In 1973, the Health Maintenance Organization Act (P.L. 93-222) was enacted. (55) Section 6(a) of the HMO Act amended Section 1 of the Indian Transfer Act to provide:
In carrying out his functions, responsibilities, authorities, and duties under this subchapter, the Secretary of HHS is authorized, with the consent of the Indian people served, to contract with private or other non-Federal health agencies or organizations for the provision of health services to such people on a fee-for-service basis or on a prepayment or other basis. (56)
DHHS General Counsel advised that PL 93-222 offered the widest possible discretion to the Secretary in the selection of a health care service provider. (57) Shortly after the amendment passed permitting contracting on an or other basis, the Colville Tribe proposed a contract to Blue Cross Blue Shield for health insurance coverage. The General Counsel clarified that Section 6(a) only applied to providers of health services and not to providers of insurance, thereby advising against the use of fiscal mechanisms. (58)
In 1988 the Indian Health Service utilized PL 93-222 authority to execute a contract with Southwest Catholic Hospital Network (SCHN) in Arizona for the benefit of the Pascua Yaqui Tribe. SCHN was a Health Maintenance Organization that provided medical and health care services. Because of the changes offered to Tribes in the Indian Self Determination and Education Assistance Act, utilization of PL 93-222 authority has not been a fertile source of contracting.