• Introduction
• Resources and References
• Policies and Actions
• Other Websites and Resources

Introduction

The policy component of the Native Domain seeks to assess current healthcare needs, access and quality for rural Native Veterans and to develop and promote effective policy recommendations to create meaningful change for this special population.

Given the considerable cultural, social and geographic diversity of rural Native Veteran populations, it is important to preface the Native Domain policy component by acknowledging that while Veterans Health Administration policy (VHA) is national in scope by its very nature, VHA programs and activities targeted at this population may benefit from policy strategies that embrace a national scope while maintaining a local focus. Such programs would effectively honor the cultural uniqueness of each tribal, village and islander group to address their healthcare issues.

A national scope involves the VHA engaging at a system-wide level in a collaborative, coordinated and cohesive effort to attend to the needs of these populations. A local focus refers to the adaptation of national efforts—including policy, best practices and demonstration projects—to the environments of rural Native Veterans at the level of individual tribes, villages, islands, or communities. Thus, all work emanating from the Native Domain policy component will be considered with regards to a national scope with a local focus.

The Native Domain Policy component is a continuous process. Currently, these pages contain several resources and links to important policy issues and legislation affecting Native Veterans. Additionally, we are currently completing three policy papers. The first provides a general overview of Native Veterans’ issues, assessment of their current situation and provides recommendations for policies to improve healthcare quality and access. The second paper assesses the current situation for Native Veterans as related to transportation issues and provides key recommendations for improving transportation. The third paper assesses the current provision of traditional healing practices within the VHA and provides policy recommendations and general guidelines for further development and integration of traditional healing within the system of care. Theses papers should be posted soon.

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Resources and References

Rural Veteran Access to Healthcare Services: Investigating the Role of Information and Communication Technologies in Overcoming Spatial Barriers.
Benjamin L. Schooley, MBA, PhD; Thomas A. Horan, PhD; Pamela W. Lee, PhD; and Priscilla A. West, MPH.
Perspectives in Health Information Management (Spring 2010): 1-20.

Veterans Health Administration and Indian Health Service: healthcare utilization by Indian Health Service enrollees. 
Kramer, B. J.; Wang, M.; Jouldjian, S.; Lee, M. L.; Finke, B.; and Saliba, D.
Med Care. 2009 Jun; 47(6):670-6.

Dual use of veterans health administration and Indian Health Service: healthcare provider and patient perspectives. 
Kramer BJ, Vivrette RL, Satter DE, Jouldjian S, and McDonald LR
J Gen Intern Med. 2009 Jun;24(6):758-64. Epub; 2009 Apr 18.

Identification of American Indian and Alaska Native veterans in administrative data of the Veterans Health Administration and the Indian Health Service.
Kramer BJ, Wang M, Hoang T, Harker JO, Finke B, Saliba D.
Am J Public Health. 2006 Sep;96 (9):1577-8. Epub 2006 Jul 27.

Rural Veterans: A Special Concern for Rural Health Advocates.
NRHA Policy Brief; National Rural Health Association; July 2004.

Perceived barriers to mental health care for American Indians and Hispanic veterans: reports by 100 VA staff.
Westermeyer, J.; Canive, J.; Garrard, J.; Padilla, E.; Crosby, R.; and Thuras, P.
Transcultural Psychiatry, Vol. 39, No. 4, 516-530 (2002).

Veteran identity and race/ethnicity: influences on VA outpatient care utilization.
Harada ND, Damron-Rodriguez J, Villa VM, Washington DL, Dhanani S, Shon H, Chattopadhyay M, Fishbein H, Lee M, Makinodan T., and Andersen R.
Med Care. 2002 Jan; 40(1 Suppl):I117-28.

Comparative use of biomedical services and traditional healing options by American Indian veterans.
Gurley D, Novins DK, Jones MC, Beals J, Shore JH, and Manson SM.
Psychiatr Ser. 2001 Jan; 52(1):68-74.

Healthcare Inspection: Access to VA mental health care for Montana Veterans.
Department of Veterans Affairs Office of the Inspector General Report No. 08-00069-102 March 31, 2009.

VA and Indian Health Services (IHS): Access for American Indian Veterans.
B. Josea Kramer, PhD, MS
HSR&D Study: ACC 03-304, Department of Veterans Affairs, (2008).

Determinants of VA Ambulatory Care Use Among Native American Veterans.
Vallentine M. Villa, PhD, MA, MS
HSR&D Study: ECV 00-083, VA Greater Los Angeles Healthcare System, West LA (2003).

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Policies and Actions

The Indian Health Service (IHS) Director Yvette Robideaux, and Robert Petzel, VA Under Secretary for Health signed a new Memorandum of Understanding (MOU) (891 KB, PDF) on October 1, 2010. The purpose of the MOU is “to establish coordination, collaboration, and resource-sharing between the Department of Veterans Affairs (VA) and Indian Health Service (IHS) to improve the health status of American Indian and Alaska Native Veterans. The goal of the MOU is to foster an environment that brings together the strengths and expertise of each organization to actively improve the care and services provided by both.

The MOU establishes mutual goals and objectives for ongoing collaboration between VA and IHS in support of their respective missions and to establish a common mission of serving our nation's American Indian (AI) and Alaska Native (AN) Veteran. The MOU is intended to provide authority for a broad range of collaboration between the agencies that facilitate development of additional agreements around specific activities.

It is the intent of this MOU to facilitate collaboration between IHS and VA, and not limit initiatives, projects, or interactions between the agencies in any way. The MOU recognizes the importance of a coordinated and cohesive effort on a national scope, while also acknowledging that the implementation of such efforts requires local adaptation to meet the needs of individual tribes, villages, islands, and communities, as well as local VA, IHS, Tribal, and Urban Indian health programs.”

President Obama signs Indian Health Care Improvement Act Into Law:
An article in Indian Country Today, ”Health care reform to become law” published on Monday, March 22, 2010, the National Health Care Reform Act which passed the House of Representatives March 21, includes reauthorization of the Indian Health Care Improvement Act. This move is expected to improve the health care system for over 1.9 million American Indians and Alaska Natives. An Opinion article as a follow up to the passage of the Health Care Reform Act appeared in Indian Country Today, “Congress and President deliver on promises to improve Indian health system.” “The most important provision is the reauthorization of the Indian Health Care Improvement Act (after 10 years of empty promises) as a title in the Senate health care package.”

Senate Veteran’s Affairs Committee Hearing Testimony on Veterans Administration/Indian Health Service Cooperation November 5, 2009. This link will take you to the committee web site where the written transcript and link to the video are available.

2009 Presidential Tribal Consultation Memorandum:
President Barak Obama signed the Tribal Consultation Memorandum on November 5, 2009 indicating the administration’s commitment “to regular and meaningful consultation and collaboration with tribal officials in policy decisions that have tribal implications.” This Memorandum is a follow-up to President Bill Clinton’s Executive Order (EO) 13175 Consultation and Coordination with Indian Tribal Governments signed on November 6, 2000. The EO charges executive departments and agencies to engage in “…regular and meaningful consultation and collaboration with tribal officials in the development of Federal policies that have tribal implications, and are responsible for strengthening the government-to-government relationship between the US and Indian tribes.” President Obama’s memorandum directs each agency head to submit detailed plans of action the agency will take to implement the policies and directives of EO 13175 to the director of the Office of Management and Budget (OMB) within 90 days. It further states that the plan should be developed after consultation with Indian tribes and tribal officials and a progress report on the status of each action and proposed updates are also called for within 270 days after the date of the memorandum.

2009 Presidential Executive Order - Asian Americans and Pacific Islanders:
On October 14, 2009 President Obama signed an executive order regarding an Initiative and establishing an Advisory Commission on Asian Americans and Pacific Islanders to address issues concerning this community.
“The purpose of this order is to establish a President's Advisory Commission on Asian Americans and Pacific Islanders and a White House Initiative on Asian Americans and Pacific Islanders. Each will work to improve the quality of life and opportunities for Asian Americans and Pacific Islanders through increased access to, and participation in, Federal programs in which they may be underserved. In addition, each will work to advance relevant evidence-based research, data collection, and analysis for AAPI populations and subpopulations.”

List of Federal Tribal Consultation Statutes, Orders, Regulations, Rules, Policies, Manuals, Protocols and Guidance.
This list was prepared by the White House – Indian Affairs Executive Working Group (WH-IAEWG), Consultation and Coordination Advisory Group (CACAG). It contains those federal Tribal consultation statutes, orders, regulations, policies, manuals, and protocols that specify procedures as to how Departments, agencies and bureaus are to carry out consultation, It also includes many of the laws, orders, regulations and policies requiring that government-to government relationships with tribes be carried out however, it does not purport to be comprehensive or all encompassing. January 2009.

Consultation and Visitation with American Indian and Alaskan Natives. This document (VA Directive 8603) “establishes a directive regarding government-to-government relationships, consultations, and visitation policy between the Department of Veterans Affairs (VA) and American Indian and Alaska Native tribal governments. It sets forth the policies and procedures to be used by VA’s staff when contacting or contacted by American Indian and Alaska Native tribal governments. January 5, 2007.

Gordon Mansfield, Deputy Secretary for Veterans Affairs Testimony before the U.S. Senate Committee on Indian Affairs on the presentation of Gold Medals to Native American Code Talkers and the Department’s outreach efforts to American Indian Veterans. September 22, 2004.

February 25, 2003 IHS/VHA Collaboration:
Indian Health Service (IHS)/Veterans Health Administration (VHA) Collaboration--“On February 25, 2003, the Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) entered into a Memorandum of Understanding (MOU) to encourage cooperation and resource sharing between the Indian Health Service (IHS) and the Veterans Health Administration (VHA). The goal of the MOU is to use the strengths and expertise of both organizations to deliver quality health care services and enhance the health status of American Indian and Alaska Native veterans. ”

In the Native American Veterans' Memorial Establishment Act of 1994 (Public Law 103-384), Congress found that, among other things, Native American Veterans have a long, proud and distinguished tradition of service in the Armed Forces of the United States; Native Americans have historically served in the Armed Forces of the United States in numbers which far exceed their representation in the population of the United States; and that a National Native American Veterans’ Memorial would further the purposes of the National Museum of the American Indian by giving all Americans the opportunity to learn of the proud and courageous tradition of service of Native Americans in the Armed Forces of the United States.

The Department of Health and Human Services (HHS) Statement of Policy for the Indian Health Service (IHS) on the Traditional Cultural Advocacy Program. “The Indian Health Service (IHS) recognizes the value of traditional beliefs, ceremonies, and practices in the healing of body, mind, and spirit. The IHS encourages a climate of respect and acceptance in which traditional beliefs are honored as a healing and harmonizing force within individual lives, a vital support for purposeful living, and an integral component of the healing process. It is the policy of the IHS to facilitate access to traditional medicine practices, thereby protecting the right of American Indian and Alaska Native people to their village's traditional culture.” July 29, 1994.

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Other Websites and Resources

The National Congress of American Indians (NCAI) is a national organization founded in 1944 to inform the public and Congress on the governmental rights of American Indians and Alaska Natives. Membership includes tribes from throughout the United States, while monitoring federal policy, and coordinating efforts to inform federal decisions that affect tribal government interests. NACI monitors and provides information on various federal policy issues including the 2009 Presidential Memorandum on Consultation and Tribal-Federal Relations, legislation regarding Veterans Policy Issues, and Health and Human Services Policy Issues which, along with other topics, are tracked and available via the NCAI Policy webpage.

The National Conference of State Legislatures (NCSL) is a bipartisan national organization that serves legislators and staff throughout the United States, its commonwealths and territories. NCSL provides research, technical assistance and opportunities for policymakers to exchange ideas on various state issues, in addition to being an effective advocate for the state government interests before Congress and federal agencies.

The NCSL State-Tribal Institute page provides information on issues that affect and involve state governments and tribal governments in their unique government-to-government relationship and also highlights the unique leader-to-leader relationships that exist between tribal leaders and state legislators. In addition, the Institute provides a searchable database, powered by StateNet, which tracks state policy and legislation on a variety of issues that affect the Native American population.

Thomas a Library of Congress web site provides access to federal legislative information and searchable databases on current legislation and Public Acts; the Congressional Record; Committee information; Treaties and Government resources, among others.

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