- Policy Development: Developing clear policies on the utilization of third-party revenue and compact funds can support the justification and maximization of CSC reimbursements.
What REDW services are now covered under CSC?
Based on recent insights, particularly following the Supreme Court ruling, several REDW services can now be covered under Contract Support Costs (CSCs) for Tribes. These services include essential administrative and operational support necessary for managing federally delegated programs like health services. Here are the specific services:
Audit & Assurance Services:
Consulting Services:
Accounting Services:
Tax Services:
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Technology Solutions:
Human Resources Consulting:
Wealth & Investment Management:
Fraud & Forensic Accounting:
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By covering these REDW services under CSCs, Tribes can ensure better management of their programs and more effective utilization of third-party revenues, as confirmed by recent developments and legal victories.
Has the House Appropriations Committee approved FY 2025 Funding for IHS?
Yes.
On July 9, the House Appropriations Committee approved its version of the Interior, Environment, and Related Agencies FY 2025 appropriations bill, which includes a 23% increase in funding for the Indian Health Service (IHS)… (with) $985 million increase for Contract Support Costs (CSC).
Read: House Committee Approves FY 2025 Bill with Major Funding Boosts for the Indian Health Service
🎙 Insight in Indian Country Podcast
The recent Supreme Court ruling in Becerra v. San Carlos Apache Tribe is a significant win for tribal sovereignty and self-determination.
Dive deeper into the case and its impact for Indian Country with host and REDW National Tribal Practice Leader Wesley Benally as he welcomes Kevin Cronk, CPA, and Lloyd B. Miller of Sonosky, Chambers, Sachse, Miller & Monkman, LLP to the podcast.
Listen Now 🎙
