January 10, 2013
ACA Policy Subcommittee Meeting Action Items
Action Items
Send recommendations concerning navigator
grant requirements to CCIIO via Ms. Marx.
Engage CMCS staff in the discussion of
navigators and MAM funding with CCIIO.
Coordinate future discussions of high-priority
issues and schedule regular Subcommittee
calls.
Timeline
Person
Responsible
Status
ASAP
Subcommittee
Members
Ms. Gillaspie
Ongoing
Mr. Nakahata,
Ms. Marx, and
Mr. Roberts
Ongoing
ASAP
ASAP
Notes
Ongoing
January 10, 2013
ACA Policy Subcommittee Meeting Minutes
Agenda Item
Documents Received
Roll Call
Discussion
Action
 Agenda (Attachment A)
 ACA Subcommittee Tribal Priorities Matrix (Attachment B)
Ms. Liz Heintzman, Legislative Program Associate, National Indian
Health Board, took the roll:
TTAG:
James Crouch
Mim Dixon
Doneg McDonough
Myra Munson
Phil Norrgard
James Roberts
Dee Sabattus
Jay Stiener
CMS:
Cyndi Gillaspie
Lisa Marie Gomez
John Johns
Johanna Lauer
Kitty Marx
Pete Nakahata
Lane Terwilliger
Paul Tibbits
Holly Whelan
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 1
IHS:
Raho Ortiz
John Rael
NIHB:
Liz Heintzman
Other:
Adrienne Wiley, KAI
Brandon Biddle
Welcome
Mr. Jim Roberts, Policy Analyst, Northwest Portland Area Indian
Health Board, welcomed the participants and expressed the
Subcommittee’s appreciation of the Centers for Medicare &
Medicaid Services’ (CMS) willingness to continue meeting with
the Subcommittee. The purpose of the call was to address several
issues that remain unresolved. These issues were outlined in a
matrix that identifies each issue, provides a brief summary of the
issue, and identifies next steps and timelines for completion
(Attachment B). He hoped that group would identify one or two
high priority issues to discuss during the call.
Mr. Pete Nakahata, Office of Exchanges, Center for Consumer
Information and Insurance Oversight (CCIIO), CMS, pointed out
that CCIIO staff members from the financial management and
consumer support groups were on the call. He recommended
that the group start the discussion with the cost-sharing issue and
move onto the issues related to navigators. Dr. Mim Dixon, Tribal
Technical Advisory Group (TTAG) Technical Advisor, Mim Dixon &
Associates, expressed her approval of this approach. She reported
that there was a discussion of the need for a list of state exchange
contacts and of tribal contacts for the states participating in the
federally-facilitated exchange (FFE) during the previous day’s
TTAG conference call and recommended that the development of
the list be added as a priority.
Tribal Provider Cost
Sharing
Mr. Roberts stated that he had sent an email message to Mr.
Nakahata concerning the cost-sharing assistance issues. He asked
whether the message clearly outlined the concerns about the
proposed rules for cost-sharing. Ms. Johanna Lauer, Health
Insurance Exchanges Group, CCIIO, CMS, replied that the central
question seemed to relate to the way in which the U.S.
Department of Health and Human Services (HHS) payments will
filter down to the providers to reimburse them for the cost
sharing reductions. Dr. Dixon asked how the qualified health
plans (QHPs) will know that a provider, especially an out-ofnetwork provider, is an Indian provider. Mr. Roberts added that
this is part of the contracting issue he mentioned in his email. In
instances where there is a contract between a QHP and a tribal
provider, the provider’s status is known. In instances such as that
described by Dr. Dixon (out-of-network provider), it might not be
known.
Ms. Lauer began her discussion of cost sharing by thanking the
Subcommittee for its comments on the payment notice. CMS is in
the process of reviewing comments. Because CMS is in the rule
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 2
making process, she could only discuss information included in
the notice. The policy approach that CMS is suggesting is
contained in Section 156.430(c). The notice proposes that HHS
will reconcile any type of cost-sharing reduction or elimination
(for any group or individual) by reimbursing the QHP issuers for
the value of their cost-sharing reductions. The data that HHS will
use to determine the reimbursements must include only the costsharing reductions for which the provider has been compensated.
Section 156.430(c)(1) of the notice specifies that the QHP issuer
with a fee-for-service arrangement with a provider can only
submit the amount of cost sharing that the QHP has reimbursed
to the provider. The proposed reimbursement is slightly different
for capitated contracting arrangements section 156.430(c)(2). In
situations where there is no contract with a provider, Ms. Lauer
stated that the issue is not whether a provider is in or out of
network; instead the issue is whether the QHP is making any type
of payment to the provider. If a QHP receives a claim and pays 20
percent because the provider is out of network, HHS would
expect that the QHP include an additional payment to
compensate the provider for the cost-sharing reduction or the
elimination of cost sharing .
Mr. Roberts noted that in cases where there is no relationship
between the issuer responsible for submitting data to HHS and
the tribal system, there are many potential problems that could
arise. He was concerned that any cost-sharing payments made to
the QHP would not ultimately reach the provider in cases where
there is no relationship. Ms. Lauer stated that the proposed
regulation would require the QHP to forward the payment to the
provider. One of the challenges with this arrangement is that HHS
does not regulate the payments all the way to the provider or
collect all of the claims data. From an oversight perspective, HHS
intends to conduct audits to ensure that regulations are followed;
these audits would provide a look back to ensure that the
payments are made properly all the way through the system. Mr.
Roberts expected that these issues would be less significant in
cases where there is an established relationship between the
provider and the plan. Based on past experience with the
Medicaid program, he was concerned that QHPs would not be
willing to contract with tribal health providers.
Mr. Doneg McDonough, Technical Advisor, Tribal Self
Governance Advisory Committee, noted that the preamble
explained that HHS expects plans to pay the cost-sharing
reductions to all providers, including Indian/Tribal/Urban (I/T/U)
providers, that provide services to American Indians/Alaska
Natives (AI/ANs) who are eligible for cost-sharing reductions.
Because of this expectation, HHS did not include a statement to
this effect in the proposed regulation. Additionally, the way the
notice states that plans will be reimbursed by HHS when they
make up the cost-sharing reductions to the provider makes it
sound as if it the cost-sharing payments to the providers are
optional. He stressed that the regulation should explicitly state
that I/T/Us should be paid for cost-sharing reductions in the same
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 3
way and position that non-I/T/Us are paid. Ms. Lauer clarified
that the assumption was that this would be covered by the
overarching Section 156.430 provision and that a more explicit
discussion of the issue would be duplicative.
With regard to the issue of how the QHP will know whether an
individual is using an Indian provider, Ms. Lauer pointed out that
this becomes important in cases where an individual falls under
the limited cost-sharing plan variation (i.e., cost sharing is
eliminated if an individual receives services from an I/T/U). CMS is
working to identify the operational hurdles to the smooth
implementation of this variation and is talking to issuers about
reimbursements. She indicated that CMS would be willing to
discuss this issue more fully with the TTAG in an effort to ensure
that the process works smoothly. One approach is to ensure that
a list of I/T/U providers is available to issuers so that they know
when a claim is coming from an I/T/U or a Contract Health
Services provider. Dr. Dixon asked Ms. Lauer how she anticipated
the process of discussing the issues and hurdles would occur and
in what timeframe it would occur. Ms. Lauer indicated that CMS
is working through some other issues at the moment, but
indicated that it would be better to address the issues sooner
rather than later. Mr. Nakahata asked whether this issue must be
worked out as part of the final rule or whether it would be
worked out during the implementation process. Ms. Lauer
anticipated that the issue would be dealt with through guidance
during implementation.
Mr. Nakahata indicated that one of the items that CCIIO has been
developing in tandem with the model I/T/U addendum is a list of
I/T/U providers. CCIIO has been working with the Indian Health
Service (IHS) to create the list. He indicated that this list would
help the issuers identify I/T/U providers. Dr. Dixon asked that the
Subcommittee be able to review any lists that CCIIO produces
because there are multiple lists of I/T/U providers, some of which
are more complete than others. Mr. Nakahata indicated that he
would take the request under advisement and noted that given
the time constraints, the list might need to evolve over time. Ms.
Kitty Marx, Director, Tribal Affairs Group, Office of Public
Engagement, CMS, stated that Mr. John Rael, Management
Analyst, Office of Resource Access and Partnerships, IHS, worked
on the list, which she believed to be fairly comprehensive. Mr.
Raho Ortiz, Director, Division of Regulatory Affairs, IHS, indicated
that IHS would be willing to discuss how best to share the list with
tribes. He added that the IHS website includes an I/T/U locator,
which should include most of the I/T/Us.
Navigators and
Assisters
Mr. Nakahata asked the Subcommittee members to share any
questions they might have concerning navigators and assisters
with Mr. Paul Tibbits, Consumer Support Group (CSG), CCIIO,
CMS, and Ms. Holly Whelan, CSG, CCIIO, CMS.
Mr. Roberts suggested that the group briefly review some of the
approaches that the various state exchanges are using to fund
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 4
navigator-related functions. He observed that the word
“navigator” has become a sensitive term when discussing the
financing of exchange-related outreach and enrollment activities.
States are using a variety of approaches to work around the
limitations in the regulation related to financing these functions,
especially in Year One when there is no funding for navigators. He
was interested in how these approaches might work under the
FFE.
Mr. Tibbits agreed that states are taking different approaches to
funding navigators. In Nevada, statutes allow the state to borrow
against future funding. As a result, the state is estimating its
budget and considering borrowing against this amount to fund
the navigators. Vermont is anticipating that its state budget will
include a line item for navigators.
Mr. Tibbits clarified that the only restriction in the final rule
concerning funding for navigators is that federal funds cannot be
used for this purpose. The rule specifies the use of exchange
operational funds. This has led to the assumption that the
exchange must be up and running and funds generated by the
exchange used to fund navigators. This is not the way that CCIIO
has interpreted the regulation. As CCIIO interprets the rule,
operational funds are any funds that are not federal
establishment funds. Operational funds could include state funds,
funds provided by private foundations, or other funding sources
identified by the states. He acknowledged that states face budget
challenges, but stressed that they can use any financing
mechanism they choose to fund the program. In the final rule, the
section preceding the one on navigators addresses consumer
assistance. Sections 155.205(d) and (e) discuss other programs
that states might establish to conduct consumer outreach and
education. Some states have requested funds to do this work
under a different authority.
With regard to the FFE navigator program, Mr. Tibbits stated that
CCIIO will fund a program. The TTAG has raised the possibility of a
carve-out within the navigator program. CCIIO has looked into
this and determined that such a carve-out does not exist in the
regulation. He stressed that the final rule identifies Indian
organizations as possible navigators.
Ms. Whelan clarified that states that choose to build an in-person
assistance program under Sections 155.205(d) and (e), cannot use
these programs to replace navigator programs. Navigator
programs are a required function of the exchanges. Mr. Roberts
pointed out that these programs can be used to complement the
navigator functions.
Mr. Roberts asked whether the FFE would use the same
authorities to support outreach and education assistance. Mr.
Tibbits replied that CCIIO is working to determine which options
are available under the current HHS construct. He indicated that
CCIIO is not yet able to share information on how it will approach
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 5
this.
Dr. Dixon understood that CCIIO will issue grant opportunities for
the navigator program for the FFE early in 2013. She stressed the
importance of ensuring that there are no elements within the
requirements that might exclude tribes from obtaining grants to
support outreach and enrollment. It is essential that CCIIO work
with the TTAG to better understand how some of the
requirements could unintentionally exclude tribes and how
others might support the inclusion of tribes. She asked the CCIIO
representatives to explain how they envision outreach and
enrollment assistance funds filtering down to tribes. Mr. Tibbits
reported that there have been internal discussions with the TTAG
CMS representatives about these issues. He recommended that
the Subcommittee or the TTAG provide these individuals with a
document that outlines grant requirements that are both harmful
and helpful to tribes. CCIIO would be willing to review the
recommendations and incorporate them into any grant
opportunities to the extent possible. Mr. Nakahata
recommended that the Subcommittee send any
recommendations to CCIIO through Ms. Marx or himself.
The Subcommittee will send
it recommendations
concerning grant
requirements to CCIIO via
Ms. Marx.
Dr. Dixon offered non-discrimination requirements and statewide
coverage as factors that would eliminate tribes from
consideration. Requirements such as these would put Indians in
competition with groups that serve all people. Tribes want to be
able to serve Indian people because they are most able to so.
Short of a carve-out, there are several ways to help Indians
compete for funding. One option is the creation of more than the
two navigator programs required for each state. Others would be
the establishment of grants tailored to specific populations or a
requirement that grantees subcontract with specific groups. It is
essential that CCIIO does not inadvertently exclude tribes by
favoring ease of administration without considering the specific
dynamics of groups within the state.
Mr. Tibbits explained that the two-grant minimum is actually a
two-entity minimum. There could be three entities, or 20 entities,
as long as there are at least two types of entities. The goal is to
fund more than two grants in each FFE state. The number of
grants will be driven by budgetary considerations.
Mr. Tibbits asked Dr. Dixon to explain why a non-discrimination
clause might prevent Indian organizations from becoming
navigators. Dr. Dixon explained that federal law expects Indian
health programs to serve primarily Indian people. While Indian
programs can serve non-Indians, they are allowed to serve only
Indians without being considered in violation of nondiscrimination laws. Non-discrimination clauses in grants that do
not recognize these federal laws could require tribes to serve all
people in a county regardless of Indian status even though the
role of the tribe is to serve tribal members and those who come
to its clinic. By asking tribes to serve a broader population, such a
requirement would make it virtually impossible for tribes to
compete with other entities. On the flip side, a non-tribal entity
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 6
would not be able to serve the Indian population as well as the
tribe could. Allowing tribes to define their service group as tribal
members or users of tribal services enables them to target their
resources toward what they do best and meet the needs of their
communities. Mr. Tibbits replied that CCIIO expects the
navigators to define their own communities, target populations,
and geographic areas. This would enable a tribal entity to define
its target population as a tribe. However, this would not allow
navigators to refuse to serve individuals who seek their help but
do not belong to the target population. All navigators need to
have an open door policy for individuals who come to them for
assistance.
Dr. Dixon asked whether navigators could refer individuals to
other navigators that might be better able to serve their
particular needs. Mr. Tibbits replied that details such as this still
need to be worked out. CCIIO realizes that there will be
circumstances in which it will be difficult for a particular navigator
to serve a specific individual. In these cases, referral might be a
possibility. In all cases, there must be a good faith effort to assist
all consumers who seek help.
Mr. Roberts asked what financial/administrative vehicle will be
used to award the navigator funds (e.g., an application process in
which applicants are evaluated and ranked). Mr. Tibbits
anticipated that the grants would be made using the traditional
federal grant award process. Ms. Whelan added that the grant
announcement would include specific evaluation factors.
Mr. Roberts explained that past experience shows that tribes are
often unable to meet the service area size requirements (e.g.,
number of individuals served) of grants for these types of
services. Also, the review panels are often unfamiliar with the
Indian health care delivery system and the unique character of
Indian reservations. The Tribal Employment Rights Organizations
(TERO) were established to create job opportunities in Indian
Country. They work to ensure that tribal employment rights are
recognized in local, state, and federal contracting mechanisms.
For example, a contractor building a highway through a
reservation must employ five percent of its workforce from the
reservation or pay a compliance fee to the tribe for not meeting
the threshold. In some cases, usage taxes must be paid to the
tribe or TERO. With regard to the grants, he pointed out that
there might be TERO compliance issues. He hoped that the
Subcommittee would have the opportunity to work with CCIIO on
the grant scoring criteria and review process.
Mr. Tibbits thanked Mr. Roberts for his comments about issues
unique to Indian Country. With regard to the number of people
served, he acknowledged that many grants do include this as a
scoring factor. CCIIO understands that there are a number of
states that are not densely populated, either in the state as a
whole or specifically on a reservation. There are people in these
areas who are eligible for public programs and deserve just as
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 7
much assistance as those in more densely populated areas. A
population-based scoring model is not the only one available and
might not be the best model for this particular grant. The
navigator program is designed to help specific communities,
including those that have traditionally been underrepresented in
health insurance and health coverage. He stressed that CCIIO
would not use an evaluation scheme that systematically excludes
these types of communities. The intent of the statute is to create
a program that is responsive to specific community needs;
therefore, CCIIO will strive to employ reviewers who are very
familiar with the needs of specific communities.
Dr. Dixon noted that there has been some confusion among tribal
advocates concerning the difference between the navigator
program and the in-person assister program. She asked Ms.
Whelan to confirm that the navigator program will be a grant
program and the in-person assister program will be a contract
program. Ms. Whelan replied that the navigator program is a
grant program for the state-based exchanges, consumer
partnership exchanges, and FFE. The grant applicants must
provide a budget that includes all of the activities it will
undertake. The budget could include salaries, travel, and
equipment. Under the in-person assister program, the statebased and consumer partnership exchanges have the flexibility to
create their own programs. These programs could take the form
of contracts, grants, or direct hires. CCIIO has not yet made the
policy decision concerning the form the in-person assister
program will take under the FFE. Ms. Whelan did not think that
funding for navigators or in-person assisters would be provided
on a per-enrollee basis, as the goal is to encourage outreach
activities, not just enrollment.
Ms. Alida Montiel, Health Systems Analyst, Inter Tribal Council of
Arizona, asked whether there would be training on the unique
aspects of the Indian health care system and the cost-sharing
protections and provisions specific to AI/ANs. She also asked
whether grantees would be responsible for arranging training for
navigators. Mr. Tibbits indicated that CMS would develop the
training for the FFE. He anticipated that the training and
certification program would be rigorous. The statute includes
specific provisions that navigators need to be aware of, including
those identified by Ms. Montiel. The training will ensure that
navigators are able to respond to the needs of the people they
are serving. In-person assisters will also have to complete a
training program; however, the requirements for their training
are not spelled out in the final rule.
Ms. Montiel stated that Arizona created a proposal for planning
that included the development of a training curriculum for
navigators when it was planning to establish a state-based
exchange. Now that the state is planning to use the FFE, she
indicated that the whole work plan needs to be adjusted. Mr.
Tibbits indicated that CCIIO would be happy to review the plan
and consider it for use in the FFE training.
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 8
Mr. McDonough asked whether CCIIO will issue guidance
concerning the relationship of navigator funding and services to
Medicaid Administrative Match (MAM) funding and services and
how the two might interact. Mr. Tibbits stated that this question
has come up frequently, especially with regard to Medicaid. CCIIO
is working on obtaining answers to these types of questions. Ms.
Cyndi Gillaspie, Lead Native American Contact, CMS, offered to
help engage Center for Medicaid and CHIP Services (CMCS) staff
in the conversation with CCIIO concerning navigator and MAM
funding. Guidance for MAM would have to be issued by CMCS.
Mr. Tibbits pointed out that language in the rule permits
navigators to be funded through Medicaid funds. CCIIO’s
expectation is that navigators will help anybody who seeks
assistance, especially with regard to the single, streamlined
application that will be used for both Medicaid and the
exchanges.
Ms. Gillaspie will help
engage CMCS staff in the
discussion of navigators and
MAM funding with CCIIO.
Ms. Myra Munson, TTAG Technical Advisor, Sonosky, Chambers,
Sachse, Miller & Munson, LLP, expressed her hope that CCIIO
would consider permitting the use of navigator funds to enable
states to expand their work with tribal programs through MAM
outreach and enrollment activities. Many states continue to have
a hostile relationship with tribes. She was concerned that there
would be a very small chance that tribes and tribal health
programs in these states would ultimately receive navigator funds
if states are not encouraged to fund tribes. She was also
concerned that a generic approach to distribution of navigator
funds would result in little meaningful participation of tribes and
tribal programs in the navigator programs. As a result, a
population that already experiences significant barriers to
Medicaid participation will now also experience similar barriers to
obtaining information about and enrolling in the exchanges. This
is an issue that should be discussed in more detail.
Next Steps
Noting that the call had already exceeded its one-hour limit, Mr.
Roberts asked Mr. Nakahata how CMS would like to proceed on
these issues moving forward. Mr. Nakahata suggested that he
work with Ms. Marx and Mr. Roberts to coordinate future calls
and activities. He suggested meeting regularly once or twice a
month.
Schedule Next Call
The Subcommittee did not schedule the next conference call.
Adjourn
With no other business to address, the Subcommittee adjourned.
Mr. Nakahata, Ms. Marx,
and Mr. Roberts will
coordinate future
discussions of high-priority
issues and schedule regular
Subcommittee calls.
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 9
Attachment A:
Agenda
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 10
TTAG ACA Policy Subcommittee Conference Call
Thursday, January 10, 2013
4:00 – 5:00 PM (EST)
Call in number: 877-267-1577
Meeting ID: 9295
AGENDA:






Tribal provider cost sharing
FFE Tribal sponsorship/aggregate payments
IHS RPMS system in FFE and state exchanges
Verification process for single application
Script & training for call center FFE
Navigators and assisters
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 11
Attachment B:
ACA Subcommittee Tribal Priorities Matrix
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 12
ACA SUBCOMMITTEE TRIBAL PRIORITIES
ONGOING
Issue: ITU
addendum
Issue: CostSharing
Reductions for
Indians
Background
Next Step/Plan
Timeframe/Target
Dates
CMS is waiting for
comments from the
tribes which are due
on December 19,
2012.
With input from the ACA subcommittee, CMS drafted a model QHP
ITU Addendum to facilitate the inclusion of Indian health care
providers in the QHP provider networks. By offering contracts with
provisions outlined in the Addendum, QHP issuers will be able to
contract more efficiently with Indian health care providers.
The QHP ITU Addendum went
out to the Tribes with a Dear
Tribal Leader Letter on November
19, 2012. Comments are due on
December 19, 2012.
Background
CMS TAG held an All Tribes’
Call to discuss the QHP ITU
Addendum on December 7, 2012.
Next Step/Plan
CMS will then
distribute QHP ITU
addendum to issuers.
Timeframe/Target
Dates
Next Step/Plan
Timeframe/Target
Dates
Several issues were raised on the December 11th and 14th All Tribes
Calls regarding the proposed rules on cost-sharing that need further
clarification, such as “HHS reimbursing for copayments that were not
contained in the regulation.”
Issue: Tribal
Sponsorship
(Aggregation
of Premium
payments)
Background
Tribal sponsorship enables Indian tribes, tribal organizations, and
urban Indian organizations to pay premiums on behalf of AI/ANs.
Sponsorship mechanisms have proven to be effective at increasing
the enrollment of ethnic and racial minorities, particularly AI/ANs, in
comprehensive health insurance coverage.
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 13
Issue: Use of
the IHS active
user database
in the
application
process
Issue:
Verification of
Indian status
for the single
streamlined
application
Issue: Scripts
and training
Background
Next Step/Plan
Timeframe/Target
Dates
The establishment of a near real-time application and eligibility
verification process for all CMS-related coverage would address, in a
sequenced way, the special benefits available for individual AI/ANs
under the Children’s Health Insurance Program, the Medicaid
Program, and the Exchanges. Use of the IHS active user database
would also necessitate that the application process request applicants’
Indian status under specific definitions taken from the ACA.
Background
Next Step/Plan
Timeframe/Target
Dates
The statutory ambiguity created by the ACA’s use of three different
statutory references for the definition of “Indian” is amplified by the
single streamlined application for the Exchanges and Medicaid
Expansion. It will be difficult for the parties responsible for
implementing the ACA to determine eligibility for Indian-specific
protections and benefits, resulting in many individuals being treated
as “Indians” for Medicaid cost-sharing exemptions, but not for the
Exchanges cost-sharing protections.
Background
Next Step/Plan
Timeframe/Target
Dates
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 14
for call center
staff
Issue: The
navigator and
in-person
assistor
requirements
This issue addresses whether there should be an Indian desk at the
call center to handle questions and resolve problems regarding
AI/ANs and I/T/Us or whether everyone who works at a call center
should receive training about tribes in the State, the I/T/U system and
special provisions, regulations and systems for AI/ANs.
Background
Next Step/Plan
Timeframe/Target
Dates
Next Step/Plan
Timeframe/Target
Dates
This issue addresses whether there will be carve outs for navigator
contracts for the I/T/Us and other enrollment assistance funding, like
Medicaid Administrative Match (MAM).
Issue:
State/Tribal
consultation
Background
Secretary Sebellius sent a letter to all State Governors on Sept. 14,
2011, addressing the responsibility of States to consult with Tribes in
the development of Health Insurance Exchanges. To complete the
Exchange application, the Exchange, in consultation with Federallyrecognized Tribes, must have developed and implemented a Tribal
consultation policy or process, which has been submitted to HHS and
the Exchange must have an outreach plan for populations including
Federally-recognized Tribal communities. As part of a State’s
Approval or Conditional Approval decision, States should post its
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 15
Tribal-consultation plan (excluding test data) of a State’s Exchange
Application on the appropriate State website within ten (10) business
days of an Approval or Conditional Approval decision.
ACA Policy Subcommittee Meeting – January 10, 2013 – Page 16