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.