44TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 1999

REQUESTING CONGRESS AND THE HEALTH CARE FINANCING ADMINISTRATION TO IMPLEMENT THE NATIONAL INDIAN HEALTH BOARD MEDICAID MANAGED CARE RECOMMENDATIONS AND PRINCIPLES FOR THE DEVELOPMENT OF MEDICAID MANAGED CARE PROVISIONS RELATED TO NATIVE AMERICAN CONSUMERS AND INDIAN HEALTH PROVIDERS.

WHEREAS, the goals of the federal Indian Health Care Improvement Act and the Indian Self-Determination and Education Assistance Act is to consult with tribes in development of their health programs in recognition of the sovereign status of tribes and to develop special provisions for American Indian and Alaska native health care consumers as well as Indian health care system providers in medicaid and other health programs that receive federal funding; and

WHEREAS, there have been and remain cultural, geographic, financial and historic barriers to accessing health care, and special health care delivery systems have been developed for Native Americans; and

WHEREAS, pursuant to the health care financing administration regulations, states are encouraged to design their medicaid and other health care programs to protect and enhance Indian health service facilities and services so that the highest level of care that can be delivered is delivered to Native American people; and

WHEREAS, Native American individuals who are medicaid beneficiaries need to have access to their customary Indian health care providers, as well as providers that are available to other medicaid beneficiaries; and

WHEREAS, the Indian health service operates on a "fee for service" basis and not on a "capitated" basis, and it has become very difficult for Native Americans to receive care at their local and familiar Indian health service direct service facility, tribally operated health facility or urban Indian health clinic; and

WHEREAS, medicaid should reimburse the Indian health service direct service facilities, tribally operated health facilities or urban Indian health clinics at a rate that covers the cost of delivering services because there is little or no opportunity for costs to be shifted to third party payers; and

WHEREAS, barriers that prevent Native Americans from participating in health care services should be eliminated for all health care programs receiving federal funds; and

WHEREAS, limited funding for health care programs demands that resources be used to their maximum potential, especially for direct patient care and preventative medicine, to provide the greatest possible benefit to Native American individuals; and

NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that it request congress to adopt the recommendations of the national Indian health board, specifically the following:

A. that the same protections that congress provided for Indian people in the federal Balanced Budget Act of 1997 be provided under state waivers that limit the freedom of choice for native Americans;

B. that federal law specify that one hundred percent of the "federal medical assistance percentage" and the Indian health service encounter rate for tribally operated health facilities be applied to health services provided by the Indian health service, tribally operated health facilities and urban Indian health clinics; that the negotiated rulemaking process used for Public Law 638 be used to develop regulations regarding the meaning and application of the encounter rate and the use of one hundred percent of the federal medical assistance percentage; and that the state role in ensuring that licensing standards are met and that the memorandum of agreement between the Indian health service and the health care financing administration be expanded to include urban Indian clinics;

C. that all states be required to retain a mechanism that allows fee for service and federally qualified health center rate payments to the Indian health service, tribally operated health facilities and urban Indian health clinics that includes direct payment by the state, not through health plans, for medicaid services provided to Native Americans and state provisions to help the Indian health service, tribally operated health facilities and urban Indian clinics collect payments owed by health plans contracting with the state to provide medicaid services;

D. that states be required to pay the Indian health service, tribally operated health facilities and urban Indian health clinics for off-plan services provided to Indian health service beneficiaries who are also medicaid beneficiaries;

E. that an alternative be provided to the federally qualified health care reimbursement that is adequate to cover costs of the Indian health service, tribally operated health facilities and urban Indian health clinic services for Native American and non-Indian patients, maintaining the current federally qualified health care level of cost reimbursement for now;

F. that cost-sharing be eliminated and other barriers that will prevent Native American children from participating in the child health insurance program and medicaid;

G. that the health care financing administration be required to institute tribal consultation in the renewal assessment process and renewal application review for Section 1915(b) and 1115 waivers;

H. that the health care financing administration be required explicitly to enforce its current regulations regarding accessibility to ensure that Native Americans' access to necessary specialty medical care is not restricted;

I. that the "direct billing of medicaid" demonstration project be reauthorized and expanded to include more tribes and approve a research and demonstration project to allow tribes to directly bill the health care financing administration without a state or the Indian health service acting as intermediaries; and

J. that new funding be provided, not a reallocation of current funds, to monitor and evaluate the participation of tribes and Native Americans in state medicaid managed care programs; and

BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the members of the New Mexico congressional delegation, the director of the health care financing administration and the national Indian health board.