Governor Martinez Signs SB 221 establishing a State-based HIX

Just as it was stated by members of the NM HIX Task Force, now the real work begins.

We as Tribes need to contact the Governors office and Senator Shendo and Representative Taylor to submit names for the Executive Board of Directors and the Native American Advisory Board.

FOR IMMEDIATE RELEASE March 28, 2013   Contact: Enrique Knell (505) 819-1398 enrique.knell@state.nm.us     Governor Susana Martinez Signs Bipartisan Legislation to Establish State-Based Health Insurance Exchange By New Mexicans, For New Mexicans   SANTA FE – Governor Susana Martinez announced today that she has signed Senate Bill 221, establishing a state-based health insurance exchange in New Mexico. The bill creates a framework for a marketplace where consumers can shop for affordable health insurance. The legislation was sponsored by Sen. Benny Shendo (D-Jemez Pueblo) and Rep. Tom Taylor (R-Farmington).   “As I said during my State of the State address, I didn’t support Obamacare, but it is the law of the land. My job is to implement this law in a way that best serves New Mexicans,” said Governor Martinez. “For over 18 months, we have been working to design, build, and implement a health insurance exchange that meets the unique needs of New Mexicans. This legislation builds on those efforts, which had already received conditional approval from the Obama administration, and represents a tremendous amount of hard work and compromise shared by my administration, the legislature, advocates, and the healthcare industry. We still have plenty of work left to do, but I am confident that, working together, we can get it done.”   SB 221 also lays out board appointments, requires the establishment of strong conflict of interest policies, and allows the board to create a Native American Service Center (NASC) to help with outreach to Native American populations. The legislation closely mirrors the Martinez administration proposal to operate a state-based exchange that already received conditional approval from the federal government in January.   “Governor Martinez reached across party lines and compromised to get this done,” said Rep. Taylor. “Once enacted, this new statute will provide a framework to establish an exchange for New Mexicans, by New Mexicans. I appreciate the hard work of the governor and everyone involved to help pass this legislation.”   “SB221 represents a compromise on the establishment of a state-based health insurance exchange. Many parties were able to come together - including legislators, the administration, industry, and advocates - and work towards a solution for New Mexicans,” said Sen. Shendo. “I especially would like to thank Governor Martinez, Senator Jerry Ortiz y Pino, and Representative Taylor for their input and support.  This may not be a perfect solution, but it is a start that helps keep New Mexico on the path towards the creation of a unique solution for New Mexicans. I am pleased we were able to accomplish passage of this legislation and look forward to working on the exchange for years to come.”   Governor Martinez also acted on the following legislation:   SIGNED HB 72 – Commercial Car Lease Adjustment Clauses SIGNED HB 93 – Campaign Fund Transaction Recording SIGNED SB 40 – No Electronic Communications in Jails SIGNED SB 140 – NM Poison & Drug Information Center SIGNED SB 320 – Assistance Animal Act Changes   ###

NM HIX Task Force Accepts NAWG Recommendations

Good Afternoon Everyone, 

This morning the Office of Health Care Reform Health Insurance Exchange Task Force met to accept of reject the recommendations of the individual Workgroups including the disbanded Native American Work Group ( NAWG)

I was the only member of the NAWG present at the meeting in Santa Fe, so I attempted to answer questions by the Task Force regarding the NAWG Recommendations. (BELOW)

It was brought up that there will be an NA Advisory Board and the Board of Directors will reflect the Ethnic Diversity of NM, the Board will be selected by the Governor and certain Legislators.  I stated that there is no guarantee that a NA will be selected and Approved as a board member, and that I was not satisfied with this portion of the Law.

For the most part the Task Force accepted all recommendations on made by the NAWG.  There were a few misunderstandings regarding NA exemptions and it was clarified that "exemptions" related to the ACA regulation Exempting NA from the Mandate to purchase Health Insurance in 2014.
(Exchange Integration third bullet point)

Andy Vallejos from HSD Office of General Council had some objections for language regarding the Federal Tort Claims Act,  but I stated that these recommendations are currently in effect and by including them in this document we are just asking that HSD OHCR HIX "Puts it in WRITING"

I the end Milton Sanchez asked me if there was anything that I would Like to add in Closing...

I commented on:
Lack of Consultation the OHCR NMHIX has yet to directly consult with any Tribal Leader or Government regarding the implementation of an Exchange. While I appreciate the fact that OHRC established a NAWG and had NA on other Work Groups, that does not take the place of Tribal consultation, the information presented today should have been shared with Tribal leaders, before accepted or rejected. According to Federal and State Law the OHCR NMHIS is obligated to consult with tribes when ever a program is introduced or changed that will directly affect NA individuals.

The Fact that the there are no other NA present for this meeting and that the NAWG was the only HIX workgroup told not to meet anymore.  NA are dissatisfied with the process of consultation and collaboration.

I did not talk about the NASC development and budget, and I did not address the letter sent to CCIIO.
I think that we need to wait until Governor Martinez signs the HIX into Law before we ask Tribal Leaders to invoke Tribal Consultation.

Native American

The Native American Work Group met six times between October 23, 2012, and February 12, 2013. During the first meeting, CCIIO representatives joined the Work Group to discuss questions the group had regarding Native Americans and their participation in the Exchange.  It was initially discussed to divide Work Group members into subgroups to research topics in greater detail, but this was overturned at a later meeting.  Over the next several meetings, the group discussed barriers to Native American participation in the Exchange, including tribal members’ current access to health care through HIS which obviates the need for insurance,  cultural barriers against planning for ill health, and challenges for outreach in areas with little or no access to technology in very rural areas.  Differing tribal requirements for proof of membership were discussed, including the need to avoid challenges to tribal sovereignty, and federal rules for tribal membership were discussed.  Concerns were voiced about plan certification of I/T/U providers to become part of “in network” systems.  A primary source of discussion was a proposed Native American Service Center (NASC).  Challenges around rules allowing Native Americans to move from plan to plan, and in and out of the Exchange monthly were also considered.  Work Group members expressed strong opinions about Native American representation on the governing board of the Exchange.

The Native American Work Group made the following recommendations on the February 27, 2013 Advisory Task Force meeting:

Tribal Consultation

The Exchange must adopt a tribal consultation, collaboration, and communication policy that is consistent with New Mexico and federal tribal consultation rules. This policy should include provisions to confer with Indian Health Services, tribal health programs, and urban Indian health programs prior to the roll out of new policies and procedures. Consultation should include, but not be limited to, the following topics:

.    Development of a communication, collaboration, and consultation policy for the Exchange;

.    Development of the NASC, including the Center’s tasks and its advisory council;

.    Assisting tribal governments with premium payment on behalf of its members;

.    Development of the Navigator program, cultural competency training, and education and outreach materials;

.    Development of a tribal enrollment verification system

The Exchange governing board should establish a work group to define criteria and qualifications for prospective Native American board members, of which there must be at least one. The board should coordinate with administrative, legislative, and stakeholder entities to ensure sufficient inclusion of Native Americans.

Exchange Integration

• Tribal enrollment verification documentation might include a tribal enrollment card, certificate of degree of Indian blood (CIB), or any HHS-approved electronic data sources available to the Exchange. If approved data sources are unavailable, the individual does not appear in the source, or the source is not reasonably compatible with an applicant’s attestation, the Exchange must follow HHS-delineated inconsistency procedures.
• The Exchange should provide a mechanism for tribes and urban Indian programs to make individual premium payments to multiple carriers on behalf of their members.
• The Exchange must recognize AI/AN exemptions.
• As a condition of certification, qualified health plans (QHPs) should be required to offer provider contracts to I/T/Us, designated as essential community providers. These contracts must accommodate the unique features of the I/T/U system, including:

.    No open network access (i.e., an I/T/U may limit who is eligible for services);

.    Licensed health care professionals who are employed by tribally operated health programs are exempt from state licensing requirements, if the professional is licensed in any state;

.    Applicability of the Federal Tort Claims Act;

.    QHPs should also accept referrals from I/T/Us as primary care providers

Native American Service Center

Specific outreach, education, and training competencies/functionalities of the Native American Service Center (NASC) should include:

.    A resource specialist on the AI/AN application and enrollment process;

.    Specific AI/AN benefits and protections;

.    Tribal sponsorship of premiums (if applicable);

.    Benefits of the Exchange and the potential for increased revenues for I/T/U clinics;

.    Benefits of becoming an “in-network” provider for each exchange plan, and the designation of I/T/Us as essential community providers;

.    Cultural competency training

The NASC should work with tribal officials and tribal enrollment offices to develop a system of communication and enrollment verification that does not infringe on tribal sovereignty.

The NASC should work with the Exchange to ensure that the web portal can identify AI/ANs for appropriate exemptions, provide a mechanism for aggregated premium payments, and account for “mixed” households (i.e., households with tribally enrolled and non-enrolled members).

As the recommendations were presented to the Advisory Task Force, some members of the Advisory Task Force expressed concern about the lack of progress that has been made by the state on the Native American Service Center.  It was clarified that many aspects of the Exchange, including the Native American Service Center, have been stalled until Exchange legislation is passed.  Discussion ended, and the recommendations were tabled for further consideration.

Article from The Commonwealth Fund "HHS 'Anxious' to Talk to States About Using Medicaid Expansion Funds for Private Coverage"

 

The Commonwealth Fund Washington Health Policy Week in ReviewHash: HHS 'Anxious' to Talk to States About Using Medicaid Expansion Funds for Private Coverage

By John Reichard, CQ HealthBeat Editor

March 18, 2013 -- Top Health and Human Services (HHS) official Michael Hash told reporters last week that the Obama administration is not only interested in talking to states about using federal Medicaid expansion funds to buy private coverage but, in fact, is "anxious" to do so.

"We're anxious to talk about this with any state that has an interest," Hash, director of the Office of Health Reform, said in a telephone press briefing that HHS held to trumpet the accomplishments of the health care law (Pl 111-148, PL 111-152) as it approaches its third anniversary, which is on March 23. But federal officials do not yet have a proposal on that type of Medicaid expansion to which they can respond, he said.

Hash said states are talking to HHS about using federal Medicaid expansion funds under the health care law to buy private coverage for uninsured residents. But the conversations have been informal so far."To my knowledge, we do not have a formal proposal," he said.

States appear to be specifically interested in having those eligible for the expanded Medicaid program under the law use federal dollars to buy private coverage on insurance exchanges without having to meet current Medicaid regulations.

In Florida, GOP state Sen. Joe Negron is working on what he calls a "Florida solution," under which the state would buy private insurance policies with expansion funds, according to the Miami Herald.

The approach could be to allow adults to be covered in the Florida Healthy Kids program, the state's public-private program for low-income children, lawmakers said.

Arkansas officials are considering something similar. Gov. Mike Beebe, a Democrat, has said that HHS Secretary Kathleen Sebelius has told him that Medicaid expansion funds could be used to place low-income citizens in private insurance plans.

Florida Senate President Don Gaetz, a Republican, said in a written statement that the House and Senate will work together to explore how to provide private health insurance options for low-income people and replace the Medicaid program.

 

NY Times Article "The Sequester Hits the Reservation"

The Sequester Hits the Reservation

The Congressional Republicans who brought us the mindless budget cuts known as the sequester have shown remarkable indifference to life-sustaining government services, American jobs and other programs. So what do they make of the country’s commitments to American Indians, its longstanding obligations to tribal governments under the Constitution and treaties dating back centuries?
Very little, it seems. The sequester will impose cuts of 5 percent across theIndian Health Service the modestly financed agency within the United States Department of Health and Human Services that provides basic health care to two million American Indians and native Alaskans. It is underfinanced for its mission and cannot tolerate more deprivation.

Here lies a little-noticed example of moral abdication. The biggest federal health and safety-net programs — Social Security, Medicaid, the Children’s Health Insurance Program, the Supplemental Nutrition Assistance Program, Supplemental Security Income, and veterans’ compensation and health benefits — are all exempt from sequestration. But the Indian Health Service is not.

The agency was supposed to be spared the worst of the automatic cuts; at least that is what its officials believed. Under a 1985 law that served as the model for the current sequester, annual cuts to appropriations for the Indian Health Service could not exceed 2 percent.

Even a cut of that amount is very bad news for the main health care provider for some of the poorest and sickest Americans, living in some of the most remote and medically underserved parts of the country. Like care for veterans, Indian health was supposed to be one area in which duty and compassion trumped cheapness.

The agency’s officials were braced for that level of cuts, but they were mistaken. The Office of Management and Budget interpreted the sequestration law to mean that the 2 percent cap did not apply to most of the Indian Health Service financing.

The agency’s director, Yvette Roubideaux, had to warn tribal leaders last September to plan for a much bigger, $220 million cut, which it expects will lead to 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits each year.

The Indian Health Service operates 320 health centers, 45 hospitals, 115 health stations and 4 school health centers across the country. The vast majority of these are on reservations, where poverty, disease, substance abuse, suicide and other public health challenges are severe.

The government has been increasing its support for the service in the last decade; at a hearing on Tuesday of the House Appropriations Subcommittee on Interior, Environment and Related Agencies, the chairman, Mike Simpson, an Idaho Republican, noted that between 2000 and 2012, financing rose to $4.4 billion from $2.4 billion.

This has allowed some improvement and stability in services. But Dr. Roubideaux told Mr. Simpson that the agency’s catastrophic health emergency fund, which reimburses providers for trauma care and major surgeries, would still run out of money before the end of the year.

The federal government cannot use its budget nihilism to avoid its moral and legal obligations.

HHS Health Care Law 101 follow up

From HHS:

Subject: Follow Up to the Health Care Law 101 Webinar on March 7

 

Good Afternoon,

 

Thank you for your interest in the Health Care Law 101 webinars. Many of you attended our March webinar and we have new information for you. The Power Point slides that were presented are available here: http://www.healthcare.gov/news/brochures/. You will note that the first presentation is the one I gave and there are notes pages so that you can give this presentation to others in your congregation and community. This website also has other presentations you may be interested in.

 

We have also recorded the presentation so that you can view it again or share it with others. The recorded presentation is here: http://www.healthcare.gov/news/brochures/. This website also has many brochures, fact sheets and other helpful information.

 

New information on the Health Insurance Marketplace is located here: http://www.cms.gov/Outreach-and-Education/Outreach/HIMarketplace/index.html and on the orange tab of www.HealthCare.gov.

 

I also mentioned the following websites:

 

www.cms.gov

http://www.cciio.cms.gov/

 

Note that www.cms.gov has a Frequently Asked Questions tab.

 

I have attached the updated schedule of webinars for March and April . To keep updated on when we schedule new webinars, please go to our website, www.hhs.gov/partnerships and add your email address in the right top side of the website page.

 

If you have suggestions on new materials and webinars that you would like the HHS Partnership Center to offer, please email us at ACA101@hhs.gov.

 

Finally, we are working on finalizing our Top 20 questions asked about the health care law and hope to share the questions and answers with you soon. We will share the info in our monthly newsletter, so please stay tuned.

 

Best Regards,

 

Lisa M. Carr, MSW

NMICoA Health Committee Regional meeting Summary

Regional Meeting

Pueblo of Santa Ana
March 22, 2013

I’d first like to thank the Pueblo of Santa Ana (Tamaya) for hosting and providing the location, as well as the refreshments.

I would also like to thank all the presenters, Southwest Women’s Law Center, Pueblo of Jemez and NCPSSM, for giving comprehensive presentations on the NM HIX, Tribal Programs Development, and Social Security.

The meeting Started with an opening Prayer from Santa Ana Pueblo Lt. Governor

Introductions of NMICoA Health Committee members, Presenters and audience members were given.

Paige Duhamel, Staff Attorney from the Southwest Women’s Law Center, gave a power point presentation (included with this document) on the NM Health Insurance Exchange, from Development, to its current status and approved legislation that will govern the NM HIX going forward.  There is a lot of speculation that even with the new legislation, NM will not be able to make certain deadlines in order to implement the HIX.  Other topics not covered include:

·         Native American Work Group (NAWG) being disbanded until after the Legislative session and because the House and Senate bills called for Advisory committees to be developed and selected by State officials taking place of the NAWG.  Unofficially, because members sent a letter (Attached) demanding that the state release the $1.3 million so that Tribes can start to develop the purposed Native American Service Center (NASC).  This project had been approved by the Office of Health Care Reform and CCIIO/HHS and was being looked at as a model for other States with Tribal populations or for Tribal populations as a technical resource by region.

·         NAWG recommendation for Tribal Leaders to Evoke Tribal Consultation with HHS and CCIIO regarding the NMHIX, which to date has not NM HSD has not officially consulted with Tribal leaders about the impacts the HIX may have on Tribal Populations.  A Template Letter (Attached) was developed by NAWG members for Tribal Leaders to consider.

You can reach Paige Duhamel for additional questions, or to schedule an informational meeting for your community at

Paige Duhamel
Healthcare Staff Attorney
Southwest Women’s Law Center
1410 Coal Avenue SW
Albuquerque, NM 87104
Telephone:     505-244-0502
Facsimile:       505-244-0506
pduhamel@swwomenslaw.org
Evelyn Blanchard from the NM Center on Law and Poverty, gave a brief background on the development and outcome regarding Representative James Roger Madalena’s House Bill 376 “Native American Opt out of Managed Care”, which would have exempted all Medicaid Eligible Native Americans in NM from being mandated into a managed care organization (MCO).  Currently CMS has dictated to the State that Children and young adults will remain opted-out of managed care with the ability to opt-in. Elders and disabled Native Americans would still be continued to be automatically enrolled into a MCO.  HB 376 Passed every committee in the House and a House floor vote 60-7. HB 376 passed Senate IAC and Judiciary Committees unanimously but was stopped in the Senate Finance committee due to an aide to Sen. John Author Smith not agreeing to the opt-in opt-out of Native Americans on a month to month basis.  For more information visit www.Nahainformation.blogspot.com
April Wilkinson and Lisa Maves from the Pueblo of Jemez gave a presentation (Attached) on Tribal Health Department’s interaction with the State on NM regarding the development and submission of the CMS 1115 Research and Demonstration Waiver “Centennial Care”.  April explained Jemez experience with 638, Third party billing, contracting with MCO, and opposition to Centennial Care.  Lisa described the Jemez ability to care coordinate and their experience with MCO “Service Coordinators”.  Lisa gave several examples of Jemez interventions into the coordination of care Jemez tribal members. Both expressed the Pueblo of Jemez’s willingness to consult with other Tribes regarding 638 development, best practices, and contracting with MCOs.  You can contact them at:
Pueblo of Jemez Tribal Administration        575-834-7359

April Wilkinson- Lwilkinson@jemezpueblo.org

Jemez Health and Human Services    575-834-7413

Lisa Maves- Lisa.maves@jemezpueblo.us

Leroy Aragon from the National Committee to Preserve Social Security and Medicare (NCPSSM) spoke about the myths of Social Security and Medicare and gave the facts.  Roy, explained Cost of Living Adjustments, Chained CPU, proposed changes to Aged eligibilities, and politics of Washington DC and Social Security. He fielded questions from the audience members. Roy is available to speak to Elders in Tribal communities he can be reached at:
Roy Aragon
Regional Organizer
NCPSSM
(505) 884-3946
aragonr@ncpssm.org

Visit www.ncpssm.org for more information relating to Social Security and Medicare.

Closing prayer was given Former Governor, Andrew Gallegos, from Santa Ana Pueblo

HB 376 Comments

From the Center on Law and Poverty:

 

Good day, Everyone,

Despite overwhelming support of committees of both the House and Senate and a full House vote of 60 in favor and 7 opposed our effort to secure passage of HB 376 was thwarted in the final days by Senator John Arthur Smith’s (D-Deming) policy analyst, Michael Burkhardt, who insisted that the bill be amended to require that Indian managed care enrollees be locked into membership for a year.  A compromise was sought that would have a lock-in period of three months but the proposal was rejected.  The bases of Mr. Burkhardt’s demand are not clear but it may have been tied to HSD’s repeated assertion that “the managed care program will become unsustainable when Native Americans would switch between managed care and fee for service on a monthly basis.”  The department offered no substantiation of its position.  The history of managed care enrollment by Indian people shows a consistent pattern of non-enrollment over a sixteen year period.  Only 15% of Indian Medicaid beneficiaries are enrolled in managed care out of a Medicaid population of approximately 100,000 people.  A related point of contention raised by HSD was the $108,000 state cost for technological changes which would have to be made by HSD to accommodate the purported month-by-month enrollment/disenrollment.  These issues were fully covered in the March 6 synopsis of the bill prepared by CLP attorney Quela Robinson.

 

• Under the state’s current rules, Native Americans are already afforded the option of “opting-out” of managed care during the first 90 days of any 12-month enrollment lock-in period.  Reducing the deadline to 30 days should not require a massive new influx of technology spending.
• The Affordable Care Act mandates that Native Americans are subject to a special enrollment period that permits purchasing of or changes to qualified health insurance plan through the Exchange on a monthly basis.  The ASPEN system is already required to accommodate this functionality before 2014 to permit Native Americans to transition between Exchange and Medicaid coverage accordingly.
• Lastly, any technological improvements made to a state’s Medicaid eligibility and enrollment IT systems made before December 31, 2015 are eligible for a federal match of 90/10.  That means that any changes the state makes to the ASPEN system to accommodate enrollment periods, transitions or renewals of Medicaid coverage will be re-imbursed 90 to 10.  If it is indeed true that the state will have to spend $108,000 to make this adjustment, the federal government will pay 90% of this cost.  Therefore, the actual cost to the state is $10,000.

This information highlights the arbitrariness of Mr. Burkhardt’s decision to block passage of HB 376 by preventing a hearing before the Senate Finance Committee which is chaired by Senator Smith.  The action is unacceptable. One has to ask: How is it either the purview or responsibility of a Senate policy analyst to thwart the consensus of not only the unanimously-endorsed position of tribal leadership but also of state legislative bodies that over-whelming supported the tribes’ position?  In the next several days discussions will be initiated to examine the action and a response.  It is important that the broad-based participation that was developed to work for passage of HB 376 is sustained and that we are able to gather together to construct a response that makes clear the voice of our leadership and people will not be dismissed.

 

The road to respectful co-existence has and continues to be difficult.  Jemez historian Joe S. Sando’s description of conditions leading up to the Pueblo Revolt come to mind: “Indignity was created upon indignity” and because of the indifference to the human suffering of the people, the actions of the conquerors became repugnant to the people.

Best regards, Evelyn

 

Evelyn Blanchard

NMICoA Health Committee Regional Meeting

The agenda for the Next Regional meeting, I am trying to see if I can find a any additional meeting space for the afternoon to have a Strategy session regarding next steps for opposition to Centennial Care.  Will keep you all posted.

New Mexico Indian Council on Aging

Regional Health Committee meeting

Pueblo of Santa Ana (Tamaya) Council Room

March 21, 2013

9AM-12PM

Agenda

 

• Welcome Invocation Santa Ana Pueblo Councilman Leonard Armijo
• Introductions
• NM HIX Presentation Paige Duhamel Southwest Women’s Law Center
• Legislative/Title VI Update Ray Espinosa NM ALTS Department
• Medicaid Centennial Care
• Affects Tribal Governmental Policy April Wilkinson Pueblo of Jemez
• Affects to Tribal Coordination of Care Lisa Maves Pueblo of Jemez
• Social Security/Medicare Update, Leroy Aragon National Committee to Preserve Social  Security and Medicare (NCPSSM)
• Closing Prayer Councilman  Leonard Armijo

NM HIX Native American Work Group recommendation

From Roxane Bly Co-chair of the NM HIX Workgroup:

Based on the current situation, we believe our best strategy is to ask tribal leaders to invoke the consultation policy and meet with CMS directly.  I will be drafting a template that we can use for these letters.  The State has not formally consulted with the tribes regarding the Health Insurance Exchange since 2011.

Exchange Legislation:

• SB 221 is Senator Shendo's bill to establish the NM Health Insurance Exchange.  It passed the Senate on 3/11 with a 36-5 vote.  It's been assigned to the House Health, Government & Indian Affairs Committee and is expected to pass through the House.  There are significant problems/flaws with this bill, but at this point, we each need to consider what is best for our consumers - a federally facilitated Exchange or a flawed State Exchange
• One good thing about SB 221 is it includes language to establish the Native American Service Center.

The Following document is a Template that Tribal leaders can use to invoke Tribal Consultation.  Supporting documents can be found in previous posts on this Blog.


Marilyn Tavenner
Acting Administrator
Center for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD  21244

RE:  New Mexico Tribal Consultation

Dear Ms. Tavenner:

In November 2011, the State of New Mexico was awarded a Level I Establishment Grant to develop the New Mexico Health Insurance Exchange (NM HIX).  Included in the grant was an initiative designed to create a Native American Service Center (NASC) to ensure that the NM HIX is accessible, complies with American Indian components of the Affordable Care Act (ACA) and Indian Health Care Improvement Act (IHCIA), and facilitates meaningful, ongoing tribal consultation.   Approximately $1.3 million was allocated for tribal consultation, Native American outreach, education, and assistance activities, and staffing for the NASC.

Since 2010, the State of New Mexico Human Services has not formally consulted with tribal leaders regarding plans to establish the NM HIX and NASC.  Further, they have not spent any of the Establishment Grant funding to complete any of the activities for which the $1.3 million was allocated.   As part of the New Mexico Health Insurance Exchange Advisory Task Force, the State convened an informal Native American Work Group , but recently cancelled its meetings and suspended its activities.

Despite the lack of formal consultation, the State has proceeded to make pivotal decisions and miss key deadlines related to the establishment of an Exchange.  Specifically, they have chosen to suspend all activities related to the Establishment grant until there is an entity established with the legal authority to operate as the NM HIX.   While efforts have been made to pass legislation necessary to allow the New Mexico Health Insurance Alliance to operate as the NMHIX, it is not clear that Governor Martinez will enact it.

This letter serves as a formal request to consult with the Center for Medicare & Medicaid Services and the Center for Consumer Information and Insurance Oversight regarding the New Mexico Health Insurance Exchange and Level I Establishment Grant funding.  It is not acceptable for the State of New Mexico to proceed with (or suspend) key policy and funding decisions without formally consulting with the New Mexico Indian Pueblos, Tribes, and Nations.

Sincerely,

HB 376 What Happens Now?

 

Good Afternoon and happy St. Patrick day,

 

After what happened with the legislative process I was, at the least, very frustrated and angry, but then I remember that, getting support for the bill and passing it through the legislature and involving Tribal Leadership in the fight, getting all Tribes and Programs on the same page WAS the POINT! We knew going in that the chances of the bill getting Through and out of the house let alone the Senate was a long shot.  We also knew that it would be a huge accomplishment if the bill was passed, but we always knew that if it passed Governor Martinez would most likely VETO it. 

 

That was the point, to Show HHS, CMS, Congress, BIA that the State doesn't want to work with Tribes, even though we have overwhelming support from both Tribes and Non-Indians in NM.  We have to point out that the bill passed 60-7 (89% in favor) in the House and was unanimously passed in every Senate Committee that it was heard. 

 

 

 

From Center on Law and Poverty:

 

There are different ways to look at this dastardly act by a temporary analyst, former NM Dept of Health Secretary.  CMS can have no doubts about the stand the tribes have taken re managed care.  As Regis says, this ugly maneuver is as good as gold in that sense.  But, we do not accept Mr. Burkhardt’s decisive action and it calls for a clear, forceful response that informs him and any other analyst who may harbor undermining actions that is not the way we play the game and there are consequences for errors.  We will meet to develop our strategy.  When I called attention to the Pueblo Revolt at Ohkay Owingeh had no idea that we’d be enjoined  to again let it be known, this is will not be allowed to happen.  Through our work together we have developed strength.  Now we will use it in the wisest and most effective way we can.

 

Evelyn Blanchard

ABQ Journal Article "Legislature hires ex-govt, officals"

This article in not directly related to health care but given our recent trouble in the legislative process it speaks to who the legislature really listens to, hired ex-government officials, not constituents.

Legislature hires ex-govt. officials

By Thomas Cole / Of the Journal on Sat, Mar 16, 2013

POSTED: 12:31 am
LAST UPDATED: 1:03 am

For its regular session each year, the state Legislature hires several former government officials as temporary workers to help them analyze proposed legislation and provide other support.
Among those on the payroll this year: the recently fired head of the New Mexico Finance Authority, former Secretary of State Mary Herrera, a former public regulation commissioner busted for pot possession while on government business and a former legislator convicted of drunken driving three times while in office.
Former Finance Authority CEO Rick May earned $23 an hour as an analyst for the House Republican leadership during the Legislature’s 60-day session ending today.
The Finance Authority board dismissed May in September in the fallout over an audit of the agency forged by its former controller. May was never accused of taking part in the forgery or trying to cover it up, and he has said he did nothing wrong.
May served as Gov. Susana Martinez’s secretary of the Department of Finance and Administration before being moved to the Finance Authority in 2011.
Herrera, a Democrat elected secretary of state in 2006, earned $12.90 an hour as a roving secretary for House committees during the session.
Herrera was defeated for re-election in 2010 after being repeatedly accused of creating a pay-to-play culture in her office. She said the allegations were false and politically motivated.
Herrera was also accused of general mismanagement of the office, including its handling of elections, but she said she inherited many problems from her predecessor.
Former Public Regulation Commissioner E. Shirley Baca earned $28.13 an hour during the session as an analyst for the Democratic leadership in the Senate.
While on the PRC and en route to an out-of-state conference on utility financing, Baca was arrested at Albuquerque International Sunport when marijuana and a glass pipe were found in her luggage. Misdemeanor charges were dismissed, because airport police failed to tell her about her right against self-incrimination.
Baca, a Democrat, was defeated for re-election to the PRC in 2006. She served six years in the House as a representative from Las Cruces before her election to the commission in 2002.
Former state Rep. Albert Shirley earned $25 an hour as an analyst for House Speaker Ken Martinez, D-Grants.
While in the House, Shirley pleaded guilty twice and no contest once to DWI. He was arrested on marijuana charges in 1998, but a prosecutor later dismissed the case, citing insufficient evidence.
Shirley, a Democrat, served eight years in the House as a representative from Church Rock before being defeated for re-election in 1992.
Other former government officials hired by the Legislature for this year’s session:
♦ William J. Verant, fired by Gov. Martinez in 2011 as head of the state Financial Institutions Division. Verant led the !– –ision for 16 years under Republican and Democratic governors.
Verant earned $19 an hour as an analyst for the House Democratic leadership.
♦ John Kormanik, former state budget director and deputy secretary of the Department of Finance and Administration.
Kormanik, recently appointed to the state Board of Finance by Gov. Martinez, earned $43.20 an hour as an analyst for the Senate Republican leadership.
♦ Dennis Hazlett, former assistant state treasurer and former deputy land commissioner. He earned $32 an hour as an analyst for House Speaker Martinez.
♦ Dannette Burch, former secretary of the Department of Finance and Administration. She earned $41.14 an hour as an analyst for the Senate Republican leadership.

♦ Michael Burkhart, former secretary of the Department of Health. He earned $40.83 an hour as an analyst for the Senate Finance Committee.

♦ Dorothy Danfelser, former secretary of the Department of Human Services. She earned $26.38 an hour as an analyst for Senate Republicans.
♦ Paul Minogue, former state budget director and deputy secretary of the Health Department. He earned $43.20 an hour as an analyst for the Senate Democratic leadership.
♦ Dona Wilpolt-Cook, former state budget director and deputy secretary of the Department of the General Services. She earned $36.76 an hour as lead analyst for Senate Republicans.
♦ Ron Forte, former deputy secretary of the Department of Transportation. He earned $54.24 an hour as chief of staff to Senate Majority Leader Michael Sanchez, D-Belen.
♦ Ron Beserra, former deputy state treasurer and former director of the state Racing Commission and the Albuquerque Convention Center.
Beserra was deputy to former Treasurer Michael Montoya, who was convicted after leaving office of collecting millions of dollars in kickbacks in exchange for state investment contracts.
Beserra earned $26.38 an hour as deputy sergeant-at-arms of the Senate.
♦ Florence “Lee” Witt, former assistant to Barbara Richardson, wife of former Gov. Bill Richardson. She earned $25.12 an hour as a secretary for Senate Majority Leader Sanchez.
The former government officials were among more than 460 temporary workers, including custodians, cooks and proofreaders, hired for the legislative session.
Many of the employees are retired government workers, but temporary workers for the Legislature are exempt from restrictions on collecting a pension and a government paycheck at the same time.
UpFront is a daily front-page news and opinion column. Comment directly to Thom Cole at tcole@abqjournal.com or 505-992-6280 in Santa Fe. Go to www.abqjournal.com/letters/new to submit a letter to the editor. — This article appeared on page A1 of the Albuquerque Journal

Last Day of Legislative Session

Good Morning Everyone,

From the looks of the Senate floor schedule it doesn't look like House Bill 376 is going to be heard in this morning.  I do not have any further details on it's status. From what I have been told House bill 376 never made it out of the Senate Finance Committee.  It was being held up, because Senator John Author Smith's aid Mike Burkhardt didn't understand/like the ability for NA to switch between Managed Care and Fee for Service on a monthly basis.  We were not given the chance to challenge, debate, or present an amendment, the bill was simply not heard therefore tabled.  I am new to the whole legislative process,  I think that we could have lived without this provision or amended it so that NA were given a period of 30 days after becoming eligibility was determined enrollment was completed, to switch between the 2 options. After that 30 day period is over then that NA would be locked into that option for one years time.  This is how enrollment currently works with the Salud program.  I believe that the issue was that HSD thought that allow NA to do this would put a burden on HSD administrative staff and increase administrative costs. The other issue with this ability is HSD believed that allowing NA to switch would have a negative affect on MCOs ability to coordinate care.  

Both of these statements are unsubstantiated, there is no evidence that NA currently switch between Managed Care or Fee for Services on a regular basis, 80-85% of NA population continues to remain "opted out" of Managed Care. Care Coordination for those NA individuals who opt out may not happen at a MCO but, as Tribal Health programs have stated, does happen at the Health Clinic level, by Health Benefits coordinators, CHR and Clinical Staff.

HSD has also stated that they do not have a "Fee For Services" Program they do have the ability to reimburse for Medicaid Services provided by Medicaid Providers, and that this program is too costly, because they do not have the ability to Track cost vs. Health outcomes. I don't think that HSD understands the Argument where they might not have the ability to track health outcomes or coordinate care through the Fee For Service Provision of Medicaid, but Tribes Do, and Do well.  This it seems less about providing healthcare services and more about Control, control of policy, control of services, control of eligibility, and Control on Funding. 

I will keep you all informed if there are any changes, the conflict with HSD and MAD over Centennial Care and its mandates for NA doesn't end here.

Support HB 376 CALL Senator John Arthur Smith office

From The Center on Law and Poverty:

Good morning, everyone,
All of you have received the below message from Erik Lujan with an update on HB 376 and his recommendation about what we all need to do right now.  Please take a minute and make the call to Senator Smith’s office (505-986-4714) or email him (john.smith@nmlegis.gov) to tell him that you want the bill moved to the Senate floor for a vote.  If all of us will make this effort, it will be impressive.  Rep. Madalena, Regis Pecos and others are working diligently to get this bill to the floor, your voice will enlarge and reinforce these efforts.  As Erik states the bill is not on the today’s Senate agenda but with our help, it could be heard tomorrow which is the last day of the session.  Let’s make it happen.

From Councilman Joe Garcia:

Greets All,
I have made a call to Senator Smith office. Relayed that we are in support of the passage of the HB 376.  The office did not have knowledge about where it will go next, committee or floor.

From Center on Law and Poverty:

Senator John Arthur Smith’s direct line is 505-986-4365 (john.smith@nmlegis.gov).  For those of us who are not officials, identify yourself by tribe or that you work for a particular tribe.  When I called, his secretary asked where I lived.  It is not an unusual question as the legislators listen to their constituents first, but HB 376 impacts every Indian in the state, so we are speaking on behalf of all of us when we call.             

 

From Lisa Maves Pueblo of Jemez:

I agree.  We need to get as many people behind this as possible RIGHT NOW.  Shouldn’t there at least be some counter proposal to the monthly enrollment option if they are going to use that as the reason to hold this up?  Yesterday there was some discussion of a quarterly alternative, which would be completely acceptable and if the bill passes, even annual wouldn’t be horrific if people are allowed to choose whether to be in an MCO or not.

 

Governor Bruce Tafoya Pueblo of Santa Clara:

Already sent him an email as well!!

 

From Lisa Maves Pueblo of Jemez:

By the way I placed a call to Senator Smith’s office as well.  I encourage all of you to do so

 

From Maria Clark Pueblo of Jemez:

Just heard that Senate Finance closed down and won't hear any more bills. We are wondering how many other Native American bills were shut down. Some current and former state HSD employees need to go to Tribal Sovereignty 101.

NO hearing Agenda for HB 376

Good Morning everyone,

I just wanted to relay the information that was given to me yesterday by the Senate Finance Committee Staff.  The way I understand it all bills that were waiting to be heard in the Senate Finance Committee are going straight to the Senate Floor for a vote.  With only two more days left in the Legislative session this is not uncommon.  I checked the Senate Floor Agenda for today Friday March 14, 2013 and HB 376 was not on it.  I also checked the Agenda for the Senate Finance Committee and the same notice from yesterday "Committee called at the will of the Chairman" and  "See door for agenda". 

In discussion with other advocates Committee Chairman might be holding the bill because of a recommendation of his Staff member Mr. Mike Burkhardt's objection to NA ability to enroll or dis-enroll on a monthly basis.  The full discussion was posted yesterday. Mr. Burkhardt wanted an amendment to the bill to exclude this portion. As I understand it currently Salud members have a month to decide whether they want to "Opt-in" to managed care, or whether the want to "opt-out" and use Medicaid Fee For Service, after that they are "locked in" to that option for one year.  In my opinion continuing this practice is okay if it gets the bill passed and we get permanent legislation on this issue.  There is a possibility that Senator Smith will hold the bill because this issue is unresolved an to me that is unacceptable, to come all this way do all this work and have one Staffer (who is a Former HSD Director) hold up the bill.

What is needed now is Tribal leaders, Health Programs, Advocates, community members to call Senator John Arthur Smith and demand to know the status of HB 376.  If the bill is being held up demand that it be sent to the Senate floor for a vote.

Senator Smith does not have his office number posted online but you can call the Chief Clerk of the Senate and ask to be directed to his offices (505) 986-4714 or email:

john.smith@nmlegis.gov

HB 376 hold up in Senate Finance Committee

From The Center on Law and Poverty

Good morning, Everyone,
Movement of HB 376 is being held up by Mr. Mike Burkhardt who is a policy analyst for Senator John Arthur Smith, Chairman of the Senate Finance Committee. Mr. Burkhardt who is an unelected official is demanding an amendment to HB 376 that would establish an annual enrollment/disenrollment criterion. There is nothing in the bill that speaks to enrollment periods but in repeated testimony the Human Services Department has stated its objection to month-by-month open enrollment for Indians. As the state law reads now there is the option to “opt-out of managed care during the first 90 days of any 12-month enrollment lock-in period.” Regrettably, our needs are being overshadowed by political power-playing that is familiar to all of us. Rep. Madalena and Regis Pecos are trying to get the matter of the amendment resolved so that the bill can be heard in the Finance Committee today. The Finance Committee will not meet until after today’s floor session which will likely be 5:00pm to 6:00pm. The Finance Committee meets in Room 322.

Two actions are needed now. We need to have as many people as possible show up by 6:00pm at Room 322 of the Roundhouse to attend the committee hearing so that we will have a show of strength. I will not leave for Santa Fe until 5:00pm so will or will not be able to confirm with you that a hearing will be held. I should learn earlier and will notify you as soon as I know. The second action needed is for every one of us to make a call or calls to Finance Committee members to ask for their support for HB 376. You may be told by the Senators’ secretaries that the bill is not on the schedule to be heard but you can respond that it will be and the Senator’s support is important. Today the Finance Committee schedule was not published but was posted on the door to the hearing room and this is likely what will happen for the next two last days of the session. I’ve attached the list of committee members previously sent so you have the information handy. It’s up to us now to put as much pressure on the Senators as we can. We can be successful.
My best regards,

Evelyn Blanchard
Organizer
NM Center on Law & Poverty