Private clinics may again receive Medicaid patients

Community Bulletin
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(Press Release) — The CNMI Medicaid program is pleased to announce to all Medicaid beneficiaries and private providers that all adult and children on-island outpatient primary care services may begin receiving and providing outpatient care services to its 15,000 Medicaid beneficiaries in the Commonwealth effective, March 1, 2020.

The CNMI Medicaid program received the official grant award notification, dated February 20, 2020, from the Centers for Medicare and Medicaid Services.

Background

In December 2019, the U.S. Congress increased the budget and the FMAP in the Further Consolidated Appropriations Act, FY 2020. For two years, the CNMI Medicaid program will receive $120 mil in federal funding. The Act further increased the Federal Matching Assistance Percentage or “FMAP” from 55% to 83%. This means that the CNMI funding has been substantially lessened but nonetheless is required since federal funds may not be disbursed without the CNMI share. The CNMI is receiving the maximum provided to any state or territory in accordance with Title XIX of the Social Security Act.

For FY 2020 and 2021, the CNMI Medicaid will require an increase from the local appropriations and allotments to be able to pay for the matching funds for the FMAP programs for medical services. The required local matching for FMAP is now 17%.

The CNMI Medicaid program anticipates that there will be sufficient funding for the CHIP Beneficiaries for the current fiscal year that ends on September 30, 2020.

For adult beneficiaries, however, please be advised that the Medicaid program may need to rescind the ability to seek treatment from a private provider should there be insufficient funding for the CNMI match for the federal funds as required by law.

At the same time, the U.S. Congress attached conditions on the funding because of the significant increase in funding to ensure that the territories manage the Medicaid program in a manner similar to the states. Specifically, the Congress requires that the territories to:

• Make “Reasonable and Appropriate” progress to submit data to the Transformed Medicaid Statistical Information System or T-MSIS;

• Establish a Medicaid Fraud Control Unit, and

• Submit reports directly to the chairs and ranking members of the U.S House of Representatives and Senate committees of jurisdiction.

The Further Consolidated Appropriations Act, FY 2020 further provides for penalties if the territories are unable to make reasonable and appropriate progress in achieving the requirements.

The penalties include a 0.25% reduction in the federal share for each quarter that the CNMI does not make progress. This will require additional action by CNMI Legislature and funding of a “Program Integrity” function Medicaid Fraud Control Unit and program.

Helen Sablan, director of the CNMI Medicaid program, said that: “I want to acknowledge and express my deep gratitude to Delegate Kilili Sablan for raising and diligently pursuing the problem of the ‘Medicaid Fiscal Cliff’’ in the CNMI and other territories. His leadership was absolutely essential in encouraging his colleagues and staff that are behind the scenes to hold two unprecedented hearings on the Medicaid funding problems in the territories. I also want to acknowledge and appreciate the efforts of Gov. Ralph Torres for raising the issue directly with Secretary Alex Azar III of the U.S. Department of Health and Human Services. Finally, I want to thank the many individuals such as Esther Muna and Kaitlyn Neisis of the Commonwealth Healthcare Corp. and the many organizations that supported and provided information to the U.S. Congress about the Medicaid program in the territories. The funding provided will benefit over 15,000 Medicaid and CHIP beneficiaries in the Commonwealth, help our health care system to be sustained, and aid our economy and government with tax and health care expenses for the CNMI.”

Director Sablan further said that “I would like to remind all Private providers that the Medicaid claims must be submitted in the manner and timetable required by the Medicaid program. The data required to meet the requirements of federal reporting and will be provided to the federal and CNMI Medicaid Fraud Control Unit.”

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