OMAHA TRIBE OF NEBRASKA (2025)

OMAHA TRIBE OF NEBRASKA

Members

Galen Aldrich Sr.

Calvin Harlan

Leander Merrick

Executive Officers

Jason Sheridan, Chairman

Jerome Hamilton, Vice-Chairman

Alan Harlan, Treasurer

Dustin Lovejoy, Secretary

RESOLUTION NO. 25-01

OF THE

OMAHA TRIBE OF NEBRASKA

RE: P.L. 93-638 CONTRACT REQUEST FISCAL YEAR 2025 Carl T. Curtis

Health Education Center.

WHEREAS: The Omaha Tribe of Nebraska is federally recognized Indian tribe of organized under a

constitution and bylaws approved by the Secretary of Interior on April 30, 1936, pursuant

to Section 16 of the Indian Reorganization Act of June 18, 1934; and

WHEREAS: pursuant to Article III, Sec.1 of the constitution of the Omaha Tribe of Nebraska, the

governing body of the Omaha Tribe shall also be known as Tribal Council; and

WHEREAS: Omaha Tribal Council, pursuant to Article IV, (Dj, has the Responsibility to safeguard,

promote and enforce the peace, economy, safety, law and order, and general welfare of the

Tribe and the Omaha Reservation; and

WHEREAS: the Omaha Tribe has established P.L. 93-638 contracts with the INDIAN HEALTH

SERVICES to provide an array of services; and

WHEREAS: _ the Omaha Tribe would like to continue these services so the health,

welfare and safety of the Tribal members is protected an honored; and

NOW THEREFORE, BE IT FURTHER RESOLVED THAT: The Omaha Tribal Council of the

Omaha Tribe of Nebraska approves the Annual Funding Agreement for FY 2024 for the OTN CTCHEC

in the amount of $16,795,197, which includes a Secretarial amount of $14,062,501 and Contract Support

Costs in the amount of $2,732,696. See Attached Cumulative Funding Report.

Resolution No. 25-01

CERTIFICATION

This is to certify that the ies resolution was considered at a duly called meeting of the

Omaha Tribal Council on the a day of OC fob 2. /__, 2024, and was adopted by a vote

of: U for; © against; abstaining; with the Chairman not voting. A quorum of 5 was

present.

MEMBERS VOTE:

YES

NO ABSTAIN/ABSENT

Jason Sheridan

Absent

Jerome Hamilton

A bSTex ma)

Alan Harlan

Dustin Lovejoy

Galen Aldrich Sr.

Calvin Harlan

Leander Merrick

AbSent

Submitted by:

DLL

Dustin Lovejoy, Secretary

Omaha Tribal Council

Attest:

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CA in td.

Cg enn

(e/2 [24

Daté c

Jason Sheridan, Chairman

Omaha Tribal Council

Resolution No. 25-01

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Attachment 2 - Annual Funding Agreement

Annual Funding Agreement

between

the Secretary of the

United States Department of Health and Human Services

and the

Omaha Tribe of Nebraska

Contract Number: HHS-I-241-2023-00006 Fiscal Year (“FY”) 2025

SECTION ONE — AUTHORITY AND PURPOSE

This Annual Funding Agreement (“AFA” or “Agreement”) is executed by and between the

Omaha Tribe of Nebraska (“Contractor”) and the Secretary of the Department of Health and

Human Services, acting through the Indian Health Service (“IHS”), pursuant to Title I of the

Indian Self-Determination and Education Assistance Act (Pub. L. 93-638, 25 U.S.C. §§ 5301-

5332 as amended, (“ISDEAA”) and is incorporated into and governed by the ISDEAA Contract

Number HHS-I-241-2023-00006 (“Contract”). Pursuant to the terms of this Agreement, the

Contractor is authorized to plan, conduct, operate, and administer the programs, functions,

services and activities (“PFSAs’’) identified in Attachment B (Scope of Work (“SOW’”)) to this

AFA. All terms of this Agreement shall be governed by the ISDEAA, its implementing

regulations, including IHS eligibility regulations, and, to the extent expressly agreed to by the

parties hereto, applicable IHS policies. To the extent that any term in this Agreement may be

construed as being inconsistent with the ISDEAA or as exceeding the authority granted by the

ISDEAA, the provisions of the ISDEAA shall govern. The attachments listed and denoted as

Attachments A (the Recurring Funding Report (“Funding Table”)) and B (the SOW) appearing

at the end of this Agreement are incorporated by reference as part of this Agreement as if fully

set forth herein.

SECTION TWO — EFFECTIVE DATE AND TERM

This Agreement shall be effective October 1, 2024 and shall extend through September 30, 2025.

SECTION THREE — TRIBAL PROGRAMS AND BUDGETS

The Contractor agrees to provide and be responsible for the PFSAs identified below in

accordance with the Contract, this Agreement, the SOW, and the Funding Table. The Contractor

agrees to provide the PFSAs identified below to IHS eligible beneficiaries in accordance with the

ISDEAA, 25 U.S.C. § 1680c, 25 C.F.R. Part 900, 42 C.F.R. Part 136, and any other applicable

law or regulation.

The Contractor’s PFSAs are:

(A) Hospitals & Clinics

(a) Clinic services (including, but not limited to, Lab and Nutrition)

Omaha Tribe of Nebraska AFA FY 2025 Page 1

Attachment 2 - Annual Funding Agreement

(B) Dental

(C) Behavioral Health

(a) Mental Health

(b) — Alcoholism/Substance Abuse

(D) Health Education

(E) Maternal Child Health

(F) Community Health Representative

(G) Public Health Nursing

(H) Purchased Referred Care

(1) Environmental Health Services

The Contractor reserves the right to rebudget funds with respect to allocations within the

Funding Table pursuant to 25 U.S.C. § 5325(0).

SECTION FOUR — AMOUNT OF FUNDS

The total amount of funds associated with the PFSAs provided from October 1, 2024 through

September 30, 2025, pursuant to the Contract, and which the Secretary or an authorized

representative shall make available to the Contractor as provided in the Contract, shall be

determined as provided in this Agreement.

A. Section 106(a)(1) amount: Pursuant to 25 U.S.C. § 5325(a)(1), the Secretarial amount

available to the Contractor for its Fiscal Year (FY) 2025 AFA for IHS PFSAs assumed in whole,

or part, by means of the Contract is $14,062,501 (see Attachment A). Additional amounts may

be made available through appropriate modifications to this AFA.

B. Contract Support Costs (“CSC”): CSC will be paid in accordance with 25 U.S.C. § 5325

The parties agree that, according to the best data available as of the date of execution of this

agreement, the amount to be paid for FY2025, which represents the parties’ estimate of the

Contractor’s full CSC requirement, is $2,732,696 including $1,210,122 for direct CSC and

$1,522,574 for indirect or indirect-like CSC. This estimate shall be recalculated as necessary as

additional data becomes available including information regarding the direct cost base, pass

throughs and exclusions, and the indirect cost rates to reflect the full CSC required under 25

U.S.C. § 5325, and, to the extent not inconsistent with the Indian Self-Determination Act, as

specified in the IHS Indian Health Manual, Part 6, Chapter 3. The parties will cooperate in

updating the relevant data to make any agreed upon adjustments. In the event the parties disagree

on the CSC amounts estimated and paid pursuant to this paragraph and the Contractor’s full CSC

requirement under the ISDEAA, the parties may pursue any remedies available to them under the

ISDEAA, the Contract, and the Contract Disputes Act, 41 U.S.C. §§ 7101-7109.

C. Adjustments and Increases: The funding amounts referenced in this AFA and its

attachments are subject to change based upon IHS FY2025 appropriations. Within twenty (20)

calendar days of receipt of advice to the Area of adjustments to the FY 2025 base, the amounts in

this Agreement will be adjusted and any increases promptly paid to the Contractor in a lump sum

payment. To the extent applicable, the Contractor shall be eligible for funding for new services,

service increases, inflation increases, and general increases on the same basis as other ISDEAA

Omaha Tribe of Nebraska AFA FY 2025 Page 2

Attachment 2 - Annual Funding Agreement

Contractors. Amendments reflecting payment of these funds shall be provided to the Contractor

after any such funds are added to the AFA. The Contractor retains the right to reject the addition

of the funds to the AFA and return the funds to IHS.

D. Emergency Room and Inpatient Reserve: On February 28, 2024, IHS retained $3,068,811 of

prior and current years emergency room and inpatient funding to closeout undelivered orders. By

June 1, 2025, IHS will transfer the remaining balance of the reserve to the Tribe through a

modification. IHS may continue to hold funding in reserve past June 1, 2025, However, if there

are any pending contract claims or lawsuits concerning the funding in the reserve that have yet to

be resolved. In that event, IHS will only continue to reserve enough funds to cover the open

disputes should they be decided against IHS. IHS will make every reasonable effort to facilitate

an orderly and timely transfer of these funds to the Tribe. If there are still pending contract

claims or lawsuits concerning the funding in the reserve, starting on June 1, 2025, and recurring

each month thereafter, IHS will provide the Tribe an updated report on the status of undelivered

orders associated with the Tribe’s emergency room and inpatient PFSAs. As funds associated

with the Tribe’s emergency room and inpatient PFSAs become available, IHS shall pay such

funds to the Tribe as soon as feasible and no later than 30 days after each report that identifies

such funds as being available. The Tribe and IHS will meet as frequently as necessary, in the

view of either party, to ensure timely accountability and transfer of these funds.

SECTION FIVE — METHOD OF PAYMENT

Funds shall be paid as expeditiously as practicable, in accordance with Section (b)(6) of the

Contract for the PFSAs identified in this AFA. The payment for the period covered by this AFA

shall be made in lump sum payments through the system utilized by the IHS.

Specifically, except as otherwise provided in this Agreement, the IHS shall provide all FY 2025

recurring funding due under this Agreement in one lump sum payment due within twenty (20)

calendar days of the allotment to the Great Plains Area Office (““GPAO”) of such funds, or

within ten (10) calendar days of the effective date of this Agreement, whichever is later. In the

event of a Continuing Resolution, IHS will pay the Contractor its proportionate share of such

funds received within (20) calendar days of the allotment to the GPAO. Competitive, formula,

and other funds that require further calculation shall be paid within ten (10) calendar days of the

date on which the Area Director reaches a final allocation decision following tribal consultation,

or within ten (10) calendar days of the effective date of this Agreement, whichever is later. IHS

shall pay to the Contractor any interest that may be due under the Prompt Payment Act 31 U.S.C.

§§ 3901-3907.

SECTION SIX — SPECIAL EARMARKED PROGRAMS, SERVICES, AND FUNCTIONS

The Contractor is not authorized under this AFA to redesign, shift, or to transfer any of the

funding for any PFSAs which are subject to special restrictions imposed by Congress.

SECTION SEVEN — REPORTS

Omaha Tribe of Nebraska AFA FY 2025 Page 3

Attachment 2 - Annual Funding Agreement

Pursuant to the Single Audit Act, as amended, 31 U.S.C. §§ 7501-7506, the ISDEAA, 25 U.S.C.

§ 5305(f)(1) and 45 C.F.R. Part 75, the Contractor shall provide to the Federal Audit

Clearinghouse and National External Audit Review (or their successors), its annual Single

Agency Audit Report (formerly known as A-133 Audit). The Contractor shall provide such

other reports as agreed upon by the parties from time to time. A SF-425 — Federal Financial

Report shall be submitted to IHS within thirty (30) days after the close of each fiscal quarter,

except for the fourth quarter, which will be submitted within ninety (90) days after the close of

the federal fiscal year. A brief annual narrative report will be submitted to IHS within ninety

(90) days after the end of the contract year. 25 U.S.C. § 5305(f)(2), 25 C.F.R. § 900.65.

SECTION EIGHT — RECORDS

The records generated and maintained by the Contractor shall not be treated as federal records

under Chapter 5 of Title 5 of the United States Code, except that:

A, Patient Records Disclosure: Patient medical records may be disclosed only in accordance

with the applicable provisions of the Health Insurance Portability and Accountability Act, 45

C.F.R. Parts 160 and 164, 42 C.F.R. Part 2, and the American Recovery and Reinvestment Act of

2009; and

B. Patient Records Storage: Pursuant to Section 25 U.S.C. § 5324(o) of the ISDEAA, the

patient records generated by the Contractor shall, at the option of the Contractor, be deemed to

be federal records for the limited purpose of making such records eligible for storage by Federal

Records Centers to the same extent and in the same manner as other Department of Health and

Human Services patient records.

C. Maintenance of Records: Pursuant to 25 U.S.C. § 5305, each recipient of federal

financial assistance shall keep such records as the appropriate Secretary shall prescribe by

regulation promulgated under Sections 552 and 553 of Title 5, including records which fully

disclose the amount and disposition by such recipient of the proceeds of such assistance, the cost

of the project or undertaking in connection with which such assistance is given or used, the

amount of that portion of the cost of the project or undertaking supplied by other sources, and

such other information as will facilitate an effective audit. These records shall consist of

quarterly financial statements for the purpose of accounting for Federal funds, the annual singleagency audit required by chapter 75 of title 31 and a brief annual program report.

SECTION NINE — SUCCESSOR ANNUAL FUNDING AGREEMENTS

As provided in subsection (b)(14) of the Contract, negotiations for a successor AFA shall begin

no later than 120 days prior to the conclusion of the preceding AFA. IHS review of successor

funding agreements is described in 25 C.F.R. §§ 900.32 and 900.33. The amount of funds

required to be provided by 25 U.S.C. § 5325(a)(1) for each successor AFA, which is subject to

the availability of appropriations, shall only be reduced in compliance with the requirements of

25 U.S.C. § 5325(b).

SECTION TEN — AMENDMENT OR MODIFICATION OF THIS AGREEMENT

Omaha Tribe of Nebraska AFA FY 2025 Page 4

Attachment 2 - Annual Funding Agreement

A. Form of Amendments: Except as otherwise provided in this AFA, the Contract, or by

applicable law, any modifications to this AFA shall be in the form of a written amendment and

signed by both the Contractor and the IHS.

B. Amendment to Add Additional Programs: The Contractor reserves the right to identify

other PFSAs that it wishes to include in this Agreement by amendment during the term of this

Agreement. If the Contractor’s proposal(s) to include additional PFSAs is approved by IHS, this

Agreement will be amended to include such PFSAs.

C. Funding Increases: Written consent of the Contractor shall not be required for issuing

amendments which result from increases in actual appropriation levels for PFSAs identified in

this AFA. Amendments reflecting payment of these funds shall be provided to the Contractor

within ten (10) working days after any such funds are added to the AFA. If the Contractor does

not agree with the amounts, it retains the right to reject the addition of the funds to the AFA and

return the funds to IHS.

D. Non-Recurring Funds: Non-recurring funds are funds that are transferred to the

Contractor on a one-time basis to support the existing scope of work. These funds are designated

as “non-recurring”/”NR’/etc. on Attachment A. Pursuant to section (e)(2)(B) of the Contract,

non-recurring funds may be added unilaterally by IHS.

SECTION ELEVEN — BUYBACK IHS SERVICES, RESOURCES, SUPPLIES, FUNCTIONS,

AND PROGRAMS.

The Contractor may choose to purchase from the IHS any goods and services transferred from

the IHS to the Contractor under the Contract and this Agreement. The IHS, if it has the capacity

to do so, will provide any such goods and services to the Tribe on a reimbursable basis, including

payment in advance with subsequent adjustment. The terms of any such buyback arrangement

will be negotiated in a buyback agreement.

SECTION TWELVE — FEDERAL TORT CLAIMS ACT

(1) Generally. For purposes of Federal Tort Claims Act (“FTCA”) coverage, the

Contractor is deemed to be part of the Public Health Service in the Department of Health

and Human Services and its employees (including individuals performing personal

services contracts with the Contractor to provide health care services) are deemed to be

employees of the Federal government while performing work under this AFA. This

status is not changed by the source of the funds used by the Contractor to pay the

employee’s salary and benefits unless the employee receives additional compensation for

performing covered services from anyone other than the Contractor. Under this AFA, the

Contractor’s employees may be required as a condition of employment to provide health

services to non-IHS beneficiaries to meet the obligations associated with this AFA.

Omaha Tribe of Nebraska AFA FY 2025 Page 5

Attachment 2 - Annual Funding Agreement

These services may be provided in the Contractor’s facilities or in non-Contractor

facilities. The employees’ status for FTCA purposes is not affected.

In addition, no reference to collaboration, coordination, or other interaction with a

federal, state, or local government, university or other school, or private agency is

intended to extend, nor does it have the effect of extending, FTCA coverage to such other

entity.

(2) Traditional Medicine. Although the Contractor may engage in traditional health

care practices, pursuant 25 U.S.C. § 1680u, the United States is not liable for any

provision of traditional health care practices that results in damage, injury, or death to a

patient.

(3) Tribal Officials. The [HS and Contractor agree that Tribal Officials are a

substantial part of carrying out the AFA and further agree that a claim against Tribal

Officials in their official capacity as the legal representative of the Contractor, which

arises from the Contractor’s administrative duties with respect to this AFA, may be an

action against the Contractor.

(4) Case-by-Case Determination. IHS does not determine the scope of coverage

under the FTCA. The Contractor understands that whether the FTCA applies in any

particular case is decided on an individual case-by-case basis by the United States

Department of Justice and subsequently by the Federal Courts.

(5) Records. Should the FTCA apply to a claim against or in litigation involving the

Contractor’s employees, the Contractor will promptly provide all documents necessary

for the defense of such case. All such documents, and any related documents, shall be

preserved throughout the pendency of the claim, case, and all appeals.

(6) Insurance. The Contractor may, without approval of the Secretary, expend funds

provided under this AFA to purchase insurance and indemnification, including insurance

covering the risk of loss of or damage to property used in connection with this AFA

without regard to the ownership of such property, to the extent that the expenditure of the

funds is supportive of the PSFAs carried out by the Contractor under this AFA.

SECTION THIRTEEN— LICENSING

In carrying out its Contract and the PFSAs identified in the SOW, the Contractor will ensure that

all PFSA’s are provided in accordance with sections 221 and 706 of the IHCIA. 25 U.S.C. § §

1621t, 1665e.

The Contractor’s health program employees shall be exempt from payment of licensing,

registration, and any other fees imposed by a Federal agency to the same extent that officers of

the Public Health Service Commissioned Corps and other employees of the IHS are exempt from

such fees. 25 U.S.C. § 1616q

Omaha Tribe of Nebraska AFA FY 2025 Page 6

Attachment 2 - Annual Funding Agreement

SECTION FOURTEEN — PURCHASED AND REFERRED CARE

Eligible IHS beneficiaries who receive purchased and referred care (“PRC”) services authorized

by the Contractor are not liable for the payment of any charges or costs arising from the

provision of such services. The Contractor agrees to be bound by 42 C.F.R. Part 136, subpart I in

the administration and provision of PRC services carried out under this Agreement. The

Contractor opts in to 42 C.F.R. Part 136, subpart I for the purpose of securing Medicare-Like

Rates.

SECTION FIFTEEN — TRADITIONAL HEALTH CARE PRACTICES

The Contractor is permitted to employ traditional health care practices and practitioners, and

does so from time to time as circumstances warrant, but per 25 U.S.C. § 1680u, as amended, the

United States is not liable for any provision of traditional health care practices that results in

damage, injury or death to a patient.

SECTION SIXTEEN — BACKGROUND CHECKS

The Contractor shall: (1) verify that all health care providers are appropriately licensed and

credentialed; and (2) conduct background check(s) and fingerprinting of employees, contractors,

and patient care providers as required by applicable law (including but not limited to 25 U.S.C.

§§ 3207 and 1647a(b); 42 C_F.R. §§ 136.401 to 136.418) and in accordance with the policies and

procedures of the Contractor.

Once the Contractor becomes aware that an individual does not meet the requirements as stated

above, or the Contractor has obtained information that reasonably indicates that a health care

provider is not qualified to provide clinical services, it will immediately address these concerns.

If IHS becomes aware that the Contractor is not satisfying the above requirements, IHS will

notify the Contractor. Upon receipt of that notification, the Contractor agrees it will respond, in

writing, to IHS within seven (7) days verifying its compliance with applicable law.

SECTION SEVENTEEN — LEASE

The parties have negotiated and entered into the following lease to carry out PFSAs under this

agreement pursuant to section 105(/) of the Indian Self-Determination and Education Assistance

Act, 25 U.S.C. §5324()):

Lease Number: IHS-OTON-2020-225 Carl T. Curtis Health Education Center, 100 Indian Hills

Drive, Macy, Nebraska 68039.

Lease Number: IHS-OTON-2022-427 Alcohol Treatment Program, 575 Indian Hills Drive,

Macy, NE 68039.

Except as otherwise provided under this agreement, funds due to the Omaha Tribe of Nebraska

pursuant to the lease constitute full, reasonable, and non-duplicative compensation for the use of

Omaha Tribe of Nebraska AFA FY 2025 Page 7

Attachment 2 - Annual Funding Agreement

the facilities and no additional compensation is due for that purpose. Subsequent lease

negotiations shall be controlled by the terms of the relevant lease, a copy of which is attached to

this Annual Funding Agreement.

SECTION EIGHTEEN — ATTACHMENTS

A. Scope of Work: The SOW is hereby incorporated in its entirety in this AFA as

Attachment B.

B. Funding Table: The Funding Table is hereby incorporated in its entirety in this AFA as

Attachment A.

Omaha Tribe of Nebraska AFA FY 2025 Page 8

Attachment 2 - Annual Funding Agreement

Omaha Tribe of Nebraska

CONTRACTOR

DATED THIS DAY OF , YEAR 2024

BY:

Jason Sheridan, Chairman

Omaha Tribe of Nebraska

Department of Health and Human Services

INDIAN HEALTH SERVICE

DATED THIS DAY OF , YEAR 2024

BY:

Joe Amiotte, Area Director

Great Plains Area Indian Health Service

Omaha Tribe of Nebraska AFA FY 2025

Page 9

Attachment B to the Annual Funding Agreement

SCOPE OF WORK

PREAMBLE

The Omaha Tribe of Nebraska (’’Contractor’”) Carl T. Curtis Health Education Center

(CTCHEC) shall administer the programs described herein to all eligible beneficiaries in

accordance with 42 C.F.R. Part 136. The target population for this contract is eligible Native

Americans living on or near the Omaha Indian Reservation consisting of Thurston, Monona, and

Burt, Cuming, and Wayne counties. Services are provided in various locations as listed in

Exhibit 1.

The Contractor is committed to and will provide quality health services to meet standards the

Contractor believes to be appropriate and applicable to the delivery of the health services

identified below. The Contractor’s services consist of:

e Comprehensive Ambulatory and Acute Medical Care;

e Dental Health;

e Community Health Outreach, including Public Health Nursing, Health Education, and

Community Health Representative (CHR) programs;

e Environmental Health;

e Elder Care and Dialysis;

e Behavioral Health and Alcohol/Substance Use Programs; and

e Purchased/Referred Care.

Additionally, by Council Resolution 98-109, the Contractor receives its shares of Indian Health

Service Headquarters and Great Plains Area Office funds.

SCOPE OF SERVICES

I. Ambulatory and Acute Medical Care

CTCHEC provides a comprehensive range of primary and specialty healthcare services,

appropriate for a local medical center to prevent and treat disease and injury and to promote

improvements in health status and outcomes. All medical services, treatments, laboratory, and

radiology services provided to pediatric and adult patients at CTCHEC include the coordination

of referrals to outside services not available at the clinic. Services provided include:

1. Family Health: Provides outpatient medical care for pediatric, adolescent and adult

patients, which includes diagnosis, treatment, education, prevention, and consultation

including, but not limited to, Primary Care and Subspecialty Services such as Geriatric,

Rheumatology, Dermatology, Neurology, Infectious Disease, Hematology, Nephrology,

Cardiology, Pulmonary Disease, Allergy, Immunology, Nutritional Therapy, Endocrine

and Metabolic and Nutritional Disorders.

2. Maternal and Child Health: Prenatal and postpartum care and education, STD prevention,

family planning, and case management. :

10.

11.

12.

13.

14.

Urgent Care: Provides acute care services and initiates basic life support treatment in the

care of any emergency/traumatized patient, arranging for transfer to a facility with a

higher level of care as needed.

Diabetes Treatment and Prevention Services: Provides primary, secondary, and tertiary

prevention services, including, but not limited to, diagnosis, treatment, education,

prevention, research, screening, monitoring case management services, including dialysis

services provided by dialysis unit located at the Tribe's clinic locations, and physical

fitness training related to diabetes treatment and prevention services

Dietary Services: Provides diet manuals and dietary services including meal planning,

provision, and delivery of meals for residents.

Medical Records: Maintains a comprehensive medical record system that is manual

and/or electronic that includes, but is not limited to, record storage and retrieval, review

and analysis of medical records, transcription, inpatient and outpatient data collection and

management, and managing release of medical information.

Laboratory Services: Provides a full range of laboratory services including, but not

limited to, chemistry, hematology, urinalysis diagnostics, pathology and other supporting

tests, coordination of referral to outside reference lab in support of patient diagnosis and

treatment.

Radiology Services: Provides outpatient services for pediatric, adolescent and adult

patients, which includes, but is not limited to, providing diagnostic examinations that

include general radiography, and the coordination of referral to outside services not

available at the CTCHEC.

Pharmacy: Provides pharmaceutical services including, but not limited to, prescribing

therapies, recommending therapies, dispensing medications, drug utilization review and

monitoring of medication treatment plans. Providing prescription medication education.

Ambulance Services: Provides stabilizing treatment and emergency transportation on the

Omaha Reservation.

Facilities Operation and Maintenance: Provides security, housekeeping, supply

management, building maintenance, and other services necessary to operate and maintain

a safe, sanitary, and secure facility.

Quality Assurance: Ensures quality, patient-centered services and maintains compliance

within the scope of work.

Telemedicine Services: Provides outpatient services for pediatric, adolescent and adult

patients including evaluation, treatment, education, prevention, and consultation

including, but not limited to, the diagnosis and treatment, consultation, monitoring, and

management of patients through interactive audio, video, and data modalities. Teleradiology services are also supported to provide interpretation of diagnostic images with

contract providers.

Traditional Healing: Provides services including, but not limited to, traditional Omaha

healing practices and ceremonies. These services will be provided in accordance with

Section 831 of the Indian Health Care Improvement Act, as amended at 25 U.S.C. §

Z

1680u. The United States is not liable for damage, injury, or death that results from

traditional health care practices.

II. Dental Health

Treatment services under this contract include those provided by a licensed dental provider for

dental, clinical, and preventative care. Services include:

1. Routine Services: Examinations, prophies, fluoride treatments, sealants, restorations,

uncomplicated endodontic, periodontal, surgical, orthodontic, prosthetic, and Silver

Nitrate treatments.

2. Emergency Services: Treatment for pain relief, acute infection, and immediate care of

traumatic injuries to the oral and related facial structures.

3. Dental Health Promotion: Oral hygiene outreach and education.

Referrals: Referral to outside providers when needed if funds are available through the

Purchase/Referred care program.

II. Community Health Outreach

A. Public Health Nursing

Public Health Nursing (PHN) services provided under this contract address health promotion and

disease prevention by identifying individual, family, and community health needs; implementing

health planning based on individual and family care plans and community profiles; maintaining

and improving the delivery of preventive services; and assessing health and health care needs,

prevention of illness, injury disability, and premature death.

Services include:

1. General PHN: Addressing communicable diseases; chronic disease case management;

school health; elder health; primary and secondary prevention; community health

development; partnerships and collaboration for disaster and emergency preparedness,

injury prevention, and child health, including high risk infants, infants and preschool

children, school-age children, and children with special needs.

2. Vaccination: Administration of influenza and other vaccines.

3. Podiatry: Follow-up with chronic and other foot problems.

B. Health Education

Services under this contract include health education services to educate and empower the

community with regard to health issues.

Services include:

1. Community Health Organization: Leadership development; disease prevention and

control; injury prevention and control; substance abuse education; self-help education;

and tobacco cessation.

2. School Health Education Services: Coordination of youth health committees and

awareness campaigns; assisting and coordinating school health activities; recruiting and

referring to health clinic.

3. Patient Education: Health education communications; home visits and follow-up.

Staff Support: Administrative assignments; implementing and coordinating health

promotion campaigns and programs; in-service training and health fairs.

C. Community Health Representatives

The Community Health Representative (CHR) Program includes activities designed to provide

quality outreach regarding health care services, health promotion, and disease prevention. CHRs

provide community-oriented primary care services, including traditional Native concepts in

multiple settings, using community-based, well-trained, medically guided paraprofessional

health care workers.

Services include: health education and counseling; monitoring clients/community; case

management/coordination; emergency care; health promotion; disease prevention;

transportation/delivery on or near the reservation; translation/interpretation; non-emergency care;

optometry; diabetes management; and ENT clinic.

IV. Environmental Health

Environmental Health services include:

1. Epidemiological investigations: Assist in limiting spread and controlling incidence of

infective and parasitic diseases.

2. Injury prevention: Reduce injuries and deaths by implementing environmental health

activities.

3. Institutional & residential environmental health and safety: Conduct comprehensive

institutional environmental health surveys at community institutions and businesses.

4. Celebration sanitation: Promote environmental health conditions and practices at

celebrations and other community events.

5. Recreational sanitation: Assure optimum environmental conditions in tribally owned,

leased, or operated recreational facilities.

6. Food services: Minimize food borne illness through proper sanitation and food safety

practices.

7. Industrial health & safety: Assure work environments are free from harmful factors and

hazardous conditions and provide safety planning, training and inspections.

8. Vector control: Minimize introduction and spread of vector borne diseases.

9. Emergency-disaster situations: Minimize adverse health effects of floods, fires, storms,

and other disasters.

10. Waste disposal: Ensure collection and proper disposal of wastes.

11. Air sampling: Partner with Omaha Tribe EPA to protect community through a referrals

system to EPA and monitor testing of carbon monoxide and radon.

12. Water supply: Evaluate and assess water supplies, and coordinate efforts with EPA and

IHS.

13. Biomedical standards: Ensure compliance with biomedical standards, coordinating with

the Great Plains Area Clinical Engineering Services Program.

V. Nursing Home Services

Nursing home services include medical, nursing, and related services with an emphasis on

rehabilitative and restorative nursing to promote individuals to the highest possible mental and

physical capacity. The Nursing Home provides a home-like atmosphere that incorporates

cultural and traditional beliefs and activities.

Services include: physician services; nursing services; rehabilitation and restorative services;

pharmaceutical services; diagnostic services; dental services; social services; nursing home

activities; optometry; podiatry; plan of care development and management; transfer support and

services; nutrition services; and telemedicine services.

VI. Behavioral Health and Alcohol/Substance Use Programs

A. Behavioral Health

The Omaha Behavioral Health Program provides quality, accessible direct and indirect mental

health services to eligible persons.

Services include:

1. Direct care: Outpatient therapeutic services provided by appropriate licensed or

recognized professionals, including mental health therapists, social workers,

psychologists, and psychiatrists.

2. Community care: Identification of social problems and community needs; education of

and coordination with tribal administration to respond to needs; development of

recommendations and proposals to address needs; collaboration with existing community

programs; and provision of social services based on needs and treatment plans.

3. Support services: Transportation, community resource coordination, volunteer services,

continuum of care and follow-up services, and other services to assist in meeting

behavioral health needs.

4. Managerial and administrative: Administration and supervision of programs, budgets,

intake approval, client files, and appointment scheduling.

B. Alcohol and Substance Use

The UMO*HO® NITA-GAXA TEGA MO®THI “NEW WAY OF LIFE” ALCOHOL

PROGRAM (UAP) incorporates intervention, prevention, and culturally relevant treatment

activities to support and create behavior change within the client, their families, and their

community in order to live a healthier, alcohol and drug free lifestyle.

Services include:

1. Coordination of social services: Services are coordinated, as needed, with Omaha Tribal

Court, Omaha Child & Family Services, schools, and other social, medical, and

behavioral services.

2. Pre-treatment services: Screening, assessments, and recommendations as well as pretreatment groups offered while awaiting treatment.

3. Intensive outpatient treatment: Evidence-based approaches, cognitive behavioral therapy,

twelve-step facilitation, and individual/crisis therapy is provided along with specialized

cultural/traditional activities.

4. Education and outreach: Prevention, community education, and special awareness group

activities to support abstinence and wellness.

5. Halfway house: Based on Client treatment plan and individual needs, these services are

available to support client sobriety goals and preventative treatment during stay.

VI. Purchased/Referred Care

Authorizes funds within established medical priorities services provided by non-IHS or nontribal providers and facilities. Access by qualified beneficiaries to PRC may be obtained only by

authorization of CTCHEC staff that have been delegated the authority to approve PRC. This

requires that beneficiaries must be eligible for PRC services in accordance with 42 C.F.R. §

136.23 and referred by a CTCHEC physician/provider to the PRC program for consideration of

their PRC request prior to approval, or must obtain required approval for care as provided by

applicable federal regulations.

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Attachment B to the Annual Funding Agreement

SCOPE OF WORK

PREAMBLE

The Omaha Tribe of Nebraska (”Contractor”) Carl T. Curtis Health Education Center

(CTCHEC) shall administer the programs described herein to all eligible beneficiaries in

accordance with 42 C.F.R. Part 136. The target population for this contract is eligible Native

Americans living on or near the Omaha Indian Reservation consisting of Thurston, Monona, and

Burt, Cuming, and Wayne counties. Services are provided in various locations as listed in

Exhibit 1.

The Contractor is committed to and will provide quality health services to meet standards the

Contractor believes to be appropriate and applicable to the delivery of the health services

identified below. The Contractor’s services consist of:

Comprehensive Ambulatory and Acute Medical Care;

Dental Health;

Community Health Outreach, including Public Health Nursing, Health Education, and

Community Health Representative (CHR) programs;

Environmental Health;

Elder Care and Dialysis;

Behavioral Health and Alcohol/Substance Use Programs; and

Purchased/Referred Care.

Additionally, by Council Resolution 98-109, the Contractor receives its shares of Indian Health

Service Headquarters and Great Plains Area Office funds.

SCOPE OF SERVICES

I. Ambulatory and Acute Medical Care

CTCHEC provides a comprehensive range of primary and specialty healthcare services,

appropriate for a local medical center to prevent and treat disease and injury and to promote

improvements in health status and outcomes. All medical services, treatments, laboratory, and

radiology services provided to pediatric and adult patients at CTCHEC include the coordination

of referrals to outside services not available at the clinic. Services provided include:

1.

Family Health: Provides outpatient medical care for pediatric, adolescent and adult

patients, which includes diagnosis, treatment, education, prevention, and consultation

including, but not limited to, Primary Care and Subspecialty Services such as Geriatric,

Rheumatology, Dermatology, Neurology, Infectious Disease, Hematology, Nephrology,

Cardiology, Pulmonary Disease, Allergy, Immunology, Nutritional Therapy, Endocrine

and Metabolic and Nutritional Disorders.

Maternal and Child Health: Prenatal and postpartum care and education, STD prevention,

family planning, and case management.

10.

11.

12.

13.

14.

Urgent Care: Provides acute care services and initiates basic life support treatment in the

care of any emergency/traumatized patient, arranging for transfer to a facility with a

higher level of care as needed.

Diabetes Treatment and Prevention Services: Provides primary, secondary, and tertiary

prevention services, including, but not limited to, diagnosis, treatment, education,

prevention, research, screening, monitoring case management services, including dialysis

services provided by dialysis unit located at the Tribe's clinic locations, and physical

fitness training related to diabetes treatment and prevention services

Dietary Services: Provides diet manuals and dietary services including meal planning,

provision, and delivery of meals for residents.

Medical Records: Maintains a comprehensive medical record system that is manual

and/or electronic that includes, but is not limited to, record storage and retrieval, review

and analysis of medical records, transcription, inpatient and outpatient data collection and

management, and managing release of medical information.

Laboratory Services: Provides a full range of laboratory services including, but not

limited to, chemistry, hematology, urinalysis diagnostics, pathology and other supporting

tests, coordination of referral to outside reference lab in support of patient diagnosis and

treatment.

Radiology Services: Provides outpatient services for pediatric, adolescent and adult

patients, which includes, but is not limited to, providing diagnostic examinations that

include general radiography, and the coordination of referral to outside services not

available at the CTCHEC.

Pharmacy: Provides pharmaceutical services including, but not limited to, prescribing

therapies, recommending therapies, dispensing medications, drug utilization review and

monitoring of medication treatment plans. Providing prescription medication education.

Ambulance Services: Provides stabilizing treatment and emergency transportation on the

Omaha Reservation.

Facilities Operation and Maintenance: Provides security, housekeeping, supply

management, building maintenance, and other services necessary to operate and maintain

a safe, sanitary, and secure facility.

Quality Assurance: Ensures quality, patient-centered services and maintains compliance

within the scope of work.

Telemedicine Services: Provides outpatient services for pediatric, adolescent and adult

patients including evaluation, treatment, education, prevention, and consultation

including, but not limited to, the diagnosis and treatment, consultation, monitoring, and

management of patients through interactive audio, video, and data modalities. Teleradiology services are also supported to provide interpretation of diagnostic images with

contract providers.

Traditional Healing: Provides services including, but not limited to, traditional Omaha

healing practices and ceremonies. These services will be provided in accordance with

Section 831 of the Indian Health Care Improvement Act, as amended at 25 U.S.C. §

2

1680u. The United States is not liable for damage, injury, or death that results from

traditional health care practices.

II. Dental Health

Treatment services under this contract include those provided by a licensed dental provider for

dental, clinical, and preventative care. Services include:

1. Routine Services: Examinations, prophies, fluoride treatments, sealants, restorations,

uncomplicated endodontic, periodontal, surgical, orthodontic, prosthetic, and Silver

Nitrate treatments.

2. Emergency Services: Treatment for pain relief, acute infection, and immediate care of

traumatic injuries to the oral and related facial structures.

3. Dental Health Promotion: Oral hygiene outreach and education.

Referrals: Referral to outside providers when needed if funds are available through the

Purchase/Referred care program.

Iii. Community Health Outreach

A. Public Health Nursing

Public Health Nursing (PHN) services provided under this contract address health promotion and

disease prevention by identifying individual, family, and community health needs; implementing

health planning based on individual and family care plans and community profiles; maintaining

and improving the delivery of preventive services; and assessing health and health care needs,

prevention of illness, injury disability, and premature death.

Services include:

1. General PHN: Addressing communicable diseases; chronic disease case management;

school health; elder health; primary and secondary prevention; community health

development; partnerships and collaboration for disaster and emergency preparedness,

injury prevention, and child health, including high risk infants, infants and preschool

children, school-age children, and children with special needs.

2. Vaccination: Administration of influenza and other vaccines.

3. Podiatry: Follow-up with chronic and other foot problems.

B. Health Education

Services under this contract include health education services to educate and empower the

community with regard to health issues.

Services include:

1. Community Health Organization: Leadership development; disease prevention and

control; injury prevention and control; substance abuse education; self-help education;

and tobacco cessation.

2. School Health Education Services: Coordination of youth health committees and

awareness campaigns; assisting and coordinating school health activities; recruiting and

referring to health clinic.

3. Patient Education: Health education communications; home visits and follow-up.

Staff Support: Administrative assignments; implementing and coordinating health

promotion campaigns and programs; in-service training and health fairs.

C. Community Health Representatives

The Community Health Representative (CHR) Program includes activities designed to provide

quality outreach regarding health care services, health promotion, and disease prevention. CHRs

provide community-oriented primary care services, including traditional Native concepts in

multiple settings, using community-based, well-trained, medically guided paraprofessional

health care workers.

Services include: health education and counseling; monitoring clients/community; case

management/coordination; emergency care; health promotion; disease prevention;

transportation/delivery on or near the reservation; translation/interpretation; non-emergency care;

optometry; diabetes management; and ENT clinic.

IV. Environmental Health

Environmental Health services include:

1. Epidemiological investigations: Assist in limiting spread and controlling incidence of

infective and parasitic diseases.

2. Injury prevention: Reduce injuries and deaths by implementing environmental health

activities.

3. Institutional & residential environmental health and safety: Conduct comprehensive

institutional environmental health surveys at community institutions and businesses.

4. Celebration sanitation: Promote environmental health conditions and practices at

celebrations and other community events.

5. Recreational sanitation: Assure optimum environmental conditions in tribally owned,

leased, or operated recreational facilities.

6. Food services: Minimize food bore illness through proper sanitation and food safety

practices.

7. Industrial health & safety: Assure work environments are free from harmful factors and

hazardous conditions and provide safety planning, training and inspections.

8. Vector control: Minimize introduction and spread of vector borne diseases.

9. Emergency-disaster situations: Minimize adverse health effects of floods, fires, storms,

and other disasters.

10. Waste disposal: Ensure collection and proper disposal of wastes.

11. Air sampling: Partner with Omaha Tribe EPA to protect community through a referrals

system to EPA and monitor testing of carbon monoxide and radon.

12. Water supply: Evaluate and assess water supplies, and coordinate efforts with EPA and

IHS.

13. Biomedical standards: Ensure compliance with biomedical standards, coordinating with

the Great Plains Area Clinical Engineering Services Program.

Vv. Nursing Home Services

Nursing home services include medical, nursing, and related services with an emphasis on

rehabilitative and restorative nursing to promote individuals to the highest possible mental and

physical capacity. The Nursing Home provides a home-like atmosphere that incorporates

cultural and traditional beliefs and activities.

Services include: physician services; nursing services; rehabilitation and restorative services;

pharmaceutical services; diagnostic services; dental services; social services; nursing home

activities; optometry; podiatry; plan of care development and management; transfer support and

services; nutrition services; and telemedicine services.

VI. Behavioral Health and Alcohol/Substance Use Programs

A. Behavioral Health

The Omaha Behavioral Health Program provides quality, accessible direct and indirect mental

health services to eligible persons.

Services include:

1. Direct care: Outpatient therapeutic services provided by appropriate licensed or

recognized professionals, including mental health therapists, social workers,

psychologists, and psychiatrists.

2. Community care: Identification of social problems and community needs; education of

and coordination with tribal administration to respond to needs; development of

recommendations and proposals to address needs; collaboration with existing community

programs; and provision of social services based on needs and treatment plans.

3. Support services: Transportation, community resource coordination, volunteer services,

continuum of care and follow-up services, and other services to assist in meeting

behavioral health needs.

4. Managerial and administrative: Administration and supervision of programs, budgets,

intake approval, client files, and appointment scheduling.

VIl.

B. Alcohol and Substance Use

The UMO*HO* NITA-GAXA TEGA MO*THI “NEW WAY OF LIFE” ALCOHOL

PROGRAM (UAP) incorporates intervention, prevention, and culturally relevant treatment

activities to support and create behavior change within the client, their families, and their

community in order to live a healthier, alcohol and drug free lifestyle.

Services include:

1. Coordination of social services: Services are coordinated, as needed, with Omaha Tribal

Court, Omaha Child & Family Services, schools, and other social, medical, and

behavioral services.

2. Pre-treatment services: Screening, assessments, and recommendations as well as pretreatment groups offered while awaiting treatment.

3. Intensive outpatient treatment: Evidence-based approaches, cognitive behavioral therapy,

twelve-step facilitation, and individual/crisis therapy is provided along with specialized

cultural/traditional activities.

4. Education and outreach: Prevention, community education, and special awareness group

activities to support abstinence and wellness.

5. Halfway house: Based on Client treatment plan and individual needs, these services are

available to support client sobriety goals and preventative treatment during stay.

Purchased/Referred Care

Authorizes funds within established medical priorities services provided by non-IHS or nontribal providers and facilities. Access by qualified beneficiaries to PRC may be obtained only by

authorization of CTCHEC staff that have been delegated the authority to approve PRC. This

requires that beneficiaries must be eligible for PRC services in accordance with 42 C.F.R. §

136.23 and referred by a CTCHEC physician/provider to the PRC program for consideration of

their PRC request prior to approval, or must obtain required approval for care as provided by

applicable federal regulations.