Karuk Tribe of California

1. Approval of the Minutes for November 13, 2003

Karen Derry moved and Robert Goodwin seconded to approve the Minutes for November 13, 2003. 5 haa, 0 puuhara, 0 maanata.

1. Erin Hillman

Erin requested a change to the signers on the Authorization to Bind and Invoice Approval Form for the State Indian Health Program. She requested approval to change Alvis Johnson to Arch Super with the other two signers staying the same which are Leaf Hillman and Wes Valentine.

Karen Derry moved and Florrine Super seconded to approve the changes to the signers. 5 haa, 0 puuhara, 0 maanata.

1. Alan Vandiver

Alan was present to request two items from the Council. He states the Forest Service is trying to change the way they conduct their normal business. They would like the Tribe involved in determining what projects they will work on prior to getting them on the list and starting the environmental process. He does not want to have a project listed on the books without having the Tribe involved first to make sure it is an acceptable project. He gave them a brief overview of the numerous projects that are currently underway. He requested one authorized Council member to work directly with him and he will commit to meet with that person on a monthly basis to make sure everyone is on the same page and that person can report back to the Council. He states he currently works very closely and well with DNR but he wants a Council member to be involved in the strategic planning. Leaf nominated Robert Goodwin to be the designated representative to meet with the Forest Service monthly. Leaf hopes that this will improve communication with and to the Council from the Forest Service. These meetings will be in addition to the monthly consultation meetings.

Consensus: For Robert Goodwin to be the designated point of contact for the Forest Service for project planning.

He also requested that as they move into the fire season they do some planning for the next year and set up processes to make sure that the Council is more involved when a large fire comes. He would like to have one person to come to the planning meetings as they set up their plan for the upcoming fire season so that he can call this person as soon as something happens and the Council can be involved in the process when fires start up. Robert nominated Leaf Hillman for this committee. Leaf states he will accept if that is the desire of the Council.

Consensus: For Leaf Hillman to be the designated point of contact for the Forest Service for Fire Season planning.

1. Joe Snapp

Joe states his updated activity report is very similar to the current report that is in their packets. He would like approval on his letterhead that he is using for his forms. He states it is in his computer and it will not cost anything to use this format if they approve it. Karen would like the logo cleared up so that it prints nicely. He states it is clearer when it comes directly from his computer and is not photocopied.

Consensus: To allow Joe Snapp to use his format for letterhead for his programs.

Joe states he has been working with Millie Grant regarding the Oak Knoll Facility. There has been a suggestion to meet with other Northern California Tribes to see what their input is. Leaf proposes that the Council establish a sub-committee to research this project and get it moving forward. They informed Joe that they have a Grant Writer that will be starting in January, it is Trista Parry. Robert asked if it would be worth it to have community involvement. Leaf states that in the initial stages it could be staff members, and possibly Millie, the Grant Writer, and some Council Members to get it started then they can get community involvement later. Florence and Karen would like to be on this committee. Joe was nominated to head the committee and get it going. They would also like Robert Super and Trista Parry involved in the committee with the first meeting being in January. He states Robert will most likely report back to them as he will be going back to school.

Robert Goodwin moved and Leeon Hillman seconded to approve Joe’s report. 5 haa, 0 puuhara, 0 maanata.

1. Vickie Walden

Vickie states she does not have any action items. She informed them that the compressor in the Happy Camp Dental Clinic has ended its useful life. They will need to purchase a new one, however; they have a loaner in so they can continue working while the temporary dentist is here. The current ballpark figure she has is $2600. She states that if they purchase the compressor from Highlander Dental they will not charge them for the loaner or the trip up to install it. Leaf requested a phone vote for this purchase to get it taken care of as soon as possible.

She states that they currently have the trial dentist here and she has been seeing patients. She states they have been seeing a lot of kids for exams and will be bringing them back for treatment next week. The dentist has expressed some culture shock, however; she sees that there is a definite need in the community. Vickie states she is very nice and they have received nothing but positive reactions to her.

She also states that the dentist has a class in San Francisco this weekend that she paid for previously. She requested to take the Honda down to this class since she flew in for this trial period and did not bring her own car. She is already on the insurance since she is driving the car while she is in town.

Consensus: To allow her to take the car down for the trip.

Leeon Hillman moved and Robert Goodwin seconded to approve Vickie’s report. 5 haa, 0 puuhara, 0 maanata.

1. Lessie Aubrey

She requested their approval of the Compliance Plan and Policies that she included in their packets. She reported that they had their first internal compliance audit and she is very pleased with the results of the audit. She states they kept minutes and it is all in the book if they would like to read them as they are completely anonymous and there is no finger pointing in the process. Karen asked if there is anyone internally that is cross-training with Suzanna Hardenburger. Marsha states that the three Data Entry Clerks are all cross training with her to learn the coding and she works very closely with them on the coding. They would like it to read Designated Compliance Officer instead of Designed Compliance Officer in the plan. They asked if anyone else is responsible for implementing this plan besides herself. She states that the billing clerks and medical coder are involved on the Compliance Committee and the providers also get involved quarterly. The Committee has reviewed this plan and policies and approved them. Karen inquired how they would enforce the plan and laws. She states she would go directly to the employee and point out the error and make sure it is fixed. Wes added that there are a couple of different things that can be done when errors are found. Wes states that the “laws” it is referring to are Medical and Medicare and there are specific steps you take when you find errors that in effect “enforce the laws” set by those agencies.

Karen Derry moved and Florrine Super seconded to approve the Compliance Plan and policies. 5 haa, 0 puuhara, 0 maanata.

She distributed the 2004 JCAHO Standards for Organizational Ethics to them and it included the excerpt from the Code of Ethical Behavior. Standard RI.1.20 requires that the organization defines and addresses conflicts of interest. For this reason she requested they review the standard and sign the statements for their files. They all did.

She states that previously there were two Council Members that participated in the ACQI and Managed Care Committees on a very regular basis. As they are now gone they need new representatives. They are also changing the scheduling to one entire Wednesday per month rather than many short meetings on various Wednesdays throughout the month. Florrine volunteers and Karen states that she would be interested in doing this also. They will be the entire day and will be the Wednesday prior to the Health Board Meeting each month. It would mostly be the mornings as the afternoon meetings are more staff and provider specific.

She also announced that January 7, 2003 at 10-1:00 PM has been set for a meeting between the Council and Providers in Happy Camp as they requested.

Karen Derry moved and Leeon Hillman seconded to approve Lessie’s report. 5 haa, 0 puuhara, 0 maanata.

1. David Eisenberg

David was not present and included a written report only with no action items.

Karen Derry moved and Florence Conrad seconded to approve David’s report. 5 haa, 0 puuhara, 0 maanata.

1. Marsha Jackson

Marsha was present to review her written report. She states she does not have any action items, but does have a typo; it states there are policies and procedures included for approval, but that was at a previous meeting and she did not remove it. Robert pointed out that the visits are a lot higher in Yreka and he asked the reason. Marsha states it is due to the increase in providers.

Robert Goodwin moved and Leeon Hillman seconded to approve Marsha’s report. 5 haa, 0 puuhara, 0 maanata.

1. Wes Valentine

Wes was present to review his written report with the Council.

The first action item is the Education Coordinator position description. It has been revised and requires approval. Robert states that there were some discussions regarding revamping this position to report to Head Start so that a portion a portion of the Head Start Director salary costs could to be billed to Indirect. It has to do with the placement of the program and who is overseeing the program. Leaf states they can approve the position description and the supervisor and billing could be revised at a later date.

Karen Derry moved and Leeon Hillman seconded to approve the Education Coordinator position description. 5 haa, 0 puuhara, 0 maanata.

The next item is for the replacement of the flooring in the Administration building. The proposal is to leave the carpet in the offices and only replace the flooring in the common areas and hallways. The suggestion was to use laminate flooring as it would be easier to clean and would last a much longer time than carpet. The total cost will be $11,412.21 for the hallways, lobby, conference room, and kitchen. The cost will be charged to the Indirect Cost Pool. The Council directed Sara Spence to get quotes from the other places in Yreka and bring it back to them.

He gave them an update from his recent meeting in Sacramento. They discussed the GPRA Performance indicators and states he his very happy to announce they have made significant improvement in these indicators from last year. By Fiscal Year 2010 the funding may be based on these indicators and that is reason for needing to reach them. GPRA stands for Government Performance Results Act and they are things such as how many Elder’s got a flu shot, how many children received their vaccinations, etc. He states California is receiving the highest scores and on a State level the Karuk Tribe is either high to middle.

The other item that was discussed at the meeting is the Federal Tort Claims Act and a recent court case in Alaska that found the Act does not cover non beneficiary patients in Tribal clinics. This means that a non beneficiary patient can sue the Tribe for malpractice and the Act would not protect the Tribe if they did not have additional malpractice insurance. This insurance can be very expensive, however; he got a contact from a representative at Feather River that purchased this insurance for a cost of $6,000. He has obtained the application for this insurance and will be pursuing it. Another item that needs to be in place for this reason is a Resolution stating that it is necessary for the Tribe to see non beneficiary patients in the clinics due to the rural area and that it does not decrease the services to Native American patients. If you can justify this need it can help in protecting the Clinic. He would like approval of Resolution 03-R-102 authorizing them to provide care to non beneficiary residents of the Karuk Tribe of California’s service area. He will also pursue the malpractice insurance so that they are fully covered. The Resolution will be sent to IHS for their acceptance and he will bring the final insurance amount back for approval. Dr. Burns states he should look into “nose” insurance to cover them retroactively as well.

Karen Derry moved and Florence Conrad seconded to approve Resolution 03-R-102. 5 haa, 0 puuhara, 0 maanata.

He presented them the billing printout for Third Party revenues for the first two months. They have received $32,000 cash, $50,000 medical, and $20,000 in bills have been sent out for the month of December so far. They are on track to meet their revenue goal for the year if it continues at the current level, he hopes it will increase.

He requested approval of a contract with Wellpoint Pharmacy. The cover sheet is not signed because the arbitration language is not consistent with the Tribe’s so Erin cannot sign off on it. This contract is to be a service provider for Blue Cross and receive revenues for filling prescriptions and receive funding for insured patients that get their prescriptions there so there is no incentive for Blue Cross to revise their language. The language binds the Tribe to arbitration in accordance with the laws of the State of California. There are other Tribal facilities that have signed this, United Indian Health Service is one of them. The only thing that would be disputed is whether or not Blue Cross will pay for medications and what the fee they pay will be. If the Tribe has an issue with it they would need to arbitrate it under State laws.

Karen Derry moved and Florence Conrad seconded to approve the Contract with Wellpoint Pharmacy. 4 haa, 1 puuhara (Robert Goodwin - he does not feel they should waive their sovereign immunity under any conditions because it send the wrong message), 0 maanata.

Wes states that before they are signed and mailed in he will make an attempt to have the language changed.

Wes presented them with information to participate in a study to prevent sexually transmitted diseases in women. Dr. North is interested in participating if they will approve it. The study will only be conducted on those patients that are interested and consent to the study, the patients that are interested will receive compensation from the research company for their participation.

Karen Derry moved and Florrine Super seconded to approve participation in the study. 5 haa, 0 puuhara, 0 maanata.

Dr. Burns states that if you do any type of research on humans you are required to have an institutional review board. Lessie and Vickie state that there are also policies that prevent the Health Program from doing research. The Council would now like more information considering these items. Lessie states the ACQI Committee can review the document and discuss it further at their next meeting.

Robert Goodwin moved and Karen Derry seconded to rescind the motion. 5 haa, 0 puuhara, 0 maanata.

He states the contract for the Council Meeting Cook is up for renewal. They would like to go out to bid again to see what is out there since they have had the same one for two years and it is time to re-advertise.

Robert Goodwin moved and Leeon Hillman seconded to re-advertise for the Council Meeting Cook position. 5 haa, 0 puuhara, 0 maanata.

He presented Contract 04-C-012 with Viking Services to install hardware and software for the Pharmacy to track all purchasing, dispensing, and billing. He is hoping that they can use the unspent Tide’s Grant dollars for this purpose. Robert mentioned some options for increased Indirect for starting a new facility. Wes states that he has requested an increase to the IHS Compact for this reason and will check with Laura to see if there are other funds that can be applied for. The total cost for the Contract is $12,912 which includes twelve months of maintenance to the system.

Karen Derry moved and Florence Conrad seconded to approve Contract 04-C-012. 4 haa, 0 puuhara, 1 maanata (Robert Goodwin).

The next contract is with Cimarron Medical Informatics, LLC in the amount of $7,500 to link the Viking system to the RPMS System. The contract number is 04-C-013 and they hope it can come from the Tide’s funds as well but have not heard back at of this time. It also includes one year of monitoring of the system.

Robert Goodwin moved and Florence Conrad seconded to approve Contract 04-C-013. 5 haa, 0 puuhara, 0 maanata.

The next contract is with Medco Health for accepting payments from Medco. It is very similar to the Wellpoint contract and has similar wording. This one is governed by the laws of the State of New Jersey. He only received this one today and can talk to them about the language and find out what type of financial impact there would be by not using this provider.

He distributed the Pharmacy Charging Policy Summary to them for review as it will need to be put into place. They used United Indian Health’s policies as a starting point and the Health Management Team made comments and suggestions. He does not agree with item number VII due to the impact of allowing this discount. He would like to wait until the Pharmacy gets going before they consider any employee discounts or additional benefits to their uninsured family members. Number VIII will be revised to only include Spouses and Dependents of Tribal Members. This has been reviewed by the Pharmacy & Therapeutics Committee.

Karen Derry moved and Robert Goodwin seconded to approve the Pharmacy Charging Policy with the changes. 5 haa, 0 puuhara, 0 maanata.

The next contract is with Quest Diagnostics and was distributed at the last meeting. He has put it through the review process and it has been assigned number 04-C-016 to create an interface between RPMS and Unilab.

Karen Derry moved and Florence Conrad seconded to approve Contract 04-C-016. 5 haa, 0 puuhara, 0 maanata.

He also requested out of state travel for Sara Spence to attend a training on federally mandated background and character investigations in Las Vegas, Nevada, March 30-31, 2004. A representative from the Election Committee should also attend the training to obtain information. The Council asked about funding. Wes states Sara’s will come from Indirect but does not know about the Election Committee member. Council states they should come from Indirect also.

Robert Goodwin moved and Florrine Super seconded to send Sara Spence and one Election Committee member to Las Vegas, Nevada, March 30-31, 2004. 5 haa, 0 puuhara, 0 maanata.

He requesting approval of the contract with Bay Alarm Company for the Yreka Health Clinic security system. Laura has stated it is more of a utility agreement than a Contract. The cost is $87.00 per month and can come from Indirect.

Consensus: To start the service.

Robert asked about the windows in the Pharmacy Building. Wes states there will be an anti-break screen device that will be installed to protect the contents. Wes can talk to them about other options also.

Robert Goodwin moved and Leeon Hillman seconded to approve Wes’ report. 5 haa, 0 puuhara, 0 maanata.

1. Leaf Hillman

Leaf distributed copies of a letter to the Council for their review. At the monthly coordination meeting with the Forest Service there was a discussion and this letter is a draft response to be submitted to them regarding a fuels reduction project that will take place with many reported archeological sites in the area and there have not been current surveys completed. They have been given too tight of a deadline to conduct the necessary surveys and are responding to the request and asking for more time to complete the surveys and initiate the formal consultation process to ensure the project complies with the goals and objectives of the cultural management plan. Florence gave them some information regarding her experiences with the Forest Service and the work they wanted to do surrounding her home. She states they are not handling it correctly and they are not taking the archeological sites into consideration. The Forest Service is stating they are working with the Tribe on paper, but are not making an effort to truly work with the Tribe. She feels that the Tribe should be the one to do the work as it is in such a sensitive area.

Consensus: To send the letter right away.

1. Resolution Procedures

Sara has drafted Resolution procedures to put into place for all staff as the BIA will be coming to do a site visit possibly in January to review the Tribe’s documents and there needs to be a formalized policy in place for retention of resolutions.

Robert Goodwin moved and Karen Derry seconded to approve the Resolution Procedures. 5 haa, 0 puuhara, 0 maanata.

1. Letter from Margo Kerrigan

The letter invited Robert S.uper to sit on the California Area Youth Regional Treatment Center Task Force. It will include meetings in Sacramento and Robert will be notified of them. Wes anticipates it will be a five year process to get the facility moving forward.

Closed Session from 8:12 PM to 9:20 PM

Karen Derry excused herself at 8:12 PM

Robert Goodwin moved and Florence Conrad seconded to follow the recommendation of the Credentialing and Privileging Committee to appoint and grant requested privileging to Michael Dehart, Registered Pharmacist, Lillian Maresca, M.D., and Barbara Best North, M.D. 4 haa, 0 puuhara, 0 maanata.

Robert Goodwin moved and Florence Conrad seconded to approve council members to receive $100 for training day stipends and $50 for travel day stipends in addition to per diem. 4 haa, 0 puuhara, 0 maanata.

Next Meeting Date: January 8, 2003 in Happy Camp at 5:00 PM.

Robert Goodwin moved and Florence Conrad seconded to adjourn the meeting at 9:25 PM. 4 haa, 0 puuhara, 0 maanata.

Respectfully Submitted by,

_____________________________

Leaf Hillman, Vice-Chairman

Recording Secretary,

Sara Spence