Windy Boy Indian Country health care bill heard in Senate

Monday in the Montana Legislature the Senate Public Health, Welfare and Safety Committee held a two-hour hearing on House Bill 599, introduced by Rep. Jonathan Windy Boy.

"I think it went pretty good," Windy Boy said in an interview after the hearing.

House Bill 599 which would allow certain health care services under the community health aide program to use federal certification standards for health aides and require the state to provide Medicaid funds to train providers on Montana Indian reservations to meet federal certification standards.

"This is federal law," Windy Boy said. "A lot of these standards are already in place. All that we need to do is come in there and put an amendment in there that would explain."

The bill would accept licensing requirements for specific types of service providers and create a two-year program to train people to the standards of the federal certifying body. The training would include scope of practice, supervision and continuing education.

It would apply to people providing medical assistance, medical care, home health care services, private-duty nursing services, dental services, physical therapy, mental health, clinical services, prescription drugs, dentures, prosthetic devices, eyeglasses and screenings.

Windy Boy said the bill would increase access not only to health care but also to preventive care as well. He said it follows the guidelines in the Indian Health Care Improvement Act.

The bill would also allow the tribes to set up boards to pursue third-party billing through Medicaid, he said, increasing the revenue for the tribes by three times.

Windy Boy said the opponents who spoke during the Senate Hearing did not understand the bill, "taking this thing to a place where we weren't even heading."

During the hearing, Past President of the Montana Dental Association Kevin Rencher said he opposed the bill. The Montana Dental Association is committed to helping Montanans, he said, and under-qualified, under-trained and under-experienced people practicing dental surgeries could result in irreversible damage done to patients.

He added that the idea behind the bill is a bad concept, with major flaws.

"I agree we need to work hard so every person in Montana has access to a dental home, dentists in this state are committed to that, but a dental therapist is not the answer," he said.

Al Garver, Montana Dental Association executive director, said the standards of care should not be based on income or the individual's address. The bill is not a new concept, it has been in other states across the country, he said, but people who would be practicing medicine have no accreditation under the bill.

"If the Legislature approved this, it is essentially authorizing this newer, lower-level standard of dental care in our state. Special interests could then push for this lower standard of care for other parts of the state," he said.

Helena dentist Quinn Erwin said that in the beginning he was "in the air" about what to think about the bill. After consideration, he said, he realized the state wouldn't allow an unqualified, unaccredited teacher to teach in schools. He added that the bill is a substandard solution to the problem.

"The dentists of Montana are there for this patient base and, hopefully, we can figure out something, a better model to take care of these patients," he said.

People also spoke in favor of the bill.

Margaret Morgan, representing the Montana Dental Hygienists' Association, said the association supports the bill, although it would like to add an amendment to make the bill stronger, ensuring the same quality care to the rest of Montana and preventing a double standard.

She said the amendment would require all practitioners to possess the same level of education and licensure oversight as those caring for the rest of the public. She added that she has already spoken to the sponsors of the bill and worked with them on seeing if the amendment could be included. Although, if the amendment is not included, the association would support the bill regardless, she said.

"We support the bill, we think this amendment would be an improvement," she said.

Jennifer Show, the diabetes coordinator and a nurse practitioner in Fort Belknap, said she supports House Bill 599. She said that in the recent past, one dentist served more than 5,000 people in Fort Belknap. In this system, most people are not getting dental care or preventative care, she said. Show said it resulted in just emergency care, with many people needing dental surgery or tooth extraction.

Fort Belknap now has two dentists, but the dentist-to-patient-ratio is not low enough to serve the area. Show said the bill is not a new idea, with New Zealand having a similar system. New Zealand's children's preventative services are better than in the United States, she said.

"I fully support this bill. I pray you guys do, too. It is a way for native communities to take hold of their own health care and start to get services to them," she said.

Fort Peck Tribal Councilman Jestin Dupree said that the shortage of medical providers on the reservations is a serious issue. The reservations are severely challenged in retaining and obtaining qualified practitioners who will stay on the reservation, he said. The aid provided in House Bill 599 is much needed for their communities, he said.  

"Frankly, the existing health care system is failing us, as Indian people," Dupree said.

He added that the median age of death for males on the Fort Peck Indian Reservation is 47. For females it is 58.5, and the rate of chronic diseases, such as heart disease, diabetes and  liver disease is 2 to 7 times higher than the rest of Montana, he said.

Windy Boy told the Senate committee that mental health and behavioral health are needed on the reservations and are a necessity for a community.

"The reservations in Montana have one of the highest (rates) in the state for suicides, with Montana being one of the highest in the country," he said.

On the local level, the reservations don't have specialized facilities set up to address a lot of the needs of the residents.

Northern Montana Hospital addresses mental health, Windy Boy said, although it is not enough to properly address the needs of the reservation.

"What I am attempting to do is think outside of the box," he said, "to get better access to health care for us on a local level, especially in our area where we are so isolated."

President of the Fort Belknap Indian Community Council Andrew Werk Jr .; Blackfeet Tribal Business Council Chairman Timothy Davis; Kathy Deserly from Helena and Wolf Point; Rocky Boy Health Clinic CEO Jessica Windy Boy; Indian Health Service Dr. Dan Foster, and a few others also spoke to the committee in favor of House Bill 599.

Windy Boy said in the after-session interview that preventative dental care for the kids is a major goal of the bill, so people can catch what they need to catch at an early stage and prevent any serious issues later on.

He added that in order to gain access to specific dental care; people from Rocky Boy have to travel to Helena.

"We are not trying to take away some of the jobs brought up by some of the opposition," he said. "To get to the point, the level of care that we need, we can do at our local level."

No action had been taken on the bill as of print deadline this morning.