Siletz
Community
Cha-may weeya
Medicine Talk
Health
Clinic
Funds Depleted for Health Care
The Tribal Council designated
$200,000 from the 2003 excess pledge
revenue (gaming funds) for health care
services for tribal members who are not
eligible for Contract Health Services
(CHS) or live outside the 11-county
service area. After required reductions
for indirect costs and pharmacy benefits
for out-of-area, a balance of $89,512
was left for distribution.
Contract Health staff were prepared
for a busy day July 1 to begin obligating
funds. The response was tremendous,
indicating a great need for health care.
All available funds were obligated by
9:30 a.m. to 94 tribal members who
received prior authorization in the
following categories:
Dental - 57 tribal members, $68,400
Vision - 20 tribal members, $8,000
Medical - 14 tribal members, $14,000
Hearing - three tribal members, $4,129
A slightly greater amount was
obligated than available because 34
tribal members have private insurance
and didn’t need the total benefit. Unfor
tunately, at least 80 callers could not be
served because of a lack of funding.
Telephone lines were over-taxed
and many callers experienced the
frustration of not getting through. To
be fair, CHS staff issued authorizations
on a first-come, first-served basis. We
recommend calling CHS on Jan. 3,2005,
in case any unused funds are returned
for redistribution.
In 1998,1999, and 2000, $100,000
was obligated. In 2001, the amount
increased to $130,600. In 2002, it grew
to $195,000 and this year’s 2003
obligation of $200,000 brings the total
out-of-area benefits to $825,600.
With an allocation from the 1998
excess pledge revenue of $100,000,
hundreds of tribal members who
otherwise would not have been able to
receive much-needed care have used
these funds to improve their well-being.
CHS Alert
With 26 weeks remaining in fiscal
year 2004, however, CHS has only 13
weeks of available funding. What does
this mean to you?
When you call for a prior authoriza
tion, your request will be strictly
screened. We will limit authorizations
to Priority I and II only. Priority I is
Emergent/Acutely Urgent Care and II
is Preventive Care.
Examples of Priority I include
emergency room care for heart attack,
stroke, car accident, acute pneumonia,
and acute asthma. Trauma, severe
bums, concussion, large lacerations,
fractures, eye injuries, and other trauma
also are considered Priority I.
Priority II includes preventive
services such as screenings for known
diseases, hypertension, diabetes,
mammograms, pap smears, immuniza
tions, well-child exams, sports
physicals, and medication refills.
Requests for Priority III most likely
will be deferred. These include specialty
consultations in surgery, obstetrics,
gynecology, ophthalmology, ENT,
orthopedics, and most physical therapy.
Tribal Council infused CHS with
$300,000 in excess pledge revenue to
assist us in reaching December with
positive cash flow. Unfortunately,
additional high-cost, catastrophic cases
have completely devastated the budget.
Third-party revenue from clinic
collections will be available for limited
assistance, but it will be impossible to
fully fund all needed care.
Services that are denied or deferred
will have little chance of reversal upon
appeal. If you fail to obtain prior
approval or do not call CHS within 72
hours of an emergency visit, payment
will be denied and CHS will not be
responsible for it.
You can help by accessing direct
facilities for your care (Siletz Com
munity Health Clinic, Chemawa Health
Center, or Grand Ronde Health and
Wellness). Portland-area tribal
members also have the NARA clinic
available to them.
You also can assist by accessing the
Siletz Tribal Mail Order Pharmacy Pro
gram for your prescription needs. This
is preferred over Pequot because we can
pass along our savings to the program.
If you have access to low-cost
private insurance through your or
your spouse’s employer, you would be
Urgent CHS News
Effective July 15, 2004, dental, vision and most physical therapy will
be deferred because of the current spending rate in CHS.
Additional information on the CHS situation is available on this page.
Please be patient and use IHS and tribal facilities whenever possible.
well-advised to bear that minimal
cost to avoid the frustration of denied
care through CHS. Thank you all for
your understanding.
Mail Order Pharmacy
To tribal household members,
please share this information with all
tribal members. Mail order pharmacy
became available June 1,2004, for CHS
eligible living outside the 40-mile radius
of the Siletz Community Health Clinic.
Effective June 1, 2004, the Siletz
Clinic Pharmacy now provides mail
order pharmacy to Siletz Tribal
members who live in the 11-county
service area (CHS eligible). Tribal
members can receive up to a 90-day
supply of maintenance medication
(subject to change with private
insurance or OHP coverage). Mailing
will be provided to those members who
live 40 miles outside the Siletz Clinic
area; others will be required to pick up
at the Siletz Clinic.
Pequot mail order will end Dec. 31,
2004. All mail order prescriptions must
be directed to the Siletz Tribal Mail
Order Pharmacy at the Siletz Clinic by
Jan. 1, 2005. Only a $500 annual retail
amount will continue through your
Advance PCS pharmacy card.
How to Use Mail Order
Services
To refill your prescription, call
1 -800-648-0449 or 541 -444-9624.
• Send an order form and your new
prescription to the address listed on
the mail order service form/en velope.
• Please allow 7-10 working days for
your order to be processed. If the
prescription is too soon to fill or
not refillable, you will be notified
by phone.
•
U.S. Postal Service will ship orders.
Some medicines may require an
adult signature upon receipt.
Packaging is confidential.
Business hours are 8:30 a.m. to
12:30 p.m. and 2 p.m. to 5 p.m.
Monday through Friday, with the
exception of Tuesday, when hours
are 8:30 a.m. to 12:30 p.m.
Access to a registered pharmacist
for consultation is available anytime
during standard business hours.
Call CHS for information and mail-
in envelopes, 1-800-628-5720 or
444-1236 (closed Tuesdays at noon).
•
Low-Fat Fudge Pops
1 (14 oz.) can fat-free sweetened
condensed milk
cup sugar
cup baking cocoa
2° cups skim milk
Artificial sweetener equal to ° C. sugar
1 tsp. vanilla extract
12 (3 oz.) disposable plastic cups
12 Popsicle sticks
In a heavy saucepan, combine the
first three ingredients; stir until smooth.
Bring to a boil over medium-low heat;
cook and stir for one minute. Gradually
whisk in skim milk, whisking until cocoa
and sugar are dissolved. Remove from
heat; stir in the sweetener and vanilla.
Pour into cups. Cover each cup with
heavy-duty foil; insert sticks through
the foil (foil will hold sticks upright).
Place in a 13x9-inch pan. Freeze until
firm, about five hours. Remove the foil
and cups before serving. Serves 12.
Nutritional Analysis: One serving
equals: 155 calories, 62 mg sodium,
3 mg cholesterol, 34 gm carbohydrate,
5 gm protein, 1 gm fat. Diabetic
Exchanges: 2 starch
Source: www.lose-weight-online, com
Aùgùst 2004 ‘ CT Siletz News ‘ □
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