Report From the HIX Executive Board Meeting (day one)

Good Evening everyone,

At todays meeting of the HIX Executive Board there was not Native American issues discussed, except for a about 10 minutes of the budget/request for level I establishment grant funding.  I was said that about 32 million of the original 34 million in the Level I establishment grant is still in there at HSD awaiting the creation of a MOU between HSD and HIA/HIX or for HIX to become a official licensed organization. NM can apply for any additional money quarterly for the development of the HIX as long as HIX can demonstrate the need for the additional Level 1 establishment grant funding.  So there is the May 15 Deadline for funding, but there will also be another opportunity to apply for more funding by August 15. 

The funding for the NASC is still in the budget and will be discussed at tomorrows meeting. 

Theresa Gomez our only NA Board member asked me to give her some idea of what we want in the NASC. I will give an Idea of what I would like to see and I invite everyone in the group to comment as well, please try to reply by 10AM tomorrow (April 30th) we are not sure exactly when the NASC or the creation of the NA Advisory board will be heard.

The NASC should:

• Include the 1.3 million that was set aside in the original Level one establishment grant.
• Have a Director, Liaison and three Navigators preferable fluent in at least one Native Language.
• Be a resource for Tribal Programs first, to educate/Train Tribal programs (CHR Benefits Coordinators, Senior Centers...)  how to operate as navigators/in-person assisters, or provide training to help Certify as navigators/in-person assisters, and instruct Tribal programs how to be reimbursed for providing Navigator/in-person assister Services.
• Help Tribal programs with issues of eligibility, health plan information, and program regulations.
• Be able to determine eligibility of NA individuals on a walk in basis for either Medicaid or HIX.
• Report to NA Advisory Board on  a quarterly basis.

The NA Advisory board should maintain as many of the Native American Work Group under the HIX Task force as possible to maintain continuity, but Navajo Nation Jicarilla and Mescalero as well as Northern and Southern Pueblos should be encourage to nominate a member as well to the Advisory board.  I imagine 11- 13 individuals in this Advisory board.

I also want to mention that one of the presenters, a man from Massachusetts, outlined the time table, scope of work and budget for creating that states exchange. 

• $25million and 60 employees to operate
• 14 months to complete and it s scope was less than what we envision for NM. meaning no SHOP component.
• he didn't think that we could have the Exchange that we want up and running earlier that Oct 2014.

Now on the other hand NM has done a lot of work previous to the actual creation of the exchange though the Health Insurance Alliance, Department of Insurance, and the Task Force effort, we are ahead of Massachusetts was when they started developing their exchange.
Please comment if I left anything out.

Erik Lujan

Volunteer Advocate/Policy Analyst

NMICoA Health Committee

CMS releases Q&A for Medicaid

The following is a press release from CMS regarding FAQ on the ACA.


CMCS Informational Bulletin 

DATE:  April 25, 2013  
FROM:  Cindy Mann, Director  Center for Medicaid and CHIP Services  
SUBJECT:  Affordable Care Act Questions and Answers  
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the release of important information for states on the implementation of the Affordable Care Act.  
Today we issued the next in a series of Frequently Asked Questions (FAQ) to address Affordable Care Act implementation questions.  These FAQs address three main topics: availability of the 75 percent federal match for maintenance and operations, systems issues regarding communication between the Federally-Facilitated Marketplace and Medicaid, and further policy guidance regarding the use of section 1115 demonstrations.  
The FAQs may be accessed at: http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid- and-CHIP-Affordable-Care-Act-ACA-Implementation/FAQ-Medicaid-and-CHIP-Affordable- Care-Act-ACA-Implementation.html 
If you have additional questions, please send them to CMCSPPACAQuestions@cms.hhs.gov  

From the Center on Law and Poverty RE: "Kewa Workgroup"

Good day, Everyone:

The Kewa workgroup met on April 17 to address a number of issues related to healthcare reform, including the newly established state health insurance exchange.  For those of you unfamiliar with the Kewa group,  it originated several years ago in response to the state’s announcement of its Centennial Care plan to manage the Medicaid program.  The group has been influential in educating the tribes regarding the problems related to Centennial Care and its work formed the foundation for the eventual ruling by the Center on Medicare and Medicaid Services (CMS) to prohibit state mandatory enrollment of Native American Medicaid beneficiaries in managed care organizations (MCOs).  At the most recent meeting, Kewa Health Corporation board members and staff questioned the wisdom of maintaining the name, Kewa workgroup, because the workgroup is not a function of the Kewa Health Corporation and only has the name because initial meetings of the group were held at Kewa Pueblo.  Since the Medicaid Convening last October, the concept of the Kewa workgroup which originally included only Pueblo members has been expanded to include healthcare staff from all the tribes and off-reservation facilities.  Anthony Yepa, Acting Director of Kewa Health Department, told the attendees at last weeks’ meeting that he and members of the Kewa Health Corporation Board of Directors believe it is time to recognize the growth and intertribal mixture of the group and that it should be renamed to reflect not only the growth of the group but should take on the definition of an intertribal effort.  Since then the name for the expanded group has become “Intertribal Health Workgroup” which encompasses tribal people on and off-reservation. 

 

Issues discussed:

1.        Kelsey Heilman, Center on Law and Poverty healthcare team attorney, commented on work being done at the Center regarding the health reform law that will be made available to tribal officials and workers within the next two weeks which will focus on specific features pertaining to Native Americans.   There will be two documents:  one will be a pamphlet which can be distributed in clinic offices and other places and the second will be a small manual for use by healthcare workers to give them full information about the Health Reform Law and to assist them in advising and informing consumers in their facilities.  She also highlighted various features of the health reform law that need our attention, such as money in the Health Insurance Exchange for in-person assistants, the Native American Advisory Committee and the Native American Service Center.  The Native American Subcommittee of the Medicaid Advisory Committee also needs attention.  Attached to this email is a list of upcoming Exchange deadlines prepared by the Center’s healthcare attorneys.
 
2.        Iris Reano, Kewa CHR Director, told the group about the work the CHRs are doing at Kewa Pueblo and said that home visits are proving to be the most efficient means to educate the people about the benefits of enrollment in Medicaid and the upcoming Health Insurance Exchange.  At the inaugural meeting of the New Mexico Health Insurance Exchange on Monday Apr. 29 and Tuesday Apr. 30, funding is issue no. 8 on the agenda.  The Health Reform Law of which the Exchange is a function provides for monies to support a program of in-person assistants.  It will be important to make sure that the needs of the people are reflected in a grant application submitted by the Exchange.  A request for funds to support the work of in-person assistants in all the Pueblos and Native communities in the state should be part of the Exchanges grant application. 
 
3.       Representative Roger Madalena (Jemez) told the attendees at the meeting that he hopes that the group will establish a strong identity and that there will be a representative from each of the tribes.  He sees the Intertribal Health Workgroup as the locomotive that can be used to inform all the tribes of issues that require attention and effort.  He stressed the importance of the people speaking with the same voice.  He recognized that there will be differences of opinion but that those differences be handled within the group and that the participants strive to compromise so that in public we are seen as one.  He is concerned that the navigator program which can provide essential assistance to the people is unfunded and offered to talk with the gaming tribes regarding their state contributions and the possibility that some of those funds could be designated to support a navigator program for the tribes.  He stressed the importance of organization of healthcare staff and officials and the need for a public structure so that leadership is well=-recognized.
 
4.       Michael Hely who is on the staff of the Legislative Counsel Service and was the lead drafter on HB 376. stressed the importance of contact with the Legislature and its committees so that the members are well aware of tribal priorities.  He recommended that healthcare staff and officials provide information to the Legislative Health and Human Services Committee at interim hearings throughout the state.  The Center on Law and Poverty is again partnering with Regis Pecos’ Leadership Institute to produce another convening that will address both the Health Reform Law and Medicaid.  The Center’s healthcare team attorneys are working on a Health Reform Law checklist which will form the basis of their presentation at the convening.  It is constructed in such a way that attendees will be able to identify those issues that are most pressing and on which the Intertribal Health Workgroup and the officials can work.  The convening is tentatively planned for the latter part of June.  This will give time to put together the information that can be presented to the Legislative Health and Human Services Committee and other committees during the interim period before the Legislature meets again.  One of the issues that we might address at the convening is whether or not to ask Rep. Madalena to reintroduce HB 376.
 
He explained that the Health Insurance Exchange is a non-profit corporation not a state agency but it is governed by state law.  It was established on March 28^th and within 60 days of that date it is charged with the appointment of a Chairperson and development of a preliminary plan of operation.  By September 28 the Exchange must have a final plan of operation that will include decisions regarding the navigator and in-person assistant programs, policy regarding communication and collaboration with Indian tribes which will include issues of cultural competency.  A Native American liaison will be appointed to assist the Health Insurance Exchange Board to ensure implementation of the exchange program in tribal and off-reservation communities.  The law that governs the Exchange does not require that the Native American liaison be a Native person.  This matter will be discussed at the inaugural meeting on Monday and Tuesday of next week.  It is in our best interest that the liaison be Native and it is difficult for me to understand how the Exchange can fully comply with the requirement for cultural competence if a Native person is not appointed to this very important position.  As you will note the agenda for the Exchange meeting also includes decision-making about the Native American Service Center, consumer outreach and assistance and the Native American Advisory Committee.  These issues are crucial and need serious attention.  Participation in the inaugural meeting provides the opportunity for tribal and off-rez people to be involved in the design of resources made available through the Exchange.  Teresa Gomez (Isleta) has been appointed to the Exchange Board and she has pledged to advocate for tribal and off-rez healthcare issues and needs.
 
5.        Anthony Yepa called attention to the need for tribes to work to help restore the IHS budget which was cut more severely than other agencies by the sequestration.  If you need more information about what you and your tribe can do, please contact Anthony at ayepa@kp-hc.org.   It may be that tribal officials and the Intertribal Health Workgroup would want to launch an effort regarding the IHS budget like that conducted to convince the Center on Medicare and Medicare Services to issue a ruling prohibiting a requirement that Native American Medicaid beneficiaries enroll in managed care.

 

6.       Health Insurance Exchange Inaugural Meeting
New Mexico Workforce Training Center – Room 207
5600 Eagle Rock Ave. NE
Albuquerque, NM 87113

Monday, April 29^th:  10:00am to 5:00pm
Tuesday, April 30^th:    9:00am to 5:00pm
 
A map is attached.
 
Best regards, Evelyn

NM HIX Update for Tribes

NM Health Insurance Exchange (HIX) Update.

The first meeting of the NM Health Insurance Exchange Board will be held on April 29 and 30, at the NM Workforce Training Center, Meeting Room 207, 5600 Eagle Rock Ave. NE Albuquerque, NM 87113.

The following is the best contact information I could find for the newly appointed New Mexico Exchange Board.

David Shaw – CEO, Nor-Lea Hospital District – david.shaw@nlgh.org
Dr. Martin Hickey – CEO – New Mexico Health Connections - Fax: (505)-633-8021 (fax)
Jason Sandel – New Mexico Insurance Pool - jsandel@fmtn.org
Larry Leaming – COO Roosevelt General Hospital - lleaming@myrgh.org
Patsy Romero – COO Easter Seals El Mirador – p.romero@eselm.org
Terianne Everhart – Las Cruces businesswoman - terriane@msn.com
J.R. Damron – Santa Fe Physician – I couldn’t get his email contact info.
Gabriel Parra – Lawyer for Presbyterian Healthcare Services, NM – gparra@phs.org
Ben Slocum – Lovelace Health Plan CEO – ben.slocum@lovelace.com
Dr. J. Deane Waldman – UNM Health Sciences Professor - (505)272-1212 (fax)
Sidonie Squier – Human Services Secretary - betina.mccracken@state.nm.us

Teresa Gomez- gomezt@futuresforchildren.org.

The board will be discussing applying for additional federal funding for the Exchange, including funding for in-person assistance programs, deadline for this funding is May 15th. As Tribes I think that it is important to have some tribal leaders or representatives present at the meeting during the CIICO call in portion to bring up the Native American Service Center funding/development and the complete lack of Direct Tribal Consultation during the development of the all Exchange regulations and policies.  

There was some discussion regarding available funding for navigators from the Federal Government, at a couple of webinars hosted by CIICO.  Currently Tribes are not eligible for Navigator funding, because of the type of Exchange the State is proposing, a State based Exchange where all portions of the Exchange are administered by the State of NM (eligibility, enrollment, outreach, education, IT). 

Tribes would be eligible for additional Funding from the Federal Government CIICO determines that NM will not be able to create an Exchange by certain deadlines.  In the event that the State is not able to create a state-based exchange it will be recommended that NM create a state Federal partnership, in which the State will be responsible for some administration functions and the Federal Government would be responsible for the rest.  Under this structure the State would be responsible for outreach education and Navigators, and the Federal Government would be responsible for eligibility Health plan selection and the IT web portal.

The other option would be to go with the Federal Exchange that is going to be developed to serve State populations where the State’s Governor has declined the option of developing an Exchange.  In this option the Federal Government administers all parts of the Exchange and there will be no funding for States for Navigators or in-person Assisters.

There was also a letter sent to CIICO by members of the Native American Workgroup (NAWG) of the Health Insurance Exchange Task Force regarding the $1.28 Million set aside for the Native American Service Center (NASC) in the Level I Establishment Grant procured in 2011 by the Office of Health Care Reform (OHCR).  The NASC was intended to be a resource for Native Americans hoping to enroll in the HIX.  As of today there has been no response to that letter/request from CIICO.  I have been in contact Senator Heinrich’s and Representative Lujan-Grisham office’s in an attempt to get a response to this request.

 Below is the Agenda for the HIX Board Meeting:

New Mexico Health Insurance Exchange Inaugural Board Meeting

April 29, 2013  
 (Morning Session)

1. Introductions of Board  – Superintendent Franchini

2. Review of NM legislation 
3. Board of Director NMHIX Introductions and appointment fact sheet
4. Election of Chair & Vice Chair & Treasurer
5. Board Policies 
         a. Conflict of interest
         b. Attendance, by telephone or by alternate media
6. Resolutions giving Executive Director authority regarding documents and funds (checking accounts, procurement policies, signing authority)
7. Development of meeting schedule
8. Funding
         a. Available grant funds / Process for transfer of funds to NMHIX
        b. Leveraging NMHIA staff, processes and federal fund business assessment
         c. 5/15/2013 Grant application
         d. Existing HIA MOU
         e. New MOU with DOI 9. 12:00 pm MT/ 2:00 pm ET - CCIIO available for questions from board. 

(We will stop at 12:00 for this, break for lunch and then resume agenda items.)  
Lunch Break (Lunch will be provided to board members) 

(Afternoon Session)

10. Review of first year exchange options and decision timeline

11. Review of Plan Management, NM DOI
12. Review of HSD Task Force NMHIX recommendations 
13. Consumer outreach and assistance
14. Native American Service Center (NASC)  

Day 2

NMHIX Inaugural Board Meeting Agenda     April 30, 2013

15. Committees a. Standing Board -Finance/ Operations & Benefits /Marketing / Information Technology / NMHIA b. Advisory -Native Americans - On & Off Reservation, Qualified Employer representatives, Low income and underserved (consumer) advocates, Transition Committee (Active members from NMHIA and NMMIP),  Health Insurers, Health Care Providers, Brokers and Agents, and Medicaid and State Agencies

16. Discussion/ development of initial NMHIX budget/ Staffing 
17. NMHIA Organization Chart and prior board actions
18. NMHIA implementation efforts
19. NMHIA wind down review
20. NMHIA assessment (must be approved by May 30) 
Public Comment & Adjournment 
21. Public Forum
22. Adjournment    

Parking lot for future meeting topics: 

Draft Plan of Operations NMHIA audit
Medicaid integration with HIX  
Board Reference Book
 NMHIX SB221
 Draft Plan of operations
 NMHIX Blueprint/ CCIIO Schedule of Activities
 PM and IT RFP/ Amendment #5 
 NMHIA Conflict of interest Policy
 NMHIA Consultant procurement Policy
  November 2012 NMHIA Board Retreat Discussion Guide
 NMHIA Proposed Organization chart
 NMHIA Proposed Job Descriptions 
 Mileage and Per diem reimbursement Forms
 Calendar
 Teleconferencing Dial in information 

Recommendations for Workgroup members to take back to Tribal Leaders

 At the latest "Kewa" Workgroup we came up with the following action Items we need to be considering with Tribal Leaders:

 

1.       Advocate that the “quasi-“ state-federal nature of the HIX relationship in New Mexico’s first year allow us to qualify to apply for Navigator program establishment funds.  As it stands, we are not one of the states who can apply because we are supposedly a “state-based” exchange only.

2.       Request a response from CCIIO regarding the Native American Workgroup’s (Roxanne Bly and Joyce Nasyowma) letter asking to release the $1.3 million set aside for the development of a Native American Service Center, which has been sitting at the Office of Health Care Reform.  Earmark some of the newly released $8 million implementation grant funds the state has already received so that Tribes can accomplish outreach and education for the Health Insurance Exchange, especially since it seems the state plans to do little to nothing to accomplish this themselves. 

3.       Suggest the newly appointed HIX Board members immediately focus on the May 15^th deadline to request funding from HHS through CCIIO for in-person assisters.  It is estimated that NM will need more that 600 navigators/in-person assisters, in the first 6 months of the Exchange.

4.       Request that the Superintendent of Insurance provide some clarifications on the HIX Executive Board composition and its conflict of interest requirements via draft legislation

5.       Recommend the re-appointment of a Pueblo member to the Medicaid Advisory Committee as soon as possible. Contact Medical Assistance Division, Director Julie Weinberg, with nominations from a Governor or Governors association. 

6.       Question the state on what New Mexico has to show for the money spent on the Leavitt Partners contract to date.

7.       Respond to Admiral Grinnell on the decision to use all IHS funding to appoint Audrey Solimon for what appears to be broad, non-specific training for any and all service units, ask if additional funds will be available for Navigators/in-person Assisters.

If you have any questions regarding these topics or need some one to come to your site to help inform Leadership you can contact Erik Lujan at elujan78@gmail.com or (505) 280-2811. 

 

 

Update from "Kewa Workgroup" meeting on 4/17/13

Good Afternoon All,

 

Just wanted to give a brief overview about what was discussed at the Work group meeting on Wednesday April 17.

 

The Center on law and poverty gave an brief explanation of the what direction the Health Insurance is taking and its currant status and structure. 

 

Identified known members of the Executive Board of the Exchange, and what we can do to influence the board.

 

It is likely that we will end up with a state-federal partnership rather than a State-based exchange

 

discussed the conference call that took place on Monday regarding the Navigator grants for tribes.  In a State-based Exchange it is assumed that the state will fund the navigator portion of the exchange as well as outreach.  in a State/Federal partnership or Federal Exchange Tribes can take advantage of the recently released navigator grant. We need clarification on whether or not NM is going to end up as a State/Federal partnership.

 

Michael Hely from Legislative Council Services added to the explanation of the Health Insurance Exchange as well as the outcome of the HB 376 effort.

 

Representative Madalena also explained his frustration with the outcome of the legislative session.  It was suggested that at the beginning of the interim committee sessions with would be helpful to organize a informational educational session for the legislators about Native American Law and tribal Sovereignty.

 

I gave a report from the Medicaid Advisory Committee meeting on Monday.  I have attached the full report to this email.  Basically no new information and as usual we can expect to be left in the dark when it comes to Centennial Care. Julie "Frankly, sees no need for more consultation sessions with Tribes."

 

some house keeping issues for the committee Anthony asked that we rename this "committee" "workgroup" what ever we are Kewa would like to separate its self in name form this group, because Kewa Pueblo does not own this group. So it was suggested that everyone should submit a new name to call ourselves. So start the suggestions. The blog that I started to share the information is called Native American Healthcare Alliance, but I think that is to generic and the name needs to be more New Mexican.  "Hano" committee/council was suggested (not sure on spelling)

 

Also it was suggested that we need a chairperson for coordinate our efforts, Evelyn nominated me, and I am willing to take it on as long as there are no objections.

 

 

NMICoA Health Committee report from the MAC

New Mexico Indian Council of Aging

Health Committee
Report from the Medicaid Advisory Committee

The Medicaid Advisory Committee is tasked with oversight and advising the Human Services Department and Medical Assistance Division on the administration of the Medicaid Program.

There is one Navajo representative on this committee.

There is currently no representative of any of the Pueblos sitting on this committee. A representative can be appointed by any Governor, AIPC, 8 Northern or Southern Pueblo’s organizations, for consideration on this committee.  A letter needs to be submitted to Secretary Squire to nominate an individual for this oversight Committee.

The MAD director Julie Weinberg will reconvene the Native American Subcommittee of the MAC sometime in May, interested individuals should contact Mrs. Weinberg for involvement on the subcommittee.

There was no real new information regarding the progress of Centennial Care.  HSD MAD are still on track to begin open enrollment starting October 1, 2013, and go live on January 1, 2014. CMS still has not approved the entire waiver.

MAD is planning to establish workgroups, much like the HIX, to seek stakeholder input regarding several areas of Centennial Care development and implementation, all appointment will be made by HSD and MAD.

SCI individuals will be considered a new population with the Medicaid Expansion, estimated to be 2/3 of the Expansion, and will qualify for the 100% FMAP for the first 3 years. (2017)

There was some discussion regarding integrating the ASPEN Web Portal and the HIX portal.  The ASPEN (Medicaid) web portal will have the ability to determine eligibility for HIX and direct consumers to HIX web portal.  Will include a Telephone hotline for assistance with eligibility determination.

Questions I asked Julie Weinberg:

Q:What has HSD MAD done to resolve the issues Tribes have outlined in the last Tribal Consultation session?

A: I not sure what you mean they brought up a lot of things

Q: Has there been and communication between the HSD and Tribal leaders and Health Programs?

A: We are putting letters together to start up our advisory committee. The Native American Technical Advisory committee.

Q: When is the next Tribal Consultation taking place where you (Julie) explain all the information presented here today to Tribal leadership and Tribal Health Programs? All the information presented here today is relevant to tribal health programs and how they will integrate with Centennial Care.  When are you going to release this information to Tribal leaders?

A: I don’t know when that will happen.

Q: When will the Native American MAC subcommittee start meeting again?

A: We are looking at a couple of dates in May we want to give everyone enough time to come in start, we felt the need to wait until the Legislative session was completed and we got a decision from  CMS regarding the mandatory enrollment on Native Americans into managed care organizations.

Q: So what you are saying is that given the short amount of time we have to implement Centennial Care Tribal Consultation will not happen for a month…?

A: Frankly I don’t see a need for anymore Tribal consultations. 

Q: With regards to the MCOs will the Readiness Reviews of the MCO’s be made available to the public before and/or after the open enrollment period?

A: Generally that is not made public. Any information that is reviewed in the readiness reviews will be looked at in the NA Technical Advisory subcommittee.

Essential Community Providers identified by AAIHS

Dear Indian Health Service/Tribal/Urban Indian Health Program Leaders:

 

The health insurance law, also known as the Affordable Care Act, directs qualified health plans offered on the Marketplaces in 2014 to include a sufficient number of essential community providers (ECPs) in their networks to provide access for low-income and medically underserved individuals. As defined in the statute and regulation, ECPs include providers described in section 340B of the PHS Act and section 1927(c)(1)(D)(i)(IV) of the Social Security Act and include Tribal and Urban Indian Health Programs.  QHPs are finalizing their networks in the next few months. This letter will provide you with related resources that I hope will be of use to you.

 

On March 26, CMS/CCIIO posted a list of ECPs to assist health insurance plan issuers in locating ECPs: http://cciio.cms.gov/programs/exchanges/qhp.html. This list is not exhaustive. For example, it does not include Federal IHS facilities that might otherwise qualify as ECPs under the regulatory standard. In addition, plan issuers will be permitted to write in ECPs not on the list.  If your Tribal or Urban Indian Health Program is not on the list, you should let issuers in your area know you are an ECP so that they have the opportunity to include you in their network.  

In collaboration with states, CMS will monitor Qualified Health Plans (QHPs) for network adequacy and ECP sufficiency.  At this time, health insurance issuers that wish to establish QHPs may be approaching you with offers to join their provider networks.  Whether or not you are currently engaged with private insurers, please be attentive to these discussions.  Many of the patients whom you serve will be eligible to purchase health insurance from these QHPs, and these plans will begin coverage on January 1, 2014.  It could be beneficial for these individuals to choose QHPs with networks that allow them the choice of maintaining continuity of care with their current practitioners.  CMS notes that contracted ECPs are subject to applicable issuer credentialing standards for network providers. 

In collaboration with the Indian Health Service, CMS developed a QHP Addendum for Indian Health Care Providers to facilitate issuers contracting with Tribes, Urban Indian Health programs and Indian Health Service (IHS) providers.  CMS strongly encourages issuers and providers to use this Addendum, but use of the Model QHP Addendum is optional.  The Addendum was developed through tribal consultation and the engagement of tribal and issuer input.  You may access a copy of the Addendum at http://cciio.cms.gov/programs/exchanges/qhp.html.  In addition, a list of the Indian health providers will be posted in the near future.

The health care law offers new opportunities for you to better serve your patients, and we encourage you to learn more about the law and your options. 

Electronic Resources:

 

·         CMS/CCIIO “non-exhaustive list” of ECPs to assist health insurance plan issuers in locating ECPs: http://cciio.cms.gov/programs/exchanges/qhp.html.
 
·         More information on the definition of ECP and health insurer requirements regarding ECPs, see CMS’ “Letter to Issuers on Federally-facilitated and State Partnership Exchanges,” available at http://www.cciio.cms.gov/resources/files/issuer-letter-3-1-2013.pdf.
 
·         Additional information is available on the CCIIO website at http://cciio.cms.gov/
 

You are encouraged to reach out to potential insurers in your local area regarding ACA requirements. Please provide your feedback on this ECP communication to myself or the Albuquerque Area Director, ADM Richie Grinnell, thank you.

 

 

Leonard Thomas, MD

ABQ Area CMO

505-248-8003

Leonard.Thomas@ihs.gov

Legislative Appointees to the NM Health Insurance Exchange Executive Board

State of New Mexico

House of Representatives

W. Ken Martinez, Speaker of the House

Rick Miera, House Majority Leader

Antonio “Moe” Maestas, House Majority

PRESS RELEASE

April 5, 2013

Contact: Marilyn Galano, 505-986-4782

Marilyn.Galano@nmlegis.gov

Santa Fe, NM - Speaker of the House, W. Ken Martinez and Senate President Pro Tem, Mary Kay Papen, held a news conference in Las Cruces, New Mexico today to name six members of the New Mexico Health Insurance Board of Directors.  The six members are Dr. Martin Hickey, CEO of New Mexico Health Connections, David Shaw, Hospital Administrator and CEO of Nor-Lea General Hospital, Jason Sandel, Vice Chairman and Consumer Member of the New Mexico Medical Insurance Pool, Dr. Larry E. Leaming, Respiratory Therapist and CEO of Roosevelt General Hospital, Patsy Romero, COO of Easter Seals El Mirador and state President of the National Alliance for the Mentally Ill and Teresa Gomez, President and CEO of Futures for Children and past Deputy Secretary of New Mexico Indian Affairs Department.

“Time is of the essence, that’s why it was so important to get the right people in place to steer this monumental undertaking,” says Speaker Martinez. “I am confident the people we have appointed will be able to deliver a one-stop shop for affordable health care that will meet the federal requirements. More importantly, the exchange they help to establish will make for a much more healthy New Mexico.”

“The Health Care Exchange legislation is a good first step toward providing affordable health care in New Mexico,” says President Papen. “We put our trust in these experts we are appointing today to make sure New Mexican’s get the best health care exchange possible.”

The NM Health Insurance Exchange is part of the federal Affordable Care Act and will allow individuals to comparison shop for plans offered by health insurance companies on the exchange. By October 1, 2013, the NM Health Insurance Exchange must start taking applications from qualified individuals and qualified employers for qualified health plans. The NM Health Insurance Exchange must be up and running by January 2014.

Consumer-Focused Navigator/In-Person Assister Committee

The Next Consumer-Focused Navigator/In-Person Assister Committee Meeting will be held on FRIDAY, APRIL 26th at 9:00 AM – 11:00 AM at the SOUTHWEST WOMEN’S LAW CENTER/ACLU building at 1410 Coal Avenue SW, Albuquerque, NM. The event will be in the SWLC/ACLU building main conference room.

There have been a lot of changes to the consumer assistance landscape since our last meeting! The Governor signed legislation to create a state-based Exchange, and legislators have picked members for the Exchange’s Board of Directors. This meeting will provide updates on the passing of Exchange legislation and what that means for health care reform and consumer assistance programs, as well as new federal rules regulating in-person assistance programs. Accordingly, our agenda for the April 26th meeting is as follows:

1. Update on Exchange after legislative session.
2. Exchange Task Force Recommendations – Influence of Navigator Committee on recommendations to Exchange Board
3. Current funding for in-person assistance programs
4. Update on federal regulations of in-person assisters
5. New Mexico’s Consumer Assistance Program Development

Our Conference Call Number is:

Conference Dial-in Number: (605) 475-4000
Participant Access Code: 658369#
Subscriber PIN code: 693195#

If you think of other individuals who should be a part of this discussion, please let me know.

Paige

Navigator pre-application conference calls

Reminder: Navigator pre-application conference calls As a part of the Navigator FOA, CMS is holding pre-application conference calls for potential applicants.  We are happy to announce that an additional call has been added to the schedule on April 2th.  The conference calls provide an overview of this project, budget guidance, review the instructions provided by this FOA and other available materials, and will include an opportunity for potential applicants to ask questions.

Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. ETToll-free teleconference phone number: 877-267-1577; ID: 2917

Third call: Wednesday, April 24, 2013 from 3:30-5:00p.m. ETToll-free teleconference phone number: 877-267-1577; ID: 8100

Webinar, “So You Want to Be a Navigator? Best Practices for Navigator Applicants"

 For months, we’ve all been waiting for news about the new federal grant opportunity <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=ECnd6LWA5BjjT7ZS2oVm1V3Q%2FgwD39po> . Last week, the opportunity was finally announced.

 If you’re from a state with a federally facilitated marketplace,* and your organization is interested in applying for a grant, you won’t want to miss our next webinar, “So You Want to be a Navigator? Best Practices for Navigator Applicants <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=ZvA4K4rOZoeelOBteuJUkl3Q%2FgwD39po> ”. We’ll provide an overview of this new grant opportunity, talk with community leaders from three states about lessons learned from past experiences with federal grants and with outreach and enrollment, and share information about tools that may be useful for preparing navigator grant applications. We hope that you can join our critically important conversation.


 What: Webinar, “So You Want to Be a Navigator? Best Practices for Navigator Applicants” <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=qC86IwJt23nPzRF4MmtZbF3Q%2FgwD39po>


 When: Thursday, April 18, 2013, 2:00-3:15 EDT


 Who: Jenny Sullivan and Jessica Kendall, Enroll America
 Deanna White, Legal Aid Society of Southwest Ohio <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=%2BP2JsHUgAAc6dzjBXjJ79V3Q%2FgwD39po>
 Alan Gjersvig, Arizona Alliance for Community Health Centers <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=kBaVTdprRyNeRHhgtGhZ%2Bl3Q%2FgwD39po>
 Beth Uselton, Baptist Healing Trust <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=kvMOqakS26lynYgc1PMIx13Q%2FgwD39po>


 RSVP: https://cc.readytalk.com/cc/s/registrations/new?cid=8xf5oqopvtn0 <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=S9aHtMCPhGfxddm7lk9rPF3Q%2FgwD39po>


 The webinar will be recorded, and a link to the recording will be made available shortly after the event on our webinar archives <http://salsa3.salsalabs.com/dia/track.jsp?v=2&c=pd1mznN3%2FBfM0C9R42NDxdNBUywdHOcG> .


 If you have questions that you would like us to address, please send them to webinar@enrollamerica.org.


 We hope you can join us!

 Best,

 Jenny

"Kewa Workgroup" meeting scheduled for April 17th

Good Afternoon all,

The next meeting of the Kewa Workgroup will be held next Week Wednesday 17th from 9:00AM- 12:00 PM at the Kewa Pueblo Health Corp, Traditions off of I-25

We will be discussing updates on Centennial Care, and NM Health Insurance Exchange.

Then have a Strategy Session on What the Actions Tribes should take next, as well as solutions to Centennial Care.

This meeting is open to all Tribal Health Programs and Health Advocates, if you have any questions please call Erik Lujan at (505) 280-2811 or email elujan78@gmail.com

Fed Health Insurance Exchange Navigator NPRM released

CMS NEWS
 
 
 
FOR IMMEDIATE RELEASE                                    Contact: CMS Media Relations
 
Wednesday, April 3, 2013                                                                         (202) 690-6145
 
 
CMS proposes help for consumers navigating the Health Insurance Marketplace
 
“Navigators” to provide assistance for reviewing insurance options
 
The Centers for Medicare & Medicaid Services (CMS) released a proposed rule today outlining standards that Navigators in Federally-facilitated and State Partnership Marketplaces must meet, and clarifying earlier guidance about the Navigator program.
 
 
Navigators are organizations that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.
 
“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new Marketplace,” said CMS Acting Administrator Marilyn Tavenner.
 
Millions of Americans will be eligible for new coverage opportunities in 2014. For those who are not familiar with health insurance, have limited English literacy, or are living with disabilities, Navigators will serve an important role in ensuring people understand the health coverage options available to them. Navigators will provide accurate and impartial assistance to consumers shopping for coverage plans in the new Marketplace.
 
 
Navigators are a significant component of efforts to enroll Americans in the Marketplace. And CMS will ensure that all consumers who need customer service can receive it from trained professionals. In addition to Navigators, consumers will have access to assistance through services such as a call center, where customer service representatives can provide referrals to the appropriate state or federal agencies, or other forms of assistance programs including in-person assistance personnel, certified application counselors and agents and brokers.
 
Open enrollment in the Marketplace begins Oct. 1, 2013, with coverage to begin Jan. 1, 2014.
 
To access the proposed rule released today, visit: http://www.ofr.gov/OFRUpload/OFRData/2013-07951_PI.pdf

CMS March 27, 2013 LTSS Webinar Recording Now Available

March 27, 2013 LTSS Webinar Recording Now Available
The recording of the March 27, 2013, webinar “Oneida Nation Elder Services: Cultural Adaptations to a Chronic Disease Self-Management Program”
http://www.kauffmaninc.com/ltss/video/webinar_3-27-2013.html
is now available.
In addition, “Moving Beyond Paradigm Paralysis:  American Indian End-of-Life Care (PDF),” http://www.kauffmaninc.com/LTSS/Documents/EOL-AI-AN-CIB-508-compliant.pdf
a paper that was discussed during the webinar, is available for download.
Save the Date!
The next LTSS webinar is scheduled for Wednesday, April 24, 2013. The topic is “Great Plains Tribes: The Native Elder Caregiver Curriculum and Qualified Service Provider Training.” Please consult the chart for your location’s call-in time. Additional details on this webinar will be sent to you in the near future.

Time	Zone
8:00 a.m.	HADT
10:00 a.m.	AKDT
11:00 a.m.	PDT
11:00 a.m.	AZ
12:00 p.m.	MDT
1:00 p.m.	CDT
2:00 p.m.	EDT

Questions can be directed to ltssinfo@kauffmaninc.com
Webinars will take place the fourth Wednesday of every month from 2 p.m. to 3 p.m. ET.

Save the Date CMS/IHS Outreach and Education Training for I/T/Us

SAVE-THE-DATEMay 14-15, 2013

2013 CMS - IHS Outreach & Education Training
IHS/Tribes-Tribal Organizations/Urban Indian Organization
______________________________________

Crowne Plaza Dallas Downtown

1015 Elm Street

Dallas, TX 75202

The Centers for Medicare & Medicaid Services (CMS) and the Indian Health Service (IHS) invite you to the 2013 CMS-sponsored Outreach & Education Training.  The event will be held in Dallas, TX on Tuesday, May 14 through Wednesday, May 15, 2013. The goal of the Outreach & Education Training is to improve services to American Indian beneficiaries and aid in increasing the revenue stream to American Indian/Alaska Native health programs. There is no registration fee.

Target Audience:
CMS Region VI States (AR, LA, NM, OK, and TX), IHS Area Offices, Tribal Health and Urban Indian Program, as well as State Medicaid Offices.  Also Tribal Program Directors, Clinic Managers, Health Directors, Benefits Coordinators, Billers/Coders, Contract Care Coordinators, Patient Registration, Contract Health Services, Business Care Coordinators, and 3rd Party Billers.

Topics at a Glance:

§  National CMS Legislative Overview

§  Tribal Technical Advisory Group Updates

§  Medicaid Program

§  Medicare Program

§  The Affordable Care Act

§  And much more…..

 

Registration:  To register for the training, click on the link below and complete the online form:http://www.blsmeetings.net/cmsitutrainings/index.cfm

Lodging:Reservations at the Crowne Plaza and neighboring hotels are on your own and subject to hotel availability and pricing.  You can contact the Crowne Plaza central reservations line at 877-227-6963 or by visiting the Website at www.crownedallas.com. There are also many hotels in the downtown area that are close to this meeting space.

Contact Information:
Program:               Stacey Shuman – stacey.shuman@cms.hhs.gov 

Dorsey Sadongei – eudora.sadongei@cms.hhs.gov
Registration:         Chris Dang – cdang@seamoncorporation.com  

 

 

 

 

AGENDA:

 

 

CMS - IHS Area Outreach & Education Training

---

Crowne Plaza Hotel  Dallas, TX   75202

May 14 -15, 2013

 

DAY I – Tuesday, May 14

 

08:00am – 04:00pm     Registration

           

08:30am – 09:00am    Welcome and Introductions – TBD

 

09:00am – 10:00am    Morning Session

 

• Goals/Purpose

 

10:00am – 10:15am     Break

 

10:15am – 11:30am    Legislative Session

 

• TTAG Update – Jim Lyon
• ACA Updates and Overview – Lynn Ward

 

11:30am – 01:00pm    Lunch

 

01:00pm – 03:00pm    Medicaid Session

 

• Opening Remarks – Bill Brooks
• Meet your state liaison
• State breakout groups

(DMCH state reps and state liaisons)

 

03:00pm – 03:15pm    Break

 

03:15pm – 04:15pm    SSA and Disability Session

                Charlie Brittian (unconfirmed)

 

04:15pm – 05:00pm    TBD or Dismissal

 

Day II – Wednesday, May 15

 

08:00am – 04:00pm     Registration

 

08:00am – 08:05am    Welcome and Introduction –

                Opening Remarks – Marjorie Petty, Regional Director, HHS

                (unconfirmed)

 

08:05am – 10:15am    Medicare Session

                (specific topics to be determined; Part D, Dual eligible, etc.)

 

10:15am – 10:30am     Break

 

10:30am – 11:30am    Novitas

                (presenter TBD)

 

11:30am – 01:00pm    Lunch

 

01:00pm – 02:00pm    VA Policies and Updates

                (presenter TBD)   

   

 

02:00pm – 04:00pm    Open Q&A Session – All available staff or SMEs

 

04:00pm            Closing Remarks – Jim Lyon

 

                Adjourn