VA New England Healthcare System

Veterans' Healthy Living, Spring 2013

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Improving Services for Native American Veterans

All our Veterans deserve access to health care services, and it will soon become easier for Native American Veterans to get those services closer to home.

In December, an agreement was reached between Veterans Affairs (VA) and the Indian Health Service (IHS) that enables VA to reimburse IHS for direct care services provided to eligible American Indian and Alaska Native (AI/AN) Veterans.

"The VA and IHS, in consultation with the federally-recognized tribal governments, have worked long and hard to come to an equitable agreement that would ensure quality health care would be made available to our Nation's heroes living in tribal communities," said Dr. Robert Petzel, Undersecretary for Health, Veterans Health Administration. "This agreement will also strengthen VA, IHS, and tribal health programs by increasing access to high quality care for Native Veterans, particularly those in highly rural areas."

The agreement has been several years in the making. In 2010, the VA and IHS signed a Memorandum of Understanding to, among other things, increase access to care and coordination of care, and to improve efficiency, effectiveness, and availabilityof services. VA and IHS then began developing the recently signed national agreement, which will be used to shape sharing agreements at the local level between VAMCs and Tribal Health Programs (THPs).

Once local tribal health care facilities establish sharing agreements with VAMCs, eligible AI/AN Veterans will receive the following benefits from those tribal facilities:

• The VA will reimburse for direct health services under the same medical benefits package available to all Veterans under 38 CFR § 17.38.
• Eligible AI/AN Veterans can choose to receive their health care from the tribal health care facility and/or VAMC. No pre-authorization will be required for AI/AN Veterans if care is received at the tribal health care facility.
• Tribal Health Programs will be reimbursed when providing a 30-day supply of outpatient medications to AI/AN Veterans. After the initial 30-day supply, VA will reimburse for prescriptions using the Consolidated Mail Outpatient Pharmacy for routine, long-term outpatient medication.

According to Doug Edwards, VISN 1 Rural and Native Veteran Program Manager, there are 10 federally recognized Native American tribes throughout New England: five in Maine, two each in Connecticut and Massachusetts, and one in Rhode Island.

"These sharing agreements will allow ative American Veterans greater access to the health care they have earned through their proud service to our country," says Edwards. "In my two years as the VISN's Rural and Native Veteran Program Manager, I've come to appreciate the way in which the tribes honor and respect the service and sacrifice of their Veterans. Following a meeting with the chief of a Connecticut tribe, she took us on a tour of the reservation, which included a visit to a Veterans' Wall of Honor in their Tribal Chapel where they reverently display the names and pictures of their tribe's military Veterans. As a Veteran, I noticed that many had served in combat with some of the most elite units of our armed forces. It was a very impressive tribute."

Tribal Health Program (THP) Sharing Agreement Implementation Process

Edwards is proud of the many facility-level activities in VISN 1 that have occurred in the past, such as pow-wows and other celebrations, workshops and seminars, and a Native American Employment Program. Outreach opportunities for 2013 and beyond include learning more about the Native Veteran culture, building upon existing relationships, and listening to the needs expressed by tribal elders—as well as working toward more sharing agreements.

"Our federal partners at the IHS, with whom I've met on several occasions, share VA's commitment to serving Native American Veterans," adds Edwards.

"This reimbursement agreement between the VA and the IHS will help improve health care services for American Indian and Alaska Native Veterans and further the IHS mission and federal responsibility of raising the health status of American Indians and Alaska Natives to the highest level possible." Dr. Yvette Roubideaux, director of the Indian Health Service.

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