CN allocates $9.4M to ease MRI constraints

BY BRITTNEY BENNETT
Reporter – @cp_bbennett
01/31/2018 08:15 AM
TAHLEQUAH – Cherokee Nation officials announced they are allocating an additional $9.4 million to Contract Health to alleviate budget constraints and re-establish some MRI referrals for patients with “elective orthopedic” cases.

“We are aware our patients have more health needs than we offer and (we) want to help them live healthier lives without exhausting their pocketbooks or going without these needed services,” Dr. Charles Grimm, CN Health Services interim executive director, said. “The Cherokee Nation is making aggressive efforts in several areas to collect more funds from billing patients’ private insurance, Medicaid and other third-party billing streams.”

Grimm attributed the collections increase to improved patient record management using a new electronic health records system and increased provider productivity after implementing a new compensation package. The package rewards providers on productivity and patients treated, leading to more opportunities for third-party billing, he said.

Third-party collections for fiscal year 2018’s first quarter was $36.1 million, up from $26.7 million during the last FY 2017 quarter, according to CN Communications.

The additional funds bring the FY 2018 Contract Health budget to $44.3 million, with $28.4 million received from Indian Health Service and $6.5 million from Cherokee Nation Businesses dividends, officials said.

Previously, Contract Health authorizations for surgeries and MRI referrals were limited to patients classified at Level 1 under the IHS medical priority regulations. The IHS defines Level 1 as “the highest priority medical services,” including “those necessary to prevent the immediate threat to life, limb, or senses.”

If a patient was categorized with an “elective orthopedic” issue such as chronic knee, back or shoulder pain, it would not meet requirements for an approved MRI referral. Instead, patients had to rely on Medicare, Medicaid or private insurance to help cover costs.

“We hope patients understand that Cherokee Nation Health Services strives to meet all needs of tribal citizens, but the same time have had to manage costs, and these additional dollars will help serve even more patients with contract health referrals,” Grimm said. “Our goal is to be able to be able to provide the necessary orthopedic services and related diagnostics for our patients.”

In the CN 2017 Annual Report, 11.8 percent of Health Services’ expenses came from contracted health services, the third-largest expense behind direct patient care at 66.4 percent and community health and education at 12.2 percent.

Grimm said evaluating funding would continue to be an “ongoing process.”

“We will continue to monitor the needs of the patients combined with the payer mix of the various additional funding sources and go from there,” he said.

Contract Health Director Bret Hayes said the tribe always approved referrals for oncology, cardiology and orthopedics. However, elective orthopedics had been halted as referrals grew “exponentially,” while funding grew only “in fits and spurts.”

“Every time we add a doctor we add more patient access. We add more services. Those end up getting more referrals. When I started we had 87 (referrals) a day and now we have 412 a day, so volume has grown exponentially,” Hayes said.

Previously when patients were denied, letters were sent informing them that they could appeal in writing within 30 days and submit their appeals to their local Contract Health coordinators.

“It goes centrally to the Medical Review Committee,” Hayes said. “They just evaluate for medical necessity. For all referrals, they look at the medical background of the case. They can typically appeal it through three levels, so (patients) can appeal it again.”

The process is multi-tiered and for patients to win they must provide relevant medical records.

“We will still evaluate the referrals written by our providers for medical necessity and some referrals may still not meet medical necessity,” said Grimm. “We have an appeals system in place that will enable us to review the cases as they are appealed.”

The Cherokee Phoenix submitted a Freedom of Information Act request for the number of MRI referral approvals and denials, but information was not available as of publication.

While the CN does not have MRI machines available for patients, a new 470,000-square-foot health facility near W.W. Hastings Hospital will feature two when it opens in 2019.

“We will keep (the machines) busy I know,” Hayes said. “It will definitely allow for cheaper and more prompt diagnostics. We do a significant amount of MRIs related to all kinds of things, not just orthopedics.”

However, Hayes said he doesn’t know the financial situation that will occur once the machines are operational. Until demand and cost can meet in the middle, he recommends patients look into government and private insurance options to assure they will receive needed services.

Patient benefits coordinators are available at CN health facilities for those seeking insurance plans related to elective orthopedic MRIs and other services not covered by Contract Health.

Hayes said if patients have private insurance or Medicare then they could get specialty care such as MRIs. He said purchasing insurance through the Affordable Care Act is another way patients can gain access to specialty services, including MRIs.

“There are some really good benefits from the Affordable Care Act if you sign up on the Marketplace and purchase a plan,” he said. “Depending on their plan, the cost is zero and some of those plans have really good deductibles. The other thing is if they’ve got a contract health referral and they’re one of our patients, if they have purchased a plan on marketplace, there is no co-pay or no deductible.”

To enroll in the ACA or change a plan, visit www.healthcare.gov.
About the Author
Brittney Bennett is from Colcord, Oklahoma, and a citizen of the United Keetoowah Band.  She is a 2011 Gates Millennium Scholarship recipient and graduated from the University of Oklahoma in 2015 with a bachelor’s degree in journalism and summa cum laude honors.
 
While in college, Brittney became involved with the Native American Journalists Association and was an inaugural NAJA student fellow in 2014. Continued mentorship from NAJA members and the willingness to give Natives a voice led her to accept a multimedia internship with the Cherokee Phoenix after college.  
 
She left the Cherokee Phoenix in early 2016 before being selected as a Knight-CUNYJ Fellow in New York City later that same year. During the fellowship, she received training from industry professionals with The New York Times and instructors at the City University of New York. As part of the program, she completed a social media internship with USA Today’s editorial department.
 
Now that Brittney has made her way back to the Cherokee Phoenix, she hopes to use the experience gained from her travels to benefit Indian Country and the Cherokee people.
brittney-bennett@cherokee.org • 918-453-5560
Brittney Bennett is from Colcord, Oklahoma, and a citizen of the United Keetoowah Band. She is a 2011 Gates Millennium Scholarship recipient and graduated from the University of Oklahoma in 2015 with a bachelor’s degree in journalism and summa cum laude honors. While in college, Brittney became involved with the Native American Journalists Association and was an inaugural NAJA student fellow in 2014. Continued mentorship from NAJA members and the willingness to give Natives a voice led her to accept a multimedia internship with the Cherokee Phoenix after college. She left the Cherokee Phoenix in early 2016 before being selected as a Knight-CUNYJ Fellow in New York City later that same year. During the fellowship, she received training from industry professionals with The New York Times and instructors at the City University of New York. As part of the program, she completed a social media internship with USA Today’s editorial department. Now that Brittney has made her way back to the Cherokee Phoenix, she hopes to use the experience gained from her travels to benefit Indian Country and the Cherokee people.

News

BY TRAVIS SNELL
Assistant Editor – @cp_tsnell
05/24/2018 04:00 PM
RANCHO PALOS VERDES, Calif. – A video by a 20-year-old Cherokee Nation citizen has gone viral after a security guard took his tribal identification card on May 6 at Marymount California University. Nicolas Rojas, an El Camino Community College student, said he went to MCU to study with a friend who attends the university when a security guard checking IDs took his CN photo ID card and became “hostile.” “He then told me I had to leave, yelled at me and threatened to have me arrested. He became very hostile with me, started harassing me and put his hands inside my car, during which I started to record him,” Rojas said. “He told me I had to leave, but he had taken my ID with him and refused to give it back until I left and parked at a different school nearby. The whole interrogation took over a half an hour and I had a project due that Monday. I just wanted to study with my friend, but instead was threatened to be arrested several times without reasoning.” The ID card the security guard took is a CN photo ID card that contains a tribal citizen’s photo and citizenship information one side and Cherokee blood quantum on the other. According to CN Communications, the cards are federally recognized. And TSA.gov states the cards are Transportation Security Administration-approved for domestic travel. Rojas said he’s used his CN ID card to apply for jobs, board domestic flights and at banks to withdraw money. He added that the security guard spoke unprofessionally to him and refused to give back the ID. “I want this…to bring awareness about the issues indigenous people of North America face and the constant humiliation we have to endure by just existing,” Rojas said. “Campuses should be places of sanctuary for all attempting to further themselves through education. I don’t understand why he held onto my ID considering that he already at that point had told me that I would not be allowed to enter the campus. He took my ID with him as he was threatening to have me arrested.” Rojas said he eventually got his ID back from the security guard after his friend, who is a resident advisor at MCU, showed and asked the guard for the ID back. “I find it pitiful that I have to have a communicator within a place of power just to get my ID back,” he said. Rojas said he contacted university officials about the incident who told him they needed to fully investigate the incident from both perspectives. He said officials said if they found the guard liable then they would retrain him. “Ideally I would want campus-wide diversity talks, and all guards to have a day of retraining. I personally feel that many institutions are not a welcoming places for minorities, and this demonstrates the hostility many of us face just trying to even enter a campus,” Rojas said. According to the AJ+ video of the incident, MCU President Brian Marcotte said he watched the video and was “confident there was no discrimination” and that “it didn’t seem threatening.” According to the video, the school said it would train security on different IDs. To view the video, visit <a href="https://www.facebook.com/ajplusenglish/videos/1197973477010824/" target="_blank">https://www.facebook.com/ajplusenglish/videos/1197973477010824/</a>.
BY WILL CHAVEZ
Assistant Editor – @cp_wchavez
05/24/2018 10:00 AM
WASHINGTON – U.S. Health and Human Services officials want states to settle the question of whether citizens of Native American tribes should get jobs to keep their health care after the Donald Trump administration said in April that tribes are a race rather than separate governments. The administration contends that by classifying Natives as a race rather than organized tribal governments, they would not be exempt from Medicaid work rules. This new challenge to tribal sovereignty has sparked by an unusual split between the HHS’ politically appointed administrators and legal counsel, according to an article by Politico.com. This issue has also raised concerns in Congress and alarmed tribes that say it reverses centuries of protections enshrined in the Constitution and upheld by the Supreme Court. “This decision by the U.S. Department of Health and Human Services is troubling and undermines longstanding policy and law that recognize tribes as sovereign governments, not racial classifications,” Cherokee Nation Secretary of State Chuck Hoskin Jr. said. “This understanding is the very basis of the laws that apply uniquely to tribes and that have been upheld by the courts time and time again. HHS is demonstrating a breathtaking lack of understanding of this fundamental and bedrock concept in Indian law. I intend to object directly to agency officials at the next HHS tribal advisory committee meeting in May. HHS Secretary Alex Azar, the agency’s former general counsel, has told tribal leaders that state Medicaid administrators will be able to work with tribal governments on designing any employment requirements. Tribes had requested to be exempted from new Medicaid work rules being introduced in several states, citing sovereign status. But the Trump administration rejected the request, saying in January it amounted to an illegal racial preference. Eastern Band of Cherokee Indians Principal Chief Richard Sneed said his tribe’s citizenship differentiates tribal people and tribal governments from other racial minorities. “As principal chief of the Eastern Band of Cherokee Indians, I am a leader and a citizen of a sovereign tribal nation,” he said. “The Eastern Band – like other Indian tribes – sets its own laws that define the standards for being an Eastern Band Cherokee. This citizenship – we also say membership or enrollment in a tribal sovereign – separates tribal people and tribal governments from others who may be racial minorities.” Sneed added that the U. S. Supreme Court affirmed this status in 1974 in Morton v. Mancari, a case about the constitutionality under the Fifth Amendment of hiring preferences given to Indians within the Bureau of Indian Affairs. The Supreme Court held that the hiring preferences established by the U.S. Congress “were not violative” of the Due Process Clause of the Fifth Amendment. “Indians” under federal law are citizens of Indian tribes, not persons of a racial minority as recognized in the U.S. Constitution,” Sneed said. CN citizen Mary Smith, who was acting head of the Indian Health Service during the Obama administration, said the United States has a legal responsibility to provide health care to Native Americans. “It’s the largest prepaid health system in the world,” she said. “They’ve paid through land and massacres, and now you’re going to take away health care and add a work requirement?” Native Americans’ unemployment rate of 12 percent in 2016 was nearly three times the U.S. average, partly because jobs are scarce on reservations. Low federal spending on the IHS has also left tribes dependent on Medicaid to fill coverage gaps. “Work requirements will be devastating,” Smith said. “I don’t know how you would implement it. There are not jobs to be had on the reservation.” Republican Congressman Tom Cole, who is a Chickasaw Nation citizen and the chairman of the House Appropriations Subcommittee that holds the purse strings for HHS and the Centers for Medicare & Medicaid Services, has warned the HHS to reverse course. “I am concerned that both HHS and CMS are unwittingly about to kick off what may be decades of expensive and needless litigation with tribes and other parties,” Cole wrote as part of a legal memo prepared by the Chickasaw Nation. “There’s no way I’m ever going to support something that describes tribes as racial groups and not sovereign governments," Cole said to Politico. “If Republicans (with tribal expertise) don’t push back hard…I think HHS will stumble into a big fight that they don’t need.”
BY ASSOCIATED PRESS
05/21/2018 02:00 PM
WASHINGTON (AP) – The U.S. Supreme Court will hear Oklahoma’s plea to reinstate the murder conviction and death sentence of an American Indian. The justices on May 21 said they would review an appellate ruling that overturned the conviction and sentence of Patrick Dwayne Murphy. He claimed he should have been tried in federal, not state, court because he is a citizen of the Muscogee (Creek) Nation and the crime occurred in Indian territory. The federal appeals court in Denver determined that the victim’s body was found within the tribe’s historical boundaries that take in several Oklahoma counties, and include much of the city of Tulsa. The court said the MCN reservation existed before Oklahoma achieved statehood and was never formally deprived of its official status, or disestablished, by Congress. The Trump administration, in a rare uninvited Supreme Court filing, said in support of Oklahoma’s appeal that the issue has “wide-ranging and serious implications for law enforcement.” In Tulsa, with a population of 950,000 people, and eight counties in eastern Oklahoma, most crimes by or against Indians would have to be prosecuted in federal courts if the appellate ruling is upheld, the administration said. The vast majority of crimes are handled by local and state authorities. In 2017, federal prosecutors in the region brought just three indictments for serious crimes because they involved Indian Country, the administration said. That number could increase to more than 500 indictments a year, the administration estimated. A jury in McIntosh County, about 80 miles southeast of Tulsa, found Murphy guilty of the 1999 murder of George Jacobs and a judge sentenced him to death. Prosecutors said he had confessed to killing Jacobs when he was arrested. Lawyers for Murphy had urged the justices to leave the appellate ruling undisturbed. They argued that the appeals court correctly applied Supreme Court precedents dealing with the disestablishment of Indian reservations. They also said the claims of mass disruption of the criminal justice system were overstated. The case, Royal v. Murphy, 17-1107, will be argued in the fall. Justice Neil Gorsuch is not taking part in the court’s review because he dealt with the case while a member of the appeals court.
BY STAFF REPORTS
05/21/2018 08:15 AM
STILWELL – The 71st annual Stilwell Strawberry Festival was held May 11-12, and a strong Cherokee presence could be seen in one of the longest running festivals in Oklahoma. Attractions included a parade, carnival, 5K and fun run, car show, vendor booths, live music, food and strawberries. One of the two Cherokee strawberry growers, Dylan Collyge, attended the festival even though he was unable to sell his berries or enter them in the competition this year. “My berries got hit by a late frost in April and set me back about a month,” he said. Other strawberry farmers did well with their berries and sold them from booths or from their vehicles. Visitors could be seen carrying purchased flats of strawberries around town. The Cherokee Phoenix was at the festival and produced the following video of highlights.
BY TRAVIS SNELL
Assistant Editor – @cp_tsnell
05/18/2018 04:00 PM
TAHLEQUAH – Cherokee Nation citizens living outside the tribe’s 14-county jurisdiction are eligible for free one-year subscriptions of the Cherokee Phoenix thanks to a $10,000 disbursement from the principal chief’s office on behalf of At-Large Tribal Councilors Mary Baker Shaw and Wanda Hatfield. The Cherokee Phoenix recently received the funds and is taking names on a first-come, first-served basis until the money is depleted. “These funds that have been provided to the Cherokee Phoenix by the joint efforts of our tribal administration and our At-Large (Tribal) Councilors Mary Baker Shaw and Wanda Hatfield will go a long way in providing subscriptions to at-large citizens,” Executive Editor Brandon Scott said. “It has always been our goal here at the Phoenix to make sure that every citizen that wants a copy of the Cherokee Phoenix is able to get one. That is the sole reason we exist. Our success depends on our subscribers. Our ability to remain independent relies solely on the funds we receive from subscriptions, so these funds are not only assisting at-large citizens they are also assisting us in remaining independent. I’d personally like to thank Councilors Baker and Shaw as well as the administration for making this donation possible.” Scott added that there are no restrictions on receiving a free subscription other than living outside the CN jurisdiction and being a CN citizen. Using the fund, at-large CN citizens can apply to receive a free one-year subscription by visiting, calling or writing the Cherokee Phoenix office and requesting a subscription. The Cherokee Phoenix office is located in the Annex Building on the W.W. Keeler Tribal Complex. The postal address is Cherokee Phoenix, P.O. Box 948, Tahlequah, OK 74465. To call about the fund, call 918-207-4975 or email <a href="mailto: justin-smith@cherokee.org">justin-smith@cherokee.org</a>. The Cherokee Phoenix also has a free website, <a href="http://www.cherokeephoenix.org" target="_blank">www.cherokeephoenix.org</a>, that posts news seven days a week about the Cherokee government, people, history and events of interest. The monthly newspaper is also posted in PDF format to the website at the beginning of each month. Cherokee Nation Businesses in November donated $10,000 to the Cherokee Phoenix’s Elder/Veteran Fund, which provides free subscriptions of its monthly newspaper to elders and/or military veterans who are CN citizens. No income guidelines have been specified for the Cherokee Phoenix Elder/Veteran Fund, and free subscriptions will be given as long as funds last. Tax-deductible donations for the fund can also be sent to the Cherokee Phoenix by check or money order specifying the donation for the Cherokee Phoenix Elder/Veteran Fund. Cash is also accepted at the Cherokee Phoenix offices and local events where Cherokee Phoenix staff members are accepting Elder/Veteran Fund donations. Those who donate can also have entries submitted for them into the Cherokee Phoenix’s quarterly artist giveaway. For every $10 donated or spent on Cherokee Phoenix merchandise, a person gets one entry into the quarterly drawing. The next drawing is July 2 when it gives away a two-piece, 12-foot fishing rod donated by Larry Fulton of Larry’s Bait and Tackle in Fort Gibson.
BY STAFF REPORTS
05/16/2018 04:00 PM
VINITA – Eleven Cherokee families received keys to their new homes on May 11 after participating in the Housing Authority of the Cherokee Nation’s New Home Construction Program. The 1,350-square-foot brick homes on Miller Street each feature a garage, three bedrooms and two bathrooms. According to Cherokee Nation Communications, $1.1 million was invested into the homes and infrastructure and will provide an estimated $28,000 in impact aid to local schools. CN citizen Candle Melton and her family received one of the new homes. The family of three had lived with her mother, and she said the home is a blessing. “We are so excited to have a brand new house to call our own. This would not have been possible without Cherokee Nation and the New Home Construction Program,” Melton said. “I am definitely proud to be Cherokee and cannot thank Cherokee Nation enough for their investments in our communities and for this wonderful opportunity to become the homeowners of a brand new home.” Principal Chief Bill John Baker implemented the program in 2012. The Vinita home recipients were selected from the HACN’s waiting list of applicants who do not own land. “Helping Cherokees improve their lives by establishing homeownership is creating stronger communities and healthier families in northeast Oklahoma,” Baker said. “We took these acres in Vinita and converted them into a desirable neighborhood of almost a dozen houses. Building safe and secure homes that are affordable for our citizens has established Cherokee Nation’s New Home Construction Program as the unparalleled model of excellence for Indian Country.” Chief of Staff and Vinita native Chuck Hoskin said the homes were the latest in decades of improvements to the area by CN. “In more than 25 years of serving the Cherokee people, I’ve witnessed much progress for this community. These new homes will have a lasting, positive impact,” Hoskin said. The HACN recently received a grant from Bank2 for the home program, which allows the HACN to keep the home recipients’ monthly payment at $350. Schools in the area also benefit from the homes because they receive $2,800 in federal impact aid for each enrolled student who resides in the homes. “The new Miller Street Housing Addition is a major boon for the town of Vinita,” Tribal Councilor Victoria Vazquez said. “Not only does it help citizens achieve homeownership, it’s also going to bring much-needed revenue to the school system through impact aid dollars.” Along with the homes, the CN also invested more than $100,000 in infrastructure development on Miller Street and within the housing addition. In addition to the 660 homes built through the program, the HACN has nearly 100 more homes under construction in the tribe’s jurisdiction. For more information, visit <a href="http://www.hacn.org" target="_blank">www.hacn.org</a>.