Corp. seeks to recover expenses on indigent FAS dialysis patients

The Commonwealth Healthcare Corp. may soon recover millions of dollars spent for the dialysis treatment of indigent citizens from the Freely Associated States if it will qualify dialysis as an “emergency” service.

Tom Schenck of the Division of Medicaid & Children’s Health Operations for the Center for Medicare and Medicaid Services disclosed this in a letter to healthcare corporation chief executive officer Juan N. Babauta and CNMI Medicaid adviser Esther Muña.

Babauta had written to Herb Schultz, regional director for the U.S. Health and Human Services in San Francisco, to ask for technical assistance on a number of initiatives that the corporation is exploring in order to alleviate some of its fiscal challenges.

Babauta’s letter specifically inquired, among others, the potential opportunities to recover expenses paid each year for the dialysis treatment of indigent patients from Freely Associated States (Palau, Marshall Islands, and the Federated States of Micronesia).

Schenck wrote to Babauta that under a Medicare provision (42 CFR 440.255), emergency services provided to legal aliens, including FAS patients, are eligible for Medicaid reimbursement.

“Furthermore, CMS allows states and territories flexibility to define what constitutes an ‘emergency service.’ There are states that have included dialysis in their definition of an emergency service, and are therefore claiming Medicaid Federal Financial Participation (FFP) for the provision of this service to aliens,” explained Schenck.

What constitutes an emergency service, he said, should be determined by the CNMI Medicaid Office, in conjunction with Medicare.

“In the event the CNMI Medicaid adopted an internal policy to consider dialysis an emergency service, then the expenditures related to those dialysis services can be included in the provider’s claim (as stipulated in the reimbursement section of the CNMI Medicaid State Plan) for Medicaid reimbursement. In addition, CNMI Medicaid can only claim FFP for FAS dialysis patients that would otherwise be eligible for Medicaid,” he further explained.

Babauta also inquired about the potential for Medicaid eligibility for individuals from Freely Associated States.

Schenck disclosed that that opportunity is presented by Section 214 of the Children’s Health Insurance Program Reauthorization Act of 2009, which permits states and territories to cover certain children and pregnant women in both Medicaid and the Children’s Health Insurance Program who are “lawfully residing in the United States” as described in a section of the Social Security Act.

“This section of CHIPRA allows the possibility of full Medicaid eligibility, rather than just reimbursement for emergency services, for children and pregnant women from the FAS who would otherwise be eligible for Medicaid if not for their immigration status,” he said.

As a result of these discussions, the CNMI submitted a State Plan Amendment that will implement a new Attachment 4.1 into the CNMI Medicaid State Plan. This attachment provides the authority for the CNMI to take advantage of Section 214 of CHIPRA, and to claim FFP for lawfully residing children and pregnant women who will become newly eligible for Medicaid/CHIP upon approval of the State Plan Amendment.

The State Plan Amendment is currently under review. Upon approval, its provisions will become retroactive to Jan. 1, 2012, according to Schenck.

Babauta also inquired about the appropriateness of using certified public expenditures as a source of local Medicaid match.

Schenck explained that the process of using certified public expenditures as the territory’s non-federal match in order to draw federal financial participation is allowable, and is practiced in numerous states.

“In order to do so, states and territories must have an approved State Plan protocol through which costs are certified and reconciled to actual cost by the governmental provider; the Medicaid Agency then draws the associated FFP,” he explained.

Schenck said that on March 30, 2012, CNMI Medicaid took the important step of submitting its State Plan Amendment 12-003, which will create an Attachment 4.19-A. This attachment sets forth the protocol that will be used by the healthcare corporation and CNMI Medicaid in order to certify public expenditures.

This protocol is currently being reviewed. Upon approval, this protocol will be retroactive to Jan. 1, 2012.