Good afternoon, Everyone:
HB 376 received a unanimous “do pass” in today’s Indian and Cultural Affairs Committee hearing. The next hearing will be held by the Judiciary Committee. The date and time has not been set but from what I can learn it will likely occur on Wednesday, March 6th. The Judiciary Committee convenes Monday, Wednesday and Friday at 1:30pm in Room 309. I’ll confirm the date with you as soon as I learn. Like the Judiciary Committee in the House the Senate committee is a larger hurdle than the committee we met today. Please go to the list sent to you earlier in the week and make contacts with all the members of the Judiciary Committee. It is especially important that you make contacts with Judiciary Committee members in your county. You have the greatest sway in your county because it is votes like yours that keep the individual in office. This person is your senator and will listen to you. It is also important that again we have a show of strength and unity. Please make every effort to attend the Judiciary Committee hearing next week.
At today’s hearing the state’s position was defended by Brent Ernest, Deputy Secretary, Human Services Division. His attendance is significant as he is at a higher level than Julie Weinberg, Director Medicaid Programs, who defended the state’s position at the House Judiciary Committee hearing last week and where, as you recall, the vote was a unanimous “do pass.” He stated that the Department did not set out with the intent to mandate managed care enrollment for the Indians. The requirement was seen as desirable because the state planned to provide a robust system of health care that would be tended by care coordinators who would assure that enrollees received the health care services needed. The Centennial Care Plan is simpler administratively and the state wanted to get rid of fee-for-service. He stated that state does not have the capacity to provide quality health care through the fee-for-service system. He acknowledged that there have been implementation problems with the managed care organizations and said that the tribes’ claims about the problems were valid. He asserted to the Committee that these problems would be overcome through requirements set out in the contracts with MCOs. He explained to the Committee that many of the tribal objections would be addressed through contracting arrangements between the tribes and MCOs to provide services such as transportation and care coordination.
Senator Cliff R. Pirtle (R) who introduced himself as representing Mescalero said he was bothered by HSD’s assertion in the Fiscal Implications Report that mandatory enrollment was necessary to avoid Indians “opting in” and “opting out” every month. He asked if the Indians could be restricted to “opting in” or “opting out” maybe quarterly. Ernest clarified that the monthly opting provision was related to the Health Insurance Exchange not Centennial Care. He did not support a quarterly opting arrangement but thought an annual arrangement would be more in line with what the state could do. Pirtle pursued his questioning and raised the concern of a seriously ill patient who needed specialized treatment. He expressed concern about continuity of care for someone who opts in and out on a monthly basis. Dave Panana explained that MCOs do not have specialists in rural areas and that patients are referred to providers paid through fee-for-services arrangement within the Medicaid program. This practice would continue for any patient not enrolled in an MCO. He explained that this methodology works better. It is has been Jemez’ experience that it regularly takes an MCO two to three months to determine if an enrollee is eligible for coverage which forces the health center to refer the patient for coverage under IHS Contract Health Services. Committee member Cisco McSorley informed Pirtle that rural area residents throughout the state have been subjected to MCO practices like these for many years.
Deputy Secretary Ernest informed the Committee that the Department intended to enhance telehealth systems’ capacities to handle special health care needs in rural areas and to overcome the distances that enrollees were now required to travel to receive specialized care. McSorley responded that he and other legislators attended a telehealth seminar at UNM Health Sciences Center where it was learned that there was no money in the Governor’s budget to expand the program or employ personnel in rural areas needed to make the services available in those locales. He emphasized that the state must have programs that will reach out to provide services to residents of these areas without which that aspect of the Centennial design could not be seen as workable.
In her testimony, CLP health care team attorney Quela Robinson recited the history of problems related to reimbursements for services from MCOs. In preparation for the Judiciary Committee meeting next week, would you send me descriptions of reimbursement problems you have with MCOs now and in the recent past. I recognize that there may not be overwhelming numbers as only 15% of the state’s Native Medicaid population is enrolled in MCOs, however it is important that we are able to establish a pattern. This information is needed for the hearing before the Judiciary Committee but it will be even more influential should we also have a hearing by the Senate Finance Committee. Right now, we are scheduled for hearings by both committees but there is the possibility that a hearing in Finance may not occur especially if we are able to provide a strong, solid case for our position next week in Judiciary. We are entering the last laps of this race and our determination and strength will carry us to victory.
Extremely happy to report that the Violence Against Women Act (VAWA) reauthorization with the provisions that protect Native women was passed in the U.S. House of Representatives with a vote of 286 to 138. This vote restores some of Indian Country’s losses in the Oliphant decision. Next week I’ll send out a copy of this legislation.
I will be out of the office on March 1 and 4 at the Heard Museum Art Show in Phoenix. I will take my computer with me so that you can be notified about the date of the Judiciary Committee hearing next week.
Best regards,
Evelyn Blanchard
Organizer
Organizer
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