I was invited to attend the 11^th Annual National Health and Human Service Tribal and Budget Consultation Session in Washington, DC on April 29-30, 2009.

As the current Chairman, Fallon Paiute Shoshone Tribe and current President, Indian Health Board of Nevada, I am in a unique position to address the disparities and lack of data not only in my own community, but throughout Nevada’s Native American communities. American Indians know there is a lack of inequality, but are uncertain of the extent that inequality costs our communities.

Native Americans want an equal playing field regarding our health care.

· good quality healthcare

· healthcare that is fair and equitable

· health that supports and strengthens the unique sovereign status of tribes

· health care provided as an entitlement and immune to the political administration

· policies that reinforces the Federal Trust Responsibility and strengthen sovereign status of the nation’s tribal governments

The budget allocations are based on data collected in the antiquated RPMS system, which is only as good as the data input into the system – garbage in, garbage out. An example: ethnic identification is voluntary and when not provided, the worker codes the beneficiary based on the operator’s best guess. It is not enough to estimate the statistics related to healthcare shortcomings in Indian County. Much information is captured through the “best guess” method. A new system of data research that is controlled, determined and used by Tribal communities must be created; and the 30 years of previous RPMS data integrated into the new research database. A new system providing accurate data numbers for the budget allocations.

In 1985, the only Indian Health Service hospital in Nevada was condemned and closed. Tribes were assured that a new facility would be constructed to replace the condemned facility. 24 years later, tribes in Nevada are still awaiting the arrival of the construction company to rebuild. Without a hospital, tribal health clinics have to refer patients to local providers for specialized health care. There are no facilities, Inpatient or Outpatient, being planned in Nevada.

Funds set aside to pay contract health providers are depleted by March/April. Indian Health Service is not paying the providers on a timely basis. In FY 2009, the Schurz Service Unit owes $5 million. In Northern Nevada the Service Unit owes $3.5 million. CHS funds deplete rapidly and local healthcare providers decline to accept any additional patients unless they receive payment upfront. Local health care providers bill tribal health clinics at “full charge billing”. Regulations were disseminated to clarify tribal clinics are exempt, providers have interpreted the revised regulations are to “inpatient” and not “outpatient” care. Patients referred for service are “hounded” by collection agencies to collect the cost of health care provided. Bills that rightfully belong to Indian Health Service. Patients are impacted mentally, physically and emotionally. Moreover, their credit ratings are being negatively affected.

Tribes in other states can bill for multiple encounters in each state’s Medicaid program. Nevada agreed in February 2008 to implement the multiple encounter procedure on July 1, 2008. I H S informed Nevada the procedure will not be available until July 1, 2009.

The efficient management of Contract Health Service funds by Indian Health Service is an oxymoron. As people suffer in silence, the Phoenix Area Indian Health Service was given “bonuses” for a job well done. The June 2008 GAO Report outlining the mismanagement of $48 million by Indian Health Service should have provided health care for Nevada’s Native population.

Recommendations:

Twenty-four years of waiting for a healthcare facility to be built has frustrated many Nevada tribal leaders. Twenty-four years of assurances and deliberations have run its course. Healthcare for Nevada Indians is in crisis, affirmed by the Indian Health Board of Nevada declaring it an emergency. IHBN recommends the following:

· Establish and fund a thirteenth Indian Health Service Area Office – the Nevada Area Indian Health Service Office.

· Establish and fund an Indian Health Service medical center in Nevada to meet the healthcare needs of current and future native population.

· Increase CHS funding in FY 2009/FY 2010 Budget.

I hope the words of Nevada’s Tribes are acted upon this time. The time to give Nevada Tribes just due is now. As representatives of the Administration that swept into office under the banner of change – we also want change – change that will keep my people healthy, feed my people and keep them warm.