‘PMC-GHLI standoff is No.1 priority’

Calling it the biggest issue facing him, newly hired Northern Mariana Islands Retirement Fund Administrator Karl T. Reyes yesterday said he plans to immediately address the standoff between the local health providers and Group Health and Life Insurance program, which the Fund administers.

“It is necessary to address this at once because it involves the welfare of the members of the plan. Local health providers are very important to our community and there are maybe as many as 5,000 government workers who could be placed at a disadvantage if this thing is not resolved,” he said.

Reyes stressed, however, that there are industry standards and rates that the local providers have to follow “and this is where the differences come in.”

“It’s a challenge that I will have to look into and I am looking forward to addressing it with the Board of Trustees members and the local providers themselves,” he said.

Rep. Benjamin B. Seman, who is Chair of the House Committee on Health and Welfare, had earlier called for an April 18 meeting with the Fund, its third-party administrator, Hawaii Pacific Medical Referral, and representatives of local health providers to iron out their issues.

Fund Board Chair Vicente C. Camacho confirmed, though, that Seman acceded to his and HPMR’s request to hold the meeting, instead, on April 30.

“Yes, the House committee was amendable to our request to hold the meeting on April 30, so that the HPMR’s technical staff could also be present during the meeting,” said Camacho.

This came soon after Pacific Medical Center told the Fund that it would stop accepting patients covered under the Group Health plan beginning May 10 due to the Fund’s failure to address PMC’s concerns regarding the plan’s coverage, the fee schedule and the “unreasonable” delay in payments.

Camacho, however, argued that the matter is better left to boards and commissions rather than the Legislature because, “if politics get into the Group Health picture, it would only complicate matters since “money cannot be managed if politics becomes an obstacle.”

Echoing Camacho’s stance, Reyes said it would so much better if the problems between Group Health and the local health providers could be resolved between these two parties themselves.

“It would be better if it could be worked out, with the Fund receiving the funding and having the responsibility of paying the providers without having to go through another legislation. Giving that opportunity to the Fund to address the situation first before other new legislation is drafted would be so much the better,” he said.

At the same time, Reyes said that local health providers should be made to measure up to industry standards as to rates and billings. “I think the industry standards have to be applied here.”

Reyes is a former lawmaker who served the House of Representatives from 1996 to 1999.