Tribal Medicaid
WK&G attorneys Kim Baker and Debora Juarez played a central role in
securing a favorable response from the State of Washington affirming the reimbursement of Medicaid funds to numerous tribal
entities.
Following the passage of the 1975 Indian Self-Determination and Assistance Act, U.S. Congress passed the Indian Health
Care Improvement Act of 1976 ("IHCIA"), to remedy "the deplorable status of Indian health."
Through IHCIA, Congress made significant changes to the federal medical welfare program commonly known as Medicaid. The
federal Medicaid program, established in 1965 pursuant to title XIX of the Social Security Act, 42 USC § 1896, et. seq.,
is jointly funded and administrated by state and federal government for the benefit of low income or disabled individuals.
Of significance, IHCIA allowed Indian communities to be reimbursed for 100% of the medical services provided to tribal
members at Indian Health Service (IHS) clinics on or near reservations. In short, IHCIA greatly expanded the use of
Medicaid benefits in Indian Country.
Since 1997, a private service group agreed to provide mental health screening and counseling to tribal children in
Washington State. Under varying contractual arrangements, the service also completed the Medicaid billing process for the
mental health services for a fixed fee or a percentage. After several parties learned that the services provided failed to
include complete assessments, appropriate diagnostic coding and documentation of the services and impact on the children,
internal investigations were undertaken to assess whether the Medicaid reimbursements that had been received were
appropriately billed or whether self reporting of potential regulates, accompanied by the need for repayment was necessary.
Some tribal entities in Washington self reported potential Medicaid billing irregularities to the OIG. The investigations
conducted by several other tribal programs lead to the conclusion that there was no need to either self report or repay any
of the reimbursement.
The State of Washington has admitted that while Medicaid billing guidelines exist for the reimbursement of medical services,
there are no guidelines for reimbursement of mental health services. The scope and nature of the medical care guidelines are
inapplicable to the assessment of the need for and benefit from mental health services. After reviewing the existing
billing provisions, the State and OIG concluded that while some of the billing practices appeared tenuous, the lack of
guidance precluded any finding of billing misconduct and the self reported matters would be closed without further
investigation or sanctions.
The State has been meeting with tribal representatives to address the lack of guidance relative to mental health services
reimbursement. Should you desire any information about the tribal-state Medicaid meetings, or need any assistance with
your reimbursement program, please do not hesitate to contact Debora Juarez at (206) 628-6781.
Indian Law on the Washington Bar Exam
Gabe Galanda successfully spearheaded the
Washington State Bar Association (WSBA) Indian Law Section and Northwest Indian Bar Association's efforts, in union
with local tribal leadership, to have federal Indian jurisdictional principles tested on the Washington State bar exam. In
October, the WSBA Board of Governors voted unanimously to include Indian law on the Washington bar exam, effective the summer
of 2007. Gabe was instrumental in securing support for the issue from the Association of Washington Tribes and Affiliated
Tribes of Northwest Indians, former Washington Attorney General Christine Gregoire and her successor Rob McKenna, and King
County Prosecutor Norm Maleng. In recognition of his hard word on the bar exam issue, the Northwest Indian Bar Association
bestowed Gabe with the Native Justice Award in November.
WK&G's Tribal Practice Continues to
Expand --
Leona Colegrove
(Quinalt/Hoopa) recently joined Debora Juarez (Blackfeet) and Gabe Galanda
(Nomlaki/Concow) and their colleagues in WK&G's Indian Law & Gaming Practice Group. With a unique
understanding of Indian Country's legal needs, WK&G's team of Native and non-Native attorneys provide tribal governments and businesses
with the highest quality legal counsel in litigation, regulation, business and policy matters.
Gabe Galanda Selected for Ambassadors Program in
the ABA Business Law Section --
Gabe Galanda, Associate in WK&G's Seattle office, has been selected as one of five lawyers to participate
in the American Bar Association Section of Business Law's Ambassadors Program for a two-year term. The Ambassadors
Program represents a commitment by the Section to encourage the participation of lawyers of color in Section activities.
"Tribal Debt Financing Overview" by
WK&G Of Counsel Debora Juarez and Associate Gabe Galanda.
"Reservations of Right: The Intersection of
Insurance Law & Federal Indian Jurisdictional Principles" by WK&G Associate Gabe Galanda.
"Franchising on Indian Reservations" by
WK&G Associate Gabe Galanda.
"Somewhere Over the Rainbow: The Tribal 'Pot of Gold' That Is Federal Title IV-E Funding" by
WK&G Associate Leona Colegrove.
"To Incorporate or Not to Incorporate? Taxation
of State-Chartered Tribal Businesses" by WK&G Member Jeff Wolf.
If you or your colleagues are interested in attending any of these upcoming Indian law presentations, please contact Debora Juarez, Gabe Galanda or Leona Colegrove, any of whom would be
happy to make appropriate arrangements for you to attend.
ATNI Winter Conference (February 7
- 10, 2005). Three WK&G attorneys will be speaking at the Affiliated Tribes of Northwest Indians
(ATNI) Winter Conference in Portland, OR.
"Doing Business in Indian Country" at
the ABA Mid-Year meeting (February 11, 2005). WK&G Associate Gabe Galanda will be speaking on how the
body of tribal, state and federal law that we commonly call "Indian law" is the foundation for every transaction in
Indian Country.
"IGRA's 17th Birthday: Time for
Changes?" at the ABA Gaming Law Minefield conference (February 17, 2005). Join WK&G attorney
Debora Juarez as she moderates this
discussion at the American Bar Association 9th Annual National Institute on The Gaming Law Minefield conference.
Notice
You are receiving this email newsletter because of your professional relationship
and personal friendship with Debora Juarez, Gabe Galanda and/or Leona Colegrove.
If you do not want future quarterly e-newsletters, please reply indicating as much and we will remove you from our list.
These materials have been prepared by Williams, Kastner & Gibbs PLLC for information purposes only and are not intended to
be used as legal advice. For further information, please email Debora Juarez or Gabe Galanda
For comments or suggestions regarding the Indian Legal Advisor or to enroll others to receive future issues,
contact Leslie Larson.
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