Image provided by: The Confederated Tribes of Warm Springs; Warm Springs, OR
About Spilyay tymoo. (Warm Springs, Or.) 1976-current | View Entire Issue (June 28, 2001)
Spilyqy Tyvnoo, VUii-ro Springs, Oejon June 28, 2001 Oregon Health Plan signup easier Having applications on-site to help tribal members i Vrum IliS and 'MCP st'ijj Hoth ilic Tribe and Indian Health Service (II IS) recently received great news from the State of Oregon. The state lias agreed to snpply HIS with Oregon Health iW(OIIP) eligibil ity packers, Patienrs can now apply for OIIP coverage in the Health & Wellness Center (ikWQ on a walk in basis, ' In the past, the Patient Advocate from the Managed ("arc Program (MCP), or representatives from the HIS Business Office, discussed with the patient a variety of eligibility criteria such as family size and in come level. ' 1 ' If preliminary evaluation indi cated the patient may be eligible for the OIIP, the representative then phoned the state office in Salem and an application packer wis sent to either the patient's homc'address or to the ll&WC. ' ' In either case, the patient had to then fill out all the appropriate pa perwork and return (he packet to Salem in a timely mtnner. It was this step that often caused problems; in some cases the' patient did not follow through with the application in a timely mannef once it was re ceived. ' Now that the HIS Business Of fice has an inventory of application packets, the application process should be greatly simplified. Now, once a Business Office or MCP rep resentative determines a patient is most likely eligible for "the OHP, she then can immediately help the pa tient fill out the eligibility applica tion. It is then promptly mailed to the 01 IP Office. This will save the previous' all too frequent "problem" of the patient being able to complete the paperwork in a timely manner. The end result should be many more eligible community members cbv- . i M l' 1 - ' ' - I '" Thus the use of nables the MCP better care for Native Americans by "stretching" its budget. ered by the OHP. If all community members that are eligible for the OHP become covered, the benefit to community members will be great This will be felt both via the tribally operated Managed Care Program and the In dian Health Service Clinic located in the Health & Wellness Center. Managed Care Program The goal of the Managed Care Program (MCP), operated by the Confederated Tribes of Warm Springs, is to make sure that when a Native American from the Warm Springs community sees a medical services provider outside of the Health and Wellness Center, such as a doctor or a hospital, that the care heshe receives is of good quality and at a reasonable cost. The MCP has limited funds, so it is important that they are used ef ficiently. : Health care costs are rising after a period of years of rather gradual growth. Not only are there many technological advances which drive up costs, but the reimbursement process for services are more com plex than ever. Medicare, OHP and insurances are reacting in a variety of ways. MCP costs are affected by the current environment, as reflected in the much higher costs it experi enced in 1999 and 2000. This is most likely the start of a trend that will continue. The major challenge will be to position MCP to continue to If you would like additional information or to get involved in teen pregnancy prevention, contact the Jefferson County Commission on Children and Families at 541-475-4456. alternate resources to provide more and see that quality service at reasonable cost is provided to MCP eligible pa tients in this environment with the limited funding MCP has. The MCP is the "payer of last resort" for medical claims, which means it will pay medical claims for eligible people only after alternate resources have paid their appropri ate share. Thus the use of alternate resources enables the MCP to pro vide more and better care for Na tive Americans by "stretching" its budget. The Oregon Health Plan (OHP) is one of these alternate re sources. According to federal regu lations (Cl'R 42; Ch. I; Subpt. 36.23, I), a Native American is re quired to apply for the OIIP if there is reason to believe that heshe may be eligible for it. Once on OHP, a person is required to fill out renewal forms at intervals determined by OHP. The MCP does not pay for ser vices for people who should have been on OHP but failed to follow the above process, so MCP denies any claims received and the patient is responsible for the bill. In fact, a patient's failure to follow through on application to OHP is the most common reason for MCP to deny payment of a claim. Indian Health Service The goal of the Indian Health Service located in the Health & Wellness Center is to provide qual ity care to all eligible community member. Direct services such as general medical care, dentistry, and optometry in addition to ancillary services such as pharmacy and labo ratory arc available in the Warm Springs community. However, op erating costs for the HIS arc only partially funded through a congres sional budget process that can be come fairly political and unpredict able. Thus, at best, dollars that Con gress allocates fund only a portion of the costs of operating the HIS Clinic. The remainder of the oper ating costs, as well as funding for capital equipment purchases, is pro vided through HIS billing various alternate resources, such as insur ances and OIIP, for the patient. In other words, the more com munity members that arc covered by OIIP, the more dollars that HIS can collect from billing OI IP for services it provides to community members. Operating and capital costs are thus provided for, which leads to higher quality of service. Summary The agreement between the HIS and the State of Oregon for the HIS Business Office to keep a supply of OHP eligibility packets on-site will be advantageous for the Confeder ated Tribes of Warm Springs. This will be a big plus for the Tribe on two fronts: 1) It will now be much easier for eligible community mem bers to sign up for OHP coverage. Thus, the State of Oregon will pay their medical bills for services off the Reservation, and they will no longer find themselves responsible for their medical bills once they are covered by OHP. 2) Because IHS bills OHP for care provided at the Health & Wellness Center, more dollars will be collected and thus available for health care at the Health & Wellness Center. M !'!-!. .. ItMHM' ':'.; V i ... . l IV.' A ;.r IU ,., , Fire breaks out in Warm Springs jail On June 22, at aIout 9:30 p.m., section of the Warm Springs Detention Facility. The facility holds 48 inmates; inmates that were evacuated from the facility; 4 juveniles and t adult female were transported to Mountain View Hospital in Madras where they were treated for smoke inhalatioa One of the juveniles had to be kept in intensive care for several days. The remaining evacuated inmates were housed overnight at the po lice and fire substations, in Simnasha ' Several high risk inmates were Damage was limited only to the Following about a 6 hour clean returned to the jail. The exact cause of the fire is under investigation. Stolen property recovered On June 13 and 14, 2001, officers and detectives of the Warm Springs Police Department worked throughout the day and night to recover approximately $100,000 of stolen property related to several cases throughout the Centra Oregon area, including Warm Springs. Recovered items included flatbed trailer, all terrain vehicle, snow mobiles, electric and pneumatic tools, hand tools, welding equipment, jewelry, Native American regalia and heirlooms, lawn mowers, stereo cquipmenr, firearms and miscellaneous items. Victor Smith Jr. was arrested in Madras on several counts including felony counts of bur glary and theft, after the Warm Springs Police Department provided information concerning his whereabouts. Victor faces several charges in Warm Springs, Jefferson County and Wasco County for the thefts. While recovering a stolen snowmobile related to the case in Gov ernment Camp area, detectives of the Warm Springs Police Depart ment and Clackamas County Sheriff's Department discovered a 43 plant marijuana grow at the residence of Gregory Greenfield. Mr. Greenfield faces several narcotics charges related to the case. Investiga tion revealed that Greenfield has supplied marijuana to Warm Springs residents in the past. Investigation Accident claims Arizona woman On June 23, 2001, at approximately 7:1.5 p.m. officers and detec tives of the Warm Springs Police personnel from Warm Springs Fire vehicle accident on Highway 3 at Several motorists stopped to pinned under her vehicle. Officers and emergency medical personnel performed cardio-pulmonary resuscitation while Air Life responded. After approximately 40 minutes the victim was pronounced dead. A three and a half year old child was transported form the scene and admitted to Mountain View Hospital overnight for observation. The child suffered minor injuries and was The names are not being released Speed was a factor in the accident. a fire broke out inside the juvenile 36 adults and 12 juveniles. Of 46 housed in the Jefferson County Jail. juvenile cell. up of the facility, all inmates were continues. ' 1 Department and emergency medical and Safety responded to a motor milcpost 15, which turned fatal. find a 23-year-old Arizona woman released the following day. pending notification of next kin. ''.'I '"..vt,:t- ' fi'i'iKi,! O 2001 Campaign For Our Children. Inc.