Sisseton-Wahpeton Oyate Tribal Management Capacity Development Grant - The Sisseton-Wahpeton Oyate (SWO) of the Lake Traverse Reservation is a federally recognized Tribe located primarily in northeast South Dakota with 14,806 enrolled members and user population of 6,914 operating two Title I contracts, including a master. Tribal Council Resolution NO. SWO-24-012 authorizes submission of this application to the Indian Health Service (IHS) for project type 4: Health Management Structure. Consistent with TMG intent to support Tribal efforts to enhance and develop health management capacity and infrastructure systems to prepare for assuming all or part of existing IHS programs, functions, services, and activities, SWO aims to evaluate its third-party revenue generating capacities, develop a standard process for revenue generation, and establish a centralized electronic health record for HIPAA compliant management of protected health information and billing. The TMG funding opportunity aligns with the aims of the SWO strategic Health Plan (2021-2025) adopted by Tribal Council Resolution SWO-121-095, specifically its Management and Workforce Capacity Development Interdisciplinary Team Initiative. Tribal Council Resolution SWO-24-012 directs all SWO management operating systems to collaborate with the Tribal Health Director as an interdisciplinary team to manage and sustain existing health programs and adapt to accommodate organizational change and readiness to assume operation of new programs through Indian Self-Determination and Education Assistance Act contracting or grant projects on the Lake Traverse Reservation. Objectives: By summer 2027, the following changes in health management infrastructure and workforce development will be accomplished by Tribal Health Director (THD) and project teams assigned to improve health services to the SWO user population, evidenced by 8 measures. #1. By contracting a Consultant to do organizational assessment of 3rd party billing capacities by program, SWO will obtain a complete analysis per program of revenue generation capacities and potentials. #2. By credentialing certified and licensed Tribal Health program employees who qualify for 3rd party billing work, SWO will increase by 15% annually revenue received over the 3-year project period. #3. By completing the operational assessment and evaluating options, Tribal Health will have developed proceeded with implementation of a centralized electronic health record that includes third party billing capacity. #4. By obtaining an additional NPI number for Community Health Workers to bill, SWO will increase by 25% the capacity for billable community health worker type services during the 3 project years. #5. By preparing all departments/systems for contracting or compacting and assumption of PFSAs over the 3 project years, SWO will have developed SOPs that include role responsibilities for maintaining provider enrollment status with CMS and other payers, credentialing of providers (including CHWs), registering patients in the Tribal Health EHR, documenting services provided, coding, billing, and reconciling claims with revenue received. #6. By examining and adjusting policy and procedures to include all State Medicaid Program requirements, SWO health programs will meet 100% of standards required to be approved to bill for Community Health Worker services by end of the 3-year project. #7. By providing monthly training and support for managers in 3rd party billing requirements and responsibilities, SWO will establish a competency assessment for evaluation of Program Managers and continuous improvement processes throughout the 3-year project. #8. By cross-training between programs in billing processes and electronic health record management, a revenue-generation culture will be developed and sustained.
