Monday, June 18, 2012

Inter-Tribal Meeting tomorrow

HSD next round of input meetings on Centennial care

Susana Martinez, Governor
Sidonie Squier, Secretary

Media Contact: Matt Kennicott (505) 827-6236 or (505) 819-1402
matt.kennicott@state.nm.us

June 15, 2012
For Immediate Release

New Mexico Human Services Department Announces Public Hearings
Additional Input to be Received at 4 Additional Meetings

Santa Fe – The State of New Mexico Human Services Department (HSD) announced today that it is seeking additional public input and comment on the submission of the Centennial Care 1115 demonstration waiver to the Centers for Medicare & Medicaid Services (CMS).

“With the initial submission of our waiver to CMS, we have seen the opportunity to seek out further input from New Mexicans on our work on Centennial Care,” said Sidonie Squier, Secretary of the Human Services Department. “This input will help us further shape the future of a sustainable Medicaid program to provide services to those most in need while avoiding cuts in the program. It will also help guide our discussions with the federal government as approval of the waiver progresses.”

New Mexico is in the process of modernizing the Medicaid program to ensure its sustainability into the future. New Mexico intends to do that through a request of the 1115 Demonstration Waiver that will result in Centennial Care, which will continue delivering benefits for those most in need, now and into the future, while avoiding cuts. Centennial Care 1115 Demonstration Waiver will result in:

· Maximizing chances of a healthier population
· Purchasing quality care rather than quantity of care
· Slowing the rate of growth of the program costs by maximizing administrative simplicity and focusing on better outcomes, and
· Requiring that plans, providers, recipients and the State all move together to slow the rate of growth of the cost of the program while avoiding cuts, improving quality, and modernizing our Medicaid system.

The State’s full public notice, which describes the Centennial Care Demonstration Waiver proposal in more detail, can be found on the HSD website at http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html.

The State continues to solicit comments on the Centennial Care Demonstration Waiver with several options for interested parties to submit comments.

· E-mail: Medicaid.Comments@state.nm.us
· Phone: 1-855-830-5252
· Regular Mail: Centennial Care comments – Human Services Department P.O. Box 2348, Santa Fe, New Mexico 87504

HSD will hold two public hearings, another Medicaid Advisory Committee (MAC) meeting, and will present before the Legislative Health and Human Services (LHHS) Committee to solicit comments from interested parties on the Centennial Care Demonstration Waiver on:

Date: Monday, June 25, 2012
Time: 1:00 p.m. to 5:00 p.m.
Location: Santa Fe
Legislative Health and Human Services Committee
State Capitol, Room 307 Corner of Old Santa Fe Trail and Paseo de Peralta, Santa Fe, New Mexico

Date: Tuesday, June 26, 2012
Time: 1:30 p.m. to 4:00 p.m.
Location: Albuquerque UNM Continuing Education Building
1634 University Blvd. NE, Auditorium
Albuquerque, New Mexico

Date: Wednesday, June 27, 2012
Time: 10:00 a.m. to 12:30 p.m.
Location: Las Vegas Las Vegas Middle School - Lecture Hall
947 Old National Road
Las Vegas, New Mexico

Date: Monday, July 16, 2012
Time: 1:00 p.m. to 5:00 p.m.
Location: Las Cruces NM Farm & Ranch Heritage Museum
4100 Dripping Springs Road – Ventanas Room
Las Cruces, New Mexico

Webinar and/or teleconference details will be forthcoming, and will be posted on the Centennial Care page of the HSD website at http://www.hsd.state.nm.us as well as the state website at http://www.newmexico.gov/.

If you are an individual with a disability and require an accommodation to participate in the meeting, please call (505) 827-6245 or email Betina.McCracken@state.nm.us as soon as possible.

------------------------------------------
Matt Kennicott
Communications Director | New Mexico Human Services Department | Office of the Secretary
O: (505) 827-6236 | M:(505) 819-1402

Tuesday, June 12, 2012

Center on Law and Poverty comments on Centennial Care

Medicaid “Centennial Care” Waiver:

Oppose Proposals that Harm Low-Income Families

Please join us in asking the Human Services Department to make the following changes to New Mexico’s waiver application before they resubmit it to the federal government:

1. Do Not Eliminate “Retroactive Coverage”

· The state is seeking waiver authority to stop paying healthcare providers for certain medical bills. Currently Medicaid has a feature called “retroactive eligibility” where children and adults who are enrolled in Medicaid can get their medical bills reimbursed for the three months before they were officially enrolled in the program. This ensures that low-income families are not sent to collections for unpaid medical bills.

· Eliminating retroactive coverage will send families into debt. Families should not have to choose between seeking urgent medical care for their children or face financial ruin.

· Hospitals and Indian health providers will face the loss of hundreds of millions of dollars of revenue statewide and bear the costs of unpaid patient debt.

· The state’s assumption that retroactive eligibility will not be needed as of January 2014 because everyone will have health coverage is incorrect. Native Americans and very low income people are exempt from healthcare reform’s mandate to get coverage and may not enroll right away. Many of them will have medical debt when they seek coverage.

· This proposal fails to satisfy the legal requirements for Section 1115 waivers. It is contrary to the objective of the Medicaid Act to serve the best interests of recipients and to assist people whose income and resources are insufficient to meet the costs of healthcare. The proposal also fails to meet the research or demonstration requirements of a Section 1115 waiver. HSD has not evaluated the impact of the proposal on Medicaid recipients, and therefore cannot show that it is an innovative way to improve care. At least one federal appellate court has also ruled that merely saving costs does not meet the purpose of these waivers. See Newton Nations v. Betlach, 9^th Cir. (2011).

2. Do Not Add Co-pays and Fees for Emergency Rooms

· The state plans to charge co-pays to Medicaid patients for using an emergency room when they are found to not actually have emergencies.

· Individuals who go to the ER often believe they have emergencies, and should not be deterred from accessing care for fear of having to pay fees that they cannot afford.

· While the state is proposing not to charge Native Americans co-pays when using Indian Health providers, the waiver application does not clearly address whether co-pays will be charged to Native Americans who must seek care at hospitals outside of this system.

· This proposal fails to promote the objectives of the Medicaid Act and does not meet the research or demonstration requirements of a Section 1115 waiver. Over 35 years of research has already demonstrated that cost sharing and co-pays cause people to delay or forsake access to necessary care.

· NM’s proposal will likely violate federal law which requires that before an individual can be charged co-pays, a provider must inform the individual of the name and location of an “actually available and accessible alternative sources of non-emergency, outpatient services” that charge only a nominal copayment. See 42 U.S.C. 1396o-1(e). These alternatives are not available in our state’s rural and frontier areas.

3. Consult with Tribal Leadership and Indian Health Providers about Managed Care for Native Americans.

State and federal law require the state to consult and collaborate with tribes and Indian health providers on Medicaid policies that directly affect Native Americans. These laws include New Mexico’s State Tribal Collaboration Act, the American Recovery and Reinvestment Act (ARRA), Executive Order 13175, and federal guidance from CMS.
Throughout the waiver process, Native American representatives and tribal leadership have expressed almost uniform opposition to mandatory managed care and have objected to the elimination of the fee-for-service option, citing negative experiences with managed care dating before the implementation of CoLTS in 2008. Waitlists for services remain in the thousands, and outreach and education about the program in rural areas has been insufficient and ineffective. There are also concerns that people will not have access to providers in their area and will have to travel far to get services.

4. Use This Opportunity to Make Positive Changes for Children and Families.

· New Mexico still has not simplified the enrollment process by adopting proposals such as “express lane” enrollment where the Medicaid agency could find children who use programs such as SNAP (food stamps) or IHS and easily enroll them into Medicaid. This would help reduce major disparities in enrollment – 90% of the children in New Mexico who are eligible for Medicaid but still not enrolled are Native American or Latina/o.

· The state should ask for a waiver to adopt “continuous eligibility” for adults. This would allow adults to stay on Medicaid for one year without having to reprove their eligibility each time their family’s income changes over the year. This is especially important for temporary, contract, and seasonal workers so they can have continuous coverage. The state already has continuous eligibility for children. And while the administration says it is considering the option for adults, it was not included in the last waiver application.

The New Mexico Human Services Department (HSD) will be holding public meetings to seek feedback about the Medicaid waiver application. Information and updates will be available on the HSD website at: http://www.hsd.state.nm.us/Medicaid%20Modernization/index.html

Rules governing HHS CMS waiver policy

the following is the web address for the Kaiser Commission on Medicaid and the Uninsured

The New Review and Approval Process Rule for
Section 1115 Medicaid and CHIP Demonstration Waivers

http://www.kff.org/medicaid/upload/8292.pdf

and here is the official rules from HHS and CMS
http://www.gpo.gov/fdsys/pkg/FR-2012-02-27/html/2012-4354.htm

Article in ABQ Journal by Winthrop Quigley

State Seeks Delay in Medicaid Changes

By Winthrop Quigley / Journal Staff Writer on Thu, Jun 7, 2012

The state Human Services Department – after persistent criticism from some stakeholders – has asked the federal government to delay consideration of its April 25 application to change New Mexico’s $3.9 billion Medicaid program.

In a May 29 letter to the Centers for Medicare and Medicaid Services, HSD said its failure to notify Indian health care providers in writing 60 days before submitting its application “raised a concern on the part of (CMS).” HSD said it sent written notification to the providers on May 22. HSD spokesman Matt Kennicott told the Journal the department would probably resubmit its application in late July or early August and would use the time to solicit more public comment on its plan.

Kennicott said the notification problem was a “bureaucratic technicality.”

“Their glitch is a major issue for us,” said Gary Tenorio of Kewa Pueblo Health Corp. “In the beginning there was a lack of consultation and communication between the state and the tribes. In their initial send-out they said they had meetings with the tribes, pueblos and nations. It hasn’t been that.”

The Human Services Department started its Medicaid redesign effort more than a year ago. HSD Secretary Sidonie Squier told the Journal in February that HSD hopes to slow the growth in Medicaid spending over five years by between $140 million and $205 million from the program through a combination of administrative streamlining, quality-of-care improvements, and changes in Medicaid recipients’ behaviors and emergency room use.

HSD got the first public reaction to its application last month at its Medicaid Advisory Committee meeting. Health care providers and advocates for Medicaid consumers raised a number of concerns. Several said that while the HSD concept sounded good, it was not clear how its ideas could be or would be implemented and at what cost to consumers and providers of health care.

Quela Robinson, a staff attorney with the New Mexico Center on Law and Poverty, said health care providers and Medicaid consumers saw the state’s application only after it was sent to CMS and that public comment HSD used to craft a Medicaid reform concept paper was limited to a handful of three- and four-hour meetings last summer held in the middle of workdays around the state.

“Now that they are finally responding to criticism about not being transparent and finally holding public meetings, the question is whether HSD will really listen to what the public has to say,” Robinson said, referring to HSD’s request for a delay. “In the past (the department) has merely informed people about final decisions. This is not good governance.”

In its letter to CMS, HSD says it “engaged in wide-ranging and open dialogue with all of our stakeholders in New Mexico throughout the almost full year we took to design the program.”

Anthony Yepa, a Kewa Pueblo Health Corp. analyst, said that “there are some very good things” in the state’s proposal but that the plan doesn’t adequately take into account a host of “federal laws that dictate and prescribe how health care in native communities should be implemented and carried out.”
— This article appeared on page C1 of the Albuquerque Journal

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Letter from Dr. Dan Derksen to ABQ Journal

Health of Poor Americans Rests in Hands of Justices

By Dr. Dan Derksen / Senior Fellow, Robert Wood Johnson Foundation Center for Health Policy on Mon, Jun 11, 2012

President John F. Kennedy forced Gov. George Wallace to allow the first two black students to attend the University of Alabama in Birmingham on June 11, 1963. At that time African Americans had twice the rate of unemployment, had a life expectancy seven years shorter, were denied the right to a decent public education, and earned only half as much.

Televised from the Oval Office, Kennedy said the National Guard was sent to protect the students’ civil rights because, “They have a right to expect that the law will be fair, that the Constitution will be colorblind.”

Nine Supreme Court Justices will decide this June on health legislation affecting every American, but especially those that civil rights legislation sought to redress nearly five decades ago.

Today, blacks compared with whites still have nearly twice the rate of unemployment, have a life expectancy 3.6 years shorter, are almost half as likely to graduate from college, and earn 60 percent as much. Yet we should not indulge our cynicism that for minorities over the years – less employment, poorer education and worse health – yield reluctantly to change.

Supreme Court decisions, and our state actions, affect New Mexicans. Over 40 percent of Native Americans are uninsured here, while Hispanics have twice the rate of uninsured compared with whites (24 versus 12 percent).

It’s estimated that someone dies each day in New Mexico for lack of health insurance, and 45,000 per year across the country. Glaring health disparities persist in Native American, Hispanic and African American populations – lower-quality health services, higher infant mortality and more chronic diseases such as diabetes. Nothing reduces intractable health disparities faster than insuring the uninsured.

As a nation, we pay twice what other developed countries pay per person for health care. Yet our health outcomes are worse, far worse for the uninsured, with a widening gap as demographics change. For the first time in history, minorities comprised a majority of U.S. births (50.4 percent) in May. Hispanics in states bordering Mexico comprise over half the Hispanic population of the United States. With the presidential election nearing, candidates scurry to court their vote.

New Mexico ranks in the bottom three states for percentage of the population that is insured, and last in access to health care and prevention. Within our grasp are the levers to lessen our uninsured more than any other state, if we choose to pull the crank. For struggling families, for working poor who can’t afford to buy insurance, it’s unconscionable to do nothing, or placate the growing discontent with hollow half-measures.

What will the justices decide? If the Affordable Care Act (Obamacare) is upheld, 150,000 uninsured New Mexicans whose household income is less than $32,000 a year for a family of four will be covered by Medicaid starting in January 2014. An equal number of uninsured would get help paying for health insurance through a state or federal market exchange in the state. This will create good jobs in our state, and dramatically improve health. That is unless the Supreme Court throws it all out.

Like civil rights legislation 50 years ago, decisions will soon be made whether each American can enjoy the privileges of a healthy citizenship, without regard to race or color. These opportunities come as rarely as leaders with the courage to turn the wheels of justice. As Theodore Roosevelt put it a century ago, “No nation can be strong whose people are poor and sick.” Fifty years from now Americans will wonder what took us so long, and why so many had to die, waiting for us to act.

Dr. Dan Derksen is a family physician and a professor in the UNM Department of Family & Community Medicine. and Senior Fellow at the Robert Wood Johnson Foundation Center for Health Policy. He is the former director of the New Mexico Office of Health Care Reform and past president of the New Mexico Medical Society and N.M. Academy of Family Physicians.

Julianna Koob~505.920.6002

Santa Fe Reporter article by Colleen Keane

http://www.sfreporter.com/santafe/article-6768-tip-of-the-iceberg.html

Tip of the Iceberg

After SFR told their story, two Native American elders received much-needed services. Many others still need help

Colleen Keane

Patsy Chacon (right) translated for her relatives for the 2011 SFR story that finally created momentum to get assistance for A1náábaah Begay (left) and her husband. But many Navajo elders, such as 92-year-old Elsie Werito (center), still need basic services like electricity and heating materials.

Last fall, Anáábaah and Freddy Begay, an elderly couple in their late 80s from To’Hajiilee, a Navajo community 90 miles south of Santa Fe, faced another bleak and potentially life-threatening winter [news, Oct. 4, 2011: “Winter is Coming”]. For the eighth year in a row, the Begays had been waiting for a septic tank to be installed so they could move into their new home. In the meantime, they lived with their granddaughter, Jerrilyn Nelson, and her four children in a crowded, two-room house with no indoor plumbing. Although Nelson attempted on several occasions to find help from various agencies, not one provided assistance until the Begays told their story to SFR through their niece, Patsy Chacon, who translated from Navajo.

Soon after visiting the Begays, Chacon went to talk to her sister, June Mexicano, the secretary for the To’Hajiilee Health Board, a group that oversees health care in the community. Agreeing that something needed to be done, Mexicano talked to the chapter president, Raymond Secatero, and gave a presentation at a chapter meeting, where the tribal governing body convenes in a place similar to a city hall. By spring, the federal Indian Health Service had provided the septic tank; one of the Begays’ sons paid the $1,500 bill to give them electricity; neighbors donated wood and furniture; and a friend donated a wheelchair.

SFR recently returned to the remote Navajo community of To’Hajiilee to see how the Begays are faring.

Chacon, translating for A[náábaah, says she’s grateful for the coverage.

“She believes that there was some kind of push to get the services they needed,” Chacon explains. “The attention to their situation really helped her and her husband, Freddy. Now, they have moved into their home, and they have running water.” A[náábaah adds that talking to Chacon in Navajo made a big difference, and that few proficient translators are available in To’Hajiilee, where most homes lack Internet service; no local newspapers or radio stations exist; and word-of-mouth communication in the Navajo language is the most effective form of communication.

Mexicano adds that the Begays’ story, especially when communicated in Navajo, shed light on the poor conditions in which many Navajo elders live. Secatero estimates that approximately 300 Navajo elders over the age of 60 live in To’Hajiilee.

“My aunt Barbara is in the same situation, waiting on a home to move into,” Mexicano says.

Elsie Werito, A[náábaah’s 92-year-old sister, is in a similar bind.

“She would like to have electricity in her home,” Chacon says, translating for Werito while she visits the Begays. Currently, Werito runs a power cord from her daughter’s house for electricity, Chacon explains. Werito also says she badly needs other services—firewood, a new wood stove, home repairs and handicapped access. There are cracks in her door, paint is peeling off the walls, and the floorboards are buckling.

Local and Indian Health Service funds come up short when trying to meet all the elders’ needs, and relatives and friends who at one time could have chipped in are also struggling to make ends meet. Secatero says that funding for services has declined over the past few years, with elders often hit hardest.

“They often get lost in the shuffle,” he says.

Mexicano notes that New Mexico’s Medicaid program could help fill some of the gaps in caring for Native elders, but that the program needs a Navajo language interpreter to explain the services.

Secatero says state representatives have come out “once in a great while, but it’s only bilagaanas [Anglos] who come to To’Hajiilee to explain the Medicaid program.” He adds that much is lost in translation if a speaker can’t translate technical Medicaid terminology, and many elders live in such remote areas that even these occasional presentations don’t reach them.

Matt Kennicott, the spokesman for the New Mexico Human Services Department, which administers Medicaid, notes that Native Americans can take advantage of some 40 Medicaid programs tailored to specific needs. The Coordination of Long-term Services (CoLTS) program, for instance, offers qualified elders and handicapped people in-home services like respite care, meal preparation and transportation.

Both of the state’s current CoLTS providers, AmeriGroup and Evercare, employ tribal liaisons and outreach workers—but A[náábaah says she hasn’t received any in-home services from them. As such, she’s a perfect example of a Native elder who knows exactly what she needs, yet falls through the cracks when it comes to receiving help.

But Kennicott says the state’s proposal to redesign its Medicaid program, currently pending federal approval, will help solve some of these problems.

“They will likely end up gaining more services under our plan,” Kennicott writes in an email to SFR. Some examples: flexible plans, traditional healing services, referrals to specialists, tribal program subcontracting—and no co-pays will be required. (For a full list of these services, visit SFReporter.com.)
Alicia Smith, the consultant hired by the state to help with the Medicaid redesign process, has acknowledged the need for improved services for Native Americans.

“Plans [under the current Medicaid providers like AmeriGroup and Evercare] have done a lousy job in reaching out to the Native American community and including them,” Smith said at a press conference in February. She went on to discuss the “translation issue” and said that the state hopes to employ formal translators who can also explain things using tribal-language idioms that elders will understand.

But the Medicaid redesign appears to be at a standstill. Rumors spread recently that the Centers for Medicare and Medicaid Services, the federal agency reviewing the redesign, rejected the state’s proposal because it lacked adequate tribal input and didn’t comply with transparency rules. On June 1, however, Kennicott said that the rumor was inaccurate and that he had no idea where it was coming from.

“It was not rejected,” Kennicott tells SFR.

CMS spokesman Alper Ozinal said he could not comment, but as of press time, CMS had not formally approved the redesign.

For Chacon, who is fluent in Navajo and already has the experience of explaining assistance services to her family members, the need for language translators presents a perfect job opportunity. So far, no one has come around offering translator jobs, she says, leaving the prospect of meeting Native elders’ needs to a patchwork of mostly non-Navajo-speaking local, state and federal agencies—at least for now. But she and other To’Hajiilee residents hope that will change.

“Our elders are not going to be with us forever,” Mexicano says. “We need to make them as comfortable as possible now.”

In English, To’Hajiilee means “Bringing Up Water From a Natural Well.” There are an estimated 1,658 members of the To’Hajiilee band of Navajo Indians, according to a 2005 US Census Bureau report.

Quela Robinson

Staff Attorney

New Mexico Center on Law and Poverty

720 Vassar Dr NE

Albuquerque, NM 87106

(505) 255-2840 (v)

quela@nmpovertylaw.org

June 8th meeting major points

GENERALCOMMENTS and RECOMMENDATIONS

Tribal workgroup meeting held at Kewa Pueblo Health Corporation on Friday June 8, 2012 on 1115 demonstration waiver under the Social Security Act

The Tribal workgroup meets to inform and educate members about the Centennial Plan, 1115 (b) waiver request and other tribal health care delivery systems in tribal lands. The workgroup is not authorized or sanctioned by any tribe or tribal organization and is a voluntary group meeting to share information and provide meaningful input in response to diverse tribal health care issues.

General cross-cutting issues among all tribes:

There was general agreement on the following:

1) Based on tribal sovereignty and the ACA such legal protections state there is no mandatory participation for Natives to enroll in Managed care and nor is there a penalty if a Native does not buy health insurance. This may allow for FFS for tribes and support the ‘opt out’ option currently in place and initiate Government to Government discussions and implementation of Centennial Plan with Tribes as stated in Federal and State consultation laws. Tribes want to see the No cost sharing and No mandatory participation in managed care, in writing, in the waiver.

2) Tribes feel the 1115 waiver is incomplete and request more updated tribal health outcomes data from phase 1 of Managed care. This request should include FFS data from managed care providers. Various sections and provisions of the waiver has undefined service definitions, unknown planning and design models, undetermined assessments, outcomes measures and benchmarks should be put in writing and communicated transparently to providers and stakeholders.

3) Tribes request a more defined, descriptive, process, expectations, outcomes and meaningful dialogue in the Native American section describing ‘block grants’ or ‘pilot projects’ that can be developed with tribes. What systems, new systems, blended or combined plans and health impacts are being proposed by the State in this section?

4) Tribes want input in the RFP the State has developed and address the impact on Native American health care and health delivery systems.

5) Tribes want to have direct communication with Governor Martinez on 1115 waiver to discuss waiver, process and health impact to Native Medicaid population.

6) Tribes request a meeting with CMS and State Medicaid Assistance Division simultaneously to discuss implementation of the waiver and impact on Native Medicaid population health care.

At this meeting there was general explanation on the CMS Waiver process, the current ‘voluntary’ retraction by the State and some communications with CMS. As noted in the CMS requirements the tribes request a ‘sufficient level of detail on the hypothesis, evaluation parameters, expected outcomes and expenditures’ on the waiver to facilitate meaningful communication with the tribes.

Workgroup agrees each tribe has it own current health delivery systems in place and their own independent plans along with the required concurrence by individual tribal leaderships in addressing their health care needs.

Additional comment: the demonstration 1115 waiver amendments should be subject to the new guidelines issued to state health officials on April 27, 2012. The final rule 42 CFR Part 431 Subpart G, left open whether waiver amendments were subject to the regulations governing public notice and comment that at this time states submitting amendments did not need to comply with the new rule. The Tribes MAY wish to state strongly that waiver amendments should be subject to public notice and comments requirements as amendments may have a bigger impact than the actual waiver being proposed or in place.

Friday, June 1, 2012

CMS possibly rejects Centennial Care

We have been receiving reports from health advocates that CMS has rejected NM HSD 1115 Waiver "Centennial Care", due to a lack of Tribal Consultation and non-compliance with transparency rules.

This was a verbal announcement by CMS Secretary Tribal Advisory Council STAC. This announcement was verified by Ken Lucero, but as too what it means next that not clear. According to other health advocates CMS could only oppose part of the waiver and allow the rest of the waiver to proceed.

After contacting CMS Dallas office we found out that there is no official written statement yet from either CMS or NM HSD regarding the announced rejection, and that Cindy Man is currently in talks with Julie Weinberg on NM HSD s next steps.

What all this actually means for us is unknown but Mat Kennicot from HSD has stated that there will probably be another round of input sessions and tribal consultations.