Indian Health Service: Implications of the Affordable Care Act

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1 Indian Health Service: Implications of the Affordable Care Act Carol Chicharello, Deputy Director, Health Program Improvement & Support Branch Phoenix Area Indian Health Service 8th Annual CAH Performance Improvement Summit (August 2, 2013) Wild Horse Pass Casino & Resort Gila River Indian Community

2 Presentation Overview Indian Health Service (IHS) IHS Budget Challenges Budget Formulation Process Phoenix Area Budget Affordable Care Act (ACA) Opportunities Major Changes Business Planning Phoenix Area Impacts in Arizona Other Changes Next Steps

3 Indian Health Service (IHS) HHS division responsible for providing federal health services to eligible American Indians and Alaska Natives (AI/AN) Mission: To raise the physical, mental, social, and spiritual health of AI/AN to the highest level. Goal: To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to AI/AN people. Foundation: To uphold the Federal Government s obligation to promote healthy AI/AN people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

4 Indian Health Service (IHS)

5 Indian Health Service (IHS)

6 IHS Budget Challenges IHS Budget Formulation Process Phoenix Area Recommendation (in million of dollars) National Recommendation IHS Budget Submission President's Budget Request Congressional Appropriated Budget Clinical Services 3,955 3,762 3,187 3,187 2,966 Perventive Health Urban Health Indian Health Professions Tribal Management Direct Operations Self-Governance Contract Support Costs Diabetes Funds Reimbursables ,374 1,132 1,102 6,127 5,837 5,502 5,262 4,961 Incremental % of Change -4.73% -5.74% -4.36% -5.72% Overall decrease from Phoenix Area Budget Recommendation to Congressional Appropriated Budget %

7 IHS Budget Challenges Phoenix Area Budget Fiscal Year 2013 Under Continuing Resolution PHOENIX AREA FUNDING LEVELS FY 2013 Recurring Base (in thousa nds of dolla rs) Rescission (0.2%) Sequester ( %) FY 2013 Budget w/cuts Clinical Serivces 203,600,816 (407,202) (10,115,661) 193,077,953 Preventative Health 15,286,400 (30,572) (759,485) 14,496,343 Urban Health 2,481,300 (4,963) (123,280) 2,353,057 Direct Operations 3,197,825 (6,396) (158,880) 3,032,549 Contract Support Costs 22,084,060 (44,168) (1,097,220) 20,942,672 Contract Support Health 68,127,634 (27,295) (3,390,263) 64,710,076 Totals 314,778,035 (520,596) (15,644,789) 298,612,650

8 Affordable Care Act (ACA) Opportunities ACA Major Changes in Medicaid Expansion Health Insurance Marketplace VA/IHS Reimbursement Phoenix Area Facilities in Four States (AZ, CA, NV, UT) Increase in Access to Care to non-indian health care providers Increase in Third Party Reimbursements Increase in Contract Health Service Budget Savings to pay for services provided to individuals with no alternate resources

9 ACA Opportunities IHS ACA Business Planning Area Office and Service Unit Coordination Ensure that the number of patients remains stable or increases Ensure that third party revenue remains stable or increases Ensure priority customer service and quality of care and an Indian health care system that continues to improve over time IHS ACA Business Plan Template Assess Local Environment for Health Insurance Marketplace Assess Patient Workload and Revenue Impact Assess Current Staffing, Workload, Facility Space Assess Referral and Prior Authorization Processes Determine Eligibility Process New Changes Assess Data Reporting Requirements Determine Marketing Strategy Qualified Health Plan Relations

10 ACA Opportunities Service Unit, Area-Wide, Area Office, and National ACA Efforts IHS Headquarters Phoenix Area Office National Business Office Coordinators Committee Phoenix Area Office ACA Workgroup Phoenix Area-Wide ACA Workgroup Service Unit ACA Teams NBOC ACA Subcommittee Phoenix Area ACA Outreach & Education Subcommittee

11 ACA Opportunities MEDICAID RESTORATION & EXPANSION

12 Medicaid Restoration & Expansion Medicaid Expansion State option to expand eligibility to 133% FPL (beginning January 1, 2014) Arizona: Governor signed Restoration/Expansion Legislation (impact: 300,000) California: Legislature passes Medicaid Expansion (impact: 1.4 million) Nevada: Moving forward with Expansion (impact: 204,000) Utah: Legislation passed prohibiting implementation of expansion without Legislative approval; not moving forward at this time (impact: 123,000) Colorado Service Unit serves American Indian and Alaska Native (AI/AN) residents from Arizona, California and Nevada (as well as AI/AN from other states)

13 23,000 Medicaid Restoration in Arizona AHCCCS American Indian Health Program Enrollment of Childless Adults (since Enrollment Freeze in July 2011) 21,000 19,000 17,000 15,000 13,000 11,000 9,000 7,000 5,000 Source: AHCCCS Administration

14 Medicaid Restoration in Arizona AHCCCS Uncompensated Care Payments by Phoenix Area IHS Facility (April 6, 2012 May 31, 2013) $25,000,000 $22,532,193 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $2,067,545 $556,505 $233,006 $163,144 $2,203,131 $1,950,786 $394,084 $3,505,130 $121,646 $- Source: AHCCCS Administration

15 Medicaid Restoration in Arizona Estimated CHS Costs for AI/AN Childless Adults in Arizona by Phoenix Area IHS Facility (April 6, 2012 March 31, 2013) $4,500,000 $4,332,996 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $2,124,324 $2,035,356 $1,500,000 $1,000,000 $500,000 $874,644 $522,828 $579,360 $251,004 $1,426,824 $- Parker Peach Springs Supai Ft. Yuma Hopi PIMC San Carlos Whiteriver Source: Phoenix Area Office

16 Medicaid Expansion in Arizona Potential Annual Reimbursements for the AI/AN Medicaid Expansion Population in Arizona by Phoenix Area IHS Facility $25,000,000 $20,000,000 $20,594,006 $15,000,000 $12,638,152 $10,000,000 $5,000,000 $0 $74,101 $453,032 Desert Visions $3,759,201 $2,254,524 $776,870 Ft. Yuma Hopi Parker Peach Springs $5,572,712 $220,458 PIMC San Carlos Whiteriver Supai Clinic Source: Phoenix Area Office

17 Medicaid Expansion in Arizona Potentially Eligible AI/AN in Arizona under Medicaid Expansion and Woodwork Population (Uninsured under 133% FPL) Desert Visions Ft. Yuma Hopi Parker Peach Springs PIMC San Carlos Whiteriver Supai Clinic

18 ACA Opportunities HEALTH INSURANCE MARKETPLACE

19 Health Insurance Marketplace Health Insurance Marketplace Enrollment begins October 1, 2013; Coverage begins January 1, 2014 Individual & Family Market Individuals with incomes up to 400% may be eligible for an advance premium tax credit (around $94,200 for a family of 4) AI/AN with income up to 300% FPL are exempt from copays, coinsurance, deductibles (around $70,650 for a family of 4) AI/AN have special monthly enrollment periods Tribes may elect to pay for their members premiums Hardship Exemption from Individual Mandate AI/AN who are eligible to receive services from an Indian health care provider State Decisions Arizona: Federally-Facilitated Marketplace California: Covered California (state-based) Nevada: Nevada Health Link (state-based) Utah: Federal and State Partnership

20 Health Insurance Marketplace in Arizona Estimated # of AI/AN Eligible for No Cost Sharing and Premium Subsidy ( % FPL) Desert Visions Ft. Yuma Hopi Parker Peach Springs PIMC San Carlos Whiteriver Supai Clinic

21 Health Insurance Marketplace Qualified Health Plan (QHP) Addendum for Indian Health Care Providers Persons Eligible for Services Insurance and Indemnification Licensure of Health Care Professionals Dispute Resolution Governing Law Medical QA Requirements Area-Level Coordination of QHP Contracts Contracts reviewed /cleared by Regional Office of General Counsel Area and Service Unit Considerations Electronic Claims Submission and Timely Filing Rate Negotiation Coordination of Care

22 ACA Opportunities VA/IHS REIMBURSEMENT AGREEMENT

23 VA/IHS Reimbursement VA/IHS Memorandum of Understanding Signed 10/1/2010 To establish coordination, collaboration, and resource-sharing between the VA and IHS to improve the health status of AI/AN veterans. VA/IHS Reimbursement Agreement Signed on 12/5/2012 To facilitate reimbursement by the VA and IHS for certain health care services, specifically Direct Care Services provided by the IHS to eligible AI/AN Veterans. Accreditation is required. Implementation Phase 1 (Jan-June 2012): 10 IHS pilot sites selected to develop Local Implementation Plans and begin billing the VA for direct care services provided to eligible AI/AN veterans Phase 2 (July 2013 forward): Implementation at all other federal sites

24 VA/IHS Reimbursement Potential Annual Inpatient Reimbursement Potential Annual Outpatient Reimbursement $300,000 $296,400 $1,200,000 $1,197,980 $250,000 $1,000,000 $200,000 $209,989 $800,000 $626,080 $150,000 $600,000 $100,000 $50,000 $0 $13,964 $8,506 $75,790 $400,000 $200,000 $0 $111,671 $260,967 $202,272 $326,585

25 Next Steps ACA Business Planning Training of All Staff and In-Person Assisters Outreach and Education AI/AN Specific Materials and Consistent Messaging Partnership with Direct Service Tribes and Tribal Programs Consultation with Tribes and Community Customer Service and Process Improvement Provider of Choice Medical Home Cultural Competency Patient Reception Monitoring of Workload, Productivity and Staffing Levels

26 Questions Carol Chicharello Deputy Director Health Program Improvement & Support Branch Phoenix Area Indian Health Service (602)

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