We have been receiving reports from health advocates that CMS has rejected NM HSD 1115 Waiver "Centennial Care", due to a lack of Tribal Consultation and non-compliance with transparency rules.
This was a verbal announcement by CMS Secretary Tribal Advisory Council STAC. This announcement was verified by Ken Lucero, but as too what it means next that not clear. According to other health advocates CMS could only oppose part of the waiver and allow the rest of the waiver to proceed.
After contacting CMS Dallas office we found out that there is no official written statement yet from either CMS or NM HSD regarding the announced rejection, and that Cindy Man is currently in talks with Julie Weinberg on NM HSD s next steps.
What all this actually means for us is unknown but Mat Kennicot from HSD has stated that there will probably be another round of input sessions and tribal consultations.
Friday, June 1, 2012
Wednesday, May 23, 2012
Senator Bingaman's health policy analyst interested on pueblos comments on Medicaid
Hi everyone,
We’ve recently spoken with Sandra Wilkness, the new health policy analyst replacing Frederick Isasi in Senator Jeff Bingaman’s office, about the state of the Medicaid redesign and health care reform in New Mexico. When we explained our issues with Centennial Care, she stated that she wasn’t familiar with the issue of moving Native Americans into managed care and that she hadn’t heard anything from the tribes or pueblos. She was said that she’s very interested in hearing about these issues, and it would be good to keep her in the loop about whatever you contact CMS with. They might have some pull with CMS. She can be contacted by email at sandra_wilkniss@bingaman.senate.gov, or by phone in the DC office at (202) 224-5521.
Best,
Quela
We’ve recently spoken with Sandra Wilkness, the new health policy analyst replacing Frederick Isasi in Senator Jeff Bingaman’s office, about the state of the Medicaid redesign and health care reform in New Mexico. When we explained our issues with Centennial Care, she stated that she wasn’t familiar with the issue of moving Native Americans into managed care and that she hadn’t heard anything from the tribes or pueblos. She was said that she’s very interested in hearing about these issues, and it would be good to keep her in the loop about whatever you contact CMS with. They might have some pull with CMS. She can be contacted by email at sandra_wilkniss@bingaman.senate.gov, or by phone in the DC office at (202) 224-5521.
Best,
Quela
Friday, May 18, 2012
Comments from Jemez Pueblo re: CMS 1115 waiver tribal consultation guidance
The Pueblo of Jemez does not believe that NM Medicaid met the requirements described in your email because the submitted application does not contain documented proof. It also does not contain responses from the tribal governments, only a few discussion notes.
The Pueblo of Jemez also believes that that the Centennial Care Plan submitted by the State of New Mexico should be identified by CMS as a policy that has tribal implications and a substantial direct effect on Indian Tribes or on the relationship between Tribes and the Federal Government, specifically Medicaid funding, thus compelling tribal consultation.
According to the (CMS) Tribal Consultation policy: “…policies with Tribal Implications refers to regulations, statutes, legislation, and other policy statements or actions that have substantial direct effects on one or more Indian Tribes, on the relationship between the Federal government and Indian Tribes, or on the distribution of power and responsibilities between the Federal government and Indian Tribes.”
Therefore, we submitted the attached letter to CMS formally requesting tribal consultation. Now, I want to make sure that everyone knows- Jemez in no way intended to “go ahead” of the other tribes. Instead, we just wanted a formal letter to be submitted so that CMS is compelled to respond. In that way, we can delay the approval of the Centennial Care waiver request and buy time for other tribes and tribal organizations to get their tribal leaders to formally weigh in. This is also reflected in the attached letter.
Unfortunately, we worker bees cannot exercise the right to consultation, only tribes/tribal leaders can. It is our opinion that time is of the essence and that some formal request needed to be submitted to CMS. We are hopeful that there are similar letters to CMS coming from tribal governments across the state.
CMS Guidance letter on Tribal Consultation for 1115 Waivers from July 2001
Subject: CMS Guidance letter on Tribal Consultation for 1115 Waivers from July 2001
CMS guidance requirements for states submitting 1115 waivers. The link is here:
http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/smd071701.pdf
Therefore, in reviewing all Section 1915 and Section 1115 waiver requests submitted after October 1, 2001 CMS will look to see that
1. All Federally-recognized Tribal Governments maintaining a primary office and/or major population within that State are notified in writing at least 60 days before the anticipated submission date of the State's intent to submit a Medicaid waiver request or waiver renewal to CMS.
2. The notification describes the purpose of the waiver or renewal and the anticipated impact on Tribal members. The description of the impact need not be Tribal specific if the impact is similar on all Tribes.
3. The notification also describes a method for appropriate Tribal representatives to provide official written comments and questions within a time frame that allows adequate time for State analysis, consideration of any issues that are raised, and time for discussion between the State and Tribes responding to the notification.
4. Tribal Governments were allowed a reasonable amount of time to respond to the notification. A minimum of 30 days is considered reasonable.
5. States, if requested by the Tribal Governments, provide an opportunity for an in-person meeting with Tribal representatives. A State does not need to have separate meetings with each Tribe, but may conduct one or more joint meetings with Tribes to discuss issues.
CMS will look to see that States have utilized these guidelines by looking at copies of correspondence sent by the State to the Tribal Governments notifying them of the State's intent to request a waiver or waiver renewal. Copies of any correspondence submitted by Tribal governments, and a discussion summary from any formal State-Tribal consultation meeting(s) as described in number 5 above, will also aid CMS's review of the proposed waiver or renewal request.
Thank you center on law and poverty for the information
Albuquerque journal article regarding MAC
From today's abq Journal:
Medicaid Plan Under Attack
By Winthrop Quigley / Journal Staff Writer on Fri, May 18, 2012
SANTA FE – New Mexico hospitals are worried about losing millions of dollars in revenue. Tribal officials are worried about losing sovereignty and money. Advocates are worried the poor will lose services.
Dozens of health care providers, Medicaid beneficiaries, insurance company officials and representatives of state and tribal governments and nonprofit agencies on Thursday aired those concerns about the state Human Services Department. Specifically, they were talking about HSD’s 104-page application to the federal government, submitted in late April, to overhaul New Mexico’s $3.9 billion Medicaid program, which serves 560,000 people.
Even though about two thirds of Medicaid funds are provided by the federal government, HSD officials say the program is expected to consume about 16 percent of the state’s general fund this fiscal year, up from 12 percent last year. Such growth could force cuts in other state services, they say.
HSD says its plan, called the Centennial Care waiver, will streamline administration of Medicaid, improve quality of care, allow more people to receive services and reduce costs by $453 million over five years. HSD started outlining its overhaul conceptually last June but the first public input on the resulting application occurred at Thursday’s Medicaid Advisory Committee meeting.
Participants generally praised HSD’s plans to help Medicaid recipients get better care through better patient education and programs to coordinate care among several providers. State officials were not able to provide many of the implementation details audience members were seeking.
New Mexico Hospital Association president Jeff Dye estimated one proposed change could cost Albuquerque’s major hospital systems $48 million a year in lost revenue. The state’s Department of Children, Youth and Families issued a statement opposing the change to what is known as retroactive eligibility because it would interrupt health care over administrative hiccups.
Today, people eligible for Medicaid who haven’t enrolled are allowed to enroll retroactively after they’ve started receiving care. Not allowing them to do so would leave hospitals with unpaid bills. CYFD said recipients are often removed from the rolls because of administrative problems that can be quickly resolved, but recipients, most of them children, lose care in the meantime.
Jemez Pueblo Gov. Joshua Madalena and Roselyn Begay of the Navajo Nation Division of Health both opposed plans to require Indians to receive Medicaid benefits through managed care organizations. Today Medicaid provides fee-for-service payments for Indians’ care.
Earlier HSD proposals would have allowed Indians to opt out of managed care, but officials said Thursday the waiver application requires tribal Medicaid beneficiaries to be enrolled in managed care programs.
Begay said managed care organizations would not provide adequate service on remote reservation lands. Madalena said Jemez’s own health system delivers care using fee-for-service payments to supplement costs.
He blasted state officials for failing to include pueblo representatives on the Medicaid Advisory Committee and said the state did not adequately consult with sovereign tribal nations.
“Outreach to Native American communities does not constitute consultation,” Madalena said.
Jim Jackson of Protection and Advocacy Inc. asked if the state would surrender saved money to the federal government or use it to improve and expand care. “There are still a lot of crucial details not spelled out yet,” he said.
Medicaid director Julie Weinberg told the Journal in an interview, “If we can bend the cost curve and do things we haven’t been able to do, I’m just speculating, but it gives us an opportunity for the department to invest in health care in Medicaid. We don’t want to make a decision on what we want to spend money on now.”
Providers and health plan officials said they don’t have the tools they need to execute some of the state’s quality improvement ideas.
New Mexico Primary Care Association executive director David Roddy said many primary care providers don’t have a way to coordinate care for patients and don’t have the information about patients they need.
Mary Eden of Presbyterian Health Plan said insurers have claims data but only medical providers have patient records necessary to improve care. Joie Glenn of the New Mexico Association for Home and Hospice Care said there are 18,000 people waiting for long-term care services through Medicaid but no one knows what needs those people have or even if some of them are still alive.
Dye said hospitals would have trouble collecting proposed copayments of up to $50 when Medicaid recipients use emergency rooms for non-emergency conditions and that the copayment would do little to reduce inappropriate emergency room use.
Dale Tinker of the New Mexico Pharmacists Association applauded a proposed $3 copayment for brand-name prescriptions when generics are available, but Doris Husted of the Arc of New Mexico warned that many generics do not perform as well as brand name drugs, especially psychiatric medications.
HSD said it will form working groups to hammer out details and differences. The agency said it hopes to have federal approval of its application this summer.
— This article appeared on page A1 of the Albuquerque Journal
Medicaid Plan Under Attack
By Winthrop Quigley / Journal Staff Writer on Fri, May 18, 2012
SANTA FE – New Mexico hospitals are worried about losing millions of dollars in revenue. Tribal officials are worried about losing sovereignty and money. Advocates are worried the poor will lose services.
Dozens of health care providers, Medicaid beneficiaries, insurance company officials and representatives of state and tribal governments and nonprofit agencies on Thursday aired those concerns about the state Human Services Department. Specifically, they were talking about HSD’s 104-page application to the federal government, submitted in late April, to overhaul New Mexico’s $3.9 billion Medicaid program, which serves 560,000 people.
Even though about two thirds of Medicaid funds are provided by the federal government, HSD officials say the program is expected to consume about 16 percent of the state’s general fund this fiscal year, up from 12 percent last year. Such growth could force cuts in other state services, they say.
HSD says its plan, called the Centennial Care waiver, will streamline administration of Medicaid, improve quality of care, allow more people to receive services and reduce costs by $453 million over five years. HSD started outlining its overhaul conceptually last June but the first public input on the resulting application occurred at Thursday’s Medicaid Advisory Committee meeting.
Participants generally praised HSD’s plans to help Medicaid recipients get better care through better patient education and programs to coordinate care among several providers. State officials were not able to provide many of the implementation details audience members were seeking.
New Mexico Hospital Association president Jeff Dye estimated one proposed change could cost Albuquerque’s major hospital systems $48 million a year in lost revenue. The state’s Department of Children, Youth and Families issued a statement opposing the change to what is known as retroactive eligibility because it would interrupt health care over administrative hiccups.
Today, people eligible for Medicaid who haven’t enrolled are allowed to enroll retroactively after they’ve started receiving care. Not allowing them to do so would leave hospitals with unpaid bills. CYFD said recipients are often removed from the rolls because of administrative problems that can be quickly resolved, but recipients, most of them children, lose care in the meantime.
Jemez Pueblo Gov. Joshua Madalena and Roselyn Begay of the Navajo Nation Division of Health both opposed plans to require Indians to receive Medicaid benefits through managed care organizations. Today Medicaid provides fee-for-service payments for Indians’ care.
Earlier HSD proposals would have allowed Indians to opt out of managed care, but officials said Thursday the waiver application requires tribal Medicaid beneficiaries to be enrolled in managed care programs.
Begay said managed care organizations would not provide adequate service on remote reservation lands. Madalena said Jemez’s own health system delivers care using fee-for-service payments to supplement costs.
He blasted state officials for failing to include pueblo representatives on the Medicaid Advisory Committee and said the state did not adequately consult with sovereign tribal nations.
“Outreach to Native American communities does not constitute consultation,” Madalena said.
Jim Jackson of Protection and Advocacy Inc. asked if the state would surrender saved money to the federal government or use it to improve and expand care. “There are still a lot of crucial details not spelled out yet,” he said.
Medicaid director Julie Weinberg told the Journal in an interview, “If we can bend the cost curve and do things we haven’t been able to do, I’m just speculating, but it gives us an opportunity for the department to invest in health care in Medicaid. We don’t want to make a decision on what we want to spend money on now.”
Providers and health plan officials said they don’t have the tools they need to execute some of the state’s quality improvement ideas.
New Mexico Primary Care Association executive director David Roddy said many primary care providers don’t have a way to coordinate care for patients and don’t have the information about patients they need.
Mary Eden of Presbyterian Health Plan said insurers have claims data but only medical providers have patient records necessary to improve care. Joie Glenn of the New Mexico Association for Home and Hospice Care said there are 18,000 people waiting for long-term care services through Medicaid but no one knows what needs those people have or even if some of them are still alive.
Dye said hospitals would have trouble collecting proposed copayments of up to $50 when Medicaid recipients use emergency rooms for non-emergency conditions and that the copayment would do little to reduce inappropriate emergency room use.
Dale Tinker of the New Mexico Pharmacists Association applauded a proposed $3 copayment for brand-name prescriptions when generics are available, but Doris Husted of the Arc of New Mexico warned that many generics do not perform as well as brand name drugs, especially psychiatric medications.
HSD said it will form working groups to hammer out details and differences. The agency said it hopes to have federal approval of its application this summer.
— This article appeared on page A1 of the Albuquerque Journal
Thursday, May 17, 2012
MAC special meeting re: Centennial Care
At today's meeting there were a few new points brought up regarding, duel eligibles, Small fee for service component, in home health aids, reduction in the waiting list for HCBS, but nothing big in the way of changes that will effect tribes.
Navajo MAC committee member did again express Navajos' objection to the mandatory enrollment into managed care and the loss of fee for service/opt out category for Native Americans
Several other MAC committee members did express need for more outreach/education/consultation to tribal communities.
Governor from Jemez read a statement about lack of consultation, the rights of pueblos and tribes as sovereign nations, and the lack of a pueblo representative on the MAC. Many MAC committee members agreed and seconded his statement. I would like to thank the Governor for his words on behalf of the Pueblos.
Navajo MAC committee member did again express Navajos' objection to the mandatory enrollment into managed care and the loss of fee for service/opt out category for Native Americans
Several other MAC committee members did express need for more outreach/education/consultation to tribal communities.
Governor from Jemez read a statement about lack of consultation, the rights of pueblos and tribes as sovereign nations, and the lack of a pueblo representative on the MAC. Many MAC committee members agreed and seconded his statement. I would like to thank the Governor for his words on behalf of the Pueblos.
Wednesday, May 16, 2012
Oportunity to Testify before the Legislature
I received a call this afternoon from Michael Hely with the NM Legislative Council Services expressing desire for myself and/or other members of the Work Group to testify before the legislature HHS committee on June 25th regarding HSDs consultation process surrounding the development and implementation Centennial Care. We will be given an hour for a presentation and Q&A from legislature. So we need to come up with people to present I can present major points but I think we will need a tribal leader there to enforce the lack of consultation points and someone within a tribal health program.
Any volunteers?
Erik
Any volunteers?
Erik
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