MEDICAL Referral Services Director Ronald D. Sablan told the Legislature that the medical referral program “must be depoliticalized and adequately budgeted.”
In his written comment to the House Committee on Health and Welfare last week, Sablan said the program’s objective is “to contain the cost of medical referral by excluding unnecessary referrals, minimizing inappropriate lengths of stay at healthcare facilities, and establishing cost-sharing mechanism with patients.”
Sablan submitted his written comment in response to the request of the committee chair, Rep. Tina Sablan, whose panel is conducting a series of public hearings on medical referrals.
The public hearing will continue at 3:30 p.m., Wednesday, May 26, in the House chamber. The committee will receive testimonies from the Commonwealth Healthcare Corporation, the Department of Finance, the CNMI Medicaid Agency, and the Office of the Governor.
In his comment to the committee, Director Sablan said off-island medical referrals are reviewed and approved by the medical referral committee, and not by the medical referral office. The committee is composed of six voting members who are all licensed physicians. They meet every Wednesday to review referral requests.
Director Sablan said there is always room for improvement, but it would be difficult “if its structure can [be] easily overpowered.”
He said medical referral “has a long history of [being] the top political subject in every election year. Unfortunately, its personnel and operation requirements were never fully supported or funded appropriately to meet its mandated responsibilities.”
He added, “Medical referral must be depoliticized and adequately budgeted to run smoothly and consistently following its own rules and regulation focusing on patient care.”
He said, “It’s very frustrating and an insult to us whenever news articles or personal interviews emphasize the deficit status of medical referral…when in actuality, it was never funded in the first place.”
For the medical referral program “to run smoothly with consistent policy [it should] be allowed to hire its own personnel, [be] adequately funded and be officially organized as an independent program similar to the new Medicaid model or as an autonomous agency,” the program director said.
He added that historically, the medical referral program has always been underfunded by 50% or as low as 13% in the last 10 years.
The funding level, he said, “obviously is inappropriate and the program runs under unfunded liability when expenditures are realistically within a margin of error of requested budget submission depending on the number of patients.”
Inter-island medical referral
In his written comment, Tinian Mayor Edwin Aldan told the committee that “unless you live on Tinian or Rota, you cannot understand the frustration, disappointment and oftentimes outright anger our people feel when it comes to the CNMI Medical Referral Program.”
He said his office spends “hundreds of thousands of dollars” every year to ensure that Tinian residents can obtain proper healthcare.
He said his office maintains full staff at the Tinian guesthouse on Saipan, rents hotel rooms if the guest house is full and leases cars.
Aldan said this does not include the municipal medical supplemental program that was in place prior to the Covid-19 pandemic. This supplemental program spent $150,000 a year for escorts of patients, he added.
“But let’s be very clear that the problems we face today with the medical referral program should not be blamed solely on this administration. The people of Tinian have been battling inadequate medical care for decades,” Aldan said.
“Maybe we are looking at this situation [the] wrong [way]. Maybe less focus should be placed on the inefficiency of the referral program and more on what we can do to enhance the medical services on Tinian,” he added.
Although the medical referral program will probably continue to be underfunded until a major overhaul is enacted, Aldan said he believes today’s focus must be on ensuring that Tinian and Rota residents are provided equal healthcare.
“I hope this committee takes our concerns seriously and for once, let’s take the politics out of healthcare and combine the efforts of the administration, Legislature, municipalities and CHCC to make changes to the current system so every CNMI citizen is given adequate and affordable health care regardless of which island they live,” Aldan said.
