June 8th meeting major points

GENERALCOMMENTS and RECOMMENDATIONS

Tribal workgroup meeting held at Kewa Pueblo Health Corporation on Friday June 8, 2012 on 1115 demonstration waiver under the Social Security Act

The Tribal workgroup meets to inform and educate members about the Centennial Plan, 1115 (b) waiver request and other tribal health care delivery systems in tribal lands.  The workgroup is not authorized or sanctioned by any tribe or tribal organization and is a voluntary group meeting to share information and provide meaningful input in response to diverse tribal health care issues.

General cross-cutting issues among all tribes:

There was general agreement on the following:

1)      Based on tribal sovereignty and the ACA such legal protections state there is no mandatory participation for Natives to enroll in Managed care and nor is there a penalty if a Native does not buy health insurance. This may allow for FFS for tribes and support the  ‘opt out’ option currently in place and initiate Government to Government discussions and implementation of Centennial Plan with Tribes as stated in Federal and State consultation laws. Tribes want to see the No cost sharing and No mandatory participation in managed care, in writing, in the waiver.

2)      Tribes feel the 1115 waiver is incomplete and request more updated tribal health outcomes data from phase 1 of Managed care. This request should include FFS data from managed care providers. Various sections and provisions of the waiver has undefined service definitions, unknown planning and design models, undetermined assessments, outcomes measures and benchmarks should be put in writing and communicated transparently to providers and stakeholders.

3)      Tribes request a more defined, descriptive, process, expectations, outcomes and meaningful dialogue in the Native American section describing ‘block grants’ or ‘pilot projects’ that can be developed with tribes. What systems, new systems, blended or combined plans and health impacts are being proposed by the State in this section?

 

4)      Tribes want input in the RFP the State has developed and address the impact on Native American health care and health delivery systems.

 

5)      Tribes want to have direct communication with Governor Martinez on 1115 waiver to discuss waiver, process and health impact to Native Medicaid population.

 6)      Tribes request a meeting with CMS and State Medicaid Assistance Division simultaneously to discuss implementation of the waiver and impact on Native Medicaid population health care.

 At this meeting there was general explanation on the CMS Waiver process, the current ‘voluntary’ retraction by the State and some communications with CMS. As noted in the CMS requirements the tribes request a ‘sufficient level of detail on the hypothesis, evaluation parameters, expected outcomes and expenditures’ on the waiver to facilitate meaningful communication with the tribes.

Workgroup agrees each tribe has it own current health delivery systems in place and their own independent plans along with the required concurrence by individual tribal leaderships in addressing their health care needs.

Additional comment: the demonstration 1115 waiver amendments should be subject to the new guidelines issued to state health officials on April 27, 2012. The final rule 42 CFR Part 431 Subpart G, left open whether waiver amendments were subject to the regulations governing public notice and comment that at this time states submitting amendments did not need to comply with the new rule. The Tribes MAY wish to state strongly that  waiver amendments should be subject to public notice and comments requirements as amendments may have a bigger impact than the actual waiver being proposed or in place.