services; but, it is the opinion of the Secretary that the services should be improved through Titles XVIII and XIX of the Social Security Act. SEARHC would like to state our appreciation to the idea of using Medicare and Medicaid as the sole agents for improving health services to the American Indians. The Indian Health Service definitely is the mechanism to improve the services. PUBLIC LAW 93-641 There is another area that SEARHC would like to make comments on. These comments pertain to Public Law 93-641. The law is the National Health Planning and Resources Development Act of 1974. Even though the rural medically underserved are the number one priority, in Southeast Alaska these are Indian. here are no travel funds for the people from the area to participate in SEAHSA activities. The importance of PL 93641 to the Indian community cannot be overlooked. While the HSA will have only review and comment authority where Indian projects are concerned, the. HSA, in performing their function, can defer forwarding Indian project proposals to the Secretary of HEW up to 60 days. Such delay could interrupt services supported by various grants and/or contracts. Further, a negative comment concerning Indian proposals could influence the Secretary's decision to fund or not to fund an Indian health proposal. Personally, I feel this seems to be. in infringement upon the American Indians special relationship with the United States federal government. We would like to thank you, Mr. Chairman, for coming to Southeast Alaska and hope you return again. Sincerely, Enclosures. CONRAD P. BAINES, Jr., ALASKA FEDERATION OF NATIVES, INC., Reference: Fiscal year 1977 Contract Negotiations with the Region Native Organization. GERALD IVEY, Area Director, Alaska Area Native Health Service, DEAR MR. IVEY: Pursuant to the directive of the Association of Regional Health Directors in their August 20th meeting held in the AFN, Inc. Conference Room at which time a quorum was present and the actions taken were during the "General Session", I am herewith, forwarding to you the following list of grievances in regards to how the fiscal year 1977 contracts negotiations were conducted. The so-called negotiations were conducted between the office of Community Health Development and the Regions from August 1, through 16, 1976. (1) A policy be established by IHS to notify the region a minimum of 15 days prior to any contract negotiations. Furthermore that IHS convey to the Regions as to the content of what is to be negotiated to insure preparating time for the Regions to negotiate the contract. Reason.-Many of the Regions felt that they were not given sufficient advance notice to negotiate the contract. Some were given as much as 2 days notice that they were to negotiate the contract. (2) That the Regional Health Corporation/Non-profit organizations be afforded legal council and that the costs incurred be an allowable cost in the contracts and a representative from AFN, Inc., be present during in and all the negotiations. Reason.-Practically all of the Regions did not have legal council during the so-called negotiations with the exception of Tanana Chiefs Conference, Inc. (3) IHS and ARHD's establish a Task Force for criteria for fund allocation and that IHS adhere to these fund allocations in contracting with the region. Reason. Fund allocation as determined by the ARHD's during the spring meeting was not adhered, too, resulting in the IHS personnel to make arbitrary decisions on Regional entitlements. (4) A clear definition of the Project Director and the Contracting Officer be strictly adhered too by the IHS personnel during all the negotiations and that all project officers be present during the negotiations. Reason.-Many of the contracts were negotiated (both technical aspects and Price) without the presence of the Contracting Officer. (5) No misleading or deceptive information be practiced by IHS personnel (A-OCD) during the so-called negotiations. Reason.-Many of the Regions felt such misleading and deceptive information was conveyed to them during the so-called negotiations. (6) Proper attendance of IHS personnel be adhered too during the negotiations. Reason.-Self-explanatory. (7) There was lack of professionalism on the part of IHS personnel (A-OCD) which affronts the personal dignity of the representative of the Regional Native organizations. Reason. Some derogatory statement were made by IHS personnel regarding various Native organizations which provoked regional dessertions.›. (8) IHS conducting negotiations in detrimental manner for future directors which could result in bad relationships between IHS and the Native organization. Reason. Self-explanatory. It was for these reasons cited above that the ARHD's as the representative of their respective regions by majority vote and during the "General Session" on the evening of August 20, 1976 formally took the following actions. (1) Nullify current contracting process for process for fiscal year 1977. (2) ARHD's meet with the Area Director, Deputy Director and the Executive Officer to determine confirmed dollars available for fiscal year 1977 contracts. (3) Reconvene ARHD's to determine Regional Contract allocation. (4) Renegotiate fiscal year 1977 contracts with legal council with representative from AFN, Inc. present during in and all negotiations. It is the sincerest desire of the ARHD's to come to a constructive resolution of this matter in a manner of mutual respect for all parties. Therefore, ARHD's is requesting to meet with you, your Deputy Director, Executive Officer, Contracting Officer, Chief Finance Branch and Area Office of Community Development personnel on the afternoon of August 30, 1976 commencing at 2:00 p.m. in your conference room. It is understood that such a meeting will occur on the date and time set above. Executive Director, Southeast Alaska Regional Health Corp., 130 South Seward Street. Juneau, Alaska. DEAR MR. BAINES: Your telegram of April 7 to Secretary Mathews concerning the Indian Health Care Improvement Act has been referred to this Agency for reply. We appreciate your interest in improving and expanding the level of health care services to Indian and Alaska Native peoples. While this Department shares those concerns, we find the Indian Health Care Improvement Act legislation pending in the Congress objectionable. It is our view that the legislation is essentially unnecessary primarily because it does not contain any significant new authority which would enable this Department to better meet the health needs of Indians and Alaska Natives. This bill would mainly authorize funds to be appropriated over the next seven years to expand the Indian Health Service programs to meet identified health needs, but would not appropriate any funds. Since the Indian Health Service is already authorized to expend such funds as the Congress appropriates, the Indian Health Care Improvement Act would not increase the present authorization under which the Indian Health Service now operates. It is true that the bill would enable the Indian Health Service to collect from Medicaid and Medicare for services it renders to beneficiaries of those two health programs. While we have testified favorably on this proposed authority, we believe it would be better to achieve the same results with a simple amendment to the Medicaid-Medicare portions of the Social Security Act. The Department and this Administration are committed to the improvement of the health status of Indians and Alaska Natives. Some of those conditions which cause a lowering of the health status are mentioned in your telegram to the Secretary. In keeping with this commitment, the expenditures of the Indian Health Service have increased over 175 percent during the last six years. This growth in expenditures has enabled IHS to make substantial improvements in the health care available to Indian people and Alaska Natives. We believe that these increases and the improvements which they have produced represent firm evidence of the high priority we have placed on improving these essential health services. In short, the Administration has a firm commitment to continue its pursuit of improved health care for Indians and Alaska Natives, but does not believe the Indian Health Care Improvement legislation would be helpful. It was thoughtful of you to share your concerns with us as you did. We are always interested to know the views of citizens on issues of immediate concern to the Department. Sincerely yours, LOUIS M. HELLMAN, M.D., Administrator. MOUNT EDGECUMBE SERVICE UNIT OPERATING PLAN-COST-OUT OF ADDITIONAL RESOURCE REQUIREMENTS FOR UNMET NEEDS, FISCAL YEAR 1977 |