Image provided by: The Confederated Tribes of Warm Springs; Warm Springs, OR
About Spilyay tymoo. (Warm Springs, Or.) 1976-current | View Entire Issue (July 21, 2005)
Spilyqy Tymoo, Wqrm Springs, Oregon July 21, 2005 Pqge7 Managed Care forced to limit payment for some referrals New limits apply only to off-reservation procedures By the Managed Care Program naff Effective immediately, the Managed Care Program of the Confederated Tribes of Warm Springs will only pay for prior ity I level services for medical care off the reservation. Overview The Managed Care Program is operated by the Confederated Tribes of Warm Springs but is funded with federal dollars through the Indian I Icalth Ser vice (II IS) under a "638" con tract. The stated goal of the Man aged Care Program is to: "Pro vide quality services in manag ing health care referalls to spe cialists off the reservation for eligibile Native American com munity members in order to facilitate quality care at a rea sonable cost for health care that cannot be provided at the HIS clinic." Operating with limited funds, the Managed Care Program strives to make sure that when an eligible community member sees a provider of medical ser vices outside of the I Icalth and Wellness Center, such as a doc tor or a hospital, his or her care is of good quality and at a rea sonable cost. From 1993 to 2002, by care fully managing the budgeted funds, the Managed Care Pro gram processed all requested, medically necessary referrals within priorities, and was able to pay for the services from these referrals with each current year budget. In fact, up until two years ago, the Managed Care Program was able to operate within bud get and accumulate unspent dollars ever)' year since it began operations. Operating efficiently and ag gressively utilizing alternate re sources, particularly the Oregon I Icalth Plan, the Managed Care Program was able to process all medically necessary referrals that fell with the HIS Prioriry U-vels I IV. Financial and referral ser vice status Starting in 2002, escalating healthcare costs combined with cutbacks in the Oregon Health Plan began exerting its effects on the Managed Care Program. Although the Managed Care Program finished over the cur rent year budget in 2003 and 2004, the program utilized un spent funds accumulated over the prior years, and did not re strict the referral process in ei ther of these two years. I lowever, the Managed Care Program reserve funds are be ing depleted, and the time when the referral process will be af fected has arrived. Healthcare costs are continuing to increase, and you read about their impact in the new? just about every day. Cutbacks in the Oregon Health Plan are having a dra matic effect on the Managed Care Program budget. The pro gram will not be able to continue to pay for many of the services it has paid for over the last dozen years. j Warm Springs has been somewhat unique in paying for the wide variety of services it has in the past, in that many res ervations in the Portland Area (Oregon, Washington, Idaho) either start out the year on Pri- itatus, or go to Pnpnty I status part way through the year. ority I status, Priority I I,cvel services are defined' as "KmcrgentAcutcly Urgent Care Services, and are thoserservices necessary to prc venr the immediaty death or serious impairment of the health of the individual". ' The Confederated Tribes of Warm Springs Nianagcd Care Program is totally dependent on the HIS for fuids to operate. Unfortunately, in light of the factors mentioned above, these funds are no longer sufficient to cover the range of services the Managed ('are Program has paid for in the past. Regretfully, effective immediately, the Man aged Care Program will only pay for Priority I Ixrvel services for medical care off the reser vation. This policy will be in effect until further notice. Walking team appreciates help with raffle The walking team "Wading to Exhale" raffle results arc as fol lows, with the name of winner, and item won. Many of the items were donated by Rita Squiemphen, Earlynne Squiemphen, Lynn Fluhr, Cheryl Lohman, Rcdine Kirk, Margie Ellsbury and The Museum at Warm Springs. Eyvonne Rckow, 3-pc towel set1 Rpirip Chzvp 10-nr headband; Sammi O'Reilly, Beaded Nike Visor; Earl Squiemphen, beaded Seahawks cap; Glenn Fluhr, 42" mini umbrella; Cark Mukumoto, mini radio; Noree Guerin, vivitar camera; Janell Smith, alarm sport watch; Zachary Fluhr, spongebob gloves' & hot wheel 4 -car; Val Squiemphen, beaded ! choker; Bob Porter, hand held racing game and gloves; Jim Ellsbury, hand held BB game and rubber ducky; Val Squiemphen, AT&T phone card; Warren Fluhr, elk pocket watch; Maryann Schwartz, Cheetos & Fritos pack; Audrey Bernard, thinsulate camo gloves; Judy Fluhr, grey thermolite gloves; Eyvonne Rckow, 40-pc socket set; DanHeather Martinez, blue fanny pack with coin purse; Brian Lund, outdoor companion; William Leonard, Barbie doll and barrettes; Eyvonne Rekow, coin purse with pen; Topaz O'Reilly, Eagle feather antler stand; Audrey Bernard, toothpaste and soap holder; Eyvonne Rekow, fleece throw blanket; Glenn Fluhr, easy open hamper; Rusty Marcum, photo album; Penny Flowers, water bottle with pen; Glenn Fluhr, 3 dish cloths; Val Squiemphen, 3 pc bathroom set; Zachary Fluhr, bear in a mug; Deb Alvarez, Oil of Olay lotion pack; Sissy Smith, 2-speed hand blender; Jermaine Sampson, heart shape jewelry holder with barrettes; Charles Barnett, Job boss tool holder; Tony Torres, 49er backpack; Zachery Fluhr, bath tub place mats; Lynn Davis photo screen holder; Eyvonne Rekow, Huckleberry Basket; DanHeather Martinez, 3-per-son tent. And the grand prize went to Noree Guerin, who re ceived a "Home & Garden" basket, containing everything that can be used around your home, which was donated by Earlynne Squiemphen and Lynn Fluhr. I would like to thank every one who purchased tickets and congratulate all the winners. A special thank you goes out to Rita Squiemphen, Margie Ellsbury, The Museum, Recline Kirk, Cheryl Lohman, and Lynn Fluhr for all the donated items, in conjunction with the I Iood to I lats off to my entire walk- Coast relay. ing team for selling the tickets - Once again, thank'you every- great job! We will be participat- one. ' ing in die Portland to Coast Walk Earlynne Squiemphen, August 26 Si 27, which is held team captain. T MEMORIES in STONE Custom Designed Memorials Hand Engraved In Goldendale C For Over 18 Years Pioneer Rock & Monument 509-773-4702 201 Crafon Road PO Box 548 Qoldendale, WA 98620 www.pioneerrock.com llrriorpjiiiL'- n mt&WM wwiki imiikii ':! 1- f.l r No Foolin'- The Best Food in Town! Pi-Ume-Sha stickgame raffle results The 2005 Pi-Ume-Sha Stickgame Raffle results, listed by winner, the prize, and the person who donated the prize: Rickey Walker, thermal ca rafe set, Mona Schuster. Angel Fisher, Pendleton blanket, Sam Starr. Tim Abill, chair with um brella, Mona Schuster. Bill Tay lor, cooler, Kim Starr. Amy Ramos, wolf statue, Mona Schuster. Jamie Wadamat, tent, Orlando Doney. Albert Bryant Jr., air mattress, Mona Schuster. Dakota Ramos, elk knife, Bill Taylor. Jim Garrett, $25 Safeway card, Donna Torres. Mariah Pete, cooler with radio, Mona Schuster. Barbara Starr, ceramic eagle dream catcher, Louise Taylor. Terry Benson, $50 cash, Nettie Dickson. Tamara Nielson, rodreel pole with case, Mona Schuster. Neteva Polk-Saludo, $100 cash, Sam Starr. Sam Jim, Pendleton blanket, Sam Starr. Sean Cook, ceramic wolf dream catcher, Louise Taylor. Lydell Suppha, electric scooter, Rich ard Tohet. Barbara Starr, lawn chair, Donna Torres. Kim Starr, large picnic umbrella, Donna Torres. Bob McKay, clock ra dio, Vanessa Andy. EAGLE-TECH m Eagle-Tech Systems now offers cost effective on-site business PC and Network Services in the Warm Springs and Madras area. PC installation and service for most PC desktop and laptops Network Installation and Management Office Wireless systems Peripheral Service Data backup and recovery service Network Security Microsoft Office Support Internet Security Planning to Protect Against Online Threats Certified staff including Microsoft Certified Professional, A, Cisco, Linux, .... TECHNICAL SERVICE TO THE WARM SPRINGS & MADRAS AREAS
