Thursday, August 22, 2013

Pre-Tribal Consultation Session

Please join us for a Pre-Consultation Session to prepare Tribal Leaders for the upcoming formal consultation with HSD:

Medicaid Pre-Consultation Session

MONDAY, August 26, 2013
1 p.m. to 4 p.m.

Futures for Children
9600 Tennyson St NE
Albuquerque, NM 87043

This session is designed specifically for Tribal Leaders who will be attending the Medicaid consultation session with HSD and those individuals who advise them or represent their positions/perspectives on the NATAC or other other advocacy groups (Inter-Tribal Work Group, Tribal Health Committees or Boards, etc).  Agenda is attached!

Please RSVP to Erik Lujan at:

New Mexicans Fighting To Save Behavioral Health

FOR IMMEDIATE RELEASE

Contact: Christi Fields at (505) 604-0221, or Christi_Fields@hotmail.com.
Date: August 20, 2013
                 
 

New Mexicans Fighting To

SAVE BEHAVIORAL HEALTH

 
“Two of my clients have tried to kill themselves since services were terminated. They refused to see anyone else.” – Behavioral Health Therapist
 
The State of New Mexico’s continuing saga of shutting down mental health providers in favor of management by Arizona firms is releasing a torrent of fear, concern and complaints by those directly affected.  Here are some of the verbatim comments made in a recent survey, collected in the past two weeks by
New Mexico Rising Up for Community Behavioral Health.  Many of the writers have withheld their identities due to confidential subject matter.  Others have done so for fear of retaliation.
 

Family Members and Clients (Patients)

“Continuity of care is essential to my son’s) recovery…”.
 
“My daughter fears losing another doctor, having to start all over with telling her history and then a new provider wanting to change her medications.
 
“When I have to go without therapy, it has a serious, negative impact on my life and the lives of my children….”
 
“We still don't know if the counselor she's had since she was 8 years old (she's 14 now) will still be available….”
 
I have been trying to get a neuropsyche evaluation scheduled for my son and keep running into problems due to what is going on with this take over. No one is taking any new clients at this time because of it and it is preventing me from trying to get the help my minor child needs as well as the services he needs.”
 
“It is disheartening to have no collaboration with other agencies and to see kids ending up getting worse rather than better because they can't get their mental health needs met in our city anymore.”

 

Behavioral Health Staff

 “Clients have come in asking are you closing? where will we go?  Are you going to be here next week? We have clients that have resorted to cutting and burning themselves, acting out with family members and living in fear.”
 
“….clients are looking elsewhere for their medications because they worry about getting them from (us).” 
 
“It’s very frustrating.  I can not get work (done) or serve my clients. I don’t understand how what is being done is ethical.
 
Staff (cont.)
 
“….contracts with local agencies are currently up in the air.  There have been no new clients from Federal Probation, State probation. DWI compliance, probation officers, Drug Court, the local judges, or from CYFD since the takeover process began.”
 
“Our counselor has a caseload of 57 people…these clients will be without a therapist at the end of the week.”
 
“Hundreds of mental health clients will have to be reassigned to other therapists.” 
 
”We will probably be seeing jails and prisons fill up quickly or the mental hospitals turning away seriously mentally ill patients.
 

Town Hall Meeting at West Mesa High School

Town Hall Meeting 
FREE EVENT & OPEN TO THE PUBLIC
Food, beverage and Child Care will be provided
Health Care Coverage and You
  • Are you between the ages of 0-64 without medical insurance?
  • Do you know the benefits offered through Medicaid?
  • Did you know adults become eligible for Medicaid as of January 2014?  Think you might qualify?
  • Do you know your Healthcare rights?
  • Would you like to know more about how YOU or your family can get health insurance?
If you answered yes to any of the above questions then this event is for you.  If you have any relatives, friends, patients, or neighbors that might say yes to these question, send them this invite to our Town Hall!
Saturday August 24th, 2013 
 
West Mesa HS
6701 Fortuna NW
Albuquerque, NM 8712
 
Informational sessions at 
10 am, 11:30 am & 1:00 pm 
*On-site Medicaid enrollment for qualified children and adults
 
Required documents:
1) Picture ID
2) Birth Certificate
3) Proof of income the most current month
4) Written proof of pregnancy if applicable
5) Current insurance card, if any
 
Sponsored by: 
YDI Elev8, YDI EE&T, 
Health Action New Mexico, 
Southwest Women's Law Center, 
NM Center on Law and Poverty and ENLACE

NMHIX Plan of Action Passed Approved and Adopted

cropped NMHIX logo
Plan of Operation
Passed, Approved & Adopted
The New Mexico Health Insurance Exchange is pleased to announce that our Plan of Operation was passed, approved and adopted on August 16th, 2013. 

The full Plan of Operation is available on our website at http://www.nmhix.com/board-policies

NMHIX Call Center RFP Issued

cropped NMHIX logo
Call Center RFP Issued
Starting during the Open Enrollment Period, which begins October 1, 2013, New Mexicans will likely have questions about health care reform and the health insurance options that are available to them. The Exchange is required to operate a toll-free hotline for residents to call to assist with their questions and enrollment in coverage.
 
The Exchange is seeking Call Center Services from an experienced contractor (and potential subcontractors) for the purpose of designing and implementing a Call Center that will handle all calls that come in through the NMHIX's toll-free number. The purpose of this Call Center will be to take incoming calls and connect the callers to
potentially one of six entities.

The Call Center RFP can be seen on our website at 

CMS Contacts for Comments on Behavioral Health

Hello all,

As a follow-up from the last Health Care For All meeting, I was asked to provide information for folks who would like to contact CMS to comment about disruptions in behavioral health services. Also as requested, I have attached the links to the two Facebook pages designated to this issue, as well as the link to the survey monkey application people may take online to tell their stories. Stories from the survey are sent directly to CMS.

While it would be nice to have a single line, one has yet to be designated as far as I am aware. Patrick Tyrrell and I dropped by Senator Heinrich's office to request this info and I have attached the document that Heather Brewer from Senator Heinrich's office emailed me,  as well the numbers that I know various groups have used.
 
Prior to receiving info from Senator's Heinrich's office, I used the info provided by the Facebook page "New Mexico Rising Up For Community Mental Health".
Contact: 214-767-4461
email: CMSRODALDMCH@cms.hhs.gov  or RODALDMCH@cms.hhs.gov

I know some people have sent me copies of letters that they sent to CMS via these email addresses as well- ( these are listed on the same document that is attached)
Call the Regional Administrator for CMS, Renard Murray, at 404-562-7150, or email ROATLORA@cms.hhs.gov
Call the Deputy Regional Administrator for CMS, David R. Wright, at 214-767-6427, or email RODALORA@cms.hhs.gov 

Here is also the link to the survey that folks can fill out online. The stories received are submitted each night by the folks who host the Facebook page "New Mexico Rising Up For Community Mental Health". http://www.surveymonkey.com/s/6CDWLHQ

Links to the Facebook pages are:
New Mexico Rising Up For Community Health:  https://www.facebook.com/nmrising?ref=br_tf


Hope this helps,

Christi Fields
NASW-NM Intern

Monday, August 19, 2013

Letter form NM Congressional Delegation to HHS Sec. Sebelius

I continue to be impressed by our NM congressional delegation's attention to community needs and concerns. Thank you 











OP-ED " The Human Cost of New Mexico's Behavioral Health Crisis"

  View the complete Article at:

http://www.behavioral.net/print/article/perspective-human-cost-new-mexico-s-behavioral-health-crisis  

  August 16, 2013

Perspective: The Human Cost of New Mexico’s Behavioral Health Crisis

By Sarah B. Couch, LMSW
The messages come late at night. Each morning, I open my phone, my Facebook, my email and find a steady stream of anxiety and despair:
“Tell me what’s happening—I see the news and don’t understand! I’m worried about my kids. School is about to start and we need more therapy now, but our therapist says she doesn’t know if she will still be employed next week.”
“My son lost his behavioral management worker and is out of control. I am worried he will need to be hospitalized.”
On June 24, 2013, a newspaper article stated New Mexico had performed an audit at the cost of $3 million dollars. This audit, the paper stated, was performed on 15 of the state’s leading mental health agencies who collectively serve about 85% of the publicly funded population who receives behavioral health services. This works out to about 30,000 individuals. The paper reported the audit found widespread overbilling and credible allegations of fraud. Additionally, the article stated the state was not releasing audit details and was freezing all Medicaid funds to the audited agencies. Agency staff learned this news in the article published to the public. In the past month and a half, agencies have closed their doors as 5 corporations—at the cost of about 18 million dollars for a three-month “transition” period—have been brought in from Arizona to take over our local community mental health agencies. News stories have heavily sided with the administration and been unwilling to voice the experiences of those directly affected.
Despite the state’s relentless cry that services will not be interrupted, they already have been. The human cost of such an endeavor cannot be quantified in the same way we can quantify units of service-$67.61 for an hour of therapy-or fees to out of state contractors-$300 per hour for the transition CEOs. The human cost will, no doubt, show up as increases in incarceration, emergency room usage, and suicide.
“I am so afraid. I’m not eating or sleeping. I’m worried about my own mental health and how I will continue.”
“My son only trusts his current doctor—she was the 5th we tried—what will my son do if she leaves or is fired from our agency?”
New Mexico has long been regarded as a forward-thinking state in its willingness to try on transformational initiatives in its behavioral health system. In 2004, monumental legislation was passed which braided the public funds of 15 state agencies, ran the funds through a managed care organization, and promised more efficiency and accountability for public dollars. The Interagency Behavioral Health Purchasing Collaborative was tasked with creating cohesive policy across systems which serve people with behavioral health needs and their families. The legislation included sweeping change across New Mexico’s behavioral health system and integrated language and values from the President’s 2003 New Freedom Commission on Mental Health report. The new language, which included the terms recovery, resiliency, strength- based, person-centered, and culturally competent, was offered to those providing services as well as to those receiving services as the way New Mexico would function.
Armed with millions in federal transformation grant dollars and a vision of better outcomes, New Mexico blazed ahead, asking the foundational pillars of our community mental health system, people who use services, and family members to join in the process. This is where I come in. Just 10 months out of my 11th inpatient hospitalization and angry at the systemic injustice I had experienced, I bought into the transformation and charged ahead as a leading advocate for behavioral health systems change. My local community had so much hope. We believed our voices mattered and that we were creating something together.
With the perceived national success of its transformation initiative, New Mexico applied for and received a federal System of Care grant to further incorporate the promise of collaboration and improved outcomes within our youth and family service systems. Local agencies strove to mold existing policies and practices—antiquated, coercive, and provider-centric—into new approaches that would embrace our collective vision. CEOs and clinical directors sat in meeting after meeting with the state, people who used services, families, and advocates as we strove to collaboratively hammer out the details within a Medicaid reliant, centralized government set up.
What the state asked communities to do was to embrace a localized model without ever empowering localities to implement local practices. Provider agencies were tasked with applying to be Core Services Agencies with a laundry list of unfunded mandates and few benefits. It was destined to fail. And it did. However, none of us could ever have envisioned the way failure would show up.
“So many tears, and laughs, and memories…gone.”
Here we are now, a month and a half into the shocking realization that the longstanding lighthouses of our community mental health system—our beacons of hope—are having their doors forcibly closed while the individuals who manage these agencies are bullied and shamed. This is an intentional process that is actively negating the human cost of such an inhumane and traumatizing endeavor. Perhaps most devastatingly, the voices of our entire behavioral health community have been silenced.
Systems change is about relationships; about knowing, understanding and embracing our differences to arrive at common goals, to make a collective impact, and to create a sustainable cultural shift in ideology and practice that improves outcomes. Over the past weeks, I have had opportunity to visit with some of my friends—people who use services, family members, advocates, some of the CEOs, and other providers who initially embraced me as a client, made a place for me in this community to advocate and use my voice, and welcomed me as a colleague. The commonality of these visits is powerlessness, not unlike what I experienced within the system so many years ago. This powerlessness is suffocating our state.
“What do we do when those who provide hope have lost their own sense of hope?”
Behavioral health services provide hope through connection. People’s lives are changed not because of the service they receive but because of the person who shows up and creates a space for change. New Mexico is known for its unique cultural diversity, its wide open spaces, its rural landscapes, and its abysmal outcomes as evidenced by our top and bottom place standings on national lists: suicide, drug overdose, child poverty, hunger, DWI. Those in the state’s behavioral health community willingly took on and advanced the monumental task of system change. Now, we have our efforts ripped from beneath us.
The antithesis of a transformed system is unilateral decision-making. To suggest that providers—and the people who lead them—are merely replaceable parts demonstrates a lack of understanding about the complexity of the treatment relationship, and lack of concern for people who are vulnerable.
How do we move forward when our foundation has been dismantled and privatized in a fiery show of political motivation and a sense of tyranny with no respect for the individuals—all of them—who are being affected? How do we sustain the work done when our governor single-handedly negated every initiative the community has invested in, when trust has been lost and a community sits in the grief and trauma of betrayal?
I don’t have the answers. With legal options exhausted, no sense of empathy from the state, and the federal government as our only potential hope, I have to believe that my community will sustain, that we will muster our collective strength, care for each other, lift our voices, and rise again. It’s hard to believe, though. It’s hard to look around at a sea of darkness and trust that light will ever return.
“This has been my while life’s work; what will I do now?”
“This is not my best night. Somehow I have to find a balance…”
I read the messages from my community. I read them with sorrow and with a desire to take action, to do something. I send words of hope in response, knowing that each story I read is our collective story, that each moment of suffering is owned by all of us.
What is happening in New Mexico is terrifying. It serves as a warning to other states. An article published inThe Health Lawyer in December 2012, outlined the process that is now taking place in New Mexico. The article stated that the Affordable Care Act and revised policy guidance within CMS allow for this type of wide-sweeping assault on Medicaid providers.
Today, New Mexico is a canary in a coal mine and the resilience and resolve of all in the behavioral health community is being tested. Thought the final outcome here is not yet seen, I fear that what happened here will serve as a template for similar, shortsighted endeavors in other parts of the country.
Sarah B. Couch, LMSW, is an independent mental health practitioner located in Albuquerque, NM.

Update: NAPPR as the Healthcare Guides for Tribal Communities

 Hi everyone--all of our hard work has paid off!  The NMHIX board voted today and we are IN! The activity is going to be very fast and furious now--I have some excellent applicants for the Director position (you may remember that we advertised a couple of weeks ago in preparation).  I will be doing interviews on Monday and hopefully making a decision either close of business on Monday or no later than Tuesday

WE NEED TO MEET!  I think we will need at least 2 meetings over the next couple of weeks.

I will be sending out possible meeting dates ASAP.  Thank you all for everything and I hope everyone is ready to roll up their sleeves--there will be lots to do over the next couple of months and it is absolutely essential that we do our very best to be successful--Talk to you all soon--jzl

Sincerely


Jane Z. Larson, Executive Director
Native American Professional Parent Resources (NAPPR), Inc.

IRS website launched for ACA tax subsidies


For the individual the Affordable Care Act (ACA), or health care law, includes new health insurance coverage and financial assistance options, including the Premium Tax Credit, for individuals and families. The IRS will administer the tax provisions included in the law

For Employers the Affordable Care Act (ACA), or health care law, contains many tax and other provisions for employers. The IRS will administer the tax provisions included in the law

Visit for more information:

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

New Resources Available to Help Consumers Navigate the Health Insurance Marketplace




News Release

FOR IMMEDIATE RELEASE
August 15, 2013
Contact: HHS Press Office
202-690-6145

New resources available to help consumers navigate the Health Insurance Marketplace

HHS awards $67 million to Navigators and recognizes more than 100 organizations as Champions for Coverage
Health and Human Services (HHS) Secretary Kathleen Sebelius today announced $67 million in grant awards to 105 Navigator grant applicants in Federally-facilitated and State Partnership Marketplaces. These Navigator grantees and their staff will serve as an in-person resource for Americans who want additional assistance in shopping for and enrolling in plans in the Health Insurance Marketplace beginning this fall. Also today, HHS recognized more than 100 national organizations and businesses who have volunteered to help Americans learn about the health care coverage available in the Marketplace.
“Navigators will be among the many resources available to help consumers understand their coverage options in the Marketplace,” said Secretary Sebelius. “A network of volunteers on the ground in every state – health care providers, business leaders, faith leaders, community groups, advocates, and local elected officials – can help spread the word and encourage their neighbors to get enrolled.”
Today’s announcement builds upon the significant progress in outreach and education made this summer. Consumers can learn about and enroll in coverage later this fall through HealthCare.gov. HHS launched a 24-hours-a-day consumer call center ready to answer questions in 150 languages. More than 1,200 community health centers across the country are preparing to help enroll uninsured Americans in coverage, and a partnership with the Institute of Museum and Library Services will help trusted local libraries be a resource for consumers who want information on their options. In addition, HHS has begun training other individuals who will be providing in-person assistance, such as agents and brokers and certified application counselors.
Navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. The Navigator funding opportunity announcement was open to eligible private and public groups and people who are self-employed who met certain standards to promote effectiveness, diversity, and program integrity.
Navigators will be required to adhere to strict security and privacy standards – including how to safeguard a consumer’s personal information. They will be required to complete 20-30 hours of training to be certified, will take additional training throughout the year, and will renew their certification yearly. All types of enrollment assisters – including in-person assistors, Certified Application Counselors, and agents and brokers – are required to complete specific training and are subject to federal criminal penalties for violations of privacy or fraud statutes, on top of any relevant state law penalties.
The growing list of Champions for Coverage is one more example of businesses and organizations across the nation pitching in to help consumers understand the coming options for quality, affordable coverage. Champions for Coverage, among others, include:
  • American Medical Association
  • League of United Latin American Citizens (LULAC)
  • NAACP
  • National Baptist Convention
  • National Partnership for Women and Families
For a list of Navigator awardees or more information about Navigators and other in-person assisters, please visit:http://cciio.cms.gov/programs/exchanges/assistance.html
Click here to learn more about organizations participating in Champions for Coverage: http://marketplace.cms.gov/help-us/champions-for-coverage-list.pdf.
To become a Champion of Coverage, visit: http://marketplace.cms.gov/help-us/champion-apply.html.

###

NY Times Article "The Challenge of Helping the Uninsured Find Coverage"

View Complete Article:


http://www.nytimes.com/2013/08/15/us/politics/the-challenge-of-helping-the-uninsured-find-coverage.html?_r=0


OAKTON, Va. — Cyndy Dailey held a job fair at her nonprofit agency here last weekend, with a major caveat: she did not yet know if she could hire.

Like many organizations across the country, Ms. Daily’s agency, Northern Virginia Family Service, is hoping to win a federal grant to help uninsured people in the state sign up for coverage under President Obama’s health care law. With the money, she hopes to hire at least a handful of “navigators” — a new category of worker created under the law to educate consumers about new health insurance options and, starting in October, to walk them through the enrollment process.
Navigators are seen as crucial to the success of the law. As the Jan. 1 deadline approaches when most Americans will be required to have health coverage or pay a fine,  navigators are supposed to explain away confusion and fear among the legions of uninsured, helping them understand how new health insurance markets will work and whether they will qualify for subsidies to help with the cost of coverage.
But as the navigator effort gets under way across the country, it is clear that their impact will vary from state to state, with wide discrepancies in how much will be spent to hire and train navigators and how many people they will be able to reach. Many will be operating on shoestring budgets, with extremely tight time frames and hostile political climates.
“There’s definitely going to be a tremendous difference, not only in navigators but also in marketing funds,” said Andy Hyman, senior program officer at the Robert Wood Johnson Foundation. “So what we’re going to have to see in states with fewer funds is a lot more ingenuity.”
Maryland is spending $24 million on a program that will soon dispatch 325 navigators and assisters around the state. Colorado is investing $17 million on 400 “coverage guides,” and New York is spending $27 million on a similar effort.
But in states like Virginia, which declined to build their own insurance markets under the law and ceded the task to the federal government, navigators will not have much money to get the word out. The Obama administration has promised up to $54 million for navigators in the 34 states where the federal government is setting up all or part of the markets. The grants are to be awarded Thursday.
In Virginia, up to $1.4 million will be distributed to navigator groups, which may include nonprofit community organizations, trade groups, chambers of commerce, unions and other public and private entities.

URGENT! New Mexicans Fight to Save Behavioral Health

FOR IMMEDIATE RELEASE

 
Contact: Christi Fields at (505) 604-0221, or Christi_Fields@hotmail.com.                
URGENT!

NEW MEXICANS FIGHTING TO

Save Behavioral Health


Santa Fe, NM (August 14, 2013)  A broad-based coalition of citizens has launched a major public awareness campaign attacking the State's efforts to shut down New Mexico's behavioral health providers and shift their control to Arizona companies. "New Mexicans Fighting to Save Behavioral Health", is composed of health advocates, behavioral health providers and clients, state legislators, lobbyists, and influential private citizens.

The State Human Services Division (NMHSD) has mandated the closure of fourteen agencies, alleging mismanagement. The agencies represent nearly 90% of the State's entire behavioral health services system. The system provides services to individuals and families suffering from mental illness and substance abuse.
Many in this vulnerable population are Hispanics and Native Americans. The shutdown will potentially affect 30,000 clients and their families throughout New Mexico, jeopardizing the jobs of thousands of caregivers.

None of the targeted agencies has received results of the audits conducted by HSD alleging fraud, effectively denying them due process. Multiple requests to review these results have been denied. The State has turned over the audit results to the NM Attorney General's Office. A spokesperson there has said it "could take as long as a year" to reveal the results. An HSD spokesperson has been quoted as saying that “…even if an agency is exonerated by the Attorney General, it will not result in a reinstatement.  The transition of services to Arizona is not temporary – it
is permanent.”
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NMHSD is effectively abandoning New Mexico's behavioral health system in favor of
out-of-state companies, even though many of the New Mexico providers have long-standing relationships with the communities they serve. Closure could have significant economic impact on many of the State's rural towns and villages. Two of New Mexico's provider agencies have already been closed and transitioned to Arizona companies, and several others are threatened with closure within the next few weeks. 

In the face of (yet to be revealed) evidence of fiscal mismanagement by some New Mexico agencies, the State is preparing to pay nearly $18 million to the Arizona firms, whose top executives will be paid $250-$300 an hour for their services during the transition period
.  According to Patrick Tyrrell, a member of the coalition: “We do not condone fraud or mismanagement of any kind, and are fully in support of legitimate efforts to root them out.  But, we need to know where they exist in order to correct the problems.”
The bi-partisan New Mexico Health and Human Services Committee of the New Mexico Legislature has joined the fight, urging swift action by the federal Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to resolve a crisis that may soon become irreversible.

For more information, or to interview members of the coalition, behavioral health providers and/or their clients, contact: contact Christi Fields at
(505) 604-0221, or Christi_Fields@hotmail.com.  Donations to support the awareness campaign are tax deductible, and will be gratefully accepted.  Contributions may be sent to: New Mexicans Fighting to Save Behavioral Health, c/o RFC Policy Works. P.O. Box 8602, Santa Fe, NM 87504, rfcpolicyworks@gmail.com.

                                                          - end -

Tribal Consutlation Centennial Care Agenda

New Article Kaiser foundation "Tax Credits to Average $2,700 Per Family Next Year for People Who Now Buy Their Own Insurance

WEDNESDAY, AUGUST 14, 2013

Kaiser Analysis: Tax Credits to Average $2,700 Per Family Next Year for People Who Now Buy Their Own Insurance

Menlo Park, Calif. -- A new Kaiser Family Foundation analysis estimates that Americans who currently buy their own insurance through the individual market would receive tax credits averaging nearly $2,700 next year for coverage purchased through new insurance marketplaces. The tax credits or subsidies would cover 32 percent of the premiums on average for this group of enrollees in a so-called "silver" plan.

The new analysis by Foundation researchers comes as some states are releasing information on what premiums will be in 2014 when the Affordable Care Act's market reforms and newly created health insurance marketplaces take effect. These rate announcements illustrate "sticker prices" that do not reflect federal subsidies that will offset the cost of insurance for many current individual market policy holders.

"Tax subsidies are an essential part of the equation for many people who buy insurance through the new marketplaces next year," Foundation President and CEO Drew Altman said. "They will help make coverage more affordable for low- and middle-income people."

Tax credits will be available to subsidize premiums for people who buy their insurance in the new marketplaces, do not have access to other affordable coverage, and have incomes between 100% and 400% of the federal poverty level (between about $11,500 and $46,000 for a single person, and $24,000 and $94,000 for a family of four).

An estimated 48% of people who currently have individual market coverage will be eligible for tax credits, the analysis finds. Tax credits among those eligible will average $5,548 per family, and subsidies will average $2,672 across all families now purchasing their own insurance. Many people who are now uninsured will also be eligible for subsidies in the new marketplaces, and their tax credits will likely be higher on average since they have lower incomes than those who now buy their own coverage.

There are many reasons why premium costs in the individual insurance market will change under the ACA before tax credits are applied. For instance, insurance companies will be prohibited from discriminating against people with pre-existing conditions, leading to higher enrollment of people with expensive health conditions. More young, healthy people may also enroll due to the ACA's individual mandate and premium subsidies. Furthermore, insurance providers will be required to meet a minimum level of coverage that will raise premiums for people buying skimpier coverage today, but also lower their out-of-pocket costs on average when they use those services. Premiums before and after the law goes into effect are not necessarily comparable, as health plans in the new marketplaces will be required to cover a broader range of services than are found in many current individual market policies and the health needs of people who will enroll are likely to be different. The Foundation also has developed a health reform subsidy calculator that estimates the premiums and tax credits available to people next year through the insurance marketplaces, based on their income levels, family size, ages and tobacco use.

Methodology

Based on data from the Congressional Budget Office (CBO) and the federal government's Survey of Income and Program Participation, the analysis estimates the average impact of the ACA on the individual market by quantifying how current enrollees will fare once relevant provisions of the health law are implemented. Premium data released by states to date suggest that the CBO premium projection is reliable. While subsidies and premiums will vary widely depending on each enrollee's personal characteristics, the analysis focuses on averages to provide an indication of how much overall assistance the law will provide to people buying their own coverage today.

HSD Announces Tribal Consultation regarding Centennial Care

***Please share with all public health/behavioral health related list serves in New Mexico***


Dear Friends,
As many of you know, our behavioral health system is undergoing significant changes.  On June 24, 2013, the state reported 15 community based non-profit mental health agencies had their Medicaid funding frozen due to "credible" allegations of fraud.  The state reported they had conducted an audit, but would not release the details of the audit due to investigation by the attorney general.  Since that time, corporations from Arizona have been brought in to take over our local behavioral health provider agencies. 
We need your help collecting the stories of people being impacted by this transition.  All stories are critical to ensuring this issue is brought to national attention and people receiving services get their needs met.  We especially need people who work in the communities that have already undergone transition to the Arizona companies to let people who use services and their families know that their voices matter.  If you know of anybody who has had a loss or reduction in their behavioral health services, or if you know of anybody experiencing  an increase in anxiety or other symptoms due to this transition, please encourage them to share their stories in one of the following ways. 
If people would like to type their story online (either with their name, or anonymously), they can follow this link to a simple survey and we will ensure the stories get to the appropriate people:  http://www.surveymonkey.com/s/6CDWLHQ
People can also write to Center for Medicare and Medicaid Services (CMS):
CMSRODALDMCH@cms.hhs.gov
Bill Brooks  214-767-4461

Additionally, people can contact the New Mexico State Auditor’s office to let them know their story:  http://www.saonm.org/
People who receive Medicaid funded services who have lost services can call OptumHealth at 866-660-7185 and tell them they need immediate care coordination
Anybody in crisis can contact the state crisis and access line at 1-555-662-7474
Thanks!
Sarah Couch
Gay Finlayson 

For people on facebook, please like our page for updated information on how to advocate for and support our community during this trying time.
www.facebook.com/nmrising

News Article CQ Healthbeat "State Exchanges Use Their Powers to Customize Marketplaces"

State Exchanges Use Their Powers to Customize Marketplaces
Reply-To:
hcfa@googlegroups.com


State Exchanges Use Their Powers to Customize Marketplaces

 

By John Reichard, CQ HealthBeat Editor
August 9, 2013 -- States that have launched their own insurance exchanges are taking seriously their power to customize those marketplaces, a Georgetown University professor said at a Capitol Hill forum Friday.

States, for example, are moving more quickly to provide consumers with information on the quality of health plans sooner than they have to under the health law, Sarah Dash, a professor at Georgetown’s Health Policy Institute, said at the Alliance for Health Reform/Commonwealth Fund event.

Seventeen states and the District of Columbia have chosen to establish their own exchanges, Dash noted in an analysis she conducted with other Georgetown researchers.

Nine states plan to display quality data on their exchanges in 2014, in most cases showing the performance of participating plans on national quality measures. However, some of the nine, including New York and Rhode Island, are either developing their own metrics or incorporating existing state-specific measures.

The health law (PL 111-148, PL 111-152) doesn’t require quality data until 2016, Dash said.

Do-it-themselves states also are ahead of the federal government on developing marketplaces for small employers, she said. The federal exchange won’t require an employee choice option in its marketplace for small employers until 2015. In 2014, employers will have a choice of plans, but their own workers won’t. But the employee choice feature will be a part of nearly all of the small-employer marketplaces established in 2014 by the states.

Nine states chose to limit the number of plans an individual insurer could offer. The limits were designed to give consumers a more manageable set of choices.

Thirteen states chose to establish both a navigator and an in-person assistance program. “To initially fund navigator programs, nine exchanges planned to use state funds or private grants until exchange funds become available,” said the study. Every state exchange allows agents or brokers to help consumers enroll through the exchange.

Ten of the states are relying on assessments on insurers to fund their marketplaces in the long term. Eight of the marketplaces haven’t decided on a long-term source of revenue.

Two jurisdictions—Vermont and the District of Columbia—are requiring that all individual and small group coverage be sold through their exchanges, not on the outside. Maryland and Massachusetts allow health coverage to be sold outside of the exchange but are mandating that certain insurers who sell in the small group or individual market have to also participate in the exchange or submit a bid to do so.

And several states acted to keep insurers from popping in and out of their exchanges. Colorado, New Mexico, New York and Oregon bar an insurer from entering their exchanges for up to two years if they do not join the first year, 2014. And Colorado and Connecticut prohibit an insurer from re-entering the exchange for two years if the insurer voluntarily opts out of the marketplace.

The health law requires that insurers participating in an exchange offer at least silver and gold level coverage. These metal rankings correspond to the generosity of coverage. The other metal options under the law include platinum and bronze level coverage, as well as catastrophic policies.

California, Massachusetts, and New York require plans to offer or propose coverage in all five levels: catastrophic, bronze, silver, gold and platinum. Vermont requires plans to offer all the levels except catastrophic. Connecticut, DC, Maryland, and Oregon require participating insurers to offer at least bronze, silver, and gold, and Kentucky requires at least catastrophic, silver, and gold.
John Reichard can be reached at jreichard@cq.com.

NM Indepth Article "LFC is delaying a request by HSD to move money to pay the AZ behavioral health providers"



Complete Article:


http://www.nmindepth.com/2013/08/09/legislative-committee-delays-payment-to-ariz-providers/
From the article:
Abbey explains some of the reasons for objecting in the Aug. 2 letter:
“The LFC acknowledges there are legitimate concerns about fraud, abuse and mismanagement of taxpayer funds by behavioral health providers. But the department has not provided sufficient data for the committee to understand the type of transgressions and dollar amounts that would warrant the replacement of so many New Mexico providers.”
Abbey goes on to write:
“It is clear today that the HSD has authority per federal regulations to lift pay holds. Again, I urge the HSD to consider less costly and disruptive alternatives, such as using intense oversight and training for select providers by state employees, OptumHealth or the Arizona Contractors.”

Forbes Article "Against Expectations, Health Care Reform Shows Signs Of Working"


U. S. attempts at health care reform, centered on the 2010 Patient Protection and Affordable Care Act (“ACA” or “ObamaCare”) have created controversy and evoked much criticism and cynicism. I and others have observed that the ACA is much stronger on coverage extension than on cost control. But, we are now seeing evidence that cost growth is moderating.

Three recent signs:
  • U.S. health care expenditure did not grow as a percentage of GDP in 2011 (more).
  • Prices for individual health insurance policies on the new health exchanges are coming in well below current prices and expectations in numerous states (more).
  • New approaches to coordinated care and results-oriented medicine are showing measurable benefits. For example, hospital readmission rates, a key driver of health care costs, declined in late 2012 (more).

For complete article click on the link

http://www.forbes.com/sites/toddhixon/2013/08/06/against-expectations-health-care-reform-shows-signs-of-working/

Centennial Care presentations information




Here's a link to the list of HSD presentations (dates, times, locations) on Centennial Care:

http://www.hsd.state.nm.us/pdf/CentennialCare/Centennial%20Care%20Event%20Schedule%20August%20through%20November%202013.pdf



From Roxane Bly:

Just wanted to give you a heads up that Theresa Belanger came out to Laguna last night to do a presentation on Centennial Care.  I'm attaching the brochure and PowerPoint that she used.  Note that while she made a point of verbally reiterating that Native Americans are exempt from managed care,
the materials don't reflect this.  In fact, if you look at the PowerPoint slide related to expansion it might give one the impression that only NA included in expansion are exempt.

From Ken Lucero:

Thanks for sending this out.
Teresa and the HSD Deputy Director were questioned at the AA Tribal Consultation (August 6) about the schedule. A few of the tribal leaders and the representatives asked who the meetings were being coordinated by. Many were not done through the Governor or the administrative offices. They informed the State representatives about proper protocol when requesting to present to their communities.
Teresa was also asked about the content of her Centennial Care presentations. Governor Tafoya requested, again, that the materials be made available for review prior to being presented to the communities. Teresa indicated that they did not have a ppt available to share.

Tribal representatives who had possession of the ppt used at previous education sessions, indicated that the presentations were biased to enrolling folks in managed care. Coordinated care and value added benefits were highly emphasized. There was almost no mention that AI were not required to enroll in an MCO or how fee for service at IHS, tribal clinics or urban clinics (I/T/U) would work.

The State representatives were reminded that as state officials their presentations should be as unbiased as possible and they should equally discuss all possibilities of accessing quality care for the beneficiaries. This includes discussing thoroughly all exemptions and rules specific to AI and the I/T/U facilities.

Dr Roubideaux directed the Abq area to work with the service units and the tribes to develop materials that would explain the benefits of utilizing the I/T/U system and how the fee for service model benefits the tribal members. 

Center for Natice American Health "Practices & Policies that Promote Health Justice Summit"

Subject: [CNAH-L] Practices & Policies that Promote Health Justice Summit
 
Good Afternoon, 
 
I hope this finds you all well and in good spirits.
 
The RWJF Center for Health Policy is helping organize a health disparities summit called, "Practices and Policies that Promote Health Justice, a Health Disparities Summit." The Summit will include members of Congress, as well as many health experts and advocates from across the country and here in New Mexico. The Summit will be held September 6-7, 2013 at the University of New Mexico.  Attached is an informational agenda for your review.
 
The event is free and open to the public! 
 
In order to register please use the following link:
 
If you have any questions about the Summit, please feel free to contact Ken Lucero, at ken_luc@msn.com or (505) 220-4704, or Lia Abeita-Sanchez at lasan1@unm.edu or (505) 270-6084.
 

Tuesday, August 6, 2013

Update NAPPR Healthcare Guide agreement

 
It looks like we have a preliminary agreement on our project!  They have accepted the budget we submitted on Sunday and now we are just going through the scope of work for a contract.  Please note, IT IS NOT FINAL YET!  I believe their board might be voting on it tomorrow though so let's all keep our fingers crossed that we can finalize something very soon!.

Just to be proactive, we have advertised the Project Director position and will be advertising for Healthcare Guides (probably tomorrow).  Of course, if something prevents the agreement from happening we will need to pull the ad, but we wanted to start the process because of the ambitious timelines.  One of the timelines in the proposed scope is for us to have subcontracts in place by August 30, so we will definitely need to start working on these ASAP!  More to come on that!
 
Here is the link to the job posting for the project Director--as soon as we have a signed agreement, we will distribute this widely and quickly, but for the time being, please feel free to forward to anyone you think may be interested/qualified! 
Sincerely
 
Jane Z. Larson, Executive Director
Native American Professional Parent Resources (NAPPR), Inc.
 
document link
 

MCOs contacting Tribal leaders and programs while disregarding CMS ruling

From the Pueblo of Jemez Health and Human Services Director:

Evelyn – please distribute to the listserv.  Thanks
 
Please be aware that Molina ,and possibly others will follow, are coming on to the Pueblo’s unannounced and asking to meet with Tribal leadership to push its managed care product.  What they are basically telling your tribal members and tribal leaders is that our managed care is better than your tribe’s managed care – be it provided by the tribe or IHS.  Molina was out here three times unannounced and even set up a booth on feast day (somehow).  I don’t know if they signed any our tribal members up for Molina but this is upsetting. 

Maria K. Clark
Director, Jemez Health & Human Services
 
From the Center on Law and Poverty:
 
 
Good afternoon, Everyone,
HSD and the MCO salespeople are making the rounds attempting to contract with tribal programs and enroll tribal members.  These salespeople are telling the officials and people that the healthcare services which will be provided by the MCOs are superior to those provided by IHS, tribal and off-rez facilities.  Despite the fact the tribes and advocates won the CMS ruling that removes the MCO enrollment mandate, HSD tribal liaison Theresa Ballenger and MCO representatives are disregarding the ruling.  Regrettably these disregarding behaviors are not unusual.  The violators are comfortable in their belief that they cannot be stopped.  At this juncture it is clear that the state does not accept the CMS ruling in fact and will only give lip service to it.   I have suggested to tribal officials that the MCOs receive a letter informing them of proper procedure and protocol when doing business with their tribe.  The CMS ruling that removes the requirement that Native Medicaid beneficiaries enroll in an MCO must be honored.  This behavior points up the importance of state legislation such as HB 376 which Representative Madalena will reintroduce in the next legislative session.  We worked to get it passed the first time and were sabotaged by the complicity of the HSD and Senator John Arthur Smith’s office.  We learned a lot from our first try and will put it to use in this second effort and will succeed.  There is no question now that a state law is needed to protect the rights of Native people to make their own decisions about healthcare and its delivery.  The implications of MCO takeover of healthcare services are serious and have the capacity to threaten the growth and development of indigenous healthcare systems.
Best regards, Evelyn