Meeting Details/Agenda for Tribal Programs prep for CMS Teleconference

Tribal Health Department Preparation for

Video/Teleconference with the

Center for Medicare and Medicaid Services

January 17, 2013 – 10:30am – 1:00pm

Indian health Service Regional Office

5200 Homestead Rd. NE

Albuquerque, New Mexico

505-248-4500

 

Purpose:  At the Medicaid Expansion Convening held on October 18, 2012 tribal leadership acknowledged the need for an informed and knowledgeable health department staff who would be able to advise them on health care issues.  On January 23, 2013 the Center on Medicare and Medicaid Services (CMS) will hold a video/teleconference with tribal leadership and their representatives to render its decision regarding the state’s request for an 1115 Waiver.  This meeting is being held to inform tribal health department staff of the positions taken by tribal leadership related to the state’s Centennial Care Plan and its request for an 1115 Waiver which would allow the state to implement the plan.  The information provided at the meeting and the discussions which will be held will equip tribal health department personnel with the information needed to be informed and knowledgeable advisors to their leadership on these issues.  The discussions are especially crucial to those tribes with new leadership and whose leaders may not have had the opportunity to learn about and understand the issues involved. 

Opening prayer
Welcome:  Evelyn Blanchard, Organizer, New Mexico Center on Law and Poverty
Preparation for tribal advisement:

 Presenters:     April Wilkinson, Special Assistant to the Governor, Jemez Pueblo
                        Erik Lujan, Volunteer Advocate/Policy Analyst, New Mexico Indian Council on Aging (NMICoA) Health Committee
                       Anthony Yepa, Acting Director, Kewa Health Corp.
                       Quela Robinson, Staff Attorney, New Mexico Center on Law and Poverty Health Care Team

  

 Discussion of the tribes’ opposition to granting of 1115 Waiver to the state by the Center on Medicare and Medicaid Services (CMS) which would give approval to the state to implement its Centennial Care plan.  What are the specific problems that tribes have identified with the Centennial Care plan?  What recourse, if any, do tribes have in the event that CMS grants the state’s request for an 1115 Waiver? If tribes are required to contract with Managed Care Organizations to cover the services of their people on Medicaid what are the actions tribes can take to overcome previous problems encountered with managed care organizations? What positions should tribes take regarding the composition of the Native American Advisory Board and the Native American Technical Advisory Subcommittee?  Identification of significant items for advisement and consultation with tribal leadership in preparation for Jan. 23 video/teleconference.

 

________________________________________________________________________________________________________________________

Please email me to let me know if you will attend the meeting.  If you are unable to attend, the materials and position statement developed will be sent to you for consultation with your leadership.  Look forward to working with you.

 

NM DoH Tribal Liaison Resigns

I want to thank Dr. Reid for all his work and support of our efforts in advocating for healthcare rights of NM Tribes

Dr. Reid Wrote:


Dear Interim Cabinet Secretary Brad McGrath, New Mexico Department of Health

It's been over 6.2 years that I have served as the Tribal Liaison and the Director of the office of American Indian Health that was created by former Secretary Alfredo Vigil, this office and my DOH partners have done alot in improving State-Tribal Affairs compared to the 200 year history of State-Tribal Affairs in this (6) years, it was a shock for me for the reorganization that was made with a new director took place. That reorganization just undid the progress that was made in collaboration and partnership with the tribes, nations and pueblos overnight. It was very sad to see that Dr. Torres hired someone who knows nothing about the tribes, nations and pueblos and had to be corrected several times after calling the President Ben Shelly, "Governor, Governor, Goverrnor".  For the record I have served under Secretary Michele Lujan Grisham, Dr. Alfredo Vigil, Dr. Torres and now under you. I have as the tribal liaison requested to meet you before I was reassigned to give you the State-Tribal update on health but for some reason you never wanted to meet with me, or the request never reached you. That was not in the spirit of SB196 (state-Tribal Collaboration Act). As you know I filed a greviance against Carlotta the 2nd week she was there (as the new director), "o my goodness,she created from my perspective a challenging work milieu," it was not very healthy.Despite the DOH internal grievance policy you never responded to my grievance within 10 days (Step 2), after that it was suppose to go to the Governor's Office. I selected not to pursue that. But thats is all behind me now. Good luck!the deepest heart, I wish you and the NMDOH well in your continued work to improve health services for all citizens and American Indians residing in New Mexico.I did what I could to champion the State-Tribal relations in the (6) years that I have been in this capacity. It was my goal to work toward a win-win relationship to assure both the State and Tribes were highly successful. This past year at the State-Tribal Summit, I gave Governor Martinez some of our publication efforts such as the Vol. 5 DOH Indian Tribal Report Card and the Vol 5 Indian Resource Guide to her and talked highly of the NMDOH actually being at the forefront of State-Tribal relations, alot of that success was due to my efforts (based on relationships with the tribes). Governor Martinez was very receptive and appreciative.

I just want to acknowledge and appreicate the work of the following DOH superstars besides me,  Ms. Jane Peacock, Dr. Michael Landen, Mr.David Vigil, Mr. Ty Ryburn,Ms. Teresa Padilla and Ms. Amanda Romero in working deligently to get me a lateral transfer to another position in Albuquerque. I tried out the position in ABQ and the with uncertainty I had with my continued employment with DOH although I have been verbally gaurantee a position I was not convinced. I was very insecure with the promises that were made to me. One recommendation I will make to you, I hope you follow-through with this, in selecting the next tribal liaison for the NMDOH, in the spirit of SB196, allow that person to have a dotted line to the Secretary of Health not buried under a Division director, and allow the tribes to participate in the hiring and selection of Indian candidates for this important position, its an important position, and your current director (whose on probation) is not going to build those Tribal relations. You got to build trust.

With reluctance because I am on FMLA and have a sick spouse at home, I am tendering my resignation for personal reasons effective today (Friday-1/11/13) at 5:00pm (immediately). Good luck in the challenging job you are in.

\

Respectfully,

Dr. Ron A. Reid
Isleta Pueblo & Laguna Pueblo Tribal Member  

Question on Governor Martinez possible "Bargin"

After reading the press release from the Governors office regarding her decision to Expand Medicaid I, and several others, began to question the last 2 paragraphs of the of the release.  I was worried that there might be some kind of "Deal" being made between HHS Secretary Sebelius and Governor Martinez.   Governor Martinez accepts Medicaid Expansion in exchange for Quick Approval of the Centennial Care Waiver.  The Following is From the Center on Law and Poverty.

 

"I raised the question about the expansion and waiver with the health care legal team and Quela responded.

 

“CMS processes waivers for states all the time regardless of the ACA, the expansion is a separate animal.  The approval of one isn’t linked to the other in any way.  California was early to say they would expand (began in 2010) and has submitted well over 10 waivers since then – some expanding services and some implementing co-pays or payment reforms.  They’re apples and oranges.  The Centennial Care waiver was submitted regardless of expansion and, in fact, didn’t account for expansion in any of the proposals.  They will have to amend parts of it moving forward to accommodate the expansion.  I don’t believe that the expansion decision will make any change to the state’s plans under the waiver and we should stay the course with our opposition.  Our arguments just get stronger because more people are affected – for example, the elimination of retroactive coverage has a much greater impact now that the state is expanding to cover an additional 170,000 un-insured.”

This is the way she sees it.  There would certainly be an outcry from those providers who could receive an awful lot of money for care they provided but for which they may otherwise have to eat.  Quela is working only two days a week from now on but said she would try to make the meeting. 

Talk with you soon,

Evelyn"

 

In a ideal world this is the case, I don't think it completely answers the question.  With the previous experience the Tribes have had with the NM HSD consultation policy and the complete lack of interest in working with the Tribes in a meaningful matter, I worry that this administration will do anything to speed up the process of approval.

 

These are just my thoughts on the subject

 

Gov. Martinez Announces Medicaid Expansion

The way its written it sounds to me like the Governor is accepting Medicaid Expansion in exchange for CMS Approval of Centennial Care !?

FOR IMMEDIATE RELEASE January 9, 2013   Contact: Enrique Knell (505) 819-1398 enrique.knell@state.nm.us     GOVERNOR SUSANA MARTINEZ ANNOUNCES MEDICAID EXPANSION   ALBUQUERQUE – Governor Susana Martinez announced today that New Mexico will expand access to Medicaid for up to 170,000 eligible New Mexicans. The expansion is mostly designed to assist those adults earning up to 138 percent of the federal poverty level, which is about $15,400 a year for an individual.   “This decision was made with the input of our fellow New Mexicans. Over the past few months, I’ve done a lot of listening. I’ve met with health advocates, hospital leaders, both rural and urban providers, members of the business community, legislators, and many others,” said Governor Martinez. “We have an obligation to provide an adequate level of basic healthcare services for those most in need in our state. However, we also have an obligation to ensure our state’s financial security. In deciding to expand Medicaid, I weighed every possible outcome and impact. Ultimately, this decision comes down to what is best for New Mexicans.”   The Patient Protection and Affordable Care Act provides that the federal government will cover 100 percent of the states’ costs of the expansion for the first three years, gradually decreasing to 90 percent in 2020 and thereafter. Governor Martinez has repeatedly called upon the federal government to guarantee its funding obligations and will work to implement contingency measures in the event that federal funding lapses. The governor’s budget proposal will include language to protect New Mexico’s most vulnerable citizens, removing only the most recent additions from the Medicaid rolls in response to a funding shortfall.   “I want all of us to remember, Medicaid expansion is a federal government promise,” said Governor Martinez. “Unfortunately, we know that out-of-control federal spending can create uncertainty for these kinds of programs. If the federal government breaks its promise and begins to cut their reimbursement rate, we will be forced to scale back this expansion. In the event that we are faced with such a decision, we cannot allow our children who are most in need to go without healthcare services. If the federal reimbursement rate for Medicaid expansion is cut, we must protect our kids and protect our budget by ensuring that the most recent additions to the Medicaid program are the first ones moved off.”   Governor Martinez also spoke today to Health and Human Services Department Secretary Kathleen Sebelius, who committed to working with the governor to sign New Mexico’s Centennial Care waiver, requiring more coordinated care for Medicaid patients in New Mexico. With the goal of improving overall care for Medicaid recipients, Centennial Care institutes co-pays for the improper use of emergency rooms, expands the ability of health care specialists to reach rural areas through the use of technology, offers incentives to hospitals to reduce re-hospitalization rates by encouraging follow-up care, and incentivizes patients to make healthy lifestyle choices and utilize the primary care system.   “Full implementation of Centennial Care, coupled with a fully-funded expansion of access to Medicaid, will help provide access to basic healthcare for even more New Mexicans,” the governor concluded.   ###

News Article Las Cruces Sun "Living without health care: Medicaid expansion could be 'godsend' for uninsured"

Published in the Sunday Las Cruces Sun-News, this article highlights how Medicaid Expansion would help many New Mexicans who are currently living without health insurance. There is an important decision to be made soon: "Medicaid is the only optional part of federal health-care reform upheld by the nation's top court in June. The decision... is in the hands of Gov. Susana Martinez."
Yes, Governor. Say yes to Medicaid Expansion!
New Mexico needs this. Read these statistics from the New Mexico Health Policy Commission, 2011 State Physician Workforce Data Book and U.S. Department of Health and Human Services, as cited in the above article:
"— About a quarter of the state is uninsured, one of the highest rates in the nation.
— New Mexico ranks 49th out of 50 states for number of dentists per capita.
— New Mexico's current nursing shortage will almost triple to 2,800 by 2015.
— New Mexico has one of the oldest physician populations in the country"

"Living without health care: Medicaid expansion could be 'godsend' for uninsured" - by Deborah Busemeyer/New Mexico In Depth
Published in the Las Cruces Sun-News, January 6, 2013

http://www.lcsun-news.com/las_cruces-news/ci_22321983/living-without-health-care-medicaid-expansion-could-be?utm_medium=referral&utm_source=t.co

Letter from HHS Sec Sebelius to Governor Martinez

　

Susana Martinez
Governor 4
90 Old Santa Fe Trail
Room 400
Santa Fe, New Mexico 87501


Dear Governor Martinez:

I am pleased to inform you that New Mexico has received conditional approval to establish a State-based Exchange. We commend New Mexico for taking this important step towards providing affordable health insurance for consumers. Congratulations on reaching this milestone on the path to establishing an Exchange for the people of New Mexico.
Conditional approval reflects the expectation that the New Mexico Health Insurance Exchange (NMHIX) is developing a State-based Exchange, compliant with the Affordable Care Act (ACA), and will be ready to provide affordable, quality coverage for consumers and small businesses in 2014. The Centers for Medicare & Medicaid Services (CMS) has reached this decision based on the New Mexico Exchange's self-assessment and expected progress across the entire spectrum of Exchange requirements, and is contingent upon the following conditions:

1. Comply with regulations and expected progress milestones. During the first year of the program (plan year 2014), approval of a State-based Exchange will account for timelines related to guidance and infrastructure development;
2. Participate in an Establishment Review by February 1, 2013 and develop a revised timeline and detailed work plan that aligns with the Exchange Blueprint, including dates and key milestones, to provide HHS with a clear understanding of the State's expected ability to complete Exchange activities;
3. Demonstrate legal authority to certify qualified health plans (QHPs); and
4. Confirm Information Technology and Project Management vendor selection and awards no later than February 1,2013.

We recognize that the NMHIX is working under intense timelines and will work with you to establish benchmark dates that are appropriate and will allow us to jointly monitor New Mexico's progress. CMS will continue its work with all Exchanges, including providing more detailed information directly to your State Exchange, NMHIX.

Kathleen Sebelius

most recent info on CMS conference call

The following is  an email correspondence between April Wilkinson of Jemez and Robert Nelb From CMS on
Date: January 3, 2013 9:44:56 AM MST


"Mr. Nelb,
I am writing to inquire about the conference call scheduled for January 7, 2013. Is this call still occurring? On behalf of the Pueblo of Jemez, I hope this date has changed as new tribal leadership was appointed at the end of December for nearly every pueblo within NM. It is thus unreasonable to expect the tribal leaders to be adequately prepared to effectively participate in tribal consultation by January 7th. I look forward to your response.
April Wilkinson, Program Specialist
Pueblo of Jemez



Subject: RE: Conference call

Because of the tribal leadership changes, we are working to find an alternate date - most likely January 14th or 15th.

Thanks,

~ Rob"