Smoke Signals
Your Guide to Contract Health Services
8 JANUARY 15, 2002
WHAT IS CONTRACT HEALTH??
The contract Health Service program is feder
ally funded under P.L. 93-638 by Congress for
the Grand Ronde Tribe to assist eligible Indian
people with payment of eligible medical and den
tal services.
HOW TO USE CONTRACT HEALTH
SERVICES:
Your responsibilities for using Contract Health Services are as follows:
1. You need to phone in appointments 3 to 7 days in advance for
preauthorization and to receive a conformation number even if you have
insurance such as ODS, Medicare, Medicaid, etc...
2. - Emergency visits must be reported within 72 hours after the ser
vices. Any Emergency room visit will be reviewed and prioritized for
payment by the Clinic Provider.
3. Inform doctors of private insurance such as ODS, Medicare, Med
icaid, etc. Any alternate resource that covers medical or dental services
must be utilized prior to Contract Health Service.
4. Mail CHS any preauthorized bills and insurance explanations of
benefits (EOB) you may receive.
5. All patients receiving elective surgery must receive PRIOR AP
PROVAL from a doctor at the GRHWC. These services will be rendered
upon availability of funds.
INPATIENT HOSPITAL STAYS:
All patients that do not have an alternate resource and are going to be
hospitalized must apply for Adult and Family Service Medical Card. (O.B.,
Elective Surgeries, Emergency services, etc.)
6. REFUSAL TO APPLY FOR ALTERNATE RESOURCES WILL
RESULT IN A DENIAL FOR PAYMENT.
7. PAYMENTS FROM ALTERNATE RESOURCES.
When and if a patient receives a check for payment or partial payment for
a medical or dental bill and do not apply the entire amount to the bill then
CHS will not be responsible for that portion of the bill. It will then be the
patients' responsibility for payment.
CONTRACT HEALTH SERVICES RESPONSIBILITIES:
1. Log all preauthorized patient appointments and conformation num
bers. 2. Emergency room visits will not receive a conformation number.
The claim will be held until the Clinic Provider reviews and establishes
the priority level of the service.
3. Send health applications for new eligibility and address changes.
4. Maintain CHS Correspondence Files.
Please remember that anything told to us remains within the strictest of
confidence, and cannot be given to anyone without your written permission.
DOCTOR AND DENTIST
RESPONSIBILITIS:
1. Send all appropriate billing claim forms and
EOB to CHS for payment.
2. CHS can authorize for cleaning and exam
(including x-rays) one time per year, and up to
$100 for relief of pain for emergency dental vis
its. Before a dentist can perform any dental work,
they must first submit a pretreatment plan with procedure numbers,
cost and sent to CHS for approval.
If a procedure cannot be paid for, patients will be placed on a Deferred
Services List. Patients will be notified that they are on the list and will
again be notified when funds become available for these services. So it is
very important to keep all your personal information such as address and
phone number current.
THE PRIORITIES FOR CONTRACT HEALTH SERVICES:
CHS operates under a Priority I basis. Any services other then a level I
will be added to the Deferred Services List.
PRIORITY I: Urgent and Emergent care that must be done within
30 days to preserve life, limb, function or senses.
PRIORITY II: Non-emergent care that is needed within 30 to 60 days,
but enough time during which alternate resources can be evaluated.
PRIORITY HI: Elective care that can be safely deferred for more
than 60 days.
PRIORITY TV: Luxury procedures such as cosmetic surgery.
WHO DETERMINES PRIORITIES?
The priorities are determined by Indian Health's Operational Procedures.
The interpretation of the priorities for our Tribal Health Program is deter
mined by consultation with professional Health Care Providers at he the
GRHWC.
SHOULD I KEEP MY INSURANCE?
Yes, by all means. If you have health insurance we can pay for your
deductible and any balances after the insurance company pays. ASSUM
ING YOU MEET ALL THE REQUIREMENTS OF OUR CHS PROGRAM.
If after determination that there are no other alternate resources, insur
ance or other government programs, we are responsible for the total,
charges. The disadvantage of no insurance is that with limited funds,
CHS may run out of funds before the end of the year and may not be able
to pay for any Tribal Member services.
FOR THOSE WITH INSURANCE:
Private insurance, ODS, Medicare, Medicaid, etc., all correspondence from
insurance stating what they have paid or denied must be sent to us within
60 days. If you fail to comply with the requirements of your primary
insurance, CHS may deny payment.
WE PAY ONLY AFTER THE INSURANCE COMPANY HAS RESPONDED.
U
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Q
o
o
o
o
o
o
o
o
Listed below are the dates of the classes,
the topics to be covered, as well as the
names of the individual(s) scheduled to dis
cuss the topics.
22702 Shelley Hanson
Credit Report
Resume St Page 1 1 of The Plan
Overview of the 12 weeks St The Plan
guidebook
3602 John Baker
Market Research
Marketing
31302 Shelley Hanson
Your Business & Business Location
The Competition
32002 John Baker
Cash Flow Chart
Personal Financial Statement
Personal one on one help
Loan request
Balance Sheet
Operations Statement
32702 John Baker & Elaine Moore
Cash Flow Chart
Personal Financial Statement
Personal one on one help
Loan request
Balance Sheet
Operations Statement
Contact Barbara Lake at 503-879-2476
000000000090
40302 Shelley Hanson
Legal, Speaker
Bookkeeping, Doug Iverson, Speaker
Business Plan Homework
41002 Shelley Hanson & Finan
cial Resources Panel
Representatives from Union Bank of
California, SBA, Local Banks
41702 Shelley Hanson & Business
Panel
Panelists; Steve Bobb, Eyvette
Davidson, Alice Propes, Gary Hampton,
will participate in a question and answer
session with class participants, about
their experiences in small business.
42402 Shelley Hanson
Grooming You and Your Business for
Success
Work on Business Plans with one on
one assistance
50102 Shelley Hanson, John
Baker
Quick Books Software Class Overview,
Elaine Moore, Instructor
Finalize Business Plans
One on one help
Copy completed business plans and
turn in
50302 GRADUATION 6:00 p.m.
Tribal Community Center
or Sheila Herber at 503-879-2492.
ooooooooooo
0
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
The Grand Ronde Tribal Housing Authority (GRTHA) has received approval
from the Tribal Council for the Tribal Housing Grant Program Policies for 2002.
These programs include the Minor Medical Adaptation Grant Program, the
Home Repair Grant Program, and the Down Payment Grant Program.
The policies for the Minor Medical Adaptation Grant program remain the
same as for 2001. This program is available to Grand Ronde Tribal members
throughout the United States, regardless of their income level. It provides up
to $3,000 for grab bars, wheelchair ramps, and other work to provide accom
modations to persons with physical disabilities.
There are no changes to the Home Repair Grant Program. This program is
available in GRTHA's 10 county service area to provide certain home repairs to
Grand Ronde Tribal homeowners who meet the income limits for their family size.
Up to $10,000 is available per grant, or $3,000 if the home is a mobile home.
The major change for 2002 is in the Down Payment Program. The
household income limit for this program has been increased from $70,000 to
$90,000. Also, there is no longer a waiting list system. Interested Grand
Ronde Tribal members may now become pre-qualified by GRTHA and a lender,
and after that process is completed they may receive a grant at the time they
are ready to purchase a home, subject to availability of funds. The maximum
grant amount is $10,000, with a $1,000 contribution from the Tribal member.
Any additional contribution from the Tribal member up to $2,500 will receive
an additional one-to-one funding match in the grant, resulting in a grant of up
to $12,500. The grant will be funded within 30 days of receipt by GRTHA of all
required information. 60 percent of the funding will be reserved for first time
homebuyers.
Interested Tribal members should contact GRTHA at 1-800-422-0232, ext.
2401, or locally at 503-879-2401, for more information or to make an applica
tion for any of the above programs.