Now What? discussion

Okay Guys- now what? J

 Are we all in agreement that a pilot project is a good idea? If yes, then we should talk about what the pilot project would look like.

 

We need to figure out our end game.  Is it a pilot project spear headed by.. IHS, Jemez, Kewa, Navajo Nation, that other tribes can opt into once they are 638?  is it a precautionary exclusion of the Native American Population from Medicaid while HSD fixes the Waiver? is it just maintaining the FFS portion for Native Americans?

 

Once we find out what the end game is we can look at the next step.

 

The State isn't going to like anything that Tribes come up with because it will take the funding out of HSD MAD Control, and away from MCOs.

 

What is the feasibility of one of the Tribes actually taking on Medicaid as a Pilot Project and what is that project going to look like what is the scope?

 

if we ask for a FFS model we know the State is not going to go for that either, after claiming that they don't operate a FFS "program" now.  what we need to look at is what Legal options do the Tribes have if we continue to ask, and comment on the waiver, then object and reject the waiver,  and CMS approves the states plan anyway,  "What Right of Action Do Tribes have"?

 

I am still trying to secure a meeting space for February 7th 8th 14th or 15th from Santa Ana so that we can further this conversation.

 

 

 

 

For the Pueblo of Jemez- our end game is not only to get paid FFS, but also to be compensated for the administrative effort put in to coordinate care. This means that we want a piece of the “PMPM” idea that is suggested to go to the MCO’s. We say no MCO, but pass those coins this way for the professional time and effort.

 

I believe that this is the need and desire of all the I/T/U’s- we are lowballing to say we only want the OMB rate. It is a bottom line, yes, but not all that we are due.

 

To that end, I do not want to think too small. I believe we tribes and tribal organizations can do a couple of pilot projects- one that pilots a medical health home in a rural community, one that pilots the MCO target pop sample in a rural community and then in an urban setting, one that runs a Medicaid program, etc. I would hesitate to hang our hat one pilot idea.

 

Overall, I think that the state has no interest investing anything into the tribal health system- they are not interested in working with us to create innovative service delivery systems. They are only interested in working with MCO’s. They made that clear yesterday, so if we agree to pilot programs, I think we have to continue to say to CMS that we do not agree to Centennial Care, but are still interested in working together and here are the ways we will work with the state. This would be our tribal plan. I am not confident they will even think about it, but it is worth our effort to be creative.

 

So, Erik, I would be pleased to attend the meeting to think through some ideas. I do agree that we need to think through the present situation, as well. We have to think about how to fight this round and plan for the next one.

By the way, did I hear Julie say: “trust us?”  wow.

 

 

 I know that Navajo was trying to become a tribal MCO but I don't see it being successful.  However, I did ask Julie yesterday about the possibility of having an existing MCO take on the responsibility of being an MCO for all NM I/T/Us? It would eliminate the need to secure contracts with MCO A, B, C and D.  All our payments would come from one source, our referrals to one source, we could each have a contract with one MCO for all lines of business (i.e. Transportation, enrollment, case management, education). We would have only one middle man and not several middle men.  It was a last minute thought. I think we also should push for a two-day consultation with CMS. One day is not enough.