PROJECT STAFF:	Alida Montiel, Health Systems Analyst Sherrilla McKinley, Health Programs Specialist Melva Zerkoune, RD, Diabetes Nutrition Coordinator
STEERING COMMITEE MEMBERS:	Arlan Melendez, Chairman, Reno-Sparks Indian Colony Alvin Moyle, Chairman, Fallon Paiute Shoshone Tribe Waldo Walker, Chairman, Washoe Tribe Billy Bell, Chairman, Fort McDermitt Paiute Shoshone Tribe Davis Gonzales, Councilman, Te-Moak Tribal Council Curtis Cesspooch, Chairman, Uintah & Ouray Tribal Council Jeanine Borchardt, Chairwoman, Paiute Tribe of Southern Utah William Rhodes, Governor, Gila River Indian Community David Reede, Vice-Chairman, San Carlos Apache Tribe Herman Honanie, Vice-Chairman, Hopi Tribe Louise Benson, Councilmember, Hualapai Tribe Martin Harvier, Vice-President, Salt River Pima Maricopa Indian Community Walter Murillo, Acting Exec. Director, Native Health, Inc. Dorothy Dupree, Acting Phoenix Area IHS Director
PROJECT PERIOD:	October 1, 2009 - September 30, 2010
FUNDING SOURCE:	Phoenix Area Indian Health Service

PURPOSE:

To provide the necessary support to facilitate an open and objective forum to address American Indian health care concerns, policy issues and Indian health budgetary priorities by operating the Tribal Health Steering Committee consisting of tribal leaders from Indian tribes in Arizona, Nevada and Utah. The Area Director of the Phoenix Area Indian Health Service, the Area Director of the Tucson Area Indian Health Service and a representative of the Phoenix Area Bureau of Indian Affairs are key participants in the Steering Committee meetings. The Steering Committee serves as the Phoenix Area Budget Team and advises the Area with regard to planning the annual consultation session on the IHS budget. Information on health risks and Indian health care policy is disseminated to the Steering Committee and all tribal leaders in the Phoenix Area. All tribal leaders in the Phoenix Area are notified and asked to participate in tribal consultation meetings and quarterly Steering Committee meetings.

ACTIVITIES:

Through the mechanism of the Tribal Health Steering Committee, American Indian health concerns in the Phoenix Area, among tribes in Arizona, Nevada and Utah are identified and analyzed. The issues are addressed at the joint meetings of the Phoenix Area tribal leaders. The Tohono O’odham Nation and the Pascua Yaqui Tribe are also involved in the project as the Phoenix Area Indian Health Service serves communities of the two tribes that are located in the Phoenix Area. Ongoing information exchange and collaboration with the Navajo Nation also occurs on a regular basis and there is communication with the Tucson Area IHS and the Navajo Area IHS as needed.

FACILITATION OF FEDERAL/TRIBAL CONSULTATION POLICIES: The project creates a forum for the implementation of federal/tribal consultation policies as directed by the following:

• Presidential Memorandum of September 23, 2004 – “Government to Government Relationship to Tribal Governments”
• Department of Tribal Consultation Policy, U.S. Department of Health and Human Services (January 14, 2005)
• Indian Health Circular No. 2006-01, Tribal Consultation Policy (January 18, 2006))

TOPICS OF CONCERN: Tribal health concerns and policy issues are addressed at the quarterly meetings of the Tribal Health Steering Committee and at consultation meetings that are held with the Phoenix Area tribal leaders. The following topics were addressed.

Alcohol and Substance Abuse

Methamphetamine prevention, trafficking and treatment issues were addressed at all meetings of the Steering Committee this year. The Steering Committee had approved a document to guide a tribal leader initiative titled, “Strategies to Address Methamphetamine Abuse on Indian Lands-Arizona, Nevada and Utah Tribal/State/Federal ‘Roundtable’ Work Sessions.” Funding was received through the Office of Minority Health (Region IX, and Region XII) to plan tribal leader sessions in each state to address methamphetamine use. Concerns regarding policy, the role of the Federal and State agencies with regard to tribes and the development of local tribal meth response plans were addressed. The Steering Committee was informed of plans by the Phoenix Area IHS to implement ‘readiness surveys’ in tribal communities to address meth and efforts regarding treatment services provided at the Desert Visions Youth Regional Treatment Center in Sacaton, Arizona and at the Nevada Skies satellite youth treatment facility.

The Steering Committee received analysis developed by the ITCA, Inc. Epidemiology Center on American Indian alcohol and substance abuse data available from the Indian Health Service, Bureau of Indian Affairs and some state data. The leadership was informed about Epi Center efforts to develop a tribal public health code template that was amended to address the public health aspects of drug abuse. And at the request of the leadership, staff continued to provide information on tribal law and order codes that contain provisions on meth and tribal housing policies in the region that have been updated to address meth labs, trafficking and environmental clean-up. Another related topic that tribal leaders requested information on was effectiveness of behavioral health service delivery through telehealth technology.

Phoenix Area FY 2010 Tribal Health Priorities/Budget Recommendations

The FY 2010 Phoenix Area IHS Tribal Budget Consultation Meeting was held in Las Vegas, Nevada on January 10-11, 2008. At the meeting tribal leaders agreed on the fiscal year 2010, top ten health area wide priorities for tribes in the Phoenix Area IHS.

1. Diabetes (Includes a prevention focus and implementation of the Chronic Disease Care Management Model)
2. Alcohol/ Substance Abuse (includes a prevention and treatment focus, an Aftercare Initiative and a continued need to address Methamphetamine Use)
3. Heart Disease (Includes Hypertensive Disease)
4. Mental Health
5. Malignant Neoplasm (Includes a Cancer Screening initiative)
6. Dental Health
7. Elder Health
8. Renal Disease/Dialysis
9. Obesity
10. Maternal and Child Health

The tribal leadership in Arizona, Nevada and Utah also agreed on the recommended budget of $4,070,726,000 for the Indian Health Service. The recommendation includes a major increase for Current Services with funding for Federal and Tribal pay costs, inflation, contract support costs and population growth. In addition, specific recommendations for Program Increases were identified to address tribal priority health concerns.

2008 Region IX U.S. Department of Health and Human Services (HHS) Tribal Consultation Meeting

During this period, ITCA, Inc. staff communicated to the members of the Steering Committee and tribal governments in the Phoenix Area information on the 2008 Region IX U.S. Department of Health and Human Services (HHS) Tribal Consultation Meeting held on April 22-24, 2008 in Pala, California. Steering Committee members participated in this planning group along with tribal leaders or their representatives from tribes in the Phoenix Area, the California Area and the Navajo Area. Other participants in the planning group included representatives from tribal organizations in Region IX, including the California Rural Indian Health Board, the Intertribal Council of Nevada, the Indian Health Board of Nevada and the Inter Tribal Council of Arizona. Phoenix Area, California Area, Navajo Area and Tucson Area IHS staff also participated on these calls and provided technical assistance in the identification of issues and the formulation of the agenda. Steering Committee members, other tribal leaders and tribal health officials in Nevada and Arizona were identified to present area wide health concerns and recommendations and specific tribal issues at the consultation session. The topics included;

• New and Emerging Issues
• Anti-Methamphetamine Use Initiatives
• Improving State-Tribal Consultation
• Health Information Technology/Electronic Health Records
• Medicare, Medicaid, SCHIP (Social Security Act) Issues

Special Diabetes Program for Indians

Information regarding the Special Diabetes Program for Indians (SDPI) and other tribal and IHS related initiatives were provided to the tribes. This included reports by the Representative or Alternate on the Tribal Leaders Diabetes Committee (TLDC), information on the distribution of SDPI funds, including the competitive grant funds and information on SDPI reauthorization efforts. Louise Benson, Councilmember of the Hualapai Tribe is the Phoenix Area Representative on TLDC and Elwood Emm, Vice-Chairman of the Yerington Tribe is the Alternate.

Indian Health Care Improvement Act Reauthorization

Efforts to reauthorization the Indian Health Care Improvement Act (IHCIA) in the 106th, 107th, 108th, 109th and the 110th Congress continue to be reported often to the tribal leadership. The Phoenix Area is represented on the National Tribal Leaders’ Steering Committee (NSC) for IHCIA Reauthorization. In recent e years the following individuals have served on the Committee; Arlan Melendez, Chairman of the Reno-Sparks Indian Colony, Kathy Kitcheyan of the San Carlos Apache Tribe and Jamie Fullmer, of the Yavapai Apache Nation. The current representatives are Mr. Melendez and Margaret Baha-Walker, Vice-Chairwoman, White Mountain Apache Tribe.

Medicare Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2006

The passage of these two acts prompted efforts to initiate tribal input in the policy development and regulations process to the Center for Medicare and Medicaid Services (CMS). Critical concerns ranged from the difficulties that would have to be overcome so that American Indian seniors served at tribal, urban Indian and Indian Health Service pharmacies may participate in the new Part D prescription drug program and the magnitude of needed outreach so that enrollment of American Indian seniors into the program would not be difficult. Other tribal concerns included changes to allow greater state flexibility in developing state Medicaid plans, instituting co-pays, deductibles and premiums and the requirement that beneficiaries provide proof of U.S. citizenship to enroll in the Medicaid program. The Tribal Technical Advisory Group (TTAG) to CMS which includes tribal leader representation from each Area of the IHS is advising the agency regarding tribal concerns.

Phoenix Area Master Plan for Facilities and Services

The Master Plan has been a topic of discussion by the tribal leaders for the past few years. It was originally utilized as a planning tool for the tribes in the Phoenix Area, but it is now a requirement in all IHS Areas. In recent years, the tribes had advised the Phoenix Area on the need to update the document. The Phoenix Area IHS developed a new schedule to begin the process of meeting with tribes and urban Indian programs to update their sections of the Plan. The first plan addressed needs of the population through 2008 and the updated plan addresses future needs through the year 2015 based in the direction of the key tribal and IHS participants. The renovation and replacement construction of the Phoenix Indian Medical Center (PIMC) and concerns regarding how it would be a resource for the rural Service Unit populations across the region was discussed in this process. It was recognized by the Steering Committee that for many tribal members in rural and remote locations in Nevada, Utah and some parts of Arizona, traveling to Phoenix to obtain medical care is not feasible, so tribal leaders also supported the expansion of needed Contract Health Service funding in the Plan to provide greater access to tertiary and specialty care services to those locations.

Telemedicine

Another topic that tribes focused on was the utilization and effectiveness of telehealth technology by IHS and tribal health programs. An overview of the teleheath program has been provided along with specific presentations on the application of the technology at the Steering Committee meetings. Tribal leaders noted that advancing telehealth services is extremely important in terms of strategic planning for the future regional health care delivery system in the Phoenix Area. The concept includes strengthening local health care delivery through a network of tribal, urban, Indian Health Service and the contract health providers. The Steering Committee had recommended that a tribal/IHS telehealth work group be established and that the members assist the Area Office in developing a plan to outline implementation of telemedicine services in the Phoenix Area.

Nutrition and Diabetes Prevention

The ITCA Diabetes Nutrition Coordinator provides technical assistance to the tribal diabetes programs in Arizona, Nevada and Utah. This includes advisement in nutrition, diabetes prevention, diabetes program development and evaluation and physical activity information. The Coordinator works with the IHS/Tribal nutritionists of the Phoenix Area to survey training needs and develop the annual area wide nutrition meeting. The Coordinator also communicates with Tribes regarding any training, conferences, meetings, and recent news related to nutrition and diabetes especially with regard to the continuation of the Special Diabetes Program for Indians.