In response to ‘no more life or limb citeria’
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I am compelled to respond to correct the information contained in a letter published in the Dec. 3, 2014 Valley Journal headlined, “No more life or limb criteria.”
Like the writer, the Confederated Salish and Kootenai Tribes Tribal Council has heard the horror stories of inadequate health care provided to our tribal members and other Indian Health Service beneficiaries. We have heard the stories for decades.
While the CSKT previously operated the Contract Health Service program there were escalating costs due to medical inflation, population growth, and the inability to get favorable rates from providers. These issues compounded year after year.
In the final year, fiscal year 2004 which ended Sept. 30, 2005, the CSKT were provided $8 million to provide care. The final FY 2004 expenditure was in excess of $16 million.
The CSKT were liable for all costs. Funds were exhausted from every health program and reserve account to pay the bills for that year. This was a situation that could not be sustained.
The CSKT retroceded the Contract Health Service program back to the federal Indian Health Service on Oct. 1, 2005. The federal government, i.e. the Indian Health Service has operated the Contract Health Service program since that time.
The Indian Health Service as a federal agency cannot by law expend any more funds than it is appropriated. That severe shortage of federal funds by which the Indian Health Service operates has caused them to limit the level and types of care they will pay for.
Anger and frustration have been evident when a medical procedure has been determined to be needed; yet because it does not meet the “life or limb” threshold the Indian Health Service routinely denies payment for the service.
It is important to understand the difference between the CSKT Tribal Health Department and the federal Indian Health Service. They are two completely different agencies operating under different requirements.
Patients who experience denial for a medical visit/procedure must understand the agency making the denial is the federal Indian Health Service not the CSKT Tribal Health Department.
It is true that under the Indian Health Service operation only those medical services threatening one’s life or limb are authorized for payment. All other health care services including numerous diagnostic procedures, standard preventive measures or surgery improving one’s quality of life are denied or deferred until such time as funding may become available but the funding never becomes available. Consequently the person requiring the care goes without.
Over the past years, the CSKT Tribal Council has authorized the use of funding we generate to provide a wide range of health care services in our tribally owned modern facilities. We are proud of the services we provide and will not permit the CSKT Tribal Health Department’s work to be represented as the work of the federal Indian Health Service. It is not. A complaint regarding the health care Indian Health Service provides or does not provide needs to be directed to them.
