Notes from Tribal Consultation Session on 01/23/13

 From The Center on Law and Poverty:

 

At today’s CMS state tribal collaboration meeting this morning, Cindy Mann confirmed via phone that CMS has disapproved the state’s proposal to eliminate retroactive eligibility under Centennial Care. They would like to have information from the state after 2014 on how their outreach, enrollment and renewal strategies are working before they implement this change. This is a huge victory for low income families in New Mexico! Thank you all for your hard work and support on this issue.

CMS has not yet made a final decision on the state’s plan to mandate enrollment of Native Americans in managed care. Throughout the over 7 hour discussion today, the state did not move from their position. Tribes have been consistent and uniform in their opposition. Tribes have suggested discussing alternatives such as a pilot project for those Native Americans already enrolled in managed care or a sample population to evaluate the effects of Centennial Care before imposing the plan on the entire population. Kind of similar to what CMS would like to see with the retroactive eligibility piece- evaluation before implementation. Unfortunately, CMS is only stating that they will carry this information back to Baltimore, but that the state’s position has not changed. They are also requesting extensive details from the tribes as to what this would look like. It is not clear where this will go next. Tribes are hoping that this is not the last of the input opportunities with CMS. I will keep you posted.

 Thanks,

 

Quela

From NMICoA Health Committee:

Tribes in attendance: Santa Ana, Isleta, Zia, Acoma, Ohkay Owingeh, Mescalero Apache, Laguna, Kewa, Cochiti, Jicarilla Apache, Jemez, Navajo Nation, Taos.

For the State on NM:
Julie Weinberg, Theresa Belanger, Alicia Smith, Priscilla Caverly

For CMS:

Cindy Mann(via telephone), Kitty Marxs, Robert Nelb, Lane Terwilliger, Julie Hinkle(via video conference)

After introductions and opening remarks the Tribes were given the opportunity to ask questions of Cindy Mann Medicaid Program Director.

Cindy Mann did confirm for the Leadership there that:

 They (CMS) would be directing NMHSD to drop the exclusion of (presumptive) retroactive eligibility from the Waiver.

 That there is no set timeline attached to the 1115 Waiver process, the research and demonstration project gives CMS the authority to impose limitations and regulatory oversight at any time during the Waiver implementation.


Tribes reaffirmed their unified positions on inclusion of the Presumptive Eligibility (retroactive), maintaining the Opt in ability of the NA individual into an MCO, maintaining the Fee For Service component on Medicaid, and called for continued consultation between the Tribes and CMS.

From Ohkay Owingeh Joe Garcia outlined the methods of healthcare delivery for NA individuals, IHS Direct Services, Tribal 638, IHS regional hospitals, and Private providers. Articulated on how Centennial care changes would negatively affect the ability of each method to delivery healthcare to NA population, noted that each tribe is different no one method or MCO would benefit all Tribes.

Kewa presented specific positions on payment capitations PMPM and regulations governing provider credentialing

Jemez commented on possibly delaying the mandatory enrollment of NA population until HSD worked out all the "kinks" in the system.  pointed out that we already know that mandatory enrollment does not work and that it would be more costly to enroll and then opt out.

Navajo Nation explained that they have to interface with three states Medicaid systems and that more consultation is need with NM HSD and asked for a follow up consultation with CMS and HSD for Navajo Nation Larry Curly stated that They received notification for this consultation session the previous day through advocates.

Zia stated that it appears that CMS is not Satisfied with the Information is being presented by the State, and pointed out that burden of proof lies on the State to prove that Managed care works for Tribes and Rural communities.  Tribes already have proved that there are many issues with access and payment/reimbursement of MCOs for health care providers.

Laguna talked about the lack of Trust that the Tribes have in HSD use of MCO s to delivery Health care for the Medicaid population, sighting previous experiences in Salud (opt in, out) , Behavioral Health collaborative and CoLTS programs (Mandatorily enrolled) and their failure to provide timely adequate and comprehensive Health care services to NA communities.

Julie Weinberg spoke about the negative aspects of a Fee For Service model and pointed out that the State of NM does not operate a Fee For Service Program. In a Fee for Service system the STATE CAN NOT track health out come and improvements only usage of services.   There is also no ability to coordinate Care in a Fee for Services setting.  She also spoke about the MCO RFP time line, a Tribal leader had asked if the MCOs had been selected and whether they had started developing their plans, Tribes need to know who they are so we can determine if a particular MCO will work best with a tribe over another. Julie Stated that the RFP had been released and that there were many responses but that they were still in the Procurement phase and Could not comment on which MCOs had been selected and awarded contracts.

At this point the Tribes decided that they need to confer with each other independently from CMS and HSD.  The Tribal Caucus lasted through Lunch

When the meeting reconvened the Ohkay Owingeh read two Statement one from the Governors office and one from the NMICoA Health Committee

San Felipe read a statement provided by their health department

outcomes

Tribes asked for Continued consultation with CMS

Tribes Reaffirmed there common objection to Centennial Care:
Mandatory enrollment into Managed care
Maintenance of the ability for reimbursement on a Fee For Services basis
no cost sharing for NA individuals in Medicaid written into the Waiver
funding for Administrative work performed by I/T/Us
Tribes should appoint members of oversight boards TAG MAC MCO advisory boards.

Unless these positions are changed/added to the Waiver in clear language all Tribes of NM asked that CMS NOT APPROVE the WAIVER