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Last updateTue, 23 Jul 2019 12am







    Monday, July 22, 2019-8:00:39P.M.






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Starting June 1, NMI Medicaid will no longer reimburse private health providers

DUE to depleted local and federal funding for the Medicaid program, CNMI Medicaid Director Helen C. Sablan said they will no longer reimburse private health clinics for any services provided to Medicaid beneficiaries starting June 1, 2019.

Sablan advised the beneficiaries to use the Commonwealth Healthcare Corp.’s clinics for outpatient care until further notice.

She said the CNMI Medicaid Program has designated CHCC as the only provider specifically for primary care.

“Services provided by the Kagman Community Health Center, MMC & Pacific Labs, Pacific Medical Center, and Saipan Health Clinic will not be reimbursed by the CNMI Medicaid Program for outpatient care. This means these clinics may not bill Medicaid for services and may ask you for cash payment. If you choose to attend a non-CHCC clinic for outpatient care, and pay out of pocket for the service, Medicaid will not reimburse you,” Sablan said.

She told private health providers: “While we hope that you might consider continuing to provide medical care for some of the Medicaid beneficiaries as charity care or through some arrangement directly with the patient, please be advised that any such agreement is between you as a provider and the patient. The CNMI Medicaid program will not reimburse you, or the patient, for any of these services.”

On Wednesday, Sablan said the CNMI Medicaid program had completely exhausted the federal and local funding for the Medicaid program for the current fiscal year. “No further financial assistance has been committed that would enable the CNMI Medicaid program to continue payments to medical services to beneficiaries,” she said.

The CNMI has 15,316 Medicaid beneficiaries.

Sablan said the central government has been incurring debt every day for the Medicaid program.

She also noted that the U.S. Congress has not passed the Medicaid disaster assistance fund for the CNMI while the local Legislature has not yet identified funding for the program.

On May 1, Sablan said they presented a proposed plan of action to Gov. Ralph DLG Torres who, she added, approved the implementation of the following:

1) All beneficiaries and providers shall be notified that CNMI Medicaid will only provide services through the CHCC unless arrangements can be made separately with the provider;

2) The secretary of Finance shall prioritize payments for dual eligible Medicare and Medicaid beneficiaries;

3) CNMI Medicaid shall disseminate information to beneficiaries and providers on changes to outpatient services under the Medicaid program; and

4) All travel authorization requests shall be submitted to the Office of the Governor for review and approval based on the availability of funds.

On April 25, Sablan said they received a letter from CHCC Chief Executive Officer Esther Muna informing the CNMI Medicaid Office that the hospital could provide outpatient services to Medicaid beneficiaries.

Obligated by law

Recognizing the financial situation of the CNMI government, Muna assured that CHCC will assist the Medicaid office by making health services available at CHCC. “As a government entity, we are obligated by law to provide services,” she added.

Unlike private health providers, Muna said they cannot turn down a patient. She added that she has also communicated with CHCC doctors and medical staff of the possible influx of patients.

“For Medicaid, [we will accept] whatever funding they have. CHCC is really committed to the health and well-being of the CNMI,” Muna said in an interview.

Zoe Travis, CHCC communications and public relations specialist, said CHCC has been preparing its existing providers to accommodate the influx.

“We are just getting into this crisis. There’s a lot of things that can change in the future. We are planning as we go along. There is no huge long-term plan for all of this right now. Rest assured that the CNMI is supported by a lot of different grants and funding. We do believe that we have the resources to fully serve patients for as long as necessary,” Travis said.

According to Sablan, they are notifying all Medicaid beneficiaries and private providers.

The notices include information about CHCC outpatient clinics, their hours and their contact information for appointments.

Travis said CHCC has three outpatient clinics: the Family Care Clinic, the Children’s Clinic and the Women’s Clinic.

The Family Clinic is open on Monday through Friday from 7 a.m. to 6 p.m., and on Saturdays from 8 a.m. to 5 p.m. by appointment only. For more information, call 236-8372.

The Children’s Clinic and the Women’s Clinic are open from Monday through Friday from 7:30 p.m. to 11 a.m., and from 12:30 p.m. to 4 p.m. For more information call 236-8309.

Lawmakers vow to help

The chairmen of House Committees on Health & Welfare and the Ways & Means on Wednesday said they will “help” CHCC, which now has to accommodate more indigent patients in light of the CNMI Medicaid Office’s recent announcement.

Health & Welfare Committee Chairman Jose Itibus said it has always been his goal to help CHCC “because I know we really need to assist the hospital.”

Although CHCC generates its own revenue, there are a lot of people who don’t have health insurance and depend on Medicaid.

Itibus said he has been meeting with CHCC and Medicaid officials to discuss these “pressing issues.”

For his part, Ways & Means Committee Chairman Ivan A. Blanco scheduled a meeting with CHCC officials for May 20.

Blanco said CHCC should get funding support from the central government.

He noted that Gov. Ralph DLG Torres proposed $3 million for CHCC and $5.3 million for Medicaid matching funds in the fiscal year 2020 budget. “I don’t think there is going be an issue with that. If that is the amount needed, we will support it,” Blanco said.