NM HIX Task Force Accepts NAWG Recommendations

Good Afternoon Everyone, 

This morning the Office of Health Care Reform Health Insurance Exchange Task Force met to accept of reject the recommendations of the individual Workgroups including the disbanded Native American Work Group ( NAWG)

I was the only member of the NAWG present at the meeting in Santa Fe, so I attempted to answer questions by the Task Force regarding the NAWG Recommendations. (BELOW)

It was brought up that there will be an NA Advisory Board and the Board of Directors will reflect the Ethnic Diversity of NM, the Board will be selected by the Governor and certain Legislators.  I stated that there is no guarantee that a NA will be selected and Approved as a board member, and that I was not satisfied with this portion of the Law.

For the most part the Task Force accepted all recommendations on made by the NAWG.  There were a few misunderstandings regarding NA exemptions and it was clarified that "exemptions" related to the ACA regulation Exempting NA from the Mandate to purchase Health Insurance in 2014.
(Exchange Integration third bullet point)

Andy Vallejos from HSD Office of General Council had some objections for language regarding the Federal Tort Claims Act,  but I stated that these recommendations are currently in effect and by including them in this document we are just asking that HSD OHCR HIX "Puts it in WRITING"

I the end Milton Sanchez asked me if there was anything that I would Like to add in Closing...

I commented on:
Lack of Consultation the OHCR NMHIX has yet to directly consult with any Tribal Leader or Government regarding the implementation of an Exchange. While I appreciate the fact that OHRC established a NAWG and had NA on other Work Groups, that does not take the place of Tribal consultation, the information presented today should have been shared with Tribal leaders, before accepted or rejected. According to Federal and State Law the OHCR NMHIS is obligated to consult with tribes when ever a program is introduced or changed that will directly affect NA individuals.

The Fact that the there are no other NA present for this meeting and that the NAWG was the only HIX workgroup told not to meet anymore.  NA are dissatisfied with the process of consultation and collaboration.

I did not talk about the NASC development and budget, and I did not address the letter sent to CCIIO.
I think that we need to wait until Governor Martinez signs the HIX into Law before we ask Tribal Leaders to invoke Tribal Consultation.

Native American

The Native American Work Group met six times between October 23, 2012, and February 12, 2013. During the first meeting, CCIIO representatives joined the Work Group to discuss questions the group had regarding Native Americans and their participation in the Exchange.  It was initially discussed to divide Work Group members into subgroups to research topics in greater detail, but this was overturned at a later meeting.  Over the next several meetings, the group discussed barriers to Native American participation in the Exchange, including tribal members’ current access to health care through HIS which obviates the need for insurance,  cultural barriers against planning for ill health, and challenges for outreach in areas with little or no access to technology in very rural areas.  Differing tribal requirements for proof of membership were discussed, including the need to avoid challenges to tribal sovereignty, and federal rules for tribal membership were discussed.  Concerns were voiced about plan certification of I/T/U providers to become part of “in network” systems.  A primary source of discussion was a proposed Native American Service Center (NASC).  Challenges around rules allowing Native Americans to move from plan to plan, and in and out of the Exchange monthly were also considered.  Work Group members expressed strong opinions about Native American representation on the governing board of the Exchange.

The Native American Work Group made the following recommendations on the February 27, 2013 Advisory Task Force meeting:

Tribal Consultation

The Exchange must adopt a tribal consultation, collaboration, and communication policy that is consistent with New Mexico and federal tribal consultation rules. This policy should include provisions to confer with Indian Health Services, tribal health programs, and urban Indian health programs prior to the roll out of new policies and procedures. Consultation should include, but not be limited to, the following topics:

.    Development of a communication, collaboration, and consultation policy for the Exchange;

.    Development of the NASC, including the Center’s tasks and its advisory council;

.    Assisting tribal governments with premium payment on behalf of its members;

.    Development of the Navigator program, cultural competency training, and education and outreach materials;

.    Development of a tribal enrollment verification system

The Exchange governing board should establish a work group to define criteria and qualifications for prospective Native American board members, of which there must be at least one. The board should coordinate with administrative, legislative, and stakeholder entities to ensure sufficient inclusion of Native Americans.

Exchange Integration

• Tribal enrollment verification documentation might include a tribal enrollment card, certificate of degree of Indian blood (CIB), or any HHS-approved electronic data sources available to the Exchange. If approved data sources are unavailable, the individual does not appear in the source, or the source is not reasonably compatible with an applicant’s attestation, the Exchange must follow HHS-delineated inconsistency procedures.
• The Exchange should provide a mechanism for tribes and urban Indian programs to make individual premium payments to multiple carriers on behalf of their members.
• The Exchange must recognize AI/AN exemptions.
• As a condition of certification, qualified health plans (QHPs) should be required to offer provider contracts to I/T/Us, designated as essential community providers. These contracts must accommodate the unique features of the I/T/U system, including:

.    No open network access (i.e., an I/T/U may limit who is eligible for services);

.    Licensed health care professionals who are employed by tribally operated health programs are exempt from state licensing requirements, if the professional is licensed in any state;

.    Applicability of the Federal Tort Claims Act;

.    QHPs should also accept referrals from I/T/Us as primary care providers

Native American Service Center

Specific outreach, education, and training competencies/functionalities of the Native American Service Center (NASC) should include:

.    A resource specialist on the AI/AN application and enrollment process;

.    Specific AI/AN benefits and protections;

.    Tribal sponsorship of premiums (if applicable);

.    Benefits of the Exchange and the potential for increased revenues for I/T/U clinics;

.    Benefits of becoming an “in-network” provider for each exchange plan, and the designation of I/T/Us as essential community providers;

.    Cultural competency training

The NASC should work with tribal officials and tribal enrollment offices to develop a system of communication and enrollment verification that does not infringe on tribal sovereignty.

The NASC should work with the Exchange to ensure that the web portal can identify AI/ANs for appropriate exemptions, provide a mechanism for aggregated premium payments, and account for “mixed” households (i.e., households with tribally enrolled and non-enrolled members).

As the recommendations were presented to the Advisory Task Force, some members of the Advisory Task Force expressed concern about the lack of progress that has been made by the state on the Native American Service Center.  It was clarified that many aspects of the Exchange, including the Native American Service Center, have been stalled until Exchange legislation is passed.  Discussion ended, and the recommendations were tabled for further consideration.