VA Office of Tribal Government Relations (OTGR)

1. 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 communities…. Ms. Mary Culley, Tribal Relations Specialist

2. 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 2

3. 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 policy) • 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 3

4. VA Tribal Consultation Report FY2012 Available on OTGR website: www.va.gov/tribalgovernment 4

5. VA Office of Tribal Government Relations 5

6. 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 • VACANT • Executive Officer • Terry Bentley • OTGR Specialist • Western Region • Peter Vicaire • OTGR Specialist • Central / Northeast Region • L.HoMana Pawiki • OTGR Specialist • Southwest Region • Mary Culley • OTGR Specialist • Southern Plains/ • Southeast Region 6

7. 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 Veterans Efforts focus on : • Increasing Veteran Access to healthcare and benefits • Economic Sustainability • Implementing Tribal Consultation Policy 7

8. 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 8

9. 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 17.38 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, long-term 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 9

10. 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 10

11. 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 2013 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 11

12. Statistical Data This $7.3 million and 2800 eligible AI/AN Veterans equates to Total disbursed by Program IHS - $4.6 million THP $2.8 million Total disbursed by transmitted FY 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% enrolled 12

13. Minnesota • Fond du Lac Band of Lake Superior Chippewa • Lac Vieux Desert Band of Lake Superior Chippewa Indians • Oregon • Confederated Tribes of Grand Ronde • Confederated Tribes of the Umatilla Indian Reservation • Oklahoma • Muscogee (Creek) Nation • Choctaw Nation • White Eagle – Ponca Nation • Chickasaw Nation • Cherokee Nation • Idaho • Benewah Medical and Wellness Center (Coeur d’ Alene Indian Tribes) • Nez Perce Tribe (Nimiipuu Health ) Current Tribal Health Programs with Signed Reimbursement Agreements Alaska 26 Tribal Consortiums or Corporations Arizona Tuba City Regional Health Corp (Navajo Nation) Winslow Indian Health Care Center California Indian Health Council, Inc Southern Indian Health Council United Indian Health Services Toiyabe Indian Health Colorado Southern Ute Indian Health 13

14. 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 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 Programs 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 programs 14

15. Southern Plains and Southeastern Region Contact Department of Veterans Affairs Office of Tribal Government Relations 921 NE 13th Street Oklahoma City, OK 73104 Mary.Culley@va.gov 405-456-3876 405-626-3426 (BB) www.va.gov/tribalgovernment 15