Monday, December 17, 2012

Kewa Workgroup meeting notes 12/14/2012


 

 

Discussion topics

UNM expansion hospital

Letter from Greg Ortiz urging Tribal Leadership to get involved in advocating for the construction of the Proposed Adult Hospital

·         Will not impose any new Taxes or mill levy for Bernalillo County residents and will help honor the UNM 1952 contract agreement with Pueblos.

·         Construction was halted after opposition in NM Legislature and Bernalillo County commissioners

 

Dismantling of the DOH office of Native American Health

Dr. Ron Reid Director of ONAH requests assistance in raising awareness of the unilateral dissolution of the Office of Native American Health, by the DoH Secretary prior to her resignation, without any Tribal consultation.

·         This is another example of the State of NM (Executive) unilaterally making decisions about Tribal Programs without consulting tribes.

 

Tribal Consultation follow up:

·         Identified the major points of contention between the Tribes and the State.

1.      Complete Lack of Meaningful Tribal Consultation between the State of NM and Tribes

2.      Mandatory Enrollment of All Native Americans in to Managed Care Organizations (MCO) Through the Indian Health Care Improvement Act (IHCIA) Native Americans are protected being mandatorily enrolled into Managed Care Programs

3.      Elimination of the “Opt in” ability for Eligible enrolled Native Americans in the Medicaid Program Native Americans have had this option since the institution of the Salud Program in NM and many other Tribes in other states including tribes in AZ and Kansas have similar provisions in their states Medicaid program

4.      Elimination of the Fee for Service Component from the Medicaid program for Native American Population. The fee for service program is utilized and preferred by Tribal Programs and IHS when billing for Medicaid Services, because of prompt payments.  The Fee for service program is going to remain intact for undocumented immigrants in the State of NM

5.      Elimination of the Prior Quarter Coverage “presumptive eligibility” for Medicaid Enrollment. The elimination of this provision will greatly affect Tribal health program and IHS budgets that rely Medicaid reimbursements.

6.      Any individual Native American enrollee cost sharing or Tribal program/facility cost Sharing.  Native Americans are protected from cost sharing through provisions in the ARRA, PPACA and the IHCIA

 

           

·         talked about dialogue between the State and CMS after the Consultation- State is unwilling to alter Waiver after being presented with the Tribes issues brought up at the session and unwilling to sit back down with Tribes to discuss tribal concerns with the waivers contents

1.      After the November 27th meeting with Tribes CMS reps called the State and presented HSD with the Tribes Demands Per IHS and CLP:

 

“Admiral Grinnell and Navajo VP Jim met with Cindy Mann last week, apparently the state received our demands from the consultation on the 27th and has indicated that they don’t plan to meet with tribes again and will not back down from their proposal. No timelines yet relative to a decision.

Rumors started swirling about the approval dates for the waiver and RFP after I informed the Con Alma health policy forum December 30th about the consultation on the 27th and CMS’ plans to meet with tribes again during the first week of January. Apparently, MCO’s and state contractors in attendance got nervous about their paydays and asked the state during the LFC hearing last week. Secretary Squier insisted that everything is on track and that they had been mis-informed. I spoke to our CMS Project Officer Robert Nelb today and he confirmed the following;

a. CMS is working on scheduling a call with the group from the 27th for the first week of January

b. No final decision will be made on the waiver before this call/meeting occurs.

c. The state could go ahead and grant the contracts on January 7th anyway, but they will have to be amended if any part of the waiver isn’t approved.”

 

·         Next consultation with CMS will be Conference call in first week of Jan 2013,  this is a major concern with the group because the proposed call is expected to be the 6th  or 7th of January 2013, as you all know new leadership will just be taking office and will be expected to participate in this CMS Call!?  We as a workgroup need to do two things, contact CMS and ask for a later date and educated incoming leadership as to the situation with the State and CMS

need to educate new leaders/councils

 

Medicaid Expansion

Small good news Governor Martinez is leaning more towards accepting Exchange as part of a “bargin” to get the exchange passed her way. CLP reported after having a one on one conversation with Governor Martinez

 

NMHIX

·         There isn’t much to report on the exchange other than the Blue print was transmitted to CMS on Friday December 16th

·         It was pointed out that NA while will be able to take advantage on the Exchange we are protected for the Mandate to purchase Insurance

·         The NA workgroup of the HIX is talking about what the Native American Service Center is suppose to be its function and role within the Exchange

 

Action Items:

 

Obtain resolutions from AIPC on Medicaid Expansion and Centennial Care from Ken Lucero

 

One pager on Centennial Care for Leadership

 

Five to Six pages on Centennial Care for Tribal Councils Health Departments/workers

 

Letter from Governor Magdalena to other Governors urging involvement in educating incoming leadership on Centennial Care

 

Need bullet points to April on focus of letter ie. major points/ concerns for your pueblo

 

Form a small Group to go to each Tribe (if need be) to Educate Leadership and Councils so that we have a unified voice when speaking to State and CMS

(Erik April volunteer so far)

 

Tuesday, December 11, 2012

NM HSD responses to Kewa Questions on Centennial Care








CMS Clarification on Medicaid Expansion

On December 10 CMS released a FAQ on Exchanges Market Reforms and Medicaid, Governor Martinez had asked in a letter whether NM could limit FPL eligibility or phase in Expansion implementation. 




26. Can a state expand to less than 133% of FPL and still receive 100% federal matching funds?
A. No. Congress directed that the enhanced matching rate be used to expand coverage to 133% of FPL. The law does not provide for a phased-in or partial expansion. As such, we will not consider partial expansions for populations eligible for the 100 percent matching rate in 2014 through 2016. If a state that declines to expand coverage to 133% of FPL would like to propose a demonstration that includes a partial expansion, we would consider such a proposal to the extent that it furthers the purposes of the program, subject to the regular federal matching rate. For the newly eligible adults, states will have flexibility under the statute to provide benefits benchmarked to commercial plans and they can design different benefit packages for different populations. We also intend to propose further changes related to cost sharing.
In 2017, when the 100% federal funding is slightly reduced, further demonstration opportunities will become available to states under State Innovation Waivers with respect to the Exchanges, and the law contemplates that such demonstrations may be coupled with section 1115 Medicaid demonstrations. This demonstration authority offers states significant flexibility while ensuring the same level of coverage, affordability, and comprehensive coverage at no additional costs for the federal government. We will consider section 1115 Medicaid demonstrations, with the enhanced federal matching rates, in the context of these overall system demonstrations.

Friday, December 7, 2012

Secretary Sebelius' remarks at today's White House Tribal

Secretary Sebelius' remarks at today's White House Tribal 
> Nations Conference
> 
> White House Tribal Nations Conference
> 
> December 5, 2012
> Washington, DC
> 
> Good Morning.  The Department of Health and Human Services is proud  
> to be partners with you in working to open new doors of opportunity  
> across Indian Country.
> 
> During a recent visit to Tribal communities in South Dakota, I saw  
> some great examples of our work together.
> 
> At Sinte Gleska University on the Rosebud Sioux Indian reservation,  
> I met young people served by a unique children’s mental health  
> program that blends Western and traditional Lakota cultural  
> approaches to healing.
> 
> I met students at the Red Cloud Indian School on the Pine Ridge  
> Indian reservation where the Administration is supporting a Lakota  
> Language Program which teaches the Lakota traditions through a rich  
> K-12 curriculum.
> 
> And I met community members who had begun to eat healthier and  
> increase their physical activity with support from the Special  
> Diabetes Program for Indians.
> 
> There are rich partnerships like these all across Indian Country.  
> And they are giving more First Americans reason to feel hope for  
> the future instead of despair.
> 
> To be sure, we face incredibly persistent challenges today: high  
> unemployment, energy costs, suicide, chronic disease and federal  
> resources stretched thin.
> 
> But I also know that smart investment has allowed us to make real  
> progress. Programs like those I visited in South Dakota were made  
> possible by a strong collaboration between tribes and the Obama  
> Administration.
> 
> They are also part of something bigger happening across Indian  
> Country.
> 
> When President Obama took office, he recognized that we needed more  
> than a series of individual success stories. We needed a  
> comprehensive approach. And if you look back over the last 4 years,  
> you can begin to see what that has meant for Indian Country.
> 
> Four years ago, the Indian Health Service had a budget of $3.8  
> billion. Today, it’s 29 percent larger at $4.3 billion.
> 
> Four years ago, the Contract Health Service budget was $579  
> million.  In most places, IHS could fund only life or limb  
> referrals. Today, the Contract Health Service budget is $843  
> million, a 46 percent increase that has allowed many more patients  
> to get the referrals they need.
> 
> And it’s not just the budget.
> 
> Four years ago, the reauthorization of the Indian Health Care  
> Improvement Act was hopelessly stuck in Congress. Today, after more  
> than a decade of trying, it has been permanently authorized. The  
> Indian Health Service is here to stay.  The law also means that  
> Tribes can get coverage for their employees through the Federal  
> Employees Health Benefits Program.  More than 10,000 are already  
> enrolled.
> 
> And by approving every single Tribal Facility for the National  
> Health Service Corps, we’re bringing more providers to communities  
> in need. As you know this is a program that says to doctors,  
> nurses, and dentists: “If you go practice in an underserved  
> community, we’ll give you a scholarship or help pay your loans.”  
> Four years ago, because of the complicated certification process,  
> fewer than 60 IHS and Tribal facilities were eligible for Corps  
> members. Today, there are 587.
> 
> I am also proud to say that after close consultation with Tribes,  
> the VA and IHS will announce a national agreement tomorrow for the  
> VA to reimburse IHS for the direct care it provides veterans. This  
> agreement includes the outpatient all-inclusive rate that Tribes  
> preferred. Implementation will begin soon at federal sites. This  
> agreement will make it easier for tribes to enter their own  
> agreements with VA for the health services they provide.
> 
> Now at HHS, the well-being of the American Indian and Alaska Native  
> people is a priority that extends beyond the Indian Health Service  
> to reach every operating division and program office.  We recognize  
> that giving people the opportunity to thrive requires more than  
> just access to quality care. It is also comes from investing in  
> whole families and strong communities.
> 
> Four years ago, American Indian and Alaska Natives in the foster  
> care, and child welfare system had to go through large state  
> programs and outside groups. Today, we have created a process for  
> tribes to operate their own Title IV-E programs. The Port Gamble  
> S’Klallam [ SKLAW-lam] Tribe was the first. And right now we  
> continue to process additional agreements with other tribes.
> 
> Four years ago, we were seeing a steady decline in the number of  
> children in Head Start who spoke a tribal language at home. Today,  
> we’re using Head Start’s new performance standards to begin  
> integrating tribal language and culture into their classrooms and  
> curricula.
> 
> Four years ago, tribal nations were largely on their own in the  
> ceaseless fight against alcohol and substance abuse. Today, our  
> department has a dedicated office working with tribes as they  
> develop detailed action plans and coordinate resources from across  
> the federal government.
> 
> All of this progress is built on a strong foundation of  
> consultation. And we’ve made progress here too.
> 
> Four years ago, HHS had an outdated consultation policy on its  
> books. Today with your guidance it has been updated, and 7 agencies  
> within the Department have their own new or updated consultation  
> policies. Our new Department-wide policy calls for us to regularly  
> evaluate our progress. So we recently sent each of you a letter  
> asking for your input. And I look forward to your perspective.
> 
> Four years ago, our Department’s leadership was receiving irregular  
> updates about its work in Indian Country -- often only when there  
> was a crisis to solve. Today, our senior leaders and I meet  
> regularly with the Secretary’s Tribal Advisory Committee or STAC --  
> the first cabinet level committee of its kind.  And we have charged  
> the STAC not only with addressing today’s biggest problems but also  
> with making the most of tomorrow’s opportunities.
> 
> One of the biggest of those opportunities is our ongoing work to  
> implement the Affordable Care Act. We need your help to make sure  
> people are taking advantage of the law which includes many  
> important benefits for American Indians and Alaska Natives.
> 
> It puts in place new rules prohibiting insurers from imposing  
> lifetime dollar limits on your benefits. Young adults who would  
> otherwise be uninsured, can now stay on their parents insurance  
> until they turn 26.  And key preventive services like diabetes  
> screening and mammograms, now cost nothing out of pocket for most  
> people in private plans and elders on Medicare.
> 
> In 2014, more of Indian Country’s most vulnerable may be covered by  
> Medicaid. States will receive federal funding assistance to extend  
> their programs to uninsured adults with incomes below 133 percent  
> of the Federal Poverty Level. That’s about $15,000 a year for an  
> individual and $31,000 for a family of four.
> 
> At the same time, new competitive insurance marketplaces will allow  
> hundreds of thousands of American Indians and Alaska Natives to  
> purchase quality, affordable health coverage for the first time.
> 
> But we need your partnership to educate tribal communities about  
> the law’s new benefits and protections -- and to identify everyone  
> who is eligible and help them enroll.
> 
> And together, we need to hold our partners in the states  
> accountable. Last year, I wrote a letter to Governors reiterating  
> my full commitment to strong government-to-government relationships  
> with Tribes. And I will continue to remind states that they must  
> consider Tribes full partners during the design and implementation  
> of any programs that use HHS funds.
> 
> Looking back, it’s clear that we are in a much better place today  
> than we were 4 years ago. But the time is now to look forward.
> 
> The journey ahead will not be easy. But it is possible to envision  
> an Indian Country 4 years from now where everyone has access to the  
> quality care they need to get healthy and stay well; where more  
> children have the chance to follow her dreams; and where every  
> community can protect its culture and traditions while creating new  
> opportunities for work and growth.
> 
> We can fulfill that great promise by continuing our work together.  
> We have made great progress, but we have much more work to do. And  
> this Administration is committed to working hand-in-hand with you  
> to improve lives for the better in Indian Country.

NMICoA Health Committee commentary to CMS

NMICoA Health Committee
Commentary to CMS
Re: Centennial Care, Medicaid Expansion, Health Insurance Exchange

The New Mexico Indian Council on Aging (NMICoA) Health Committee was developed in 2009 by its late President, Archie Chavez of Sandia Pueblo, in response to  the institution of the Coordination of Long Term Services (CoLTS) Program by the State of New Mexico (NM).  This program during its development phase did not seek Tribal input or consult with tribes in any proactive fashion.  The State of NM Human Services Department (HSD) felt that contracting with Managed Care Organizations (MCO) would vastly improve access to care and diminish disparities in Native American Elder Populations enrolled in NM’s Medicaid program.

The Health Committee has had meetings with HSD since November 2008 and presented issues and concerns to HSD, Aging and Long Term Services (ALTS) and the Indian Affairs Department (IAD) Secretaries, and the Health Committee has noted that Pueblo seniors enrolled in the CoLTS program still have problems accessing services such as Transportation personal care and respite care because providers are mostly off-reservation and cannot bring services to many rural pueblo communities.  We feel more community based Services should be provided via the network of Pueblo senior Centers and MCO’s would upgrade accessibility and services to Pueblo elders and disabled members.
The Health Committee recommends
  1. Acceptance of a true Government-to-Government relationship between Tribes/Pueblos/Nations with the Federal and State Governments
  2. Tribal/Pueblo/Nations Sovereignty be fully recognized and accepted by NM State Government and the US Government
  3. The Federal obligation be maintained in maintaining Health care programs and funding for Tribes/Pueblos/and nations in NM.
  4. NM HSD needs to be transparent in development of its medicaid 1115 Waiver plan with active interaction, consultation, input from Tribes/Pueblos/Nations
  5. NM HSD has also not provided adequate outreach and Tribal involvement in developing its  Health insurance exchange until very recently.  NM HSD has not developed the proposed special, office of Indian outreach and education with any discussion or input from Tribes and Tribal Health organizations.
  6. The health committee also recommends Medicaid Expansion for Indian people on and off reservation this program need full information outreach to Tribes/Pueblo/Nations explain the benefits and access to care that will be improved for this population.  The Health Committee understands the 100% Federal Medical Assistance Percentage (FMAP), and 138% Federal Poverty Level (FPL) will improve insurabillity of up to 25,000 more American Indian.  The Government of NM has not committed to approving the Medicaid  Expansion in NM and this decision should also be from Tribal Governments on behalf of this very vulnerable population.
  7. The health committee is in discussion with current Pueblo leaders and will continue to evaluate better practice models to long term care fro Pueblo seniors and disabled members to improve clinical behavior and social services for this population in need of these services.

Respectfully submitted,

Florence Chavez, Pueblo of Sandia
Vice President NMICoA
Manuel Cristobal, Pueblo of Santa Ana
Pueblo Councilman, NMICoA Health Committee Member
Joe Cherino, Pueblo of Taos
NMICoA Health Committee member
Kay Ray, Pueblo of Laguna
President Elders Association, NMICoA Health Committee Member
Leonard Armijo, Pueblo of Santa Ana
Pueblo Councilman, NMICoA Health Committee member
Eloise Smith, Pueblo of Laguna
NMICoA Health Committee member
Robin Clemens, Pueblo of Acoma
Senior Center Director, NMICoA Health Committee member
Ron Lujan, Pueblo of Taos
NMICoA Health Committee member

Tuesday, December 4, 2012

Native American HIX work group rescheduled

The meeting scheduled for Dec. 4th has been changed toDecember 18th, 1:30 – 4:00 and will again be at:
Albuquerque Area
Indian Health Service
5300 Homestead Road, NE
Albuquerque, NM 87110