Learn the advantages of becoming or creating a Tribal clinic and the processes to do so. We will take you through turn-key or do it yourself step-by-step processes. Find out those answers to difficult questions you have wondered about.
We all know there are big advantages to having an employee clinic; saves money, convenient for employees, less time off work, lowers costs for HR benefits and the lists goes on. What you may not realize is that if you turn this employee clinic into a designated “Tribal” clinic, you just opened a revenue generating machine. Some Tribal clinics are generating more money than gaming. Yes, it is true.
- So how do you do this if you don’t have experience?
- What will happen to the existing Tribal/IHS clinic?
- Can we see non-Natives?
- Can we operate the Tribal clinic under the business development division, or does it have to go under the health division?
- What are the other benefits of becoming a Tribal clinic?
- Is it true the clinic will get paid $719/diem?
All of these are good questions. Let’s begin with the question about the existing Tribal clinic. Many Tribes are concerned about how the change or start-up of a new Tribal clinic will affect the existing clinic that most of its members are using. It doesn’t have to affect anything. You can leave your program dollars and shares with the existing clinic. You will be profitable without them. You could also choose to negotiate with IHS to bring some or all those program dollars/shares to your clinic. This is something you can change annually. You need to do what is best for your people. The good news is you will be able to claim your costs for running the clinic, eligible for 105 (l) Lease funding, 340B pharmacy purchasing plan, NSSC VA Prime Vender discounted purchasing plan for pharmacy and clinical supplies, and Tribal Management grants. There is no downside to this.
The 340B program allows you to purchase medications for pennies on the dollar. As an example, Humira costs $7,000/month. Through 340B program, you purchase it for 1 cent. Ozempic is $1,400/month. Through 340B, you can purchase at $350. The application process takes 10 minutes for Tribes. To be eligible to receive 340B medication, you must be a patient of the clinic.
What about seeing your non-Native employees and families? The Tribe would need an 813 Resolution to see non-Natives. Face Rock has a sample resolution you can use. After that, you can designate who you want to allow to be seen in the clinic. Your first priority must always be to treat Natives. You cannot have non-Natives being seen and Natives on a wait list. Some clinics became so successful, they open to the community; allowing non-Natives to pay for the care for Natives. If you are going to see non-Natives, they must have a payor source, such as Medicare/Medicaid/Commercial insurance.
You can operate the Tribal clinic under the Business Development Division of the Tribe or under your Health Division. You do not have to have the same tax ID. Should you have an existing 638 Tribal clinic, you will need to add your new clinic to the existing clinic’s Annual Funding Agreement and Scope of Work documents with IHS. All can be accomplished easily.
What if you don’t have experience running a clinic? There are many good companies who can run the clinic for you turn-key. You can train staff to take over once you get going. You will still be profitable.
What are the additional benefits a Tribal clinic is eligible for that and employee clinic is not? As a Tribal clinic, you are eligible for Tribal Management Grants, Start-up Grant, Small Ambulatory Grants, 105 (l) Lease program, and various funding programs. According to 25 USC 1621 e, Indian Health Care providers must be paid at the highest rate regardless of contracting status with insurance plans. You also become eligible for the all-inclusive Office of Management and Budget (OMB) rate of reimbursement from Medicaid which is currently $719/visit. Some states allow separate benefits for non-Natives and pharmacy.
The process of adding a location or changing to a Tribal clinic designation is not difficult, you just need the right help. Contact Face Rock and we will help you through this process.
Should you have any questions or would like a meeting to discuss further, please contact Karen Knight at KKnight@FaceRockInc.com.
We look forward to serving you as we have with many Tribes.
