1. VA Office of Tribal Government Relations California Rural Indian Health Board Thunder Valley Casino Resort Quarterly Board of Directors Meeting Ms. Stephanie Birdwell July 7, 2015

2. 2 Office of Intergovernmental Affairs VA Update CO  Intergovernmental affairs serves as the Departments liaison in all intergovernmental matters with federal, state, local, and tribal government officials  My VA – Email MyVACommunities@va.govMyVACommunities@va.gov  Reimbursement Agreements  Over $22.6M and 5,416 unique Veterans  Choice Act Update  Office of Rural Health Initiatives

3.  Three times more highly rural than non- Native Veterans  Younger as a cohort than all other Service Members and Veterans  More female Veterans serve than Non- Native  Income levels and educational levels lower  Higher degree of combat service - more service connected Veterans than other non- Native counterparts Challenges Facing American Indian/Alaska Native Veterans

4. 4 My VA Regions

5. 5 Intergovernmental Affairs Update CO  Approx. 1.8M Veterans in CA state  Over 645,255 enrollees  About 403,945 use VA Healthcare  109 tribes in CA state  American Indian and Alaska Native Veterans have played a vital role in the U.S. military for over 200 years.  Native Americans serve at a high rate when compared to other races – females in particular  Approximately 154,000 Veterans, comprising of 0.7% of almost 22 million Veterans – this is important to note because there is less than 1.0% AIAN race

6. 6 Intergovernmental Affairs Update CO  Placer County (Auburn Rancheria) – home of 30,501 Veterans  $89,906 in Compensation & Pension  $153,314 total VA benefits  Sacramento County (Wilton Rancheria) – home of 89,733 Veterans  $322,385 in Compensation & Pension  $638,606 total VA benefits

7. 7 Reimbursement Agreements CO  79 total/12 CA, 2 ID, 4 OR, 1 WA, 3 NV  To get started – send email to tribal.agreements@va.gov tribal.agreements@va.gov  Direct care services only  Enrolled and eligible AI/AN Veterans  Forms Available at: http://www.va/gov/PURCHASEDCARE/progra ms/veterans/nonvacare/ihs/index.asp http://www.va/gov/PURCHASEDCARE/progra ms/veterans/nonvacare/ihs/index.asp  Certification/Accreditation – either Centers for Medicare & Medicaid (CMS) certification; The Joint Commission or Accreditation Association for Ambulatory Health Care (AAAHC)

8. 8 Reimbursement Agreements CO

9. 9 Reimbursement Agreements CO

10. 10 Choice Act Update CO  Reimbursement Agreements & Choice are two separate categories at this time  VHA has $2.4B Non-VA Purchased Care shortfall  Effective June 8, 2015, VA implemented in accordance with Congressional wishes a hierarchy of purchased care to those eligible. Choice is at the top of the hierarchy

11. 11 Choice Act Update CO  Tribes must establish themselves as choice providers. This is applicable to those Tribes who want to be a choice referral site for non- native Veterans (Tri-West Healthcare Alliance) https://vapccc.triwest.com/PCCCWeb/index.ht ml#/provider-home https://vapccc.triwest.com/PCCCWeb/index.ht ml#/provider-home  Medicare rates apply for Choice Providers  Pre-authorization and referral process required  VA payer of last resort like Reimbursement Agreement program

12. 12 VA – IHS MOU – Five Mutual Goals CO 2014 – VA Consulted on the VA-IHS MOU in September 2014 in Albuquerque, NM – report due to be released within next 30-days 1.Increase access, improve quality of health and leverage strengths; 2.Promote patient-centered collaboration and communication; 3.In consultation with tribes at regional and local levels, establish effective partnerships with: IHS, Tribal and Urban (I/T/U) Indian health programs in support of American Indian/Alaska Native (AI/AN) Veterans; 4.Ensure appropriate resources are identified and available to support programs for AI/AN Veterans; 5.Improve health-promotion and disease-prevention services to AI/AN Veterans to address community-based wellness.

13. 13 Office of Rural Health Initiatives Impacting Indian Country CO  During FY 2014, VA, IHS and their Tribal partners achieved significant successes in care coordination, health information technology, health care services, training and cultural competency. Listed below are some of the high level accomplishments :  $11,377,388 reimbursed to IHS and THPs from VA for direct medical care to AI/AN enrolled Veterans  440,575 prescriptions transmitted through VA Central Mail Out Pharmacy (CMOP)  18,618 AI/AN Veterans and family members impacted by VA-IHS Tribal contacts, outreach events, and training  11,500 contacts made through suicide prevention outreach activities

14. 14 Office of Rural Health Initiatives Impacting Indian Country CO  3,759 Veterans served through the reimbursement program at VA and THPs  726 trainees attended educational presentations from the Posttraumatic Stress Disorder workgroup  186 shared trainings between VA and IHS  147 VA Medical Centers received videos that promote outreach to Tribes  8 additional IHS facilities added the Bar Code Medication Administration program to increase patient safety, and avoid loss  IHS achieved electronic health record stage 2 meaningful use certification  VA and IHS established telemedicine direct point-to-point connectivity

15. 15 VA Organization OFFICE OF TRIBAL GOVERNMENT RELATIONS Robert McDonald Secretary Peter Vicaire OTGR Specialist Central / Northeast Region L. HoMana Pawiki OTGR Specialist Southwest Region Terry Bentley OTGR Specialist Western Region Appointment Pending OTGR Executive Officer Mary Culley OTGR Specialist Southern Plains / Southeast Region Sloan D. Gibson Deputy Secretary Christopher E. O’Connor Interim Assistant Secretary for Congressional & Legislative Affairs Deputy Assistant Secretary Office of Intergovernmental Affairs Stephanie E. Birdwell, Director Office of Tribal Government Relations Rob Nabors Chief of Staff

16. Goal 1: Facilitate Increased Access to Health Care & Benefits Goal 2: Promote Economic Sustainability Goal 3: Implement VA’s Tribal Consultation Policy VA OTGR NATIONAL UPDATE VA OTGR – 3 MAIN GOALS

17.  Conducted 8 tribal site visits in FY2015  October – Northwest Portland Area Indian Health Board – Worley, ID  February – Site Visit with NARA  February – ATNI 2015 Winter Convention  March – Site visit with Advisory Committee on Minority Affairs – Seattle, WA  April – Veterans Summit – Swinomish Indian Tribal Community, Anacortes, WA  April – 2015 Tribal Self-Governance Conference, Reno, NV OTGR Western Region Update

18. Upcoming Events:  July 9-11, 2015 - Native Veterans Summit – Hosted by Confederated Tribes of Grand Ronde  July 16-17, 2015 CAL Vet VSO Training (TVRs invited) – Sacramento, CA  September 14-17, 2015 – ATNI Fall Convention, Hosted by Kalispel Tribe of Indians, Spokane, WA  September 22-24, 2015 – TVR Training for Region – hosted by ODVA, Salem, OR  September 26, 2015 – Celebration of Honor, Chinook Winds Casino Resort, Lincoln City, OR OTGR Western Region Update

19. Department of Veterans Affairs Office of Tribal Government Relations Terry.Bentley@va.gov 541-440-1271 www.va.gov/tribalgovernmentwww.va.gov/tribalgovernment - Main website Tribal.agreements@va.govTribal.agreements@va.gov – VA-IHS-THP Reimbursement Agreements Tribal.Consultation@va.govTribal.Consultation@va.gov – email for tribal leaders to submit inquiries directly to VA Office of Tribal Government Relations Point of Contact/Western Region 19

20. VA OTGR NATIONAL UPDATE Questions?