NM HIX Task Force Accepts NAWG Recommendations

Good Afternoon Everyone, 

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

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

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

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

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

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

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

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

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

Native American

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

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

Tribal Consultation

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

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

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

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

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

.    Development of a tribal enrollment verification system

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

Exchange Integration

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

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

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

.    Applicability of the Federal Tort Claims Act;

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

Native American Service Center

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

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

.    Specific AI/AN benefits and protections;

.    Tribal sponsorship of premiums (if applicable);

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

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

.    Cultural competency training

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

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

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

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

 

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

By John Reichard, CQ HealthBeat Editor

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

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

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

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

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

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

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

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

 

NY Times Article "The Sequester Hits the Reservation"

The Sequester Hits the Reservation

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

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

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

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

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

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

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

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

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

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

HHS Health Care Law 101 follow up

From HHS:

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

 

Good Afternoon,

 

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

 

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

 

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

 

I also mentioned the following websites:

 

www.cms.gov

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

 

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

 

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

 

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

 

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

 

Best Regards,

 

Lisa M. Carr, MSW

NMICoA Health Committee Regional meeting Summary

Regional Meeting

Pueblo of Santa Ana
March 22, 2013

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

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

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

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

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

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

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

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

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

April Wilkinson- Lwilkinson@jemezpueblo.org

Jemez Health and Human Services    575-834-7413

Lisa Maves- Lisa.maves@jemezpueblo.us

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

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

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

HB 376 Comments

From the Center on Law and Poverty:

 

Good day, Everyone,

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

 

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

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

 

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

Best regards, Evelyn

 

Evelyn Blanchard

NMICoA Health Committee Regional Meeting

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

New Mexico Indian Council on Aging

Regional Health Committee meeting

Pueblo of Santa Ana (Tamaya) Council Room

March 21, 2013

9AM-12PM

Agenda

 

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