OLYMPIA — Attorney General Bob Ferguson, the Swinomish Indian Tribal Community and the Washington Health Care Authority announced today that a federal appeals court has reversed a last-minute Trump Administration decision to deny Medicaid funding for Dental Health Aide Therapists in Washington tribal communities.
Dental Health Aide Therapists, or DHATs, help fill a void in tribal communities, many rural, which have a significant shortage of dentists and dental services. Native Americans experience untreated dental conditions at more than three times the rate of the United States’ general population.
The state and Swinomish jointly filed an appeal with the U.S. Court of Appeals for the Ninth Circuit after President Biden took office. The state and Tribe also asked the Biden Administration to reverse the decision, but it defended the decision. Last week, the Ninth Circuit ordered the Centers for Medicare & Medicaid Services (CMS) to approve Medicaid funding for the dental therapists.
The decision to deny Medicaid funding, made by CMS, came on the last day of the Trump Administration and nearly a year after an independent federal hearings officer recommended the funding be approved. CMS previously approved Medicaid funding for a similar program in Alaska under the George W. Bush Administration.
Ferguson, on behalf of the Health Care Authority, and the Swinomish Tribe jointly filed their petition with the Ninth Circuit in March of 2021 asking the court to overturn the federal agency’s decision.
On Jan. 12, a three-judge panel with the Ninth Circuit agreed with the state and Swinomish that CMS’ denial was “not in accordance with law.” The court ordered CMS to approve the Medicaid funding for DHATs in Washington.
Once approved, the federal government will cover the entire cost of DHAT services for Medicaid patients in Washington. Currently, the state is covering all of the Medicaid costs out of its own budget.
In 2015, Swinomish became the first tribe in the country to establish its own dental health provider licensing law and regulatory system, which includes the licensing and regulation of dental therapists.
“We are very thankful for the decision of the Ninth Circuit Court of Appeals authorizing Federal Medicaid payments to Dental Therapists working in tribal dental programs,” said Steve Edwards, Chairman of the Swinomish Indian Tribal Community. “Dental Therapists are a Native solution to the unmet oral healthcare needs in Native communities. They provide culturally appropriate care to the patients and communities they serve, and they free up dentists’ time for the most complex conditions and procedures.”
“But in order for Dental Therapists to be a sustainable part of tribal oral health programs, it is essential that Federal Medicaid payments be available for Dental Therapist services,” continued Chairman Edwards. “We are grateful for the Court’s decision that will make this sustainable Medicaid funding possible.”
“I want to thank the tribes, tribal leaders and tribal organizations who have worked with us for years to bring Dental Therapists to tribal health programs,” said Chairman Edwards. “I also want to express appreciation to our partners in the Washington Legislature, to the Governor and the Health Care Authority, and to the Attorney General’s Office for their support of Dental Therapists and their commitment to making Federal Medicaid available for their work. This has truly been a partnership of the tribes and state to address the oral health disparities in Native communities.”
Chairman Edwards added, “At the same time that we pursued approval of Medicaid in the Court of Appeals, we have worked with Skagit Valley College to create the dəxʷx̌ayəbus-Dental Therapy Education Program, the first Dental Therapy training program in the lower 48 states. This program has been accredited by the Commission on Dental Accreditation (CODA) and is beginning to train future Dental Therapists to help address oral health disparities. We look forward to further collaboration with the state to ensure the success of our dəxʷx̌ayəbus-Dental Therapy Education Program.”
“This successful case is a great example of building strong state-tribal relations,” Ferguson said. “I appreciate the leadership of the Swinomish Tribe. I will continue to partner with tribal governments in order to reduce health disparities.”
“This is very welcome news, and the result of tremendous efforts by Swinomish, AG and HCA,” said Gov. Jay Inslee. “This is a big step toward ensuring access to dental care, and for recognizing Tribal sovereignty.”
“This decision creates a space for tribal members to directly serve their communities,” said Aren Sparck, Director of the Office of Tribal Affairs at the Washington State Health Care Authority. “It highlights the importance of state and tribal health leaders partnering with each other to create change. This is one of the more promising developments we have seen in the country toward creating needed access for tribal communities disproportionally affected by health disparities.”
Dental Health Aide Therapist program
In 2017, Senate Bill 5079 authorized DHATs to provide dental services statewide on reservations. The bill also directed the state to pursue federal Medicaid funding for the services.
The bill, proposed by Tulalip Tribes member and then-Sen. John McCoy, passed with overwhelming bipartisan support in the Legislature and was signed into law by Gov. Inslee.
DHATs are professionally trained to perform about 40 oral health care and dental procedures in a culturally competent manner, ranging from preventative services like cleanings to simple extractions. They work under the supervision of dentists, who are trained in a much wider array of procedures. DHAT services increase tribal access to preventative dental care, allowing dentists to focus on more complex procedures. They also reduce wait times and off-reservation referrals that could require patients to travel long distances for care.
Washington’s DHAT program was modeled after the successful program in Alaska, which is widely used in tribal communities there. Alaska originally sent native villagers to New Zealand to train as DHATs before eventually creating its own training program.
After Swinomish created its own dental licensing program, the first tribal Dental Therapist outside Alaska began practicing at the Swinomish Dental Clinic in 2016. Swinomish subsequently sent several tribal members to Alaska to be trained, and has since developed a training program with Skagit Valley College which is more accessible to students in the lower 48 states.
CMS approved Medicaid funding for Alaska’s DHAT program, which began in 2004.
Medicaid funding fight
After McCoy’s bill became law, HCA began the process with CMS to approve the use of federal Medicaid funding for DHATs for tribal communities.
The federal Indian Health Care Improvement Act, reauthorized as part of the 2010 Affordable Care Act, specifically referenced that DHAT services could be included under the federal Indian Health Service. As a result, if HCA’s request were approved, the federal government would pay 100 percent of Medicaid costs for DHAT services in tribal health programs, with no matching contribution from the state.
CMS initially denied the request in May of 2018. HCA and the Swinomish Tribe asked the federal agency to reconsider its decision. A federal hearings officer conducted a day-long hearing in Seattle and in February 2020 agreed with the state agency and Swinomish that Medicaid funding could be used, and recommended approval.
After nearly a year of inaction, on the last day of the Trump Administration, the administrator of CMS disagreed with the hearings officer, and again denied the use of Medicaid funds for DHATs in Washington.
Last week’s ruling by the Ninth Circuit reverses that decision.
IN OTHER STATE NEWS...
AG Ferguson statement on Washington State Supreme Court declining to review Albertson’s $4 billion dividend payment.--WA AG
Ecology penalizing seafood processor for fuel spill after vessel fire in Tacoma.--DOE
TACOMA –
Free Fuel Reduction Workshops for Contractors Scheduled in Eastern WA.
More than $4,000,000 available for Eastern Washington forest landowners to promote forest health, reduce impacts of wildfire.--DNR
Eastern Washington restaurant convicted in case involving misbranding of fish.
SPOKANE – A multi-year investigation by Washington Department of Fish and Wildlife (WDFW) detectives into the illegal, unreported, unregulated (IUU) and misbranding of fish has resulted in hefty fines for a popular eastern Washington restaurant, TJ’s Bar and Grill in Kettle Falls.--WDFW
(2) NEWS FROM OUR CONGRESSIONAL DELEGATION TO DC.
Amtrak to Add Second Round-Trip to Vancouver BC by March 7
Cantwell: “I’m thankful that Amtrak is finally on the path to fully restore service in the Pacific Northwest”; Additional service pushed for by Cantwell will restore Amtrak Cascades service to pre-pandemic levels--Sen. Cantwells office
WASHINGTON, D.C. – This week, Amtrak announced in a letter to the Washington State Department of Transportation and the Oregon Department of Transportation that the company will add a second round-trip to Vancouver, B.C. beginning March 7, restoring full service on the Cascades line to pre-pandemic levels.
In the letter, Amtrak also stated that it will increase the number of daily trips between Seattle and Portland from four to six beginning in fall 2023.
“I’m thankful that Amtrak is finally on the path to fully restore service in the Pacific Northwest. I-5 corridor in the State of Washington is one of the most congested corridors in the nation and the Cascades service provides a convenient alternative to travelers. I will work to make sure Amtrak meets its commitment to restore additional service to Vancouver B.C. by March 7th and add two trips this fall,” said U.S. Senator Maria Cantwell (D-WA), who serves as Chair of the Senate Committee of Commerce, Science and Transportation.
Pre-pandemic, more than 750,000 annual riders utilized the route connecting the State of Washington, Oregon and British Columbia – a critical connector for the region’s businesses and travelers. The route from Seattle to Vancouver, B.C. was suspended altogether in May 2020 due to the COVID-19 pandemic.
In May 2022, as the country recovered from the pandemic, Sen. Cantwell spoke with Amtrak CEO Stephen Gardner and urged him to restore service between the State of Washington and Vancouver B.C.
Amtrak restored one of the two round-trips in September 2022. Shortly after, Sen. Cantwell pressed the nominees for Director of the Amtrak Board of Directors in a committee hearing on how they planned to restore full service.
“We had a pandemic and we had disruption of services in key areas across the West,” Sen. Cantwell said. “We cannot simply say we don't have enough conductors, we don't have enough baggage handlers… We're not messing around here. We're not messing around here when it comes to the reestablishing (of) these services.”
Throughout the pandemic, Sen. Cantwell was a champion of the nation’s freight network. Due to her leadership, the bipartisan infrastructure bill provides $66 billion for rail grants she authorized as Chair of the Senate Commerce Committee, including $22 billion for Amtrak. Currently, USDOT is accepting applications for the Federal-State Partnership Passenger Rail grant program which can be used to improve the Cascades service or build a new rail route in Washington state. The applications are due on March 7, 2023.
IN OTHER CONGRESSIONAL NEWS...
Former Preschool Teacher Patty Murray, Now Incoming Senate Appropriations Chair, Returns to Olympia: Vows to Keep Fighting to Fix Child Care Crisis After Securing $1.8 Billion Funding Boost--Sen. Murray's office
(3) WORLD & NATIONAL HEADLINES.
Ukraine war: No chance for serious peace negotiations yet, says UN chief--UN NEWS CENTER
The UN Secretary-General said on Wednesday that he did not believe that there was an opportunity yet, to organise “a serious peace negotiation” between the warring parties in Ukraine, nearly a year on from Russia’s full-scale invasion.
Following that sobering assessment, António Guterres also told the World Economic Forum meeting in Davos, Switzerland, that he remained committed to alleviating the suffering of Ukrainians and vulnerable people in the wider world, still reeling from the conflict’s “dramatic, devastating impacts” on the global economy.
“There will be an end…there is an end of everything, but I do not see an end of the war in the immediate future,” Mr. Guterres said. “I do not see a chance at the present moment to have a serious peace negotiation between the two parties.”
In a related development, the UN’s top humanitarian official in Ukraine expressed her deep sadness at the helicopter crash close to a kindergarten, in a Kyiv suburb on Wednesday morning, which claimed the lives of at least 18 victims, including the country’s Interior Affairs Minister.
“I am deeply saddened by the tragic deaths of the Ukrainian Minister of Internal Affairs Denys Monastyrskyi, First Deputy Minister Yevhen Yenin and State Secretary Yurii Lubkovych,” said Denise Brown. The UN Resident Coordinator for Ukraine confirmed that other unnamed Government officials and residents, including children, had been killed and injured in the incident at Brovary.
In Other World news...
Afghanistan: Collapse of legal system is ‘human rights catastrophe’
The ongoing collapse of the rule of law and judicial independence in Afghanistan is “a human rights catastrophe”, UN-appointed independent human rights experts warned on Friday.--UN NEWS CENTER
Remarks by Ambassador Linda Thomas-Greenfield at a UN Security Council Briefing on the Situation in the Middle East--USUN
Austin to Convene Meeting on Ukraine Defense.
Secretary of Defense Lloyd J. Austin III will convene another meeting of the Ukraine Defense Contact Group tomorrow at Ramstein Air Base in Germany. The meeting will be the eighth in a series of meetings, initiated in April 2022, to discuss current and future efforts to provide support to Ukraine in maintaining its sovereignty.--DOD
NATIONAL.
Eye Surgery Practices Agree to Pay $1 Million and End Discriminatory Policies Towards People with Disabilities--DOJ
The Justice Department announced today that it has filed a proposed consent decree with Barnet Dulaney Perkins Eye Centers (BDP) and American Vision Partners (AVP), to resolve its lawsuit alleging that the eye care practices violated the Americans with Disabilities Act. The lawsuit alleged that BDP and AVP refused to operate on certain patients who needed assistance transferring from their wheelchairs for surgery and required other such patients to pay for third-party medical transport and transfer assistance. Medical providers routinely offer this type of assistance to patients who need help transferring from a wheelchair to an examination or surgical table for surgery and exams.
“The Americans with Disabilities Act requires health care providers to offer equal access to their services,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “Patients with disabilities must not be denied crucial medical services or forced to pay surcharges because they need transfer assistance. The Justice Department is fully committed to protecting the civil rights of individuals with disabilities to get the medical care they need.”
“This agreement reflects an important step in obtaining equal access to health care services for Arizonans with disabilities,” said U.S. Attorney Gary Restaino for the District of Arizona. “The U.S. Attorney’s Office will continue to work closely with the Civil Rights Division to ensure that all Arizonans are afforded equal opportunity to access health care services in our state.”
Under the decree, BDP and AVP will end their policies of denying surgery and prohibiting staff from providing transfer assistance to people with mobility disabilities. BDP operates eye care facilities throughout Arizona, and AVP, one of the largest eye care practice management organizations in the country, partners with eye care providers in Arizona, New Mexico, Nevada and Texas, including BDP, Southwestern Eye Center, M & M Eye Institute, Retinol Consultants of Arizona, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Havasu Eye Center, Visage Aesthetics and Plastic Surgery and Moretsky Cassidy Vision Correction. These eye care providers will also train staff on the new policy requirements and on safe transfer techniques, and pay $950,000 to patients and prospective patients who were harmed by its policies and a civil penalty of $50,000.
For more information on the Civil Rights Division, please visit http://www.justice.gov/crt. For more information on the ADA, please call the department’s toll-free ADA information line at 800-514-0301 (TDD 800-514-0383) or visit www.ada.gov. ADA complaints may be filed online at http://www.ada.gov/complaint.
IN MORE NATIONAL HEADLINES...
Department Awards Grants to Improve Opportunities and Outcomes for Nation's Postsecondary Students--Dept. of Education
HUD Announces $5.5 Million in Funding Opportunity for Hispanic Serving Institutions
WASHINGTON - The U.S. Department of Housing and Urban Development (HUD) announced that it will make available $5.5 million for Hispanic Serving Institutions (HSIs) to establish research Centers of Excellence (COEs) to conduct housing and community development research. This funding opportunity will help strengthen capacity and invest in innovative and actionable research to address issues regarding housing, economic development, and the built environment for underserved communities.
(4) BUSINESS HEADLINES
State payroll employment increased moderately; unemployment rate rose slightly.--WA. ESD
OLYMPIA – Washington’s economy gained an estimated 2,500 jobs (seasonally adjusted) in December. Job growth was highest in the following industries: Leisure and hospitality, other services, education and health services, professional and business services and financial services.
Washington’s monthly unemployment rate rose from 4.0% to 4.2% in December.
"Job growth appears to be slowing,” said the Employment Security Department’s (ESD) State Economist Paul Turek. "The December jobs report brings another sign that the labor market is beginning to soften but still remains very strong.”
Visit ESD’s website to view the entire Monthly Employment Report for December.
ESD paid unemployment insurance benefits to 52,715 people in December, an increase of 9,945 paid claims over the previous month. Typical seasonal increases in paid claims within agriculture and construction contributed to the overall increase in paid claims over the month.
IN OTHER BUSINESS NEWS...
Washington Community Economic Revitalization Board invests more than $10 million in four counties.--WA Commerce Dept.
NASAA and SEC Announce $45 Million Settlement with Nexo Capital Over Interest-Bearing Accounts--WA DFI
UTC names acting pipeline safety director
LACEY, Wash. - This week, the Washington Utilities and Transportation Commission announced the appointment of Scott Rukke as acting director of Pipeline Safety.--UTC
(5) LOCAL MEETINGS.
CLALLAM COUNTY MEETINGS:
Clallam County Commission work session for 1/23/23
https://www.clallamcountywa.gov/AgendaCenter/ViewFile/Agenda/_01232023-644
Clallam County Commission meeting for 1/24/23
https://www.clallamcountywa.gov/AgendaCenter/ViewFile/Agenda/_01242023-642
Port of Port Angeles Commission meeting for 1/24/23
https://www.portofpa.com/AgendaCenter/ViewFile/Agenda/_01242023-648
City of Sequim Council meeting for 1/23/23
https://www.sequimwa.gov/ArchiveCenter/ViewFile/Item/2745
Clallam County PUD meeting for 1/23/23
https://clallampud.net/wp-content/uploads/2023/01/1-23-23-WEB-Packet.pdf
JEFFERSON COUNTY MEETINGS
Jefferson County Commission meeting for 1/23/23
https://media.avcaptureall.cloud/meeting/db8aa0eb-6dd0-4573-a249-330d4cbf13fa
Port of Port Townsend Commission meeting for 1/25/23
https://portofpt.com/wp-content/uploads/2023-01-25-CommMtg-Agenda1.pdf
Weekly devotional
BIBLE VERSE: Galatians 6:7-8 (New King James Version)
Do not be deceived, God is not mocked; for whatever a man sows, that he will also reap. For he who sows to his flesh will of the flesh reap corruption, but he who sows to the Spirit will of the Spirit reap everlasting life.
Weekly Bible Study
The Broadening Definition of Racism, by Jeffrey W. Hamilton
During the week leading up to the observance of the government's Martin Luther King Day, the local paper heralded the formation of a new group called Churches Uniting in Christ. Nine denominations joined to campaign against racism.
http://lavistachurchofchrist.org/LVarticles/TheBroadeningDefinitionofRacism.htm
Free bible studies (WBS)
https://www.worldbibleschool.org/
Learn English using the bible as text (WEI)
http://www.worldenglishinstitute.org/
(Join us in worship every Sunday starting at 10:30AM Church of Christ)
1233 E Front St, Port Angeles, WA 98362
The Chosen: About the life of Christ
https://watch.angelstudios.com/thechosen
This Week's Video:
256,812 views Premiered Jan 14, 2023
Even as an Oscar-winning A-list actor, Richard Dreyfuss never really fit in with the Hollywood crowd. “There are people who now think that opposing views are un-American,” he tells Glenn. Today, that toxic belief has been spread across the country, and he couldn’t stay silent. Having grown up communist, he’s seen this before, and he believes the root issue is simple: Our schools no longer teach civics. To fight back, he founded the Dreyfuss Civics Initiative and wrote his new book, “One Thought Scares Me.” His hope is to save America by encouraging conversations between people with opposing views. He lives by this. In his own words, he’s a “Lib-o-Conserve-o-Rad-o-Middle of the road-o,” and has been for years. And of course, he’s gathered plenty of stories over those years: Activism, drugs, James Dean, the 1960s, the consequences of celebrity feuds, the power of a good teacher … Oh, and a story about how his great-grand aunt may have assassinated a Russian Emperor.
https://www.youtube.com/watch?v=gqGc6K_W4ik
HEADLINES FROM OTHER SOURCES:
Alec Baldwin Baffled That He, Not The Gun, Will Be Charged With Manslaughter--The Federalist
The Port Angeles Globe is a weekly Publication, every Saturday-- Publisher, Peter Ripley
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