NCACH Annual Summit: Addressing the Road Blocks to Whole Person Care

1. NCACH Annual Summit:Addressing the Road Blocks to Whole Person Care Jessie Dean and Alison Ball Opening Session April 12, 2019

2. Introductions

3. North Central Region: Snapshot Data • Washington State • Total Population: 6,724,540 • Total AI/AN Population: 170,638 (2.5%) • Total Population on Medicaid: 1,900,903 (28%) • Total AI/AN Population on Medicaid: 75,619 (4.0%) • North Central • Total Population: 241,124 • Total AI/AN Population: 9,243 (3.8%) • Total Population on Medicaid: 92,445 (38%) • Total AI/AN Population on Medicaid: 4,088 (4.4%) *Data from 2010 census and Healthier Washington Dashboard

4. North Central Region: Snapshot Data *Data from Healthier Washington Dashboard

5. Colville Reservation vs. Medicaid RSAs • Divided into two separate regional service areas (RSAs) • Regional service areas defines Medicaid purchasing boundaries

6. Updates from the Colville Tribes • Follow-up from July 2018 Declaration of State of Emergency in response to Youth and Adult Suicide Completions • Collaboration with Empire Health Foundation • Community Household Health Assessment • Adverse Childhood Experiences (ACEs) Survey • Developing a Competent Colville • Tribal Construction and Administration of New Omak clinic

7. Updates from HCA Office of Tribal Affairs • Merger of DBHR from DSHS and into HCA • Care Coordination and Tribal 638 FQHC • SB 5415 • DHAT and Community Health Aides • HB 1317/SB 5392 • Tribal Evaluation and Treatment Facility Workgroup • MCO Payment to IHS/Tribal Facilities at Encounter Rate

8. Merger of HCA and DBHR • Indian Nation Agreements (Contract Consolidation) • BH-ASO and Integrated Managed Care (Tribal Crisis Planning) • BH Specific Projects for Tribes • Tribal Evaluation and Treatment Workgroup • AI/AN Opioid Response Workgroup • SUD Peer Support – SPA Amendment • Opioid treatment and prevention grants

9. Care Coordination and Tribal 638 FQHC

10. DHAT, Community Health Aide, Behavioral Health Aide • DHAT Medicaid Reimbursement • Hearing on December 18, 2019 • Next Step: CMS Hearings Officer will issue his ruling • Impact: Determines Medicaid reimbursement potentially for DHAT, BHA, CHA • CHAP Board • Northwest Portland Area Indian Health Board is developing the Community Health Aide Program certification and training rules • Skagit Valley Community College and Northwest Indian College are developing curricula More information: http://www.akchap.org/html/home-page.html

11. Tribal Evaluation and Treatment Workgroup This group was formed by ESSB 6032 (2017) to develop a plan for establishing an evaluation and treatment facility that will specialize in providing care specifically to the American Indian/Alaska Native population. • Have developed recommendations regarding: • Governance • Facility and Location • Funding and Operational Costs • Laws and Regulations • Cultural and Clinical Practices

12. MCO Payment to IHS/Tribal Facilities at Encounter Rate • Currently, the Medicaid MCOs in Washington are not set up to pay the IHS or Tribal Facilities encounter rate • This is a particular issue for the Tribal 638 FQHC model, as the encounter rate will be paid for: • AI/AN and non-AI/AN clients • Clients in managed care or fee-for-service

13. Jessie Dean Tribal Affairs Administrator Phone: 360.725.1649 Email: jessie.dean@hca.wa.gov Web:http://www.hca.wa.gov/tribal/Pages/index.aspx Alison Ball Health & Human Services Director Phone: 509.634.2437 Email: alison.ball@colvilletribes.com Web: https://www.colvilletribes.com/health-director Thank you!