NAPPR budget proposal for Healthcare Guides for NM Native Communities

Good afternoon everyone the following is a budget proposal by Native American Professional Parent Resources (NAPPR), to be the Umbrella organization for the Health Care Guides for Pueblo and Apache and urban Communities. This is out of the RFI that was released by the HIX in early July. NAPPR was the only Native American focused organization that answered the RFI.  This effort is supported by; Pueblo Insurance Agency, Northern Governors Council, 5 Sandoval Governors Inc. Jemez Health Center, Laguna Pueblo Isleta Health Clinic, First Nations, National Indian Youth Council, New Mexico Indian Council on Aging Health Committee, and Native American Independent Living.

For the record, while there are several tribes and tribal organizations involved with this effort, We have taken it upon ourselves to be proactive, there still has not been any Formal Tribal consultation effort on behalf of the HIX on any of the HIX activities.


Hi again folks--here's hoping that the third time is the charm!  The budget was primarily reduced through adjusting it from a 12 month budget to a 10 month budget (assuming HCGuides would be in place for 9 months by the time they are hired, etc.)  Robin told us on Friday that the initial funding for the project only goes through June, 2014 so it made sense to reduce the budget by a couple of months!

Sincerely

 

Jane Z. Larson, Executive Director

Native American Professional Parent Resources (NAPPR), Inc.

jzlarson@nappr.org

 

 

 

 

 

 

 

 

Letter asking for HIX to add Agenda Items for August 7 Executive board meeting

good afternoon everyone, this is a letter authored by the SW Womens Law Center asking for Advocates and organizations to sign on, by Monday 8/5/13.  If you cannot get approval or do not see it in time to sign on I would ask that you make a statement in support of the effort either at the august 7 th meeting or is a statement/comment on the HIX website www.nmhix.com.  I will be attending this meeting if you cannot make it I am willing to read any statement that your organization wants to give at the public comment portion of the meeting. Either email this blog or Erik Lujan at elujan78@gmail.com. please keep in mind that time for public comment is sometimes short

 

 

 

 

 

August 3, 2013

RE: Request for August 7, 2013 Exchange Board Meeting Agenda to Include Medicaid Coordination Discussion and Exchange Financial Sustainability.

Dear Exchange Board Members,

    We are a group of organizations, many of whom have been deeply engaged in efforts to implement the Affordable Care Act (“ACA”) in New Mexico for the past three years. Our goal is to ensure that ACA implementation in New Mexico maximizes the benefit for all New Mexicans, and, in particular, for our uninsured and underserved populations. We are writing to ask the Exchange Board to place two topics that are important to the successful implementation of the Affordable Care Act in New Mexico on its August 7th meeting agenda: (1) the efficient coordination of the Exchange’s outreach and enrollment efforts with the state’s Medicaid program; and (2) the projected enrollment needed to make the Exchange financially sustainable. New Mexico can receive additional federal funding to enhance the Exchange’s financial sustainability if we apply by August 15th, and we should not miss this critical opportunity to strengthen the Exchange.

    A number of organizations and individuals have reminded the Exchange Board, both in public comment and via correspondence, of its legal obligation to engage in outreach and enrollment assistance that includes Medicaid. Not only is the Exchange legally obligated to provide enrollment assistance to Medicaid, it also makes good fiscal sense. Two separate outreach and assistance systems, one for the Exchange and one for Medicaid and CHIP, are impractical and duplicative. Federal “Section 1311” funds for In-Person-Assisters can be used for anyone who fills out the “single streamlined application” regardless of whether that person is eligible for the Exchange or Medicaid. A system that engages in outreach and helps people sign up for both the Exchange and Medicaid makes the best use of available dollars. Additionally, the Exchange will benefit in its future enrollment efforts by treating Medicaid enrollees as future Exchange customers.   Accordingly, the group of organizations undersigned below requests that the Exchange discuss and adopt a policy at the August 7, 2013 Exchange Board meeting that ensures the Exchange will provide enrollment assistance to those who are eligible for Medicaid.

    Furthermore, the Exchange must be financially sustainable by the beginning of 2017. As a result, the Exchange must find revenue sources to account for the Exchange’s operational costs and any current projected funding needs.   It is not too early for the Exchange Board to discuss using its statutory authority to assess insurance plans to provide revenue for the Exchange.   Therefore, we encourage the Exchange ensure its financial sustainability by creating strong goalposts for consumer enrollment in the Exchange, and by investing appropriately in funding to help all consumers enroll. We further urge the Exchange to monitor and report on these concrete enrollment goals. Investment in assistance to guarantee robust enrollment in the Exchange will help offset the need for the Exchange to seek funding from other sources.

    In addition to the above, the undersigned groups request that the Exchange Board discuss specific strategies for making the Exchange financially sustainable that include applying for additional federal grant funding for the Exchange by the August 15, 2013 deadline.  Supplementary federal funding supporting a strong investment in consumer assistance efforts will help guarantee robust Exchange enrollment.   Similarly situated geographically large states with substantial rural populations, such as Colorado and Arkansas, have each invested approximately $17 million in their consumer assistance programs. Colorado’s Exchange eligible uninsured population is 323,000, making their state’s per capita investment enrollment assistance approximately $52 per uninsured person.  The Arkansas Exchange eligible uninsured population is approximately 208,000, making the state’s per capita investment in enrollment assistance $82 per uninsured person. New Mexico has currently invested approximately $35 on enrollment assistance per uninsured person.  New Mexico must invest more in its consumer assistance programs to ensure robust enrollment in the Exchange by the eligible uninsured to ensure that the Exchange will be financially sustainable.

    Thank you for your consideration of these issues. If you have additional questions, please do not hesitate to contact any of the undersigned organizations.

Sincerely,

List of tribal Centennial Care outreach events sponsored by the NM Human Services Department

Be on the look out.... the HSD is still distributing media Brochures that do not reflect NM communities or have ANY Native American relevant information.

NM Health Insurance Echange announces Listening Sessions

NEW MEXICO HEALTH INSURANCE EXCHANGE

NMHIX LISTENING SESSIONS

The New Mexico Health Insurance Exchange (NMHIX) is hosting a series of Listening Sessions to hear questions, comments, and suggestions from stakeholders.  Input from these meetings will be provided in a report to the NMHIX Board at its August 16, 2013 meeting and will be utilized as the NMHIX establishes its statutory Stakeholder Advisory Committee. Questions/Comments/Suggestions may also be sent via email to the email provided under each stakeholder category.     The schedule for the meetings is as follows:   Stakeholders: Consumers/Advocates Date/Time:      August 13, 2013                         1:30 p.m.-4:00 p.m. Location:        CNM Work Force Training Center, Room 101-103                         5600 Eagle Rock Avenue, Albuquerque, NM Questions/Comments/Suggestions: Stakeholders@nmhix.com     Stakeholders: Providers/Practitioners Date/Time:      August 13, 2013                         5:30 p.m.-8:00 p.m. Location:        CNM Work Force Training Center, Room 101-103 5600 Eagle Rock Avenue, Albuquerque, NM Questions/Comments/Suggestions: Providers@nmhix.com     Stakeholders: Employers (including nonprofit employers) Date/Time:      August 14, 2013                         8:00 a.m.-11:00 a.m. Location:        CNM Work Force Training Center, Room 101-103                         5600 Eagle Rock Avenue, Albuquerque, NM Questions/Comments/Suggestions: Stakeholders@nmhix.com     Please share this invitation with members of your organization/office.   For any questions about the meetings, contact Charlotte Roybal at charlotte@policyconnections.org

Abq Journal: Editorial: HSD funding cutoff traces to Obamacare

Abq Journal: Editorial: HSD funding cutoff traces to Obamacare

Politicians, activists, providers and patients protesting the temporary suspension by the Human Services Department of Medicaid payments to 15 nonprofits that deliver behavioral health services around New Mexico are targeting the wrong people.

The requirement to suspend payments where fraud is suspected is part of President Obama’s Affordable Care Act. Remember, a portion of Obamacare costs was to be paid for by reducing waste and fraud.

On March 9, 2010, Obama unveiled his plan to crack down on waste and fraud in Medicare, Medicaid and other government programs by expanding the use of payment recapture audits, which are structured to give private auditors financial incentives to uncover improper payments. At the time, Obama predicted the use of such audits could return up to $2 billion in taxpayer money to federal coffers over three years.

In line with this intensified attempt to recover misspent federal funding, the basis for withholding payments as outlined in Title 42 of the Code of Federal Regulations was changed in 2011.

In 2011: “The State Medicaid agency MUST suspend ALL Medicaid payments to a provider after the agency determines there is a credible allegation of fraud for which an investigation is pending under the Medicaid program against an individual or entity unless the agency has good cause to not suspend payments or to suspend payment only in part.”

So federal regulators lowered the burden from “reliable evidence” to “a credible allegation,” and with the change from “may” to “must” the state agency essentially lost much of its discretionary authority. The New Mexico Human Services Department is required to suspend all payments and to send a fraud referral to an appropriate law enforcement agency – in this case, the Attorney General’s Office.

Providers may be permitted an administrative review, and the state is required to report “general allegations as to the nature of the suspension action, but need not disclose any specific information concerning an ongoing investigation.”

Though it would seem that an audit paid for with public money should be a public record, the AG has refused to make the audit public and asked Human Services not to provide more than the general summary of the allegations, which it did in a six-page report.

HSD reinstated funding to one agency after a hearing, but in a separate action a federal judge denied a temporary restraining order sought by eight of the 15 nonprofits, saying they hadn’t met the legal requirement of showing they likely would prevail on the merits.

In a recent hearing of the Legislative Health and Human Services Committee, Chief Deputy Attorney General Al Lama told lawmakers “the ACA made a significant change in how Medicaid fraud is investigated.”

That is true. And the stricter response to allegations of waste and fraud is being felt elsewhere.

CNN reported this week that California’s Department of Health Care Services has moved to temporarily cut funding to 16 drug rehab clinics under its Drug Medi-Cal program after the Center for Investigative Reporting looked into fraud and mismanagement at those clinics. A Democratic state senator has called for an audit of the entire program.

Federal regulations say suspension of payments must stop after the “agency or the prosecuting authorities” determine there is insufficient evidence of fraud or after legal proceedings are completed.

How quickly that happens would appear to be in the hands of the Attorney General’s Office.

 

 

 

Comments:

It ignores the fact that this Human Services Secretary has demonstrated her hostility to the humans she is supposed to serve, has routinely misled the legislature about the workings of the Department and has manifested her intent to shrink HSD as much as possible, regardless of the effect on New Mexico's impoverished and vulnerable.

Couple that with the fact that HSD has resisted making the audit that allegedly establishes evidence of fraud and that it already had in place a plan to outsource care to Arizona providers (which already fail to serve Arizonans) and I'd say that targeting HSD is quite well-founded.

News Article "ACA Likely to Deliver Bigger Bang in Rural Areas"

ACA Likely to Deliver Bigger Bang in Rural Areas 

By David Pittman, Washington Correspondent, MedPage Today 

WASHINGTON -- The rural uninsured may reap a bigger benefit from the Affordable Care Act than their city-dwelling counterparts, which prompted health policy experts to call for a ramped-up campaign to publicize ACA in rural communities.

 

More rural residents than urban dwellers (10.7% versus 9.6%) can receive tax subsidies under the ACA to purchase private insurance and more uninsured are eligible for an expanded Medicaid program (9.9% versus 8.5%), Keith Mueller, PhD, director of the Rural Policy Research Institute's Center for Rural Health Policy Analysis in Iowa City, said.

Educating those uninsured, rural residents about their benefits under the ACA will be vital to the 2010 health law's success, others said at an Alliance for Health Reform briefing on rural healthcare.

"On a per person basis, we have the potential for more rural folks to benefit from this expansion than their urban counterparts," Tom Morris, director of the Office of Rural Health Policy at the Health Resources and Services Administration, said. "The next couple of months are going to be critical in terms of getting the word out."

However, a few obstacles stand in the way of getting those people signed up for either Medicaid or insurance subsidies, panelists at the briefing said.

For example, 30% of New Mexicans who were eligible for Medicaid even before the ACA still are not enrolled because there are barriers to doing so, Art Kaufman, MD, vice chancellor for community health sciences at the University of New Mexico Health Sciences Center in Albuquerque, said.

"You've heard of suppression of votes. There's also suppression of getting people enrolled," Kaufman said. "There are so many ways [to suppress enrollment] even a state that has accepted Medicaid [expansion] can slow the process."

The ACA will provide coverage to those making up to 138% of the federal poverty level in states that chose to expand their programs following last summer's landmark Supreme Court decision. While its health insurance exchanges will provide online marketplaces for the uninsured to comparison shop and purchase insurance, those making between 100% and 400% of the federal poverty level will be eligible for tax subsidies to help offset to cost of coverage.

One of the main obstacles facing the Obama administration and its advocates in their attempts to reach rural residents to tell them about expanded benefits under the ACA is political resistance to "Obamacare" in many states with large rural populations.

Their state leaders have been less willing to back programs that even would enroll or educate the public on ACA programs.

"The more we can start calling these products something else besides Obamacare, the ACA, or whatever ... the better off we're going to be," Lisa Miller, former member of the Maine House of Representatives, said.

Meanwhile, the Department of Health and Human Services is pumping more than $150 million into community health centers and $54 million for navigator programs to help spur the enrollment process.

Miller said funds are also flowing from an unexpected source: philanthropic organizations that are funding enrollment campaigns.

Analysis of the Administration’s Announced Delay of Certain Requirements Under the Affordable Care Act

Letter to Congressman Ryan and others

CBO and the staff of the Joint Committee on Taxation (JCT) have assessed the effect of the recently announced one-year delay in the imposition of penalties for certain large employers and the corresponding delay in the implementation of two reporting requirements for certain large employers and health insurance coverage providers under the Affordable Care Act (ACA). This letter describes the changes CBO has made in its current-law projections to reflect those actions and recently issued final regulations.

What the Administration Announced

Under the ACA, certain large employers that do not offer health insurance coverage that meets the affordability standard defined in that law will be subject to penalties. In addition, insurers and certain other health coverage providers (primarily employers that self-insure) will be required to report the names of those receiving coverage, and certain large employers will be required to report on the health insurance coverage offered to their full-time employees. On July 2, 2013, the Administration announced its decision to delay for one year the penalties for certain large employers that do not provide affordable coverage, as well as to delay reporting requirements for insurers and employers.

In addition, the Administration recently released final regulations specifying the procedures to be used to ascertain and verify whether people applying for tax credits for premiums on insurance provided through the exchanges have an affordable offer of coverage from their employer and what their income is. Under the ACA, applicants for premium tax credits will be required to provide information in their application about any coverage by their employer for which they are eligible. The exchanges will check available databases to verify that information, but, for many applicants, no supporting information will be available. In those cases, exchanges will be required to contact employers to verify the information for a statistically valid sample of applicants; some of the exchanges operated by states had planned to rely on the Department of Health and Human Services (HHS) to perform that follow-up verification. However, the final regulations indicate that HHS will not conduct follow-up verification on behalf of state-based exchanges until January 1, 2015, one year later than expected. As a result, in 2014 only, if an applicant’s attestation cannot be verified through available databases, state-based exchanges will have the option to accept the attestation as final without conducting further verification. However, that option applies to state-based exchanges only; HHS indicated in the final rule that federally facilitated exchanges will pursue follow-up verification for a statistically valid sample of applicants in 2014, as expected.

Also, under the ACA, applicants for premium tax credits will be required to provide information about their household’s income, to be verified through electronic sources of information about people’s income, such as tax returns and Social Security Administration records. If the income reported by an applicant is significantly less than the amount of his or her income indicated by other available data or if data to verify a household’s income are not available, then the exchange will request supporting documentation from the applicant. For 2014 only, the final rule allows exchanges to request additional documentation either from such applicants or from a statistically valid sample of those applicants. For an applicant that is not contacted by exchanges to provide further documentation, advance payments of premium tax credits will be based on the applicant’s attestation. However, the law also provides that if an individual’s advance payments exceed the amount of the premium tax credits to which he or she is entitled on the basis of his or her actual year-end tax return, that person may be required to repay some or all of the credits, subject to certain limits based on income.

How CBO and JCT Updated Their Estimates

Following its usual procedures for incorporating new information in its estimates, CBO now assumes that penalties on employers and certain reporting requirements will not be enforced in 2014. In its May 2013 baseline projections, CBO projected that the insurance coverage provisions of the Affordable Care Act would have a net cost to the federal government of $1,363 billion over the 10-year period from 2014 to 2023. (The ACA includes many other provisions that, on net, will reduce federal budget deficits. Taking the coverage provisions and other provisions together, CBO and JCT estimated that the ACA will reduce deficits over the next decade.) As a result of the Administration’s announcement and recently issued final rules, the net cost is now estimated to be $1,375 billion—$12 billion more than previously estimated. The largest change is a $10 billion reduction in penalty payments by employers that would have been collected in 2015. (Penalties assessed for 2014 would have been collected in 2015.) Costs for exchange subsidies are expected to increase by $3 billion. Other small changes, including an increase in taxable compensation resulting from fewer people enrolling in employment-based coverage, will offset those increases by about $1 billion, CBO and JCT estimate.

The budgetary effects other than the loss of revenues from penalty payments stem primarily from changes in how many people will obtain insurance coverage and from what source. CBO and JCT expect that some large employers that would have offered health insurance coverage to their employees in 2014 will no longer do so as a result of the one-year delay of penalties for those that do not offer affordable coverage. However, most large employers currently offer health insurance coverage to their employees, and because the delay is only for one year, CBO and JCT expect that few employers will change their decisions about offering such coverage.

Further, as a result of the temporarily looser procedures for verifying offers of employment-based coverage, CBO and JCT expect that some additional workers with affordable offers from their employer will obtain subsidized coverage through exchanges in 2014. However, applicants for subsidies will still have to provide exchanges with information about how to contact their employer and will have to sign a statement indicating that their answers are accurate to the best of their knowledge; moreover, employers will be notified of employees who qualify for premium tax credits. Consequently, although CBO and JCT expect that the verification process will have significant effects on people’s behavior in coming years, the temporary loosening of verification procedures in 2014 is estimated to have only a small effect.

CBO and JCT also anticipate that the change in procedures for verifying income will have only a slight impact on the number of enrollees in the exchanges and on the accuracy of their income reporting because the Internal Revenue Service will be able to identify misreporting when it compares reported income with tax returns at year-end.

In addition, CBO and JCT expect that the delay in implementing reporting requirements will have only a negligible effect on sources of insurance coverage and on revenues collected through the penalties for individuals who do not obtain coverage in 2014. Although CBO and JCT expect that the reporting requirements will have significant effects on people’s behavior in coming years, the projected effects on coverage and revenues from penalties for 2014 (which will be collected in 2015) are already lower than the projected collections in subsequent years to allow for initial difficulties in implementing those provisions of the law. Moreover, the Administration has said that it will encourage insurers and self-insured employers to voluntarily comply with the reporting requirements and report the names of those covered to the Treasury.

All told, as a result of the announced changes and new final rules, roughly 1 million fewer people are expected to be enrolled in employment-based coverage in 2014 than the number projected in CBO’s May 2013 baseline, primarily because of the one-year delay in penalties on employers. Of those who would otherwise have obtained employment-based coverage, roughly half will be uninsured and the others will obtain coverage through the exchanges or will enroll in Medicaid or the Children’s Health Insurance Program, CBO and JCT estimate. In particular, fewer than half a million additional people are expected to be uninsured in 2014 than the number projected in the May baseline.