Ready for Reform!
Port Gamble S’Klallam
Tribe
Washington State on the pleasant side of the Puget Sound on the Kitsap Peninsula with treaty rights
stretching to the Olympic Peninsula, the Pacific Ocean and Canada
Ed Fox
Health Director Port Gamble S’Klallam Tribe
6 Elements of Port Gamble
S’Klallam Tribe’s readiness
1. Staffing: Support current monitor need for additional
2. Outreach and Education on Health Care reform tied to our
Eligibility and Enrollment capacity
3. Make the Accounting system produce needed information for
decision making-which option--- buy insurance or buy ‘risk’
4. Continue to pay for health insurance and prepare for
expansion of sponsorship
5. Electronic Health Record system
6. Work with other Tribes through other organizations.
Ready for Reform!
October 1, 2013 Launch of Medicaid, CHIP, Basic Health,
Health Insurance Exchange Portal (Website)
The information in this presentation was given to Tribal
Council September 2011 Tribal Council meeting.
Port Gamble S’ Klallam Tribe is well known for it steady and
deliberate approach to addressing the needs of its Tribal
members with many innovative programs and firsts to its credit.
Examples include: Medicaid Eligibility Pilot Project, Tribal
Court, ICW Title IV-E, Medicaid Administrative Match (MAM),
Basic Health Plan Sponsor.
Alignment with 4 Key elements
of Health Care Reform
1.
Medicaid Expansion
2.
Health Insurance Exchange
3.
Health Insurance Market Reforms
No pre-existing conditions for all in 2014 (true for children now)
4.
Cost Control
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OR Coordinated Care Organizations (payment reform)
WA Duals Project
Quality Improvement, Information Technology
Sharing health information with specialists and hospitals
Outreach example
Newsletter Articles
On October 1, 2013 the state Health Care Health Insurance
Exchange will be open for enrollment. If you are uninsured you
will go to a website (often with one of our staff assisting) and we
will determine your eligibility and enroll you in any of the
publically-funded health insurance programs that exist
If you are not eligible for public insurance we will explore private options
or cover your health care needs through the regular health program of the
tribe.
Health Exchange-offered plans. One application will determine
which program fits your income and family situation best.
That’s it except for the details.
Nearly every month (24 times) in the next two years, I plan to update you on the
implementation of health care reform for the Tribe.
Other Topics so far
1.
Children’s Health Insurance Program (Apple Health),
Medicaid and importance of current programs
2.
Basic Health article supporting current and potential
program in 2014
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3.
Current is an early expansion of Medicaid for up to 133% of
Federal Poverty Level (FPL)
Future 138% to 200% of poverty
90% of Indian Uninsured in WA below 200% FPL
How the underinsured act like the uninsured-and why we
want community to believe they do have access to full range
of health care services that do not threaten their finances.
1. Staffing for 2014
We are adequately staffed with long-term (many years of
experience working for Port Gamble S'Klallam Tribe)
employees and will continue to support the expected need
for additional staffing for expansion of health insurance
with 2014 reforms.
Review staffing needs!
Retain and Recruit Staff
Business office two employee 10 and 16 years service
Clinical manager 15 years service Dr 10 years
Health Director just started July 20, 2011.
2. Refine eligibility and
enrollment
Pilot Project for Medicaid/CHIP eligibility and enrollment
we already have the nation’s best Tribal effort to determine
eligibility and enroll our patients in health care plans in a
way that is sensitive to the unique federal responsibility for
health care services to American Indians and Alaska
Natives.
2003 made initial request for CMS waiver to state. In 2006
CMS agreed that this was feasible, in 2008 training began.
We also participate in the Medicaid Administrative Match
program (the first in the nation since 1999) to recoup some
of the costs associated with this activity.
MAM will be key to paying for expansion, pays ½ cost.
TANF, SNAP, LIHEAP
Families in need of assistance come to our Children and Family
Services Department offices.
2 staff at CFS have same capability to enroll for Medicaid and
CHIP so family does not have to go to clinic (1 block away).
Tribe operates its own Tribal Assistance for Needy Families
program, in addition to work assistance, medical applications are
completed along with any other need like food assistance, day care.
Pilot Project requires that staff receive same training as any other state
worker to check income, employment, and other verification of
application information.
Education is a big component of all our efforts to support families.
3. Make the Accounting system
produce needed information
The Health Services Department operates its own
sophisticated full service accounting system with
Customize management reports and detailed tracking of
expenditures that works seamlessly with our
Business office that manages the contract health services
program.
They maintain our great relationships with the local medical
community by paying our bills promptly.
CHS works closely with Medical team in clinic to identify
any troubling trends and suggest needed corrective actions.
4. Continue to pay for health
insurance
One key aspect of health care reform will allow tribes to sponsor
the health care of its Indian patients and the Port Gamble
S'Klallam Tribe has many years of experience in doing just that
through the Basic Health Plan.
We already reimburse for Medicare Part B and for Medicare Part
D (and assists tribal members in understanding their choices )
Over 10 years of ‘sponsorship’, as a sponsor the Tribe is Billed for
a state Basic Health Plan for individuals and families and that may
continue under the health exchange’s plans
Tribe would like to Sponsor tribal members and some others for
Exchange Plans, but only for plans who pay the the clinic when
their insured get services at our clinic and hopefully allow us to
referral patients without a second opinion and visit by a plan DR.
5. Health IT and Electronic
Health Records
We have already begun (3 years) the implementation of electronic
health records that will be essential to our health finances (to bill
and receive timely payment) and health care quality improvement
that is a required component of health care reform’s delivery
system changes. NextGen is our ‘solution.’
Participate in State and Regional Health Exchange efforts
Health Information Exchange (another HIE!) allows us to check
Onehealthport.com for insurance coverage and benefits of our
patients-will grow into much more
Care Coordination (sometimes known as Accountable Care Orgs)
is in the near future.
We will pass $1 million of spending on this effort by 2012 or 13.
6. Working with Other
Tribes and IHS
24 months and counting, but we have a head start on most Tribes
so we will be ready.
The Port Gamble S'Klallam Tribe is a member of :
American Indian Health Commission for Washington State, the
lead tribal/urban organization for health care in Washington and
the
Northwest Portland Area Indian Health Board, the regional
(area-wide) Tribal organization for Indian health and health care
reform nationally.
Keep Tribal Leadership informed on the potential and pitfalls of
HC Reform-it could be the best thing (next to the IHCIA and the
ISDEAA) for Indian health and our chance to provide for all the
health care needs of our community.
6 Elements of Port Gamble
S’Klallam Tribe’s readiness
Staffing: Support current monitor need for additional
Outreach and Education on Health Care reform tied to our
Eligibility and Enrollment capacity
Make the Accounting system produce needed information for
decision making-which option--- buy insurance or buy ‘risk’
Continue to pay for health insurance and prepare for expansion of
sponsorship
Electronic Health Record system
Work with other Tribes through other organizations.
Port Gamble S’Klallam Tribe
Appreciates
You for your attendance and feedback ---This meeting was sponsored
by the Port Gamble S’Klallam Tribe and we would like to thank:
Port Gamble S’Klallam Tribe Tribal Leadership for their support
Port Gamble S’Klallam Tribe Staff
American Indian Health Commission of Washington State with
funding from the Health Care Authority of Washington
Swinomish Tribe for the Sockeye Salmon…
The estimated cost to other Tribes for their staff to attend was
$20,000 (at $300-$350 per person for 60 tribal attendees).