Quick Summary
CMS - Kitty Marx, Robert Nelb,
IHS- Richie Grinnell,
Tribes in attendance:
Ohkay Owingeh,
Kewa, Zia, Isleta, Taos, Santa Clara, Santa Ana, Acoma, Cotichi, Laguna, Nambe,
Zuni, Ramah (Navajo), Jicarllia Apache, Ute (Southern)
After introductions
of Federal representatives and Tribal Leaders and representatives, CMS gave an
over view of Centennial Care as they understand it, given the information from
the NM HSD. A power point hand out was provided ( for a copy of the materials
presented contact Robert Nelb Robert.nelb@cms.hhs.gov) no new information was presented that hasn’t already
been identified in the Centennial Care Waiver as submitted on August 17, 2012.
After the
presentation by CMS Tribal Leaders voiced their concerns and many had the
common message. As is, with relation to
Tribes, we oppose NM s 1115 Research and Demonstration Medicaid Waiver “Centennial
Care” for the following reasons:
·
Complete
Lack of Meaningful Tribal
Consultation between the State of NM and Tribes.
·
Mandatory
Enrollment of All Native Americans in to Managed Care Organizations (MCO)
Through the Indian Health Care
Improvement Act (IHCIA) Native Americans are protected
being mandatorily enrolled into Managed Care Programs
·
Elimination
of the “Opt in” ability for Eligible enrolled Native Americans in the Medicaid Program
Native Americans have had this
option since the institution of the Salud Program in NM
And many other Tribes in other
states including tribes in AZ and Kansas have similar provisions in their states Medicaid program
·
Elimination
of the Fee for Service Component from the Medicaid program for Native American Population
The fee for service program is
utilized and preferred by Tribal Programs and IHS when billing for Medicaid Services, because of prompt payments. The Fee for service program is going to remain intact for undocumented immigrants
in the State of NM
·
Elimination
of the Prior Quarter Coverage “presumptive eligibility” for Medicaid Enrollment
The elimination of this provision
will greatly affect Tribal health program and IHS budgets that rely Medicaid reimbursements.
·
Any
individual Native American enrollee cost sharing or Tribal program/facility cost
Sharing Native Americans are protected from cost sharing through provisions in
the PPACA and the IHCIA
Other
topics included MCO RFP approval/disapproval, MCO relations, MCO RFP Timeline,
Contracting, direct reimbursement to Tribes from HHS/CMS, Outreach, care
coordination, Tribal Health data( Health outcomes, disparities) Tribal Sovereignty.
After
the Lunch Break CMS asked Tribal Leaders for specific details of the Waiver they
would be willing to discuss. The Tribes
elected to Caucus independent of the audience and government representatives.
It
was decided that,
·
The
Tribes oppose the Centennial Care Waiver
as it is currently written and submitted, though not the entire document there
are portions and provision within the waiver that the Tribes agree on.
·
The
issues stated above are the points of contention, unless the Waiver is altered
to include these points NM Tribes (present at the Consultation Session) ask CMS
to disapprove of the Waiver on behalf of the NM Tribes.
·
Tribes
are willing to discuss Details of the waiver but not at this time due to the
main points above and time constraints, CMS agreed and are open to many more
consultations sessions.
·
Tribes
present agree that the Waiver has many flaws and would like to see it stopped
but it is not the job of the tribes to “fix” the Waiver for the State. The Waiver
will have a negative effect on rural NM communities, but Tribes cannot make
a decision for the non-Tribal population
of NM
CMS
did extend an invitation to any tribal leader attending the Tribal celebration
in Washington DC, on December 6, 2012 to meet with Cindy Mann Director of CMS,
who will be the person with the final say in the approval of the Waiver.
CMS
will be meeting with NM HSD personnel on December 17, in Baltimore MD, to
discuss the Waiver and this tribal consultation.
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