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
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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
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Warm Springs and Madras area.
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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
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TECHNICAL SERVICE TO THE WARM SPRINGS & MADRAS AREAS