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Director's Blog

Useful Reference Materials

I wanted to share some reference materials that show the IHS Areas in relation to the HHS Regions and the Department of Veterans Affairs (VA) Veterans Integrated Service Networks (VISNs). Since we are working more in collaboration with the HHS Regions, and the HHS regional consultations are in progress, I thought the comparison between IHS Areas and HHS Regions [PDF - 2M] (courtesy of HHS) would be helpful. I also included the comparison of IHS Areas with the VA VISNs (courtesy of the VA) so that it is easy to see the areas covered by our new collaborative partners as we work on the VA-IHS MOU and the VA-IHS Reimbursement Agreement. Hope these reference materials are helpful!

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  • Thumbnail - clicking will open full size image - Map of IHS Areas and the VA Veterans Integrated Service Networks

Update on Contract Support Costs

Today I am sending an update to Tribes on Contract Support Costs (CSC) as a follow-up to my September 24, 2012, letter to Tribes. The focus of the letter is to reassure Tribes that IHS has been moving forward in its implementation of the recent Supreme Court decision, that we are working on making our CSC claims process more efficient, and that we have scheduled a meeting with over 20 lawyers representing Tribes to hear proposed strategies to continue moving forward on this important issue. Here is a copy of the letter [PDF - 62K].

IHS Listening Session Announcement

On July 26, 2012, IHS posted a draft Policy on Conferring with Urban Indian Organizations in the Federal Register and sent a letter to Tribes requesting consultation input. IHS received input and has been working on revisions to the draft policy. IHS is offering an additional opportunity to provide input on the draft policy during an IHS Listening Session to be held on January 22, 2013, at IHS Headquarters in Rockville, MD. The session is open for any interested individuals to attend. The following links provide more information:

Update on IHS Budget

I sent an update to Tribes in December on the IHS Budget with information on how our funding is distributed and other related updates. Here is the letter [PDF - 40KB] and the attachment [PDF - 103KB].

VA IHS National Reimbursement Agreement

IHS and the U.S. Department of Veterans Affairs (VA) signed a national Reimbursement Agreement on December 5, 2012, for VA to reimburse IHS for direct care services provided to eligible American Indian and Alaska Native veterans. The agreement implements Section 405 of the Indian Health Care Improvement Act and serves as the agreement for all IHS federal facilities. VA announced in August 2012 that tribally managed facilities could negotiate agreements with the VA directly, and now this new national VA IHS Reimbursement Agreement can be used by tribally-managed programs as well. VA and IHS are moving forward with implementing the agreement at 10 federal sites initially, and will expand to other federal sites soon. Tribal health facilities should contact the VA directly to negotiate their agreement; information is available at http://www.va.gov/tribalgovernment/.

With the national VA IHS Reimbursement Agreement, veterans can still choose to access VA or IHS for healthcare according to their eligibility. The reimbursement is for direct care, which includes services that are available at the local IHS or tribal facility and services that the veteran is eligible for at the VA. The VA and IHS will next work on a reimbursement agreement related to referrals and Contract Health Services. Here is a copy of the signed agreement [PDF - 370KB] and pictures of me with Dr. Robert A. Petzel, Under Secretary for Health, Veterans Health Administration, as we signed the agreement. If you have further questions, please contact your IHS Area Director for more information.

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  • Thumbnail - clicking will open full size image - VA IHS Reimbursement Agreement
  • Thumbnail - clicking will open full size image - VA IHS Reimbursement Agreement
  • Thumbnail - clicking will open full size image - VA IHS Reimbursement Agreement

Albuquerque Area Tribal Consultation

I attended the Albuquerque Area Tribal Consultation by phone in November. I provided an IHS update and answered questions. The Albuquerque Area Tribes also met with the Centers for Medicare and Medicaid Services in a separate meeting to discuss their concerns with New Mexico's Medicaid waiver proposal. Here are pictures from the meetings:

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  • Thumbnail - clicking will open full size image - Albuquerque Area Tribal Consultation
  • Thumbnail - clicking will open full size image - Albuquerque Area Tribal Consultation with CMS
  • Thumbnail - clicking will open full size image - Albuquerque Area Tribal Consultation with CMS
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  • Thumbnail - clicking will open full size image - Albuquerque Area Tribal Consultation with CMS
  • Thumbnail - clicking will open full size image - Albuquerque Area Tribal Consultation with CMS

IHS Area Directors' Meeting

The IHS Area Directors' Meeting was held on December 4, 2012, in Rockville, MD, and the agenda included updates and work on current IHS reform activities. Here is a picture from the meeting of me and the Area Directors:

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  • Thumbnail - clicking will open full size image - Dr. Roubideaux and IHS Area Directors

Tribal Delegation Meetings: December

Tribal Delegation Meetings were held in December with the Ute Indian Tribe, Wilton Rancheria Tribe, Ft. Mojave Indian Tribe, Wampanoag Tribe of Gay Head, Assiniboine and Sioux Tribes, and the Tejon Indian Tribe. Here are pictures from the meetings:

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  • Thumbnail - clicking will open full size image - Ute Indian Tribe
  • Thumbnail - clicking will open full size image - Wilton Rancheria
  • Thumbnail - clicking will open full size image - Ft. Mojave Indian Tribe
  • Thumbnail - clicking will open full size image - Wampanoag Tribe of Gay Head
  • Thumbnail - clicking will open full size image - Assiniboine and Sioux Tribes
  • Thumbnail - clicking will open full size image - Tejon Indian Tribe

Special Diabetes Program for Indians Symposium

I presented an update on the most recent outcomes and results of the Special Diabetes Program for Indians (SDPI) at a Symposium in December that focused on what our successful programs have to teach the rest of the country about diabetes treatment and prevention. Our most recent SDPI Report to Congress is now posted in print-ready format on the IHS Division of Diabetes Treatment and Prevention website. Here are some pictures from the event:

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  • Thumbnail - clicking will open full size image - Special Diabetes Program for Indians Symposium
  • Thumbnail - clicking will open full size image - Special Diabetes Program for Indians Symposium
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  • Thumbnail - clicking will open full size image - Special Diabetes Program for Indians Symposium
  • Thumbnail - clicking will open full size image - Special Diabetes Program for Indians Symposium

IHS Listening Session

On December 6, IHS held a listening session for tribal leaders who were in town for the White House Tribal Nations Conference. Here are pictures from the listening session:

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  • Thumbnail - clicking will open full size image - IHS Listening Session
  • Thumbnail - clicking will open full size image - IHS Listening Session
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  • Thumbnail - clicking will open full size image - IHS Listening Session

2012 White House Tribal Nations Conference

On December 5, President Obama hosted the 2012 White House Tribal Nations Conference at the Department of the Interior in Washington, D.C. The conference was for invited leaders from 566 federally recognized Tribes and served as a forum to strengthen the tribal/federal government-to-government relationship. The plenary sessions included presentations by the President and several Cabinet members. Breakout sessions were held with high-level officials from across the Administration. I attended the entire conference, met with many tribal leaders, and co-moderated the "Building Healthy Communities, Excellence in Education and Native American Youth" breakout session. On the day of the event, the White House released a report entitled "Continuing the Progress in Tribal Communities" that detailed how the administration has worked together with Tribes to make a difference for American Indians and Alaska Natives. The report was posted by Jodi Gillette, Senior Policy Advisor for Native American Affairs, White House Domestic Policy Council, on the White House Blog Exit Disclaimer – You Are Leaving www.ihs.gov . Here are some pictures from the event:

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  • Thumbnail - clicking will open full size image - 2012 White House Tribal Nations Conference
  • Thumbnail - clicking will open full size image - 2012 White House Tribal Nations Conference
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  • Thumbnail - clicking will open full size image - 2012 White House Tribal Nations Conference

Direct Service Tribes Advisory Committee Quarterly Meeting

The IHS Direct Service Tribes Advisory Committee met for their quarterly meeting in Spokane, WA in November. I met with them by phone, provided an IHS update, and answered questions. Here are pictures from the meeting:

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  • Thumbnail - clicking will open full size image - Direct Service Tribes Advisory Committee Quarterly Meeting
  • Thumbnail - clicking will open full size image - Direct Service Tribes Advisory Committee Quarterly Meeting

State Department Native American Heritage Month Event

The Executive Women at State Associates and the Office of Civil Rights at the State Department invited Jodi Gillette, White House Senior Policy Advisor for Native American Affairs/White House Domestic Policy Council and me to speak at their Native American Heritage Month event in November entitled "Native American Women in Senior Leadership." Here are pictures from the meeting:

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  • Thumbnail - clicking will open full size image - State Department Native American Heritage Month Event
  • Thumbnail - clicking will open full size image - State Department Native American Heritage Month Event
  • Thumbnail - clicking will open full size image - State Department Native American Heritage Month Event

Dartmouth IHS MOU

Dr. Susan Karol, IHS Chief Medical Officer, attended a signing ceremony for a new Memorandum of Understanding (MOU) between the IHS, Dartmouth College, and Dartmouth-Hitchcock Medical Center in November 2012. The MOU will allow us to partner on a variety of activities to promote health and well-being for American Indians and Alaska Natives. The MOU includes collaborative activities on improving undergraduate understanding of Native American health care, recruitment, training for health care professionals, and educational opportunities for health care providers in IHS. Here are pictures from the ceremony:

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  • Thumbnail - clicking will open full size image - Dartmouth MOU Signing Ceremony
  • Thumbnail - clicking will open full size image - Dartmouth MOU Signing Ceremony
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  • Thumbnail - clicking will open full size image - Dartmouth MOU Signing Ceremony
  • Thumbnail - clicking will open full size image - Dartmouth MOU Signing Ceremony

Norton Sound Regional Hospital and Quyanna Care Center Grand Opening

The Grand Opening celebration for the new Norton Sound Regional Hospital and the Quyanna Care Center was held on November 14, 2012 in Nome, AK. The hospital was built with Recovery Act funds, and the long term care facility was built by the Tribe to be adjacent to the hospital for better access to care for the elders. Here are pictures from the event:

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  • Thumbnail - clicking will open full size image - Norton Sound Regional Hospital and Quyanna Care Center Grand Opening
  • Thumbnail - clicking will open full size image - Norton Sound Regional Hospital and Quyanna Care Center Grand Opening
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  • Thumbnail - clicking will open full size image - Norton Sound Regional Hospital and Quyanna Care Center Grand Opening
  • Thumbnail - clicking will open full size image - Norton Sound Regional Hospital and Quyanna Care Center Grand Opening

National Indian Health Outreach and Education Partnership Meeting

The National and Area representatives that are part of the National Indian Health Outreach and Education Partnership met at the National Congress of American Indians building in November. Their goal was to share their outreach activities and tools and to plan activities to help Tribes and our patients prepare for the Health Insurance Exchanges and the Medicaid expansion due to begin in 2014 as a part of the Affordable Care Act. The organizations are developing tools and information to help individuals and Tribes make decisions about their expanded options for health coverage. Here are two pictures from the meeting:

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  • Thumbnail - clicking will open full size image - National Indian Health Outreach and Education Partnership Meeting
  • Thumbnail - clicking will open full size image - National Indian Health Outreach and Education Partnership Meeting

Tribal Delegation Meeting: Tohono O'odham Nation

IHS met with the Tohono O'odham Nation in November in a Tribal Delegation Meeting to discuss some current issues. Here is a picture from the meeting:

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  • Thumbnail - clicking will open full size image - Tribal Delegation Meeting with the Tohono O'odham Nation

Office of Personnel Management Native American Heritage Month Event

I participated in the Office of Personnel Management (OPM) Native American Heritage Month event in November. After giving a presentation, I gave OPM Director John Berry an IHS Director's Award for Federal Partnership to thank their team for successfully implementing the IHCIA provision that allows Tribes and urban Indian organizations to purchase federal insurance (FEHB, FEGLI) for their employees. Their consultation process, including the tribal workgroup that helped them implement the details of the program, is often mentioned by Tribes as a good example of how federal agencies can work together with Tribes. Here are pictures from the event:

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  • Thumbnail - clicking will open full size image - Meeting with OPM Director John Berry
  • Thumbnail - clicking will open full size image - Office of Personnel Management Native American Heritage Month Event

Update on IHS Baby-Friendly Hospital Initiative

The Rosebud IHS Service Unit has achieved designation as a Baby-Friendly® Hospital, which makes it the first hospital to achieve this designation in the Indian Health Service and in the state of South Dakota. This prestigious award is given to facilities that practice the Ten Steps to Successful Breastfeeding. Research shows that following the Ten Steps increases exclusive breastfeeding, and this helps to reduce obesity and diabetes in the population.

Co-administered by the World Health Organization and the United Nations International Children's Emergency Fund, the Baby-Friendly Hospital Initiative is an evidence-based practice care model designed to protect and promote breastfeeding as the safest, healthiest way to nourish babies. Hospitals that achieve Baby-Friendly status are committed to promoting and protecting breastfeeding at all stages, including prenatal counseling, inpatient services, and community awareness. Core components of the initiative promote the benefits of breastfeeding, such as skin-to-skin contact between mom and infant, and non-separation of mother and infant.

As a result of this initiative at Rosebud IHS Hospital, breastfeeding initiation rates are now consistently in the 90th percentile and exclusive breastfeeding rates have continued to climb.

"The staff and providers at Rosebud have made this program a success, and their hard work and dedication to protecting breastfeeding is evident," says Clifton Kenon Jr., Maternal Child Health Program Manager for Aberdeen Area Indian Health Service.

"Baby-Friendly at Rosebud is a reality because every single person made a commitment to making the program a success, which is an attribute we pride ourselves on at Rosebud," says Sophie Two Hawk, M.D., Chief Executive Officer at Rosebud Hospital.

Rosebud's achievement started as a campaign to decrease childhood obesity, through the First Lady's "Let's Move in Indian Country" initiative. Our goal in the IHS Baby-Friendly Hospital Initiative is to have all 13 IHS hospitals with obstetric services achieve the designation.

Please join us in congratulating Rosebud IHS Hospital for becoming one of the less than 5 percent of hospitals designated as Baby-Friendly in the U.S. Their work to promote breastfeeding will help improve the health of their community for generations to come.

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  • Thumbnail - clicking will open full size image - IHS Team at White House Let's Move in Indian Country Anniversary Event
  • Thumbnail - clicking will open full size image - Rosebud IHS Team with Secretary Sebelius

IHS Listening Session Update

The IHS Listening Session scheduled for December 6, 2012, in Washington, D.C., will be held from 9 a.m. to 12 p.m. in the Great Hall of the Department of Health and Human Services Hubert H. Humphrey Building. For more information, including a copy of the letter sent to Tribes and a draft agenda, go to our tribal consultation page. The Listening Session is being held the day after the White House Tribal Nations Conference.

IHS Listening Session

IHS is planning a half-day listening session the day after the White House Tribal Nations Conference on December 6, 2012, as an additional opportunity to provide input and dialogue with the IHS Director. Location and details will be posted here and sent to Tribes as soon as they are available. Please save the date!

Healthy Native Communities Fellowship

The Healthy Native Communities Fellowship (HNCF) graduation ceremony was held in Washington, D.C., in October. The HNCF program trains American Indians and Alaska Natives in health, wellness, leadership, and community mobilization concepts and is co-sponsored by the IHS Health Promotion Program and the Healthy Native Communities Partnership, Inc. HNCF has trained over 255 fellows over the past 8 years, including this year's 25 graduates. Here is a picture from the event:

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  • Thumbnail - clicking will open full size image - Health Native Communities Fellowship Graduates

IHS Navajo Area Listening Session

I traveled to Window Rock, AZ, to hold an IHS Navajo Area Listening Session in October. I met with the leadership of the Navajo Nation, including President Ben Shelly, Vice President Rex Lee Jim, and Council Delegate Jonathan Hale, and then toured the Navajo Nation Division of Health. John Hubbard, IHS Navajo Area Director, also attended the listening session. Here are some pictures from the visit:

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  • Thumbnail - clicking will open full size image - IHS Navajo Area Listening Session at Window Rock, AZ
  • Thumbnail - clicking will open full size image - IHS Navajo Area Listening Session at Window Rock, AZ
  • Thumbnail - clicking will open full size image - IHS Navajo Area Listening Session at Window Rock, AZ
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  • Thumbnail - clicking will open full size image - IHS Navajo Area Listening Session at Window Rock, AZ
  • Thumbnail - clicking will open full size image - IHS Navajo Area Listening Session at Window Rock, AZ

USET Board of Directors Meeting

I met with the United South and Eastern Tribes, Inc., Board of Directors in October, where I provided an IHS update and answered questions. Here is a picture from the meeting of me with the IHS Nashville Area Director, Martha Ketcher:

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  • Thumbnail - clicking will open full size image - Nashville Area Director, Martha Ketcher, and Dr. Roubideaux at USET Board of Directors Meeting

Meeting with Assistant Secretary Washburn

Yesterday I met with the new Department of Interior Assistant Secretary of Indian Affairs, Kevin Washburn, who oversees the Bureau of Indian Affairs and the Bureau of Indian Education. We had some initial discussions about common issues and possible collaborative efforts. Here is a picture from the meeting:

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  • Thumbnail - clicking will open full size image - Dr. Roubideaux with Department of the Interior Assistant Secretary Kevin Washburn

National Congress of American Indians 69th Annual Convention

I attended the National Congress of American Indians 69th Annual Convention in Sacramento, CA. I provided an IHS update in the general session, met with Tribes, and attended the Health Committee. In my presentation I thanked the National Congress of American Indians for their partnership with the IHS. Here are some pictures from the meeting:

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  • Thumbnail - clicking will open full size image - National Congress of American Indians 69th Annual Convention
  • Thumbnail - clicking will open full size image - National Congress of American Indians 69th Annual Convention
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  • Thumbnail - clicking will open full size image - National Congress of American Indians 69th Annual Convention
  • Thumbnail - clicking will open full size image - National Congress of American Indians 69th Annual Convention

Office of the Surgeon General

I met with Surgeon General Regina Benjamin, M.D., and her senior leadership to discuss our partnership with the U.S. Public Health Service Commissioned Corps. IHS represents the largest group of officers in the Commissioned Corps, and these officers serve in some of our most hard-to-fill positions. We discussed recent changes in the mission of the Corps that should help us more with recruitment and retention of officers in the IHS since our mission matches well with the focus of the Corps to serve the most vulnerable populations. Here is a picture from the meeting:

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  • Thumbnail - clicking will open full size image - Meeting with the Office of the Surgeon General

Hurricane Sandy Update

The impact of Hurricane Sandy continues to be felt in the New York and New Jersey areas, and our thoughts and prayers are with those affected by the storm. Our IHS Nashville Area has been working closely with United South and Eastern Tribes, Inc. (USET) as they work with FEMA to help the Tribes impacted by the storm. As of November 1, all IHS, tribal, and urban Indian health clinics on the east coast were open, but some tribal communities such as Narragansett and Shinnecock continue to deal with power outages and damage from the storm.

IHS is also helping with HHS USPHS Commissioned Corps deployments to the region, and to date, over 60 IHS officers have been approved to deploy. HHS continues to provide support for the health, mental health, and human services needs in the region impacted by the storm. The IHS Nashville Area will continue to monitor the situation and work with USET and the Tribes in the affected region.

I have received emails from IHS employees wondering how they can help. USET has set up a Tribal Emergency Relief Fund on their website Exit Disclaimer – You Are Leaving www.ihs.gov , and other non-governmental organizations that are helping to assist in the general response to the hurricane, such as the American Red Cross, are accepting donations. You can check news sources for ways you can help; for some ideas, here's an article on the CNN website Exit Disclaimer – You Are Leaving www.ihs.gov .

Thank you to all of our employees who are helping with the storm recovery efforts. I continue to be grateful for the enormous dedication and compassion of our employees and our tribal partners. Their commitment to serve makes a difference every single day.

Office of General Counsel Meetings

IHS works closely with its Office of General Counsel (OGC) on a variety of complicated legal matters each day. In September, the Public Health Division of the HHS OGC met in the IHS Reyes Building for their annual meeting. In October, the IHS Chief Medical Officers met with the regional OGC attorneys to discuss clinical and legal issues. Here are pictures from those meetings:

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  • Thumbnail - clicking will open full size image - OGC Public Health Division Meeting at IHS
  • Thumbnail - clicking will open full size image - CMO - OGC Meeting
  • Thumbnail - clicking will open full size image - CMO - OGC Meeting

Tribal Delegation Meeting: Norton Sound Health Corporation

I met with the Norton Sound Health Corporation in a tribal delegation meeting where we discussed the final steps in the construction of their new hospital in Nome, AK. Here is a picture from the meeting:

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  • Thumbnail - clicking will open full size image - Tribal Delegation Meeting with the Norton Sound Health Corporation

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