mmpc - National Indian Health Board

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POTENTIAL RAMIFICATIONS FOR FAILING TO ISSUE UNIFORM OPERATIONAL GUIDANCE: Failure to issue uniform operational guidance will impede Exchange, Medicaid and IRS staff in making accurate and consistent determinations of eligibility as well as delay or completely deny access for some AI/ANs to the Indian-specific benefits and protections established under the Affordable Care Act. Delayed eligibility for some AI/AN children: An AI/AN child who is not allowed to enroll as a tribal member until her 18 th birthday may not be considered eligible for Exchange-related Indian-specific cost-sharing and enrollment protections, despite being considered an AI/AN for purposes of IHS, Medicaid and CHIP coverage. Unwarranted application of tax penalties: If an AI/AN who is eligible and, in fact, is accessing IHS services decides not to secure health insurance coverage, but is not (ultimately) determined to be eligible as an “Indian” for the exemption from the requirement to secure minimum essential coverage, this individual could be subject to significant tax penalties imposed under the ACA by the Internal Revenue Service. Reduced timeliness: The consolidated and streamlined Medicaid and Exchange application process is intended to rely, to the greatest extent possible, on electronic verification of application-related information. The lack of uniform operational guidance would complicate (although not prevent) the use of automated databases that may be available for electronic verification, such as using the IHS beneficiary roster, hamper coordination between Medicaid and Exchange eligibility, and likely increase the administrative costs and burden on individuals. Reduced accuracy in eligibility determinations: If guidance is not issued by CMS, or if the guidance issued does not provide uniformity across the Indian-specific provisions in Medicaid, Exchange coverage, and pertaining to the exemption from tax penalties, thereby requiring each Exchange to identify any differences in eligibility standards under the various definitions, including understanding the differences, if any, in documentation permitted to satisfy each definition of Indian, error rates for eligibility determinations will increase. Blocked access for some Alaska Natives: Some Alaska Native adults and children may not be considered AI/AN by Exchanges until their parents die and they inherit stock in an Alaska Native corporation; likewise, their children would not be considered AI/AN by Exchanges until they die and the stock in an Alaska Native corporation is passed along to children even though the parent and the children would qualify as AI/AN under Medicaid and other governmental services (e.g., IHS and BIA). Reduced involvement of AI/AN in insurance options: Even if the instances of an individual being determined to be “Indian” for one Indian-specific provision and not for another represent a relatively small percentage of the total population (which we anticipate), this outcome would likely cast a shadow over AI/ANs involvement with ACA implementation more generally. For example, AI/ANs may be much more reluctant to consider transitioning from the IHS-based coverage model to comprehensive Exchange coverage if there is a risk of ending-up subject to significant cost-sharing requirements under a different, potentially unknown application of a definition of Indian. For questions please contact Jim Roberts, Policy Analyst, (503) 228-4185 or email at jroberts@npaihb.org. Page 2 of 2
Dear Tribal Representatives, October 25, 2012 You are invited to join the National Indian Health Board (NIHB) on a bold journey to GO THE EXTRA MILE with NIHB. On November 1, 2012, the first day of both American Indian Heritage Month and Diabetes Awareness month, NIHB will launch its GO THE EXTRA MILE initiative, and we invite you to join us on this year-long journey. The kickoff event will take place on November 1 st at 8 AM in front of the National Museum of American Indians in Washington, D.C., and you are invited to join us for this event and walk a mile with us. If you are unable to join us, we encourage you to organize your own community event on November 1 st to GO the EXTRA MILE and begin this journey by walking the first mile together. The GO the EXTRA MILE initiative is a result of the NIHB signing the CEO pledge, which is part of a national campaign to encourage Executive Directors to commit to supporting and fostering a physically-active workplace. NIHB’s GO the EXTRA MILE initiative achieves these goals by creating a workplace that supports physical activity for every member of its staff. Through the GO THE EXTRA MILE with NIHB initiative, we will provide staff 30 minutes during the work day to walk one mile each day for a year. We will aggregate these miles and “virtually” walk to each of the 12 Indian Health Service Areas, either to an Area Indian Health Board or to a Tribal Partner in Areas that do not have a Board. We invite you to join NIHB by signing the CEO pledge and participating in the November 1 st launch. You will have access to the NIHB Go The Extra Mile website, which will include a toolkit, electronic mapping for your journey, and access to information like “Hot Health Tips” from our partner, the Association of American Indian Physicians. More information is also provided in the enclosed materials. As you know, American Indians and Alaska Natives (AI/AN) have the highest age-adjusted prevalence of Type 2 diabetes among all U.S. racial and ethnic groups and our People’s obesity rate is 39% for those 18 and older. Among AI/AN adults 18 and older, the percentage of inactive physical activity in 2010 was 53.9%, which was far from meeting federal physical activity guidelines (at least 150 minutes or 30 minutes a day of moderate-intensity aerobic activity per week, i.e., brisk walking). There is a correlation between physical activity and chronic diseases. The Diabetes Prevention Program clinical trial, led by the National Institutes of Health, has shown that getting at least the recommended 30 minutes a day of moderate physical activity and losing 5% to 7% of body weight can reduce the risk of developing type 2 diabetes by 58% in people at risk. NIHB’s GO the EXTRA MILE is one small step toward supporting diabetes and obesity prevention for AI/AN. Remember, the journey for health is not a marathon, nor a sprint, but a relay that we, together, walk in order to outsmart chronic diseases that threaten our health in Indian Country We will be joined for the November 1 st kick off event by the Association of American Indian Physicians, American Diabetes Association, Juvenile Diabetes Research Foundation, National Obesity Awareness Coalition, and the National Coalition on Promoting Physical Activity. We hope to see you there and on the virtual road ahead, as we GO the EXTRA MILE together. Miigwech – Thank you, Stacy A. Bohlen, Executive Director, NIHB
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MEDICARE, MEDICAID, & HEALTH REFORM
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GENERAL INFORMATION TABLE OF CONTEN
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Last Updated: November 12, 2012 2.
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Ref. # 2. Task/Issue Person(s) CMS
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IV. OUTREACH AND EDUCATION MMPC: SU
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MMPC October 9, 2012 Teleconference
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To do List: -Myra will have draft b
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Internal Revenue Service Meeting No
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with a “interim/acting”. Can al
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8/7/12 DRAFT COMPANION TO ADDENDUM
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Indian Self-Determination and Educa
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Under federal law, There are privac
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1. Purpose of Addendum; Supersessio
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(1) ISDEAA, 25 USC §450 et seq.; (
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13. Medical Quality Assurance Requi
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edits on documents are due back fro
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d. CCIIO Philosophy - CCIIO is taki
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- I/T/U provider receives their all
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IHS TRIBAL SELF-GOVERNANCE ADVISORY
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Letter: Dr. Robert Petzel, Under Se
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October 17, 2012 Dr. Robert Petzel,
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A BILL To correct inconsistencies i
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California Rural Indian Health Boar
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As people have changes in employmen
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Indian eligibility determinations,
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v.7, 2012‐09‐23a ACA, (2) the s
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Indian tribe means any Indian tribe
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v.7, 2012‐09‐23a In issuing thi
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(1) to ensure the highest possible
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v.7, 2012‐09‐23a Delays in acc
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v.7, 2012‐09‐23a 1997. The prov
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v.7, 2012‐09‐23a 48 Enacted thr
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Prepared by James Crouch MPH Chair,
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Summary T he Indian Health Service
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Summary providers that were either
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Introduction Reliable determination
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Analysis Groups IHS AIAN Methods Th
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Methods group for the statistical m
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Enrollees with no Payments Methods
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Methods Table 5. Mean Medicaid and
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Restricted Benefits Methods Enrolle
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Age and Sex Methods Medical care pa
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Methods Table 9. Findings for all s
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Methods Map 1. 12 IHS Areas: Contra
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Findings Figure 1. Adjustment of Me
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Findings Payments are Higher for IH
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Findings for Group 3 was $600 and W
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Findings Unadjusted mean payments f
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Findings Table 10. Unadjusted Mean
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Findings Figure 13. Adjusted Mean T
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Analysis Group Compiled Findings fo
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Findings Adjusted Mean Payments for
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Findings Figure 18. Percent differe
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Findings providers for services nee
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premium tax credit assistance and c
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Access to this benefit is criticall
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community providers for purposes of
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November 12, 2012 Centers for Medic
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_________ American Indian or Alaska
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November 9, 2012 Page 2 We are comm
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Tribal Consultation for Health Insu
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Background Analysis of Tribal Consu
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