Attention: Updated No Show Policy
Dental Clinic: January 1, 2008 to December 31, 2008
There were a total of 1,595 dental appointments that were not fulfilled due to last minute cancellations and no shows/no contacts. Of these approximately 958 appointments could not be rescheduled. The estimated cost to the Tribe for salaries/benefits of dental staff for these appointments was $127,073.91.
Medical Clinic: January 1, 2008 to December 31, 2008
There were a total of 471 no shows of patients in the clinic. Of this number approximately 90% of the appointments could either be filled with walk-in clients or if the time allowed the receptionist was able to call patients who were on the waiting list and filled these appointments. So basically 47 of these appointments were estimated to have been not filled and the total cost of the medical clinic for staff salary/benefits was $12,136.64.
This situation has necessitated the dental and medical clinic adoption of a stricter no-show policy.
Policy effective 6/1/09
News! Nurses at Fred Leroy Health & Wellness Clinic Receive Awards Details
| Health Services Department |
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Gaining access to quality health care and delivering these services to Tribal members has been a high priority of the leadership of the Ponca Tribe of Nebraska for more than two decades. The goal of the Health Department is to improve the health care needs of both our Tribal members and other enrolled Native Americans.
The Ponca Tribal Health Services Department provides optical, dental, outpatient, in-patient hospital, and prescriptions from its Fred LeRoy Health and Wellness Center in Omaha.
In addition, other important programs within the Health Services Department include the following:
| Fred LeRoy Health and Wellness Center |
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The Fred LeRoy Health and Wellness Center,  Omaha, provides
medical, dental, and behavioral health services, plus disease prevention and diabetes education, to Native Americans.
Mission Statement:
The Mission of the Fred LeRoy Health and Wellness Center is to provide holistic, caring, family centered, and culturally sensitive services through a quality clinical and educational approach.
MEDICAL HEALTH SERVICES
The Fred LeRoy Health and Wellness Center, established in 1998, serves the urban Native American population of the Omaha area.
With the help of its on-site medical staff, the clinic's medical services include:
- Adolescent health care
- Ambulatory medical care
- Diabetes clinics
- Elder health care
- Family planning
- Fitness room
- Home health services
- Laboratory
- Lead screening
- Medication counseling
- Men’s health clinics
- Midwife services
- Newborn and well child clinics (immunizations and vaccines)
- Nutrition counseling
- Outpatient medical care
- Pharmaceutical assistance
- Physical and occupational therapy
- Pre- and postnatal care
- Smoking cessation
- Transportation
- WIC program
- Women’s health clinics
The Fred LeRoy Health and Wellness Center also offers traditional services such as inipis and healing ceremonies.
DENTAL SERVICES
In addition to dental exams and teeth cleaning, the Omaha Dental Clinic provides the following services:
- Bridges and crowns
- Denture extractions
- Fillings
- Fluoride treatment
- Oral cancer screening
- Partial dentures
- Root canal
- Teeth whitening
BEHAVIORAL HEALTH SERVICES
The Fred LeRoy Health and Wellness Center offers drug and alcohol counseling; individual and family counseling; and youth programs. (Please refer to the Behavioral Health Services section below for more information.
| Behavioral Health Services Overview |
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Within the Health Department, the Ponca Tribe of Nebraska Behavioral Health Program provides services related to the following:
- Mental health
- Substance abuse
- Youth prevention
MENTAL HEALTH SERVICES
The Behavioral Health Program provides the following mental health services (Omaha only).
- Mental health counseling
- Diagnostic interviews
- Psychological testing
- Dual diagnosis treatment
SUBSTANCE ABUSE SERVICES
A goal of the Behavioral Health Program is to improve and empower the quality of lives of American Indian people whose lives have been ravaged emotionally, spiritually, and physically from addictions to alcohol and other drugs.
We receive referrals from
- Domestic Violence Specialist of the Ponca Tribe
- Ponca Tribe Department of Health and Human Services
- Ponca Tribal Court
- Integrated Care Coordination Unit of the Department of Health and Human Services
- Nebraska Department of Health and Human Services
The Behavioral Health Program provides the following substance abuse services for adolescents through adults.
- Substance abuse evaluations
- Outpatient treatment and education for chemical dependency
- Individual and group counseling
- Treatment planning to empower and strengthen Native Americans
- Assistance and referrals for clients seeking admission to residential treatment programs and halfway houses
- Random drug tests
Treatment planning involves participation in 12-step programs such as Narcotics Anonymous, Alcoholics Anonymous, and Ala-non. These programs can feature culturally focused recovery plans according to client needs and requests. Important activities include participating in cultural activities like the Ponca Pow Wow and other family activities that encourage drug-free living.
Additional sustance abuse services include:
- Family counseling
- Referrals
- Admission into residential treatment and halfway houses
- Reporting and collaborating with legal services such as probation officers, judges, and area attorneys. Case management ensures requirements are met and not duplicated.
YOUTH PREVENTION SERVICES
Youth Prevention focuses on providing drug education and prevention activities for youth ages 5-18. After-school youth groups meet on a regular basis in Norfolk and Omaha. Please refer to the PTN Events Calendar on the Home page to see current meeting times and places.
The youth meetings provide support to those whose families are affected by alcohol and other drugs, as well as provide cultural support and education that empower them to live drug free lives.
Youth Prevention activities include:
- Drug-free educational activities (for elementary youth)
- Talking Circles (for older youth)
- Language, beading, and pow wow dancing classes
Our youth also participate in the annual Community Christmas party and field trips like visiting the Omaha Henry Dorly Zoo. Every summer a Youth Camp helps to educate and promote cultural awareness for the youth involved in our drug prevention activities.
Older youth who may be involved in substance, sexual, or physical abuse are often referred to a Substance Abuse Counselor for further evaluation and appropriate treatment.
| Behavioral Health Services Contact Information |
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Lincoln, NE
402.438.9222
Norfolk, NE
402.371.8834
Omaha, NE
402.734.5275
jaye@poncatribe-ne.org
| Contract Health Services |
|
Contract Health Services (CHS) offers limited coverage related to primary medical services, dental services, and yearly required physicals. It is neither an entitlement nor insurance program but is intended to help pay for care where no other sources of health care payments are available, or to supplement alternate resources that have been exhausted. CHS covers services that are not provided by an IHS facility.
2009 updated information
- Policies and Procedures Manual - View
- Policies and Procedures Manual Appendix - View
- Expanded Services - View
- Provider List - View
SUMMARY OF CHS SERVICES
CHS funds are used to supplelment and complement other health care resources available to eligible Indian people. Because Indian Health Service (IHS) programs are not fully funded, the CHS program must rely on specific regulations relating to eligibility, notification, residency, and a medical priority rating system. IHS is designated as the payer of last resort, meaning all other available alternate resources must first be used before payment is expected. These mechanisms enable the IHS to stretch the limited CHS dollars and are designed to extend services to more members.
Ponca Tribe of Nebraska offers its members limited routine services. In the case of specialized care the member/provider must submit the referral and all pertinent information to the Contract Health Department. A determination will then be made as to approval or denial of the referral.
Please note: Services cannot be approved or authorized until the CHS office has received the above information. The client will also be required to update their information on a yearly basis (or as needed). If the updated information involves a new address proof of residency is required.
Coverage (All Ages):
- Maximum of two primary medical (family physician visits per year)
- Specilized services
- Vision services (See vision care policy)
- Emergency services
- Prescriptions are covered in the following instances:
- Following an emergency visit
- Before and after surgery
- Following an inpatient stay
- Note: There is no coverage on refills
Dental services:
- One initial or periodic oral exam per year
- Includes: x-ray, prophylaxis, flouride,and sealants
- Amalgam restorations/composite restorations (fillings)
Emergency Dental services:
Yearly required physicals:
- Includes all needed immunizations and series
Elderly Care (65 and over: (See Elderly Care Plan for guidlines specific to this plan)
- Primary care medical services
- Prescription services
- Note: Elderly are eligible for all services listed above regardless of their coverage
To be eligible for the Elderly Care Plan with provision for unlimited access to your primary care physician you must be enrolled in Medicare Part B or have insurance. To be eligible for unlimited prescription access you must be enrolled in Medicare Part D of have insurance covering prescriptions.The individual must be denied Medicaid and provide proof of the denial. If the client does not have Medicare Part B/D they are not eligible for the Elderly Care Plan. Participation in this program is a member option, CHS cannot require a member to pay out of pocket to meet an alternate resource.
Disabled:
- Prescription co-payment coverage is avialable only if the member is covered by Medicaid and/or Medicare Part B/D as a direct result of the disability. Proof is required.
ELIGIBILITY REQUIREMENTS
CHS authorizing officials authorize all health care payments. The general eligibility requirements are as follows:
- You must be an enrolled member of the Ponca Tribe of Nebraska.
- You must reside in PTON-CHS delivery area
In addition, eligibility extends to non-Indians in the following three situations:
- Non-Indian woman pregnant with an eligible Indian’s child, for the duration of pregnancy through six weeks post partum (for pregnancy-related care only)
- Non-Indian member of eligible Indian's household - public health hazard only
- Non-Indians who are adopted, foster, step-child (ren) of eligible Indian (until age of 19 yrs)
PATIENT RESPONSIBILITY
After meeting the eligibility requirements, the patient must register with the CHS program by submitting the following:
- Copy of social security card and enrollment card
- Copy of alternate resource coverage
CHS is a payer of last resort. When a patient has Medicare, Medicaid, Veteran's benefits, private insurance, worker’s compensation, or is covered by any other resource, that resource is the primary carrier. Patients must immediately provide all explanations of benefits from the primary carrier(s) to the CHS office when received by the patient. If the client has Medicaid, CHS does not pick up any remaining balances because the provider must accept Medicaid’s payment as full payment.
Patients also need to update information with CHS annually (or as needed). If the update reflects a new address, patients must provide proof of residency prior to authorization of services.
FUNDING BACKGROUND
Indian Health Service (IHS) is a branch of the United States Public Health Service and Department of Health and Human Services that provides a full range of health services to more than 900,000 American Indian and Alaska Natives throughout the United States. It is considered the payer of last resort (notwithstanding any state or local law or regulations to the contrary).
Contract Health Services (CHS) is one of the IHS health services. Federal Regulation 42CFR 36.61 established CHS delivery areas, eligibility, notification and related requirements. The U.S. Congress allocates funds for the CHS program annually.
HEALTH RESOURCE ADVOCATE
The Health Resource Advocate (HRA) is available to help Ponca members resolve problems related to finding appropriate health care services according to the available resources. The Advocate works with the patient, his/her family, service providers, and other agencies to resolve issues of resources and treatment.
The HRA is responsible for the following:
- Conducting a needs assessment of the member’s health care issues
- Referring and assisting members with available alternate resources
- Ensuring the use of the most appropriate facility and cost effective rates
- Overseeing catastrophic illnesses and in-patient services
| Helpful Links |
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Click a link for additional health care information:
| CHS Contact Information |
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Contract Health Specialist and Clerk
Norfolk, NE
402.371.8834
Health Resource Advocate
Omaha, NE
402.734.5275
| Diabetes Program |
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Within the Health Department, the Ponca Tribe of Nebraska’s Special Diabetes Program for Indians Grant, which serves all Tribal Nations, offers the Diabetes Program. The Diabetes Program follows the I.H.S. Standards of Care for the Treatment of People Living with Diabetes.
MISSION STATEMENT
The Ponca Tribe of Nebraska Diabetes Program will provide quality health care services that improve the lives of the Native Americans we serve, through a comprehensive diabetes prevention program, self care management plan, educational information, and direct care services.
QUALIFICATIONS
To qualify for coverage and services, Tribal members must provide the following.
- Proof of diabetes diagnosis
- Proof of residency
- Copy of Tribal enrollment
COVERAGE
Services are available for diabetics who qualify for the program and receive authorization from the Diabetes Program staff prior to coverage.
- Diabetic prescriptions
Prescriptions related to diabetes treatment and prevention of complications may be eligible for coverage, if required by a physician. These costs are paid only after the client’s Medicare, Medicaid, and/or private insurance have paid their allowable costs. Authorization is required each time you have a medication filled.
- Glucose testing supplies
The following glucose testing supplies are available for diabetic clients at each office location.
- Accu-Check Advantage Meters
- Accu-Check Comfort Curve Strips
- Alcohol swabs
- Insulin syringes
- Lancets (softclix, safe-t-pros)
- Log books
- Eye exams
The Diabetes Program pays for one yearly eye exam for diabetic patients. These costs are paid only after the client’s Medicare, Medicaid, and/or private insurance have paid their allowable costs.
- Dialysis
Funding is only available to those client’s with Medicare and/or private health insurance. The Diabetes Program pays after the client’s Medicare and private health insurance have paid their allowable rates.
- Orthopedic Shoes
These costs are paid only after the client’s Medicare, Medicaid, and/or private insurance have paid their allowable costs.
SERVICES
Diabetes Program staff provides the following services.
- Diabetes education
The Diabetes Program staff uses the Indian Health Service's “Balancing Life and Diabetes Education Curriculum” to conduct self management education classes at each office site. A registered dietician and registered nurse conduct monthly Lunch and Learn classes at the Fred Leroy Health and Wellness Center. The diabetes LPN also provides educational classes during site visits.
- Nutrition consultations
In Omaha, a registered dietitian provides nutrition consultations for diabetic clients and others who are at risk for developing diabetes.
- Diabetic nursing assessments
A diabetes LPN provides basic nursing assessments for clients at the Norfolk, Lincoln, Niobrara, and Sioux City office sites. The LPN and a Public Health Nurse also provide home visits from Omaha.
- Direct care
A medical doctor and a family nurse practitioner provide direct care to diabetic patients at the Fred LeRoy Health and Wellness Center.
ACTIVITIES
The Diabetes Program promotes the following activities.
- Annual Walk/Run and Pow Wow
- Diabetes Fun Run
- Diabetes screenings
- Exercise facilities at office locations
- Youth groups
- Youth Physical Activity Scholarships
The Ponca Tribe Diabetes Program has funds available for Native American youth who need encouragement to stay active in physical activities. Each child may receive $100 in funding toward physical activities throughout the year. Children may enroll in activities like soccer, basketball, sports camps, dance classes, and much more. Please contact the staff of the Diabetes Program if you have questions.
LINKS TO MORE INFORMATION ABOUT DIABETES
http://www.unitefordiabetes.org/
http://www.diabetes.org/home.jsp
http://medlineplus.gov/
| Diabetes Program Contact Information |
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Norfolk, NE
402.371.8834
Omaha, NE
402.733.3612
hilaryh@poncatribe-ne.org
| PTN Health Services Contact Information |
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Ponca Tribe of Nebraska, Health Services Department
Twila Lush, Director of Tribal Health
twilal@poncatribe-ne.org
402.857.3341
FAX: 402.857.3771
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