THE medical referral program is a resource of last resort, Commonwealth Healthcare Corp. Chief Executive Officer Esther L. Muna said in a media conference on Monday.
She and CHCC Chief Financial Officer Perlita Santos provided an update on the medical referral program since it was transferred to CHCC from the Office of the Governor.
The transition took effect on Oct. 1, 2021, through the fiscal year 2022 budget or Public Law 22-8 which designated CHCC’s CEO as the expenditure authority of $15 million in combined funds from local appropriation and American Rescue Plan Act monies.
However, Muna said, “we did not [fully] transfer things…to us until January 2022.”
Due to funding problems, the program, originally called the Medical Referral Services Office, was transferred to the Office of the Governor through an executive order signed by the late Gov. Eloy S. Inos on May 2, 2013.
In June 2021, the Office of the Attorney General stated that Governor Inos did not have legal authority to remove MRSO from CHCC and place it under the governor’s office.
Also joining Muna and Santos in the media briefing on Monday were Medical Referral Program Director Carmiline Ogumoro and Rose Camacho who is tasked to work on the patients’ off-island hotel accommodations and ground travels.
Limits
Muna said reviewing the regulation is one of the first things they have been doing since the transition took effect.
She said they are also developing policies and procedures “that are basically aligned with the regulation.”
According to Muna, “We use medical referral funds as a resource of last resort, meaning, it is not a payer, it is not an insurance company. There is a limitation.”
She said the main purpose of the medical referral program is to help people who need medical attention, especially those in a life-and-death situation that requires immediate transfer to an off-island hospital if the medical service needed is not available in the CNMI.
“The medical referral program is not an insurance company,” she reiterated.
She said CHCC looks at available resources — federal or local — before it can even start to think of whether or not to use the program. “That is what we meant with ‘resource of last resort,’ ’’ she said.
Muna said a medical referral applicant can go to CHCC where a healthcare provider determines if the patient needs to be transferred. A team will also check the patient’s eligibility based on income, for example. In addition, CHCC must secure the acceptance of an off-island provider.
The other option is to refer the patient to the medical referral committee for a case review. Composed of six voting members, the committee can look at the case and make the determination.
According to the medical referral regulation codified as Title 75, Part 1 Section 75-50-10, “It shall be the sole responsibility of the Medical Referral Committee to screen and evaluate petitions for medical referral, including requests for additional patient treatment not initially authorized, and requests from referral health care facility physicians to refer the patient to a second referral health care facility. After a complete case evaluation, the Medical Referral Committee will determine whether a referral for medical care is warranted. In the event the Medical Referral Committee approves a referral, it shall issue a Medical Treatment Authorization Form, containing the patient’s diagnosis and listing what professional medical services will be authorized for the patient’s referral.”
Muna said once the committee approves the Medical Treatment Authorization, CHCC will look for other resources besides the medical referral funds “which are very limited.” She said the medical referral program is always “underbudgeted.” The program gets a $2 million appropriation from the CNMI government every year but ends up spending $15 million to $18 million.
Sustainability
Now that the medical referral program is with CHCC again, Muna said they want to make it more “sustainable.”
The CHCC team will have to look at the costs carefully, she said, adding that costs include lodgings or hotel accommodations and ground transportation.
Muna said they don’t use the funds for payment of medical bills because, again, the regulation does not describe medical referral services as an insurance.
The reasons for having medical referral procedures are to ensure sustainability, Muna said, adding: “It has to be the resource of last resort.”
Subsidy please
For FY 2023, which starts on Oct. 1, 2022, CHCC is asking the Legislature for a $22 million subsidy because CHCC’s projected revenue of $93 million is not enough for its targeted budget of $115 million.
CHCC is an autonomous public corporation.
Muna said the $22 million they are requesting from the central government does not include funding for medical referral services.
Santos, for her part, said there has to be a law that transfers medical referral services to CHCC so that the Legislature can appropriate money for the medical referral services.
She said they are waiting for the Senate to pass Rep. Tina Sablan’s House Bill 22-77 which would create the CNMI Medical Travel Assistance Program.
“It is a legal thing,” Santos said.
In the meantime, Muna said the governor promised CHCC that he will allot a combination of ARPA and local funds for medical referrals.
Santos said they were told that funding for medical referrals is included in the governor’s budget submission.
In his revised FY 2023 budget submission, the governor proposed a $1.169 million local subsidy for CHCC.
He also told Speaker Edmund Villagomez and Senate President Jude U. Hofschneider that the Department of Finance and the Office of Management and Budget “will continue to work together to finalize a revised ARPA spending plan that may result in the distribution of ARPA funding across all agencies.”
Muna said they expect ARPA funding for the medical referral services in FY 2023.
But Santos said ARPA funds “are not going to be here forever.” CHCC was fortunate that there were ARPA monies at the time the medical referral program was transitioned to CHCC, she added.
“We want to make use of that money as a revolving fund…. [And] if we spend [it on] something we would like to get the reimbursement from Medicaid, for the [off-island] transportation, and hopefully through some changes [in the regulation] we would be able to get reimbursed for the lodging and hotel accommodations,” she said.
Muna said if anyone would need medical referral services, the funding “will be there for you.”
“What we are doing right now is really trying to plan it out, iron that out and make sure that compliance issues are addressed. We need to follow the rules that are written in there, and make [the program] more sustainable,” she said.
And since ARPA is not going to be here forever, Muna said, “we need to make sure that we do our due diligence.”
Commonwealth Healthcare Corp. Chief Executive Officer Esther L. Muna, second left, speaks as Chief Financial Officer Perlita Santos, left, Medical Referral Program Director Carmiline Ogumoro, second right, and staff member Rose Camacho listen during a press conference on Monday in the CHCC conference room.
