Connecticut and Mashantucket Pequot Tribe Reach an Agreement

Indian Health Service

IBIA Docket No. 01-11-A, 01-75-A, 92-97-A, 03-06-A, 04-89-A, 04-118-A, 06-21-A Div. Docket No. Decision

Final decision on the review of the administrative law judge

The Indian Health Service (IHS) and Mashantucket Pequot Tribal Nation (Nation, Tribe, MPTN) are the existing IHS Health Plan operated by the Administrative Law (Alj) Andrew S. Pearlstein on March 10, 2006. Both appealed to the Indian Sel f-law (ISDA) contract, which provided a partial withdrawal of the seven proposals on pharmacy services provided. IHS has rejected the proposal that intended to expand pharmacy services to all health plans, including no n-Indians, to all beneficiaries of health plans. The main reasons for the decision were that one of the reasons for disqualifications in the ISDA was "activities that the contractor cannot do legally" was included in the proposal. After the country appealed for the decision, the parties asked for an abbreviation, saying that there was no important issue, and the second instance had the right to be ruled as a law problem. An appointment of a special investigator, who was appointed by another ALJ, who was in charge of the case, has issued a report that accepts the IHS's brief claim and recommends a sediment. However, Alj's Pearlstein did not adopt a special investigator's report, instead accepting the abbreviation claim, and recommending it to achieve precipitation.

Both parties may appeal to the Ministry of Health and Welfare (HHS) for the ALJ's recommendation on the deviation of the IHS by submitting an opposition to ALJ's recommendation for the recommendation decision. 25 C. F. R. 900. 166. The Secretary may correct, recruit, or cancel the recommended decisions within 20 days from the date of receiving a timely submitted opposition. 25 C. F. R. 900. 900. 167. On August 16, 1996, the Secretary transferred the authority to hear the appeal to the appeal of the Affairs Committee. I was nominated as a decisive authority in this case. < SPAN> Indian Health Service

IBIA Docket No. 01-11-A, 01-75-A, 92-97-A, 03-06-A, 04-89-A, 04-118-A, 06-21-A Div. Docket No.

Decision

Final decision on the review of the administrative law judge

The Indian Health Service (IHS) and Mashantucket Pequot Tribal Nation (Nation, Tribe, MPTN) are the existing IHS Health Plan operated by the Administrative Law (Alj) Andrew S. Pearlstein on March 10, 2006. Both appealed to the Indian Sel f-law (ISDA) contract, which provided a partial withdrawal of the seven proposals on pharmacy services provided. IHS has rejected the proposal that intended to expand pharmacy services to all health plans, including no n-Indians, to all beneficiaries of health plans. The main reasons for the decision were that one of the reasons for disqualifications in the ISDA was "activities that the contractor cannot do legally" was included in the proposal. After the country appealed for the decision, the parties asked for an abbreviation, saying that there was no important issue, and the second instance had the right to be ruled as a law problem. An appointment of a special investigator, who was appointed by another ALJ, who was in charge of the case, has issued a report that accepts the IHS's brief claim and recommends a sediment. However, Alj's Pearlstein did not adopt a special investigator's report, instead accepting the abbreviation claim, and recommending it to achieve precipitation.

Both parties may appeal to the Ministry of Health and Welfare (HHS) for the ALJ's recommendation on the deviation of the IHS by submitting an opposition to ALJ's recommendation for the recommendation decision. 25 C. F. R. 900. 166. The Secretary may correct, recruit, or cancel the recommended decisions within 20 days from the date of receiving a timely submitted opposition. 25 C. F. R. 900. 900. 167. On August 16, 1996, the Secretary transferred the authority to hear the appeal to the appeal of the Affairs Committee. I was nominated as a decisive authority in this case. Indian Health Service

IBIA Docket No. 01-11-A, 01-75-A, 92-97-A, 03-06-A, 04-89-A, 04-118-A, 06-21-A Div. Docket No.

Decision

Final decision on the review of the administrative law judge

The Indian Health Service (IHS) and Mashantucket Pequot Tribal Nation (Nation, Tribe, MPTN) are the existing IHS Health Plan operated by the Administrative Law (Alj) Andrew S. Pearlstein on March 10, 2006. Both appealed to the Indian Sel f-law (ISDA) contract, which provided a partial withdrawal of the seven proposals on pharmacy services provided. IHS has rejected the proposal that intended to expand pharmacy services to all health plans, including no n-Indians, to all beneficiaries of health plans. The main reasons for the decision were that one of the reasons for disqualifications in the ISDA was "activities that the contractor cannot do legally" was included in the proposal. After the country appealed for the decision, the parties asked for an abbreviation, saying that there was no important issue, and the second instance had the right to be ruled as a law problem. An appointment of a special investigator, who was appointed by another ALJ, who was in charge of the case, has issued a report that accepts the IHS's brief claim and recommends a sediment. However, Alj's Pearlstein did not adopt a special investigator's report, instead accepting the abbreviation claim, and recommending it to achieve precipitation.

Both parties may appeal to the Ministry of Health and Welfare (HHS) for the ALJ's recommendation on the deviation of the IHS by submitting an opposition to ALJ's recommendation for the recommendation decision. 25 C. F. R. 900. 166. The Secretary may correct, recruit, or cancel the recommended decisions within 20 days from the date of receiving a timely submitted opposition. 25 C. F. R. 900. 900. 167. On August 16, 1996, the Secretary transferred the authority to hear the appeal to the appeal of the Affairs Committee. I was nominated as a decisive authority in this case.

The parties appealed the ALJ's recommended decision pursuant to 25 C. F. R. В§ 900. 167. As discussed in more detail below, we conclude that IHS has met its burden of clearly proving the validity of its decision. Accordingly, we reverse the ALJ's recommendation to grant the State's motion for summary judgment and affirm the decision. See В§ 102(e)(1), 25 U. S. C. В§ 450f(e)(1), 25 C. F. R. В§ 900. 163. Contrary to the ALJ's conclusions, the proposed services for non-Indian employees are inconsistent under ISDA. First, the proposed services are not appropriate for coverage under a program authorized by the Secretary to administer for the benefit of Indians. This conclusion is supported by the State's failure to comply with the Indian Health Care Improvement Act (IHCIA), as discussed below. Moreover, the provision of these services under the State's proposal would provide substantial benefits to thousands of non-Indian employees of the State's commercial casinos, rather than to tribal members as contemplated by the ISDA contract for health care services. Moreover, the proposal is unlawful because it does not meet the requirements of section 813(b)(1)(b) of the IHCIA (25 U. S. C. В§ 1680c(b)) for the provision of services to non-Indians under the ISDA contract. This provision provides an exception to the requirement to provide services only to Indians and certain other individuals who are not eligible for IHS health care services, to which the State is not entitled. Specifically, in determining whether to provide pharmacy services to non-Indian employees, the State's tribal council did not determine that there were no reasonable alternative pharmacy services.

In addition, the Federal Rules Collection 25, 900. 32, does not provide independent evidence that overturns the contradiction. Article 900. 32 stipulates that the same annual fund contribution contract (AFA), which was approved in the previous year, is not subject to differences. However, as Alj observed correctly, 900. 32 is not applied if there is no dispute in the amount of funds. Therefore, 900. 32 is not applied. The country does not require IHS funds for pharmacy services. Furthermore, 900. 32 is not applied. This is because the nation did not meet the requirements of Article 813 (B) (1) (B) when proposing AFA, and IHS could not approve illegal proposals.

The decision is based on the previous records, the two parties 'opposition to the Alj's recommendation decision, the two parties' answers to each other's opposition, and the answers of both parties to each other's answers. (The two parties also submitted documents lacked in the records sent by Alj). IHS submitted an excerpt of two oaths that were not submitted to ALJ, along with the national opposition. Regardless of whether or not the rules prohibit new evidence, the government does not examine new evidence without letting the other party submit evidence. Considering the regulated deadline for making such a decision, these documents are excluded from the record because there was no sufficient time for such additional procedures. In any case, these documents have been submitted in connection with the issues that are the issues, and I do not need to solve them here.

The information in this section is presented to help readers understand the background of the questions described later. The contents of this section are the fact that there is no conflict on Pages 4-13 and Special Investigator's reports [page 4] page 4-9 (including related documents recorded). It is not a priority. < SPAN> In addition, the Federal Rules 25th 900. 32 does not provide independent evidence that overturns the contradiction. Article 900. 32 stipulates that the same annual fund contribution contract (AFA), which was approved in the previous year, is not subject to differences. However, as Alj observed correctly, 900. 32 is not applied if there is no dispute in the amount of funds. Therefore, 900. 32 is not applied. The country does not require IHS funds for pharmacy services. Furthermore, 900. 32 is not applied. This is because the nation did not meet the requirements of Article 813 (B) (1) (B) when proposing AFA, and IHS could not approve illegal proposals.

The decision is based on the previous records, the two parties 'opposition to the Alj's recommendation decision, the two parties' answers to each other's opposition, and the answers of both parties to each other's answers. (The two parties also submitted documents lacked in the records sent by Alj). IHS submitted an excerpt of two oaths that were not submitted to ALJ, along with the national opposition. Regardless of whether or not the rules prohibit new evidence, the government does not examine new evidence without letting the other party submit evidence. Considering the regulated deadline for making such a decision, these documents are excluded from the record because there was no sufficient time for such additional procedures. In any case, these documents have been submitted in connection with the issues that are the issues, and I do not need to solve them here.

The information in this section is presented to help readers understand the background of the questions described later. The contents of this section are the fact that there is no conflict on Pages 4-13 and Special Investigator's reports [page 4] page 4-9 (including related documents recorded). It is not a priority. In addition, the Federal Rules Collection 25, 900. 32, does not provide independent evidence that overturns the contradiction. Article 900. 32 stipulates that the same annual fund contribution contract (AFA), which was approved in the previous year, is not subject to differences. However, as Alj observed correctly, 900. 32 is not applied if there is no dispute in the amount of funds. Therefore, 900. 32 is not applied. The country does not require IHS funds for pharmacy services. Furthermore, 900. 32 is not applied. This is because the nation did not meet the requirements of Article 813 (B) (1) (B) when proposing AFA, and IHS could not approve illegal proposals.

The decision is based on the previous records, the two parties 'opposition to the Alj's recommendation decision, the two parties' answers to each other's opposition, and the answers of both parties to each other's answers. (The two parties also submitted documents lacked in the records sent by Alj). IHS submitted an excerpt of two oaths that were not submitted to ALJ, along with the national opposition. Regardless of whether or not the rules prohibit new evidence, the government does not examine new evidence without letting the other party submit evidence. Considering the regulated deadline for making such a decision, these documents are excluded from the record because there was no sufficient time for such additional procedures. In any case, these documents have been submitted in connection with the issues that are the issues, and I do not need to solve them here.

The information in this section is presented to help readers understand the background of the questions described later. The contents of this section are the fact that there is no conflict on Pages 4-13 and Special Investigator's reports [page 4] page 4-9 (including related documents recorded). It is not a priority.

A federal official Indian tribe, with about 700 tribes. The number of employees is about 12., 000 (including some members), and most of them work at Fox Woods Resort & Casino, which opened in November 1992. The country has a family medical benefit plan (Family Plan) for tribal members and its families, and an employee medical benefit plan (EHBP) for Indians and No n-Indian employees and their families. The beneficiaries of these plans include about 1. 000 Indians and 23. 000 no n-Indians. EHBP covers pharmacy services provided by Pequot Pharmaceutical Network (PRXN). PRXN initially contracted with a local provider to provide pharmaceuticals. In November 1992, PRXN opened its own pharmacy in the tribal residence. By 1993, PRXN built a network of an outpatient pharmacy that can be used by the recipients of the medical insurance system. Later, PRXN opened a satellite pharmacy in Foxwoods Casino.

One is purchased at the managerial care price, and can be used by a profitable customer (a group contracted by PRXN). The other is purchased by about 40 % of the managed care price through the Federal Supply Scheme (FSS), and can be used by the beneficiary of the plan. (One Indian tribe can use federal procurement sources for services provided based on ISDA contracts. See ISDA 105K. If it is proposed to include employees other than Indians in the ISDA contract. In this section, there is no objection that the tribe will allow the no n-Indian employee to purchase drugs from FSS).

PRXN provides free pharmaceuticals to the family recipients. PRXN is provided free of charge when the beneficiary of EHBP directly obtains drugs directly from PRXN, and when obtaining a drug from a network pharmacy, it usually charges an additional charge of 30 % of the normal management care price. The country pays all the pharmaceuticals dispensed by these beneficiary on their own funds. < SPAN> The Federal Official Indian tribe, with about 700 tribes. The number of employees is about 12., 000 (including some members), and most of them work at Fox Woods Resort & Casino, which opened in November 1992. The country has a family medical benefit plan (Family Plan) for tribal members and its families, and an employee medical benefit plan (EHBP) for Indians and No n-Indian employees and their families. The beneficiaries of these plans include about 1. 000 Indians and 23. 000 no n-Indians. EHBP covers pharmacy services provided by Pequot Pharmaceutical Network (PRXN). PRXN initially contracted with a local provider to provide pharmaceuticals. In November 1992, PRXN opened its own pharmacy in the tribal residence. By 1993, PRXN built a network of an outpatient pharmacy that can be used by the recipients of the medical insurance system. Later, PRXN opened a satellite pharmacy in Foxwoods Casino.

One is purchased at the managerial care price, and can be used by a profitable customer (a group contracted by PRXN). The other is purchased by about 40 % of the managed care price through the Federal Supply Scheme (FSS), and can be used by the beneficiary of the plan. (One Indian tribe can use federal procurement sources for services provided based on ISDA contracts. See ISDA 105K. If it is proposed to include employees other than Indians in the ISDA contract. In this section, there is no objection that the tribe will allow pharmaceuticals from FSS for their no n-Indian employees).

PRXN provides free pharmaceuticals to the family recipients. PRXN is provided free of charge when the beneficiary of EHBP directly obtains drugs directly from PRXN, and when obtaining a drug from a network pharmacy, it usually charges an additional charge of 30 % of the normal management care price. The country pays all the pharmaceuticals dispensed by these beneficiary on their own funds. A federal official Indian tribe, with about 700 tribes. The number of employees is about 12., 000 (including some members), and most of them work at Fox Woods Resort & Casino, which opened in November 1992. The country has a family medical benefit plan (Family Plan) for tribal members and its families, and an employee medical benefit plan (EHBP) for Indians and No n-Indian employees and their families. The beneficiaries of these plans include about 1. 000 Indians and 23. 000 no n-Indians. EHBP covers pharmacy services provided by Pequot Pharmaceutical Network (PRXN). PRXN initially contracted with a local provider to provide pharmaceuticals. In November 1992, PRXN opened its own pharmacy in the tribal residence. By 1993, PRXN built a network of an outpatient pharmacy that can be used by the recipients of the medical insurance system. Later, PRXN opened a satellite pharmacy in Foxwoods Casino.

One is purchased at the managerial care price, and can be used by a profitable customer (a group contracted by PRXN). The other is purchased by about 40 % of the managed care price through the Federal Supply Scheme (FSS), and can be used by the beneficiary of the plan. (One Indian tribe can use federal procurement sources for services provided based on ISDA contracts. See ISDA 105K. If it is proposed to include employees other than Indians in the ISDA contract. In this section, there is no objection that the tribe will allow the no n-Indian employee to purchase drugs from FSS).

PRXN provides free pharmaceuticals to the family recipients. PRXN is provided free of charge when the beneficiary of EHBP directly obtains drugs directly from PRXN, and when obtaining a drug from a network pharmacy, it usually charges an additional charge of 30 % of the normal management care price. The country pays all the pharmaceuticals dispensed by these beneficiary on their own funds.

PRXN's business plan was completed in July 1991 after a series of research and activities (started in 1987) to develop improved medical programs for tribal members and employees. It was adopted by. One of the studies is that the goal of a tribe that surely monitor prescriptions (DUR) to monitor prescriptions to prevent side effects of patients taking multiple drugs and other patients suffering from other patients. Was shown. (According to the country, the Connected DUR communicates through the central computer to prevent such drug interaction. PRXN offers connected DUR as well as pharmacies in the network.

At the request of the national government, IHS approved the correction to add pharmacy operations to the national ISDA contract on January 1, 1992. Until 1995, IHS approved annual contracts, including pharmacy operations. Neither of these contracts nor the subsequent year's annual funding assistance (AFAS) did not provide IHS funds for pharmacy services. (1) From 1996 to 1997, pharmacy work was not included in the national AFA proposal, but the government thought that pharmacy was still eligible. The AFA proposal for the 1998 fiscal year included the following words:

The state agrees to provide all pharmacy services that are necessary for medical care for the mashaian tacket Pecot tribes, the beneficiary of the tribal medical benefit plan, the other tribes and the government partnered with the government, and the medical benefit plan. do.

IHS approved the AFA in 1998 and the 1999 AFA, but the AFA contained a substantially similar wording to the reported. According to a resolution of a tribal council on March 24, 1998, AFA in 1998 said, "The tribal council is in consideration of the needs of the members, local communities, and employees, and this medical care and service. It has decided that the provision will not lead to refusal or reduction of medical services for qualified Indians. " "In 1999, AFA quoted a resolution of another tribal council with the same purpose. < SPAN> PRXN's business plan is a series of studies to develop medical programs improved for tribal members and employees. After the activity was completed (starting in 1987), it was adopted in July 1991 by the resolution of the tribal council, and the patients taking multiple medicines and other medical conditions. The target of the tribe to monitor prescriptions to prevent the side effects of the patient, and to ensure the goal of the tribe (DUR), (according to the country, the pharmacy has a central computer. It prevents such drug interactions as well as pharmacies in the network.

At the request of the national government, IHS approved the correction to add pharmacy operations to the national ISDA contract on January 1, 1992. Until 1995, IHS approved annual contracts, including pharmacy operations. Neither of these contracts nor the subsequent year's annual funding assistance (AFAS) did not provide IHS funds for pharmacy services. (1) From 1996 to 1997, pharmacy work was not included in the national AFA proposal, but the government thought that pharmacy was still eligible. The AFA proposal for the 1998 fiscal year included the following words:

The state agrees to provide all pharmacy services that are necessary for medical care for the mashaian tacket Pecot tribes, the beneficiary of the tribal medical benefit plan, the other tribes and the government partnered with the government, and the medical benefit plan. do.

IHS approved the AFA in 1998 and the 1999 AFA, but the AFA contained a substantially similar wording to the reported. According to a resolution of a tribal council on March 24, 1998, AFA in 1998 said, "The tribal council is in consideration of the needs of the members, local communities, and employees, and this medical care and service. It has decided that the provision will not lead to refusal or reduction of medical services for qualified Indians. " "In 1999, AFA quoted a resolution of another tribal council with the same purpose. PRXN's business plan was a series of studies to develop medical programs improved for tribal members and employees (1987). In July 1991, it was adopted in July 1991, and one of the research was taken with multiple drugs. The target of the tribe to monitor prescriptions to prevent the side effects of patients, and the tribe is to ensure a duR (according to the country, the pharmacy communicates through the central computer. PRXN offers a connected DUR like a pharmacy in the network.

At the request of the national government, IHS approved the correction to add pharmacy operations to the national ISDA contract on January 1, 1992. Until 1995, IHS approved annual contracts, including pharmacy operations. Neither of these contracts nor the subsequent year's annual funding assistance (AFAS) did not provide IHS funds for pharmacy services. (1) From 1996 to 1997, pharmacy work was not included in the national AFA proposal, but the government thought that pharmacy was still eligible. The AFA proposal for the 1998 fiscal year included the following words:

The state agrees to provide all pharmacy services that are necessary for medical care for the mashaian tacket Pecot tribes, the beneficiary of the tribal medical benefit plan, the other tribes and the government partnered with the government, and the medical benefit plan. do.

IHS approved the AFA in 1998 and the 1999 AFA, but the AFA contained a substantially similar wording to the reported. According to a resolution of a tribal council on March 24, 1998, AFA in 1998 said, "The tribal council is in consideration of the needs of the members, local communities, and employees, and this medical care and service. It has decided that the provision will not lead to refusal or reduction of medical services for qualified Indians. " "In 1999, AFA quoted a resolution of another tribal council with the same purpose.

AFA in 1999 was extended until September 2000 until the PRXN program audit was conducted by the HHS Inspection Office (OIG). In August 2000, the OIG stated that the government has expanded the qualification of discounted drugs by the federal government to no n-Indian employees without deciding that reasonable alternative drug services cannot be used by these employees. " The report was announced. The report identified several folk pharmacies within 10 miles of the location of IHS, pointing out that PRXN itself can provide services to no n-indirect employees from its commercial aspects. Therefore, the report advised IHS to "stop the custom of providing FSS pharmaceuticals to no n-qualified no n-qualified no n-indirect staff."

On September 27, 2000, IHS rejected the approved 1999 AFA further extensions, partially, because the proposal contains an activity that cannot be implemented legally.

The 2001 AFA proposal contained the following words:

Nation is a member of the Mashantucket Pequot National, which is a qualified person with medical care based on the provisions of Indian Health Service, and the employee of the NATION employee welfare program. Mu, Indian We agree to provide all medical pharmacy services to individuals who meet the standards of Health Care IMPROVEMENT ACT 813 (B) (1) (b).

IHS refused the phrase "Individuals (including national staff)" in the 2001 AFA proposal of the Indian Medical Improvement Law (including national staff). . ... "is the same reason as the previous difference. The country also proposed the same wording in 2002, 2003, 2004 (extended to FY2005), and 2006 in AFA in FY2006. For the same reason, IHS has partially denied these AFA proposals.

The two parties agree that these examples have no important conflict. April 12, 2006, Pearlstein Administrative Law Judge's recommendation for the recommendation of the appellant (IHS's objection), 13; April 18, 2006, MPTN's opposition to the opposition of the appellant on the recommendation decision of Pearlstein Administrative Law. (MPTN's objection to IHS objection), 4.

Here are some reasons to support the IHS opposition to the ALJ's conclusion that a national proposal of IHS pharmacy services is compliant with ISDA. Next, we will explain why the state supports the IHS opposition to the ALJ's conclusion that the state meets the requirements of Article 813 (1) (B). Considering my disposal to these objections, it is not necessary to mention other objections of IHS. Finally, the reason why IHS refuses to refuse the proposed AFA is not supported by ALJ's conclusion that it is not hindered by Article 900, Paragraph 32 of the Federal Rules. Is explained.

I. ALJ had a mistake in the proposed pharmacy service AFA concluded that it was involved in the federal medical program based on ISDA.

The issue of thresholds raised by IHS in this case is whether the country's proposal on pharmacy services is a service that is not subject to sel f-determination contract based on ISDA. (2) IHS has a position that pharmacy services are not specially designed for Indians, so they do not comply. As related here, ISDA will conclude a sel f-determination agreement to "design, implement, and manage the federal medical program or part of the federal medical program or a part of the federal medical program by the decision of the tribe". Is instructed.

(B) Based on the law on November 2, 1921, the Secretary has the authority to manage it for Indian interests. 25U. S. C. ВЈ 13) and subsequent laws have the authority to manage the Secretary for Indian interests.

ISDA Article 102 (A) (1) (25 U. S. C. 450f (A) (1)). Thus, IHS can only contract on programs or services based on specific laws and regulations that the Secretary (or IHS) to be managed by the Secretary of IHS for the interests of Indians. < SPAN> In the following, we will first explain the reason for supporting the IHS opposition to the Alj's conclusion that the national proposal of IHS pharmacy services conforms to ISDA. Next, we will explain why the state supports the IHS opposition to the ALJ's conclusion that the state meets the requirements of Article 813 (1) (B). Considering my disposal to these objections, it is not necessary to mention other objections of IHS. Finally, the reason why IHS refuses to refuse the proposed AFA is not supported by ALJ's conclusion that it is not hindered by Article 900, Paragraph 32 of the Federal Rules. Is explained.

I. ALJ had a mistake in the proposed pharmacy service AFA concluded that it was involved in the federal medical program based on ISDA.

The issue of thresholds raised by IHS in this case is whether the country's proposal on pharmacy services is a service that is not subject to sel f-determination contract based on ISDA. (2) IHS has a position that pharmacy services are not specially designed for Indians, so they do not comply. As related here, ISDA will conclude a sel f-determination agreement to "design, implement, and manage the federal medical program or part of the federal medical program or a part of the federal medical program by the decision of the tribe". Is instructed.

(B) Based on the law on November 2, 1921, the Secretary has the authority to manage it for Indian interests. 25U. S. C. ВЈ 13) and subsequent laws have the authority to manage the Secretary for Indian interests.

ISDA Article 102 (A) (1) (25 U. S. C. 450f (A) (1)). Thus, IHS can only contract on programs or services based on specific laws and regulations that the Secretary (or IHS) to be managed by the Secretary of IHS for the interests of Indians. Here are some reasons to support the IHS opposition to the ALJ's conclusion that a national proposal of IHS pharmacy services is compliant with ISDA. Next, we will explain why the state supports the IHS opposition to the ALJ's conclusion that the state meets the requirements of Article 813 (1) (B). Considering my disposal to these objections, it is not necessary to mention other objections of IHS. Finally, the reason why IHS refuses to refuse the proposed AFA is not supported by ALJ's conclusion that it is not hindered by Article 900, Paragraph 32 of the Federal Rules. Is explained.

I. ALJ had a mistake in the proposed pharmacy service AFA concluded that it was involved in the federal medical program based on ISDA.

The issue of thresholds raised by IHS in this case is whether the country's proposal on pharmacy services is a service that is not subject to sel f-determination contract based on ISDA. (2) IHS has a position that pharmacy services are not specially designed for Indians, so they do not comply. As related here, ISDA will conclude a sel f-determination agreement to "design, implement, and manage the federal medical program or part of the federal medical program or a part of the federal medical program by the decision of the tribe". Is instructed.

(B) Based on the law on November 2, 1921, the Secretary has the authority to manage it for Indian interests. 25U. S. C. ВЈ 13) and subsequent laws have the authority to manage the Secretary for Indian interests.

ISDA Article 102 (A) (1) (25 U. S. C. 450f (A) (1)). Thus, IHS can only contract for programs or services based on specific laws and regulations that the Secretary (or IHS's organizations) are managed by the Secretary of the Indian profit.

ALJ is a law for the interests of IHCIA, which is "as shown by its name," and IHCIA, which is the authority of the proposal. "Therefore, the program [A] approved under IHCIA is properly included within the scope of Indian sel f-determination in ISDA ..." I concluded. RD at 16. RD at 16. ALJ states that "the fact is that MPTN and individual Indian members have obtained substantial interests from the expansion of pharmacy services to no n-Indian tribal employees by tribes." Ta. 17 pages. Alj stated:

The fact that a state proposed by a state expands pharmacy services to most no n-Indian beneficiaries in EHBP is not a program that can not be legally implemented by contractors and IHS. As the country claims, such interpretation effectively disables пїЅ1680C (B) (1) (b). This clause clearly states that if certain requirements are met, the IHS or contract tribes will expand health services based on ISDA contracts to no n-Indians. IHCIA is not inconsistent with ISDA, which focuses on Indians' benefits. The two laws were interpreted in Pari Materia to achieve both purposes, and the parliament would be an Indian profit to allow medical services to no n-Indians under certain circumstances. It shows that it has been judged. In IHCIA, the rules promulgated based on the law and ISDA, as long as the legal requirements I have met, the number, percentage of no n-indians, or the situation that can expand medical services to no n-indians. do not have.

In fact, MPTN and individual Indians have gained significant benefit from tribal employees other than Indians due to the expansion of pharmacy services by tribes. The expansion of benefits to tribal employees increases the population of PRXN services. As a result, tribes can achieve great scale benefits in the operation of pharmacy programs, such as purchasing larg e-scale stocks of pharmaceuticals in the FSS program. Members of the tribe have indirectly benefit from the pharmacy program by investing the amount saved in the medical services of other tribes.

IHS claims an objection to Alj's conclusion regarding this issue. IHS opposition petition, 20-23. I agree with IHS's opinion that it was wrong to conclude that ALJ's proposed services were compatible. The fact that IHCIA is a law that IHS has the authority to manage for Indian benefits, does not mean that the service proposed by IHS has not been contracted by IHCIA. Rather, this service is not qualified to receive IHS [Page 9] medical services, and is not qualified to receive such services based on the exception of Article 813 (B) (1) (B) of IHCIA. It is intended for thousands of no n-indians. (3)

The 813 (B) section is entitled "Medical facilities that provide medical services." Article 813 (b) (1) specifies the following:

(A) In the following cases, the Secretary lives in the service area of ​​the service unit, and does not qualify for medical services under other sections of this section or the other rules of the law. Through the facility, you have the authority to provide medical services based on this section.

(i) Indian group. (II) Secretary and the Indian tribe have been determined mutually as follows.

(II) (II) The fact that the secretary and the Indian tribe do not refuse or reduce the medical services for the qualified Indians, (ii), in the service area in the service unit or outside the area. Mystery is determined that there is no reasonable alternative facility or medical services that meet personal medical needs.

(B) In the case of medical facilities operated based on the contracted contract based on the Indian Sel f-Review [25 U. S. 450F ET Seq.] , Other sections of this section or those who are not qualified to receive medical services under the other provisions of the law, have the authority to determine whether to provide medical services based on the contract. When making such a decision, the operating organization of the Indian tribal or tribal tissue must consider the considerations described in No. (a) (II). < SPAN> IHS claims an objection to Alj's conclusion regarding this issue. IHS opposition petition, 20-23. I agree with IHS's opinion that it was wrong to conclude that ALJ's proposed services were compatible. The fact that IHCIA is a law that IHS has the authority to manage for Indian benefits, does not mean that the service proposed by IHS has not been contracted by IHCIA. Rather, this service is not qualified to receive IHS [Page 9] medical services, and is not qualified to receive such services based on the exception of Article 813 (B) (1) (B) of IHCIA. It is intended for thousands of no n-indians. (3)

The 813 (B) section is entitled "Medical facilities that provide medical services." Article 813 (b) (1) specifies the following:

(A) In the following cases, the Secretary lives in the service area of ​​the service unit, and does not qualify for medical services under other sections of this section or the other rules of the law. Through the facility, you have the authority to provide medical services based on this section.

(i) Indian group. (II) Secretary and the Indian tribe have been determined mutually as follows.

(II) (II) The fact that the secretary and the Indian tribe do not refuse or reduce the medical services for the qualified Indians, (ii), in the service area in the service unit or outside the area. Mystery is determined that there is no reasonable alternative facility or medical services that meet personal medical needs.

(B) In the case of medical facilities operated based on the contracted contract based on the Indian Sel f-Review [25 U. S. 450F ET Seq.] , Other sections of this section or those who are not qualified to receive medical services under the other provisions of the law, have the authority to determine whether to provide medical services based on the contract. When making such a decision, the operating organization of the Indian tribal or tribal tissue must consider the considerations described in No. (a) (II). IHS claims an objection to Alj's conclusion regarding this issue. IHS opposition petition, 20-23. I agree with IHS's opinion that it was wrong to conclude that ALJ's proposed services were compatible. The fact that IHCIA is a law that IHS has the authority to manage for Indian benefits, does not mean that the service proposed by IHS has not been contracted by IHCIA. Rather, this service is not qualified to receive IHS [Page 9] medical services, and is not qualified to receive such services based on the exception of Article 813 (B) (1) (B) of IHCIA. It is intended for thousands of no n-indians. (3)

The 813 (B) section is entitled "Medical facilities that provide medical services." Article 813 (b) (1) specifies the following:

(A) In the following cases, the Secretary lives in the service area of ​​the service unit, and does not qualify for medical services under other sections of this section or the other rules of the law. Through the facility, you have the authority to provide medical services based on this section.

(i) Indian group. (II) Secretary and the Indian tribe have been determined mutually as follows.

(II) (II) The fact that the secretary and the Indian tribe do not refuse or reduce the medical services for the qualified Indians, (ii), in the service area in the service unit or outside the area. Mystery is determined that there is no reasonable alternative facility or medical services that meet personal medical needs.

(B) In the case of medical facilities operated based on the contracted contract based on the Indian Sel f-Review [25 U. S. 450F ET Seq.] , Other sections of this section or those who are not qualified to receive medical services under the other provisions of the law, have the authority to determine whether to provide medical services based on the contract. When making such a decision, the operating organization of the Indian tribal or tribal tissue must consider the considerations described in No. (a) (II).

As described in detail in the section described later, there are no conflicts, thousands of no n-indian employees and their families who can receive pharmacy services only based on the ISDA contract according to this section. By proposing a service, it is not recognized that the state has complied the requirements of section 813 (B) (1) (b). Thus, the country did not propose a program that is managed by the Secretary for the interests of Indians.

Even if the nation did not comply with Article 813 (1) (b), it was not positive (this is positive), for no n-Indian employees included in the proposed AFA. It is clear from an additional situation that the service is not appropriate as a program with the authority managed by the Secretary for Indian interests:

The country does not use any IHS funds for the services provided by PRXN, and AFA is a pure discretion of the ISDA contract in the country. Therefore, the main reasons for incorporating no n-Indian staff in the contract are to use FSS, which can only be used for services provided under the ISDA contract, to provide additional allowance to employees with reduced national costs. This is to do (4).

o There is no reason that the country cannot provide the same small profit through the commercial aspects of PRXN other than the ISDA contract, and the economy of the large pharmacy program and other profits (as well as access to FSS) ) Can be maintained for tribal members.

Most of the no n-O -Indians employees work for casinos operated by the government, not as an essential medical expert in the country's program, functions, services, and activities based on ISDA contracts.

O. If you provide pharmacy services to employees other than Indians under the ISDA contract, even if the tribes have some medical benefits, the number of tribes is the number of employees other than Indians. This is much larger than the interests of no n-Indians, because it is very small. < SPAN> As described in the section described later, there are thousands of no n-indians and their families who can receive pharmacy services based on the ISDA contract only according to this section. By proposing to provide a pharmacy service to, it is not recognized that the state has complied the requirements of section 813 (B) (1) (b). Thus, the country did not propose a program that is managed by the Secretary for the interests of Indians.

Even if the nation did not comply with Article 813 (1) (b), it was not positive (this is positive), for no n-Indian employees included in the proposed AFA. It is clear from an additional situation that the service is not appropriate as a program with the authority managed by the Secretary for Indian interests:

The country does not use any IHS funds for the services provided by PRXN, and AFA is a pure discretion of the ISDA contract in the country. Therefore, the main reasons for incorporating no n-Indian staff in the contract are to use FSS, which can only be used for services provided under the ISDA contract, to provide additional allowance to employees with reduced national costs. This is to do (4).

o There is no reason that the country cannot provide the same small profit through the commercial aspects of PRXN other than the ISDA contract, and the economy of the large pharmacy program and other profits (as well as access to FSS) ) Can be maintained for tribal members.

Most of the no n-O -Indians employees work for casinos operated by the government, not as an essential medical expert in the country's program, functions, services, and activities based on ISDA contracts.

O. If you provide pharmacy services to employees other than Indians under the ISDA contract, even if the tribes have some medical benefits, the number of tribes is the number of employees other than Indians. This is much larger than the interests of no n-Indians, because it is very small. As described in detail in the section described later, there are no conflicts, thousands of no n-indian employees and their families who can receive pharmacy services only based on the ISDA contract according to this section. By proposing a service, it is not recognized that the state has complied the requirements of section 813 (B) (1) (b). Thus, the country did not propose a program with the authority managed by the Secretary for Indians' benefits.

Even if the nation did not comply with Article 813 (1) (b), it was not positive (this is positive), for no n-Indian employees included in the proposed AFA. It is clear from an additional situation that the service is not appropriate as a program with the authority managed by the Secretary for Indian interests:

The country does not use any IHS funds for the services provided by PRXN, and AFA is a pure discretion of the ISDA contract in the country. Therefore, the main reasons for incorporating no n-Indian staff in the contract are to use FSS, which can only be used for services provided under the ISDA contract, to provide additional allowance to employees with reduced national costs. This is to do (4).

o There is no reason that the country cannot provide the same small profit through the commercial aspects of PRXN other than the ISDA contract, and the economy of the large pharmacy program and other profits (as well as access to FSS) ) Can be maintained for tribal members.

Most of the no n-O -Indians employees work for casinos operated by the government, not as an essential medical expert in the country's program, functions, services, and activities based on ISDA contracts.

O. If you provide pharmacy services to employees other than Indians under the ISDA contract, even if the tribes have some medical benefits, the number of tribes is the number of employees other than Indians. This is much larger than the interests of no n-Indians, because it is very small.

Thus, the fact that the ISDA contract of the country includes services for no n-Indians employees, first, is intended for the interests of no n-Indian employees and commercial casino operators. ALJ's recommendation decisions stated that "the members of the tribal council and the director of PRXN emphasize the importance of the tribal employees for continuous progress of the tribe," said ALJ. He thinks he is a member of the family, "he specifies the importance of the proposed AFA, which will be the interest of no n-Indian employees in the country. RD at 18. Alj mentions the "progress" is the success of the casino operated by the nations. The operating of casinos has gained physical benefits, but this is not an ISDA contract that provides medical services.

Therefore, he concludes that pharmacy services for no n-Indians proposed by AFAS are not consistent.

II. Alj concluded that the country's pharmacy service program meets the requirements of Article 813 (B) (1) (B), so that the country can do legal activities under ISDA.

Alj concluded Article 813 (B) (1) (b) as follows.

When IHS is determined to provide services to no n-indians, it is obliged to actually consider the possibility of use of alternative services and the decline in services to Indians. IHS is limited to examining the contract, and the court, as in the case of the appealing agency, is limited to whether or not the tribe has done so. The judging agency should point out "severe eyes" on this problem, but cannot replace the tribal judgment.

(5) In the opposition, Article 813 (B) (1) (B) examines whether it takes into account the possibility of using a reasonable alternative pharmacy service for no n-Indians. He argues that it is not appropriate to interpret that as IHS restricted. < SPAN> In this way, the fact that the ISDA contract of the country contains services to no n-Indians employees is the first to focus on the interests of no n-indigen employees and commercial casino operators. гЂ‚ ALJ's recommendation decisions stated that "the members of the tribal council and the director of PRXN emphasize the importance of the tribal employees for continuous progress of the tribe," said ALJ. He thinks he is a member of the family, "he specifies the importance of the proposed AFA, which will be the interest of no n-Indian employees in the country. RD at 18. Alj mentions the "progress" is the success of the casino operated by the nations. The operating of casinos has gained physical benefits, but this is not an ISDA contract that provides medical services.

Therefore, he concludes that pharmacy services for no n-Indians proposed by AFAS are not consistent. II. Alj concluded that the country's pharmacy service program meets the requirements of Article 813 (B) (1) (B), so that the country can do legal activities under ISDA.

Alj concluded Article 813 (B) (1) (b) as follows.

When IHS is determined to provide services to no n-indians, it is obliged to consider the possibility of the use of alternative services and the decline in services to Indians. IHS is limited to examining the contract, and the court, as in the case of the appealing agency, is limited to whether or not the tribe has done so. The judging agency should point out "severe eyes" on this problem, but cannot replace the tribal judgment.

(5) In the opposition, Article 813 (B) (1) (B) examines whether it takes into account the possibility of using a reasonable alternative pharmacy service for no n-Indians. He argues that it is not appropriate to interpret that as IHS restricted. Thus, the fact that the ISDA contract of the country includes services for no n-Indians employees, first, is intended for the interests of no n-Indian employees and commercial casino operators. ALJ's recommendation decisions stated that "the members of the tribal council and the director of PRXN emphasize the importance of the tribal employees for continuous progress of the tribe," said ALJ. He thinks he is a member of the family, "he specifies the importance of the proposed AFA, which will be the interest of no n-Indian employees in the country. RD at 18. Alj mentions the "progress" is the success of the casino operated by the nations. The operating of casinos has gained physical benefits, but this is not an ISDA contract that provides medical services.

Therefore, he concludes that pharmacy services for no n-Indians proposed by AFAS are not consistent.

II. Alj concluded that the country's pharmacy service program meets the requirements of Article 813 (B) (1) (B), so that the country can do legal activities under ISDA.

Alj concluded Article 813 (B) (1) (b) as follows.

When IHS is determined to provide services to no n-indians, it is obliged to actually consider the possibility of use of alternative services and the decline in services to Indians. IHS is limited to examining the contract, and the court, as in the case of the appealing agency, is limited to whether or not the tribe has done so. The judging agency should point out "severe eyes" on this problem, but cannot replace the tribal judgment.

(5) In the opposition, Article 813 (B) (1) (B) examines whether it takes into account the possibility of using a reasonable alternative pharmacy service for no n-Indians. He argues that it is not appropriate to interpret that as IHS restricted.

[I conclude that Alj has interpreted Article 813 (1) (b) correctly in this way. Article 813 (B) (1) (B) The IHS's view is that the IHS and Indian tribes must jointly determine that they provide specific medical services to no n-Indians based on the ISDA contract. It is not supported. See page 22. As ALJ inferred, Article 813 (B) (1) (b) The wording is Article 813, which explicitly requests a joint decision order to provide no n-Indians service. (B) (1) (1) (A) is clearly different. Furthermore, since the meaning of Article 813 (B) (1) (b) in this regard is clearly clear, according to the IHS, the parliament does not permit the "tribal decision". Based on the principle, there is no authority to consider whether this provision is invalid. IHS objection (see 19-24, in any case, interpretation of Article 813 (B) (1) (b) of Alj does not protect the decision of the tribe from the secretary's screening. The deviation and complaints procedures and the enforcement rules provide a mechanism to judge whether the government complies with Article 813 (1) (B). When the Indian tribe, which proposes to provide services based on (b), determines that it has not considered the consideration of Article 813 (1) (1) (II) (I) and (II).

Therefore, as Article 813 (B) (1) (b) requires, the government decides whether to provide a service to no n-Indian employees based on an ISDA contract, Article 813 (B). (1) The following describes whether the consideration of the consideration of "there is no reasonable alternative service" in (II) (II) is described below.

О‘. The nation does not comply with Article 813 (B) (1) (b). This is because at the same time as the proposed AFA, there was no decision on the rule that there was no reasonable alternative service. < Span> [I conclude that Alj has interpreted Article 813 (1) (b) correctly. Article 813 (B) (1) (B) The IHS's view is that the IHS and Indian tribes must jointly determine that they provide specific medical services to no n-Indians based on the ISDA contract. It is not supported. See page 22. As ALJ inferred, Article 813 (B) (1) (b) The wording is Article 813, which explicitly requests a joint decision order to provide no n-Indians service. (B) (1) (1) (A) is clearly different. Furthermore, since the meaning of Article 813 (B) (1) (b) in this regard is clearly clear, according to the IHS, the parliament does not permit the "tribal decision". Based on the principle, there is no authority to consider whether this provision is invalid. IHS objection (see 19-24, in any case, interpretation of Article 813 (B) (1) (b) of Alj does not protect the decision of the tribe from the secretary's screening. The deviation and complaints procedures and the enforcement rules provide a mechanism to judge whether the government complies with Article 813 (1) (B). When the Indian tribe, which proposes to provide services based on (b), determines that it has not considered the consideration of Article 813 (1) (1) (II) (I) and (II).

Therefore, as Article 813 (B) (1) (b) requires, the government decides whether to provide a service to no n-Indian employees based on an ISDA contract, Article 813 (B). (1) The following describes whether the consideration of the consideration of "there is no reasonable alternative service" in (II) (II) is described below.

О‘. The nation does not comply with Article 813 (B) (1) (b). This is because at the same time as the proposed AFA, there was no decision on the rule that there was no reasonable alternative service. [I conclude that Alj has interpreted Article 813 (1) (b) correctly in this way. Article 813 (B) (1) (B) The IHS's view is that the IHS and Indian tribes must jointly determine that they provide specific medical services to no n-Indians based on the ISDA contract. It is not supported. See page 22. As ALJ inferred, Article 813 (B) (1) (b) The wording is Article 813, which explicitly requests a joint decision order to provide no n-Indians service. (B) (1) (1) (A) is clearly different. Furthermore, since the meaning of Article 813 (B) (1) (b) in this regard is clearly clear, according to the IHS, the parliament does not permit "protection of the tribal decision". Based on the principle, there is no authority to consider whether this provision is invalid. IHS objection (see 19-24, in any case, interpretation of Article 813 (B) (1) (b) of Alj does not protect the decision of the tribe from the secretary's screening. The deviation and complaints procedures and the enforcement rules provide a mechanism to judge whether the government complies with Article 813 (1) (B). When the Indian tribe, which proposes to provide services based on (b), determines that it has not considered the consideration of Article 813 (1) (1) (II) (I) and (II).

Therefore, as Article 813 (B) (1) (b) requires, the government decides whether to provide a service to no n-Indian employees based on an ISDA contract, Article 813 (B). (1) The following describes whether the consideration of the consideration of "there is no reasonable alternative service" in (II) (II) is described below.