APRIL 15, 2000
13
COMMUNITY PUBLIC NOTICE - OPEN FOR COMMFNT
Health care patients: proposed pharmacy changes
Effective as of May 15, 2000, pre
scription drugs and medical sup
plies provided by the Grand Ronde
Health and Wellness Center will be
provided as a Contract Health Ser
vice benefit on a cost-reimbursement
basis. This means that drugs and
medical supplies will no longer be
provided as a free service to members
of Indian tribes other than the Con
federated Tribes of Grand Ronde,
except for those members of other
tribes who are determined to be eli
gible for Contract Health Services as
having close social and economic ties
with the Confederated Tribes of
Grand Ronde, or members of the
Siletz Tribe under reciprocity ar
rangement with the Siletz Tribal
Clinic.
For those Native patients who have
a third party payer resource, such as
the Oregon Health Plan or medical
insurance with prescription coverage
that the Pharmacy accepts assign
ment for, the Pharmacy will bill that
resource on the patient's behalf at the
allowable reimbursement rate. Co
payments and deductibles will be
waived for Native patients with third
party payer coverage. Patients are
urged to provide information regard
ing third party payer resource to the
Pharmacy in advance, which will
help keep waiting time to a mini
mum. For those Native patients who do
not have third party payer coverage,
but who are eligible for the Grand
Ronde Contract Health Service Pro
gram, the Pharmacy will bill the Con
tract Health Service Program at ac
quisition cost of the drugs and medi
cal supplies. Eligibility for the Con
tract Health Service Program requires
that a person be a Grand Ronde en
rolled member and reside in the des
ignated five county Contract Health
Service Delivery Area, or be a mem
ber of another tribe who has estab
lished and maintains close social and
economic ties with the Grand Ronde
Tribe and resides within the Contract
Health Service Delivery Area.
Those Native patients who do not
have a third party payer resource for
which the Pharmacy accepts assign
ment and are not eligible for the
Grand Ronde Contract Health Ser
vice Program will be required to pay
for prescriptions at the Pharmacy's
acquisition cost at the time the pre
scription is provided. The pharmacy
accepts Visa, MasterCard, debit card,
cash or in-state checks.
Pharmacy services which are cur
rently provided to non-Native medi
cal clinic patients on a full cost reim
bursement basis from the patient
andor their insurance coverage or
Oregon Health Plan will continue
unchanged.
This policy change is made neces
sary due to the failure of the
federal appropriations for Indian
Health Services to keep pace
with cost of inflation and popula
tion growth.
Patients who wish to obtain fur
ther information regarding this
policy and the reasons for it are en
couraged to contact the Health and
Wellness Center at (503) 879-2001
or 879-2098.
Confederated Tribes of Grand Ronde
Health & Wellness Center
Pharmacy Service Eligibility & Payment Policy
If Patient Is: Contract Health Eligible Third Party Payer Coverage Drug Cost Service Fee
Yes No Yes No
Grand Ronde Tribal Member X X Billed to third party Billed to third party
Grand Ronde Tribal Member X X Billed to CHS No Charge
Grand Ronde Tribal Member X X Billed to third party Billed to third party
Grand Ronde Tribal Member X X No Charge No Charge
Unenrolled Grand Ronde Descendant Under 18 X X Billed to third party Billed to third party
Unenrolled Grand Ronde Descendant Under 18 X X Billed to CHS No Charge
Unenrolled Grand Ronde Descendant Over 18 XX Billed to third party Billed to third party
Unenrolled Grand Ronde Descendant Over 18 X X No Charge No Charge
Member of Other Tribe With Close Social v v .. .... . .... .
Economic Ties to Grand Ronde Tribe X P Y P
Member of Other Tribe Without Close Social & v v D-n .u- a o j j
Economic Ties to Grand Ronde Tribe X X BllIed t0 third B,,led t0 th,rd Part
Member of Other Tribe Wthout Close Social & I Y I .. . I .. ,
Economic Ties to Grand Ronde Tribe Patientpays NoCharge
Member of Siletz Tribe under reciprocity Y Y I
arrangement with Siletz Tribal Clinic 111 Billed to th.rd party B.lled to th.rd party
Member of Siletz Tribe under reciprocity Y Wn r. ma M(ir. rna
arrangement with Siletz Tribal Clinic X NoCharge NoCharge
Non-Indian of Grand Ronde Community X X Billed to third party Patient copayment
Non-Indian of Grand Ronde Community X X Patientpays Patientpays
Eligibility by close social and economic ties requires that a member of another tribe be employed by the Grand Ronde Tribe,
or a business entity owned by the Tribe, or be married to a member of the Grand Ronde Tribe.