NM HIX Native American Work Group recommendation

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

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

Exchange Legislation:

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

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


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

RE:  New Mexico Tribal Consultation

Dear Ms. Tavenner:

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

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

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

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

Sincerely,

HB 376 What Happens Now?

 

Good Afternoon and happy St. Patrick day,

 

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

 

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

 

 

 

From Center on Law and Poverty:

 

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

 

Evelyn Blanchard

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

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

Legislature hires ex-govt. officials

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

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

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

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

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

Last Day of Legislative Session

Good Morning Everyone,

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

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

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

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

Support HB 376 CALL Senator John Arthur Smith office

From The Center on Law and Poverty:

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

From Councilman Joe Garcia:

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

From Center on Law and Poverty:

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

 

From Lisa Maves Pueblo of Jemez:

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

 

Governor Bruce Tafoya Pueblo of Santa Clara:

Already sent him an email as well!!

 

From Lisa Maves Pueblo of Jemez:

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

 

From Maria Clark Pueblo of Jemez:

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

NO hearing Agenda for HB 376

Good Morning everyone,

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

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

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

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

john.smith@nmlegis.gov

HB 376 hold up in Senate Finance Committee

From The Center on Law and Poverty

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

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

Evelyn Blanchard
Organizer
NM Center on Law & Poverty