Char-Koosta News
The Official Publication of the Flathead Nation online
Indian Health Service and THHS: A brief snapshot in timeBy Stacey Kiehn, Public Information Manager ST. IGNATIUS — Looking back in time to the inception of the Federal Government's trust responsibilities toward Native American people regarding health care, one must begin at the point of discovery. The turbulent history between American Indians and European settlers has been well documented. Many of our ancestors lost their lives to achieve tribal recognition and Indian rights. It is because of their struggles that tribes are afforded a government-to-government relationship today. These rights became formalized in the initial treaties of 1778, where the federal government acknowledged certain responsibilities toward indigenous people. These obligations were reconfirmed and further defined by U.S. Supreme Court decisions, congressional legislation, Executive Orders, and through various forms of federal policies. The U.S. Constitution recognizes Indian Tribes as sovereign nations with certain inherent rights. It is this recognition that subsequently distinguishes Indian Tribes from all other ethnic groups in the United States. The organization of hundreds of treaties into law formed the basis for the Government's provision of health care to Indian people. The treaty health care terms represented part of the Government's payment to Indian Tribes for giving up their ancestral homelands to the United States. These treaties were, and still are, contracts between the Federal and Tribal Governments. In 1921, Congress passed the Snyder Act (42 Stat. 208), which provided continued authority for Federal Indian programs. This Act identified the "relief of distress and conservation of Indian health" as a Federal function. Around 1954, all functions of the Secretary of the Interior regarding the conservation of Indian health were transferred to the Surgeon General of the U.S. Public Health Service (USPHS). It was on July 1, 1955, 2,500 BIA health program personnel, 48 hospitals, 18 health centers, 62 stations, 13 school infirmaries, and other locations, came under the newly created Indian Health Service (IHS) jurisdiction. As progress was being made in establishing basic health services during the 1950s, the 1960s held an emphasis on health program management, health planning, health professional and health occupation training for Indians, and health management training for IHS administrators. Medical and dental residencies were established as well as training programs for nursing, nutrition, and environmental health. The CHR program was established in 1965, training Indian community members as Community Health Representatives. This effort was designed to bridge the existing gap between patients in the community needing health care and health clinics and hospitals providing it. The CHR program was the first formal assumption by an Indian Tribe of an IHS-supported program in 1968. The 1970s were revolutionary in IHS history. Federal Indian relations were significantly impacted by President Richard Nixon's Policy Statement of July 8, 1970. Nixon's concept of Tribal "self-determination" was advanced, proposing that Tribal Governments take over the management of Federal programs provided to them. This policy was made into law when Congress enacted the Indian Self-Determination and Education Assistance Act (Public Law 93-638) in 1975. In doing so, Congress also established two major goals in the Indian Health Care Improvement Act of 1976. This Act was to: (1) ensure the elevation of the Indian peoples health status to the highest possible level; and (2) to achieve the maximum participation of Indian people in the Indian health program. Congress clearly mandated IHS to provide medical care and to eliminate the existing health disparities between Indian people and the general U.S. population. Emerging in the 1980s were vast increases in funding for Indian health programs, special emphasis on professional excellence, construction of modern health facilities, and movement toward greater Tribal involvement. The 1990s portrayed a continual unfolding growth of the self-determination process. With the passage of the Indian Self-Determination and Education Assistance Act, legislation supported Tribes' contracting or assuming responsibility for programs formerly managed by IHS. In 1994, Congress passed legislation extending Tribal self-governance on a demonstration basis. This extension allowed Tribes to contract for the programs, services, functions, and activities within IHS and the BIA. The ultimate demonstrated success resulted in permanent authority in 2000. A key success of the Indian Self-Determination policy was that it authorized Tribes to plan and deliver services appropriate to their diverse demographic, economic, and institutional needs. Today the Indian health care systems consist of 12
regional (or Area) offices and 157 Service Units. It administers health
care services through a system of 48 hospitals, 238 health centers, 167
health stations, 180 Alaska village clinics, and 34 urban projects.
Annual patient services in both Tribal and IHS facilities include: IHS funding for 2006 totaled $3.9 billion dollars with 83 percent of the funds appropriated by Congress in 3 distinct categories: (1) facilities, (2) diabetes, and (3) services. Approximately 17 percent of the funding was obtained from reimbursements through Medicare, Medicaid, and patients' private health insurance. Congressionally appropriated funds are considered discretionary, meaning they are not automatic, and are dispersed among and used in hundreds of locally operated health care programs, hospitals, clinics, and tribal health care sites located in 35 states. Because most IHS funding is to maintain previously existing levels of patient care services at all sites, the annual allocations to sites is predominantly fixed and automatic. This fixed amount is called "base funding." Of this base, in 2006 approximately $2.7 billion dollars was appropriated to the maintenance of existing medical services; $150 million dollars was appropriated to the diabetes programs via grants and other special projects; and $357 million dollars was allocated toward facilities maintenance, construction, clean water and sanitation, and facility environmental health programs. Here on the Flathead Reservation the Tribal Health department provides a wide range of services to a significant user population totaling over 10,000 Native Americans. The 2007 departmental funding level to provide health care services to this user population is $10,953,639. This amount is comprised of tribal, IHS, state, and grant funds. These dollars are increasingly constrained as the cost of health care continues to raise parallel to the increased health care needs in our area. In addition, as our federal government continues to expand it’s funding for the war in Iraq and for disaster relief efforts, the available federal funding in areas such as health care experience a lower budgetary priority. It is the distinctive mission, goal, and emphasis on wide-ranging community-based care, which makes IHS one of the most complex organizations of any type for delivering health care to the sovereign Indian Nations. The cornerstones of Federal Indian Policy are outlined not only in federal case law, but in: Article I, Section 8, clause 3 of the U.S. Constitution, which regulates commerce with foreign Nations and among the several States, and with Indian Tribes; and Article II, Section 2, clause 2, known as the "Treaty Clause," which grants the Federal Government the exclusive authority to make treaties on behalf of the United States. Today this relationship continues to carry the same immense legal and moral obligations as it did 200 hundred years ago. In the present day IHS strategic plan, two themes have become increasingly prominent. First is the role of accountability. Secondly, IHS plans to address the increased pattern of health disparities between American Indians and the general U.S. population more aggressively. The mission of the Indian Health Service is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level. Its goal is to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indians and Alaska Native people. Finally, the foundation of IHS is to uphold the Federal Government's obligation to promote the health of American Indians and Alaska Natives. The provision of quality, competent, and timely health care services for Indian people located within the service area of our Tribal Health department is of the highest priority. This is reflected in our 2007 goals and strategic planning. Our continuing efforts are geared toward efficient and effective delivery of available services, while exploring additional avenues to enhance funding levels to expand our health care systems and services. An important part of the system and service expansion involves the knowledge and awareness of our area user population. This knowledge includes the use of the current system, how to navigate through the various processes and who to contact with any questions you might have. Listed are some key points you need to be aware of: Applying for Services You can obtain an application at all Tribal Health
facilities, which are located in Arlee, St. Ignatius, Ronan, and
Polson. Upon completion you can submit the application at any one of
these locations or send it to the St. Ignatius location by mail at the
following address: Updating Applicant Information This process is similar to the initial application
process. However, once you've applied, your information is then
assigned to a Beneficiary Eligibility Specialist at the St. Ignatius
location. The disbursal of applicant information is alphabetical on a
last name basis as follows: Should you have any questions regarding the application process or services available you can contact your corresponding Specialist: 8 a.m. until 4:30 p.m., Monday through Friday. Alternate Resources Tribal Health works in concert with several federally funded, state managed health care programs available to low income or medically needy families. These programs offer assistance in covering health care costs, allowing the Tribal Health department to maximize funding received for Direct and Contract Health Care Services. Some examples of these alternate resource programs include Medicare Part A (hospital), Part B (medical), Part D (prescriptions), Medicaid, Veterans Administration and CHIP. Another alternate resource is private insurance either through an employer or purchased by an individual from a private carrier for personal health care coverage. In October of 2006, the management of Contract Healthcare Services was turned back over to IHS for fiscal purposes. Under the IHS Contract Health Service Plan, each participant is encouraged to obtain some form of alternative resource health care coverage as a primary plan if they are eligible. IHS is known as a "payer of last resort;" it is considered a secondary form of coverage behind the alternate resource coverage. Eligible participants who enroll in an alternative resource plan maximize their access to health care services. Payment for contracted services are made through IHS, the Tribal Health department does not issue any payments for health care services rendered by participants. Questions or concerns regarding alternative resource
benefit services may be directed to the Alternate Resource Beneficiary
Specialists, Monday through Friday, 8:00 a.m. until 4:30 p.m. as
follows: The primary mission of both the Beneficiary Eligibility Specialists and the Alternate Resource Beneficiary Specialists is to generally act as advisors and advocates in assessing the local health care system. It is important that all participants update their application information on an annual basis to ensure effective, continuous coverage and assistance. Available Health Care
Within the Tribal Health department there are two forms of health care services available: Eligibility for Contract Healthcare Services The CHS health plan was established to administer health
care delivered by contract providers who are not part of the Tribal
Health staff. Persons eligible for CHS services meet one or more of the
following criteria: Eligibility for Direct Care Services Direct care consists of health care services provided by
the professional and para-professional staff of the Tribal Health
department. Persons eligible for direct care meet one or more of the
following criteria: This criterion is established by CS & KT Council in accordance with federally established requirements
Clinical Services Division Questions, comments or requests for additional information regarding these services can be directed to Yvonne Grenier at (406) 745-3525 ext. 5035 Other Services Aside from the well-known medical, pharmaceutical, and
dental services, Tribal Health offers other forms of health care to
eligible participants. These areas include:
Clinical Services Division For additional information on these programs or for inquiries, Contact Kim Azure at (406) 745-3525 ext. 5110
Community Health Services Questions, comments or requests for additional information may be directed to Clarice Anderson at (406) 745-3525 ext. 5013 Surgery/Procedural Services Review • In rare cases upon the recommendation of Tribal Administration, Tribal Council may appropriate limited tribal funding toward CSKT enrolled tribal member surgical/procedural candidates rated just below the IHS "emergent-care" category who have been disqualified for IHS financial support. These candidates are prioritized in accordance with the IHS rating system, whose medical needs qualify within the "urgent-care" rating category. Questions, comments or requests for additional information regarding surgical review services, may be directed to Lorrie Meeks at (406) 745-3525 ext. 5007. Periodically, some of these other service areas conduct informational workshops throughout the communities. These workshops are a great opportunity for you to become familiar with the various programs and gain an understanding of what is available. Notices will be published in the Charkoosta News, other local publications, and posted throughout the Tribal departments for upcoming events. THHS Information to the masses Throughout the upcoming year, the Tribal Health department will be scheduling community meetings to establish a public forum for discussions on health related practices, opportunities to address questions, comments and concerns related to health care and Tribal Health services. Announcements regarding meeting dates and times will be published in the Charkoosta News and other local publications. In addition to the public forums, periodic articles covering various topics ranging from in depth looks at the Tribal Health system, state and federally funded resources, and local and national trends in health care will be made available in the Charkoosta News and other local publications. Finally, Tribal Health will be implementing the release of a quarterly newsletter and establishing a website. These tools will provide information which includes but is not limited to goods and services provided, Tribal Health departmental introductions, intra-departmental relations, inter-departmental relations (for example, relations between Tribal Health and the Veterans Administration, Medicaid, Medicare, etc...), personnel concerns pertaining to recruitment and retention, health trends and concerns, preventative health options, and departmental/division events. Should anyone have any questions or comments regarding the information provided in this article, please contact Stacey Kiehn, Public Information Manager, at (406) 745-3525 ext. 5116, or by e-mail at: skiehn@thhs.cskt.org |
