Health Services Expansion & Compliance Update Topics of SRMT Monthly Meeting

The February SRMT's monthly meeting was called to order at promptly 10am. The meeting was chaired by Chief Ron Lafrance.

A review of Action Items (January7, 2017)

1. Community member requested information on the future plans for the former IGA building.

2. Community member requested that the concerns voiced at the January 2017 Tribal monthly meeting regarding the Partridge House be looked into.

3. Community member requested the requirement for all volunteer groups.

Mike Cook, Director of Health Services answered questions on Medicaid and the SRMT billing processes. Indian Health Services are an alternate billing and not a main source. He also mentioned Fidelis has very little to do with the Partridge House and explained how billing works there. In choosing to be credentialed, you have the ability to bill private insurance. Cook reassured community members, clients of the Partridge House do have access to cultural activities, events and ceremonies. Harvey Herne is the Partridge House Patient Advocate and is answerable directly to Cook. Cook also mentioned the Dental Clinic is short one dentist and he reassured community members if any dental work was needed and they could not take care of it in house, a referral would be made for the patient. Cook expressed his shared concern over Trump's agenda. He as well as the SRM Tribal Chiefs are monitoring this situation closely.

Presentation

Community member, Ruth Herne Bell gave a presentation on the Elders Benefit. She expressed how they were still pushing forward. She stated she was in contact with Wal-Mart and Aldi's. She also met with LoraLee LaFrance in regards to whether the Elder's Benefit is taxable and reportable. She stated it is reportable but not taxable. She, as well as many others, are concerned over the possibility the Elder's Benefit will affect SSI, SNAP and other benefits seniors may receive. She mentioned the possibility of using a debit card instead of a issuing an Elder's Benefit check.

All of this is contingent on forming an Elder's Benefit committee of finding resources to fund this benefit. They had a number of people apply to sit on this committee. A discussion ensued as to the number of seniors and non-senior members who will sit on the committee.

Presentation

Compliance Program

Elliott Lazore shared how the Compliance program is helping over 1500 community members for the 2016-2017 heating season. Using the same eligibility as last year, seniors over the age of 60 years received $1000 in fuel allotment, applicants 59 and under received $600 in fuel allotment. This allotment can be used for fuel (49%), kerosene (24%), propane (17%), electric (8%), and alternative heating sources (2%). The Compliance Program regularly watches the market price on any given fuel source to ensure community members are receiving fair market value when purchasing fuel.

In 2014, they processed 1498 applicants, in 2015, 1526 applicants, in 2016, 1542 applicants. They noted they are only one month into the 2017 program and have already processed 1500 applicants.

They also shared information on home assessments and how many older homes are outdated and still using inefficient energy appliances.

Lazore also shared the senior's electric benefit of $75. They processed assistance for 208 homes in 2015, 238 in 2016 and 253 homes in 2017. The Compliance Program has streamlined with National Grid for easier processing.

Please note: if you are a senior and you haven't seen this applied to your National Grid bill, please contact the Compliance Office.

The Compliance Program also offered a $100 voucher for Seniors to use for cleaning and servicing their furnace. There are four certified service reps in Akwesasne to clean and maintain your furnace. The Compliance office also provides a checklist to ensure your furnace is being properly serviced.

There are seven unlicensed tobacco stores in Akwesasne. These seven unlicensed stores do not pay a percentage of each sale to the Compliance office.

Chief Ron Lafrance encouraged Elders to come into the Compliance Office to make sure they are receiving all benefits from the Tribe. If you are an Elder, or your relative or friends are elders, encourage them to call or visit the Compliance Office.

Presentation

Sarah Diabo, Emergency Planning updated the community on their work in verifying 911 numbers. They've had some difficulty in verifying homes due to misspelled road names, wrong house numbers and some roads do not exist or do not have a name attached to it. They are 87% near completion of this review. She stated homes in Akwesasne need to have a visible number attached. This is imperative for clear and easy identification of homes for local fire departments, emergency ambulance service and other necessary emergency responders.

Presentation

Expansion of the SRMT Health Services

This is the 4th meeting for the community on plans to expand the SRMT Health Services Expansion Project. The need is based on the growing size of the community, the need to increase Outreach and Mental Health Counseling rooms, address space constraints including a lab, pharmacy and waiting rooms. With this expansion, the A/CDP program would return back into the building allowing this program to hold child-centered activities in house. A student bus drop off is included in the plans. The expansion would also include a lab, larger pharmacy room, waiting rooms and rooms for program staff meeting. In 1991, the Tribal Clinic was housed in 702 square feet of space. In 2017, Health Services is housed in 14,200 square feet of space to serve community members. In 1991 the SRMT HS served 7,276 registered patients. Today, SRMT HS serves 14,224 registered patients. In 1991 the Clinic served approximately 20,000 ambulatory care visits and from 2015 to today, over 80,000 people have walked into the Health Services building for their health care. This expansion will include an additional 17,700 square feet of space, completed in phases with the water main extended around the addition to provide fire protection.

1st Phase – 17,00 steel frame, two story partial basement, handicap accessible with an elevator, Alcoholism/Chemical Dependency Prevention and Mental Health Programs, IT, Business and Administration office and large meeting and multi-purpose spaces

2nd Phase - Larger storage, work space and phlebotomy rooms in new Lab, increased storage and work space and private consultation area in new pharmacy, three exam/treatment rooms in new Outreach office, education room with massage therapy and space allocated for future growth

3rd Phase - Renovate south side of clinic area, 8 exam rooms, 1 treatment room, in new clinic, renovate Lobby to create clear public circulation path, size of waiting room increased to 2,400 sq. ft., ability to separate sick patients in new waiting room layout

4th phase - Chiropractic treatment room, group consultation room, nurses' station, WIC private offices, and storage in new addtion, new registration with three private booths in lobby, new referrals with one private booth in lobby.

The expansion would use energy conservation measures, including ground-mounted solar photovoltaic arrays, and high efficiency lighting, room occupancy lighting sensors, recycled building materials and furniture and construction waste management program

Discussion

Tribal Chiefs and program directors are concerned about Donald Trump's agenda in regards to the Affordable Care Act, EPA rules and regulation and EPA funding, education, and Women Against Violence programing. They stated they are monitoring this situation closely.

New Business

A community member questioned VA Benefits and the use of the VA center in the St. Lawrence CenterMall. The Tribal Clinic offered more services than the VA center.

Question – Are there plans for a dialysis clinic. There are no plans and no consideration for any plans for a dialysis clinic due to the prohibitive billing cost and the required infrastructure needed for this. It was stated 'prevention programs' have leveled the diabetes rate in Akwesasne. Three years ago, over 16 people were on dialysis, in 2017 – 3 community members people are on dialysis.

Chief Beverly Cook was appointed to the National Indian Health Board.

The Tribe is the payers of last resort, the Tribe bills Medicaid and Medicare.

Health benefits are non-taxable. She stated the Chiefs are working to secure what "we have now and we are on shifting sands".

It was announced that community members are encouraged to use the Diabetes Center, as everyone in Akwesasne is considered 'pre-diabetic' and therefore eligible to use the Center.

A community member had questions about the harassment of students in the 'P-Tech' program. The P-Tech program prepares student for work in the medical field. Currently, the program has been moved to another wing in the building and lunch and physical education classes are being held at alternate time to FA's students. A meeting is scheduled between Superintendent Harper and the Tribal Chiefs.

A community member requested quarterly reports on the Tribe's LLC businesses, Akwesasne TV and the soybean project. It was noted the Tewatahonni owns the LLC's which has all three Tribal Chiefs sitting on its Board of Directors. It was also noted by Sub Chief Shelley Jacobs the Tribe has an ordinance in place to prevent reporting. It was also noted there is an ordinance process in place where community members could use to request information.

A community member questioned the use of tax-exempt cards and how businesses surrounding the community of Akwesasne seem less reluctant to recognize the tax-exempt status. It was noted it is easier to use the SRMT tax exempt card at stores in Albany, Rochester and other cites, than is to use it at your local Wal-Mart and Home Depot stores, with most complaints being made in St. Lawrence County.

A motion was made to the SRMT to provide quarterly reports to the community. In a 19 for, 0 against and 10 abstaining vote, the motion was passed.

A community member questioned how a person with a federal offense could sit on the Election Board. It was suggested to bring this concern to the Election Board.

In closing, a community member expressed her complete anguish over the number of non-natives living in Akwesasne. Historically, up until 1986, only men could bring their non-native bride to live in Akwesasne. In 1986, a law was passed to allow women to bring their non-native spouse/partner to live in Akwesasne. She stated there are non-native people living in Akwesasne who are not "attached to anyone".

A community member questioned if the Tribe has a residency permit in place; they do not, and the Chiefs suggested this question and concern be brought to the membership code committee.

The motion was made and seconded to adjourn the meeting at 12:35.