Strengthening Tribal veterans` efforts by positive Relations with Tribes

VA Office of Tribal Government Relations (OTGR)
Society of American Indian Government Employees (SAIGE) Meeting
Thursday, June 12, 2014
How positive relations with Tribes can enhance and
strengthen our efforts with Veterans living in tribal
Ms. Mary Culley, Tribal Relations Specialist
Which VA Administrations offers services/benefits to
Tribal Governments in an effort to reach Veterans in
Indian Country ?
• Veterans Benefits Administration: VBA
• Native American Direct Loan Program
• National Cemetery Administration: NCA
• Tribal Cemetery Grants
• Veterans Health Administration: VHA
• VA Office of Rural Health- Native Domain emphasis
• VA/ Indian Health Service Memorandum of Understanding-2010
• VA/Indian Health Service Reimbursement Agreement-2012
VA –Tribal Relations Milestones
• 2000 - President Clinton’s Executive Order 13175
• 2007 – VA establishes VHA/Office of Rural Health
• 2009 (Nov) President Obama Memorandum on Tribal
Consultation (Executive Order 13175)
• 2009- 2010 VA Solicitation for Tribal Consultation (proposed
• 2010 VA-IHS MOU
• 2011 – Secretary Shinseki signs VA Tribal Consultation Policy.
The Office of Tribal Government Relations is established within
VA as part of implementation of the Tribal Consultation Policy
• 2012 (Dec) VA-IHS Reimbursement signed MOU
VA Tribal Consultation Report FY2012
Available on OTGR website:
VA Office of Tribal Government Relations
VA Organizational Chart
Sloan D. Gibson
Acting Secretary
Sloan D. Gibson
Deputy Secretary
Jose Riojas
Chief of Staff
Josh Taylor, Acting Assistant Secretary
Office of Public & Intergovernmental Affairs
Stephanie E. Birdwell – Acting Director
Office of Intergovernmental Affairs
Stephanie E. Birdwell, Director
Office of Tribal Government Relations
Mary Culley
OTGR Specialist
Executive Officer
Southern Plains/
Southeast Region
Peter Vicaire
Terry Bentley
L.HoMana Pawiki
OTGR Specialist
OTGR Specialist
OTGR Specialist
Central / Northeast
Western Region
Southwest Region
OTGR Specialists
• Specialists collaborate with VA colleagues to support
governmental relationships with tribes in an effort to support
priorities tribal leaders have for meeting the needs of tribal
• Efforts focus on :
• Increasing Veteran Access to healthcare and benefits
• Economic Sustainability
• Implementing Tribal Consultation Policy
Indian Health Service/Tribal Health Program
Reimbursement Milestones
• October 1, 2010: VA Under Secretary for Health, Dr.
Petzel and IHS Director, Dr. Roubideaux, signed a
Memorandum of Understanding
• March-May 2012: VA and IHS and Tribal Health
Programs (THP) initiated tribal consultation on a
draft national agreement
• June 2012: One (1) IHS National Agreement and
individual sharing agreements with THPs signed
under 38 USC 8153, due to their sovereignty
• August 24, 2012: Dr. Petzel signed and distributed
the DTLL with program guidance
• Dec 5, 2012: VA-IHS National Agreement signed
Indian Health Service/Tribal Health Program
Reimbursement Agreement Benefits
Medical Benefits Package: VA will reimburse for direct care services provided
under the Medical Benefits package available to eligible Veterans under 38 CFR
Choice of Care Provider: Eligible AI/AN Veterans can choose to receive health
care form their THP/IHS facility and/or the VAMC. No pre-authorization by VA
will be required for direct care services provided to eligible AI/AN Veterans if
care is received at the IHS/THP facility
Pharmacy Options: IHS/THP healthcare facilities will be reimbursed when
providing a 30-day supply of outpatient medications to eligible AI/AN Veterans.
After the initial 30-day supply, eligible AI/AN Veterans may obtain prescriptions
using the VA Consolidated Mail Outpatient Pharmacy (CMOP) for routine, longterm outpatient medication
No copayment: Pursuant to section 405(c) of the IHCIA, VA copayments do not
apply to direct care services provided IHS/THP facilities to eligible AI/AN
Veterans under the National Agreement or local reimbursements (including
medications, for which VA reimburses under an HIS/THP)
Third Party Billing: Pursuant to section 405(c), IHS/THP will bill all third party
payers, as permissible by law, prior to billing VA
Direct Care Services
• Direct Care Services are defined as any health service that
is provided directly by IHS/THP.
This does not include Contract Health Services unless those
services are provided within the walls of the IHS/THP facility
• VA will not reimburse for any services that are excluded
from the Medical Benefits package or for which the
eligible AI/AN Veteran does not meet qualifying criteria
Status of IHS and THP Agreements
• IHS: During implementation, VA and IHS completed ten
Phase I Pilot Sites two months ahead of schedule in
March 2013
Finalized all remaining 71 local implementation plans in July
81 Implementation plans cover a total of 106 IHS facilities
• THP: Currently 44 signed agreements with over 60 tribes
in progress
• In FY 2012 through today, VA has reimbursed over $7.3
million in direct care services for over 2800 eligible AI/AN
Veterans under both Reimbursement Agreements
Statistical Data
This $7.3 million and 2800 eligible AI/AN Veterans equates to
Total disbursed by Program
Total disbursed by transmitted FY
IHS - $4.6 million
THP $2.8 million
FY 12: $10K
FY 13: $3.8M
FY 14: 3.4M
Total unique Veterans by Program
IHS – 2343
THP – 495
Total Veteran AI/AN population nationally: 151,088 = .0187%
Current Tribal Health Programs with
Signed Reimbursement Agreements
• 26 Tribal Consortiums or
• Tuba City Regional Health
Corp (Navajo Nation)
• Winslow Indian Health Care
• Indian Health Council, Inc
• Southern Indian Health
• United Indian Health Services
• Toiyabe Indian Health
• Southern Ute Indian Health
• Fond du Lac Band of Lake Superior
• Lac Vieux Desert Band of Lake Superior
Chippewa Indians
• Confederated Tribes of Grand Ronde
• Confederated Tribes of the Umatilla
Indian Reservation
• Muscogee (Creek) Nation
• Choctaw Nation
• White Eagle – Ponca Nation
• Chickasaw Nation
• Cherokee Nation
• Benewah Medical and Wellness Center
(Coeur d’ Alene Indian Tribes)
• Nez Perce Tribe (Nimiipuu Health )
Examples of How Tribes are Working
with VA
OKC VAMC collaborated with
Pawnee Indian Clinic to
provide physician direct
consult capability
Oklahoma, IHS and Tribal
Health staff working with VA,
State, and local agencies on
Homeless Stand Down
Touring VA Medical Centers,
then inviting VAMC staff to
tour their health facilities
Chinle and VA collaborated to
build a VA clinic within the
Chinle IHS Clinic
VAMC providing a staff person
once a week to assist and
enroll veterans into VHA
• Tribes inviting Veterans Benefits
administration to do enrollments in their
community centers
• Oneida Nation Tribal Veteran Rep
processed approximately $1.3 million
worth of claims in one year for veterans
in his tribe
• Cherokee Tribe, NC, and the Asheville
VAMC, share salary costs for a position
to service Indian veterans out of the
Cherokee Indian Hospital
• There are approximately 4 National
Tribal Cemeteries as a result of awarded
grants: 1) Rosebud Sioux, 2) Oglala
Sioux, 3) Kurek Tribe of California and 4)
Pasqui Yaqui Tribe
• Seminole Nation of Oklahoma, received
a $1.3 million grant for a National Tribal
Cemetery & recently broke ground
Southern Plains and Southeastern
Region Contact
Department of Veterans Affairs
Office of Tribal Government Relations
921 NE 13th Street
Oklahoma City, OK 73104
[email protected]
405-626-3426 (BB)

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