Non-Insured Health Benefits (NIHB) Joint Review Update to the First Nations Health Managers Association National Conference

Transcription

1 Non-Insured Health Benefits (NIHB) Joint Review Update to the First Nations Health Managers Association National Conference Vancouver, BC November17, 2016

2 Objectives The objectives of the NIHB Joint Review is to Enhance client access to benefits; Identify and address gaps in benefits; Streamline service delivery to be more responsive to client needs; and Increase program efficiencies 2

3 Joint Review Steering Committee The AFN-FNIHB Joint Review of the Non-Insured Health Benefits Program is guided by a committee comprised of leadership and technicians from both the AFN and Health Canada. Leadership from the Assembly of First Nations: Ontario Regional Chief Isadore Day Grand Chief Patrick Madahbee (ON) Grand Chief Doug Kelly (BC) Chief Bob Merasty (SK) 3

4 Joint Review Steering Committee National First Nations Health Technician Network (NFNHTN): Lori Duncan (Yukon Rep) Tracy Antone (Ontario Rep) Jolene Mercer (MB Rep) Nadine McRae (AB Rep) National Navigator Network (NNN): Isabelle Verret (Quebec) Emily King (Northern ON) in the interim 4

5 Joint Review Steering Committee From Health Canada, the JRSC is comprised of: FNIHB Assistant Deputy Ministers (2) FNIHB Regional Executives (3) NIHB Headquarters Executives (3) NIHB Regional Directors (2) 5

6 AFN Comprehensive Review The AFN conducted an internal review, seeking to build on previous NIHB exercises both regionally and nationally in the last 10 years. The AFN reviewed the following: Chiefs-in-Assembly Resolutions Minutes from AFN committees (e.g. NFNHTN and NNN) NIHB Action Plan Previous legal opinions Reports (etc.) 6

7 Community Site Visits Kahui Tautoko Consulting Ltd (KTCL) was hired to conduct community site visits for all benefit areas. 5 First Nations communities participated in a site visit to discuss the Mental Health benefit. For remaining benefit areas (dental, vision, pharmacy, medical supplies &equipment and medical transportation), each participating region coordinated 5 community site visits, based on internal regional processes. These site visits focused on the remaining 4 benefit areas (dental, vision, pharmacy and medical supplies and equipment). KTCL has completed all of the regional site visits and draft reports were submitted September 19 and are in the process of being finalized. 7

8 Client Surveys AFN created online surveys for client and community members for ALL First Nations NIHB clients, regardless of location. These surveys were used to inform the AFN submission to the Joint Review Steering Committee, in combination with the Regional site visits conducted by the KTCL. Completed client surveys: Mental Health (210) Dental (826) Vision (366) MS&E (199) Pharmacy (424) Medical Transportation (501) 8

9 Recommendations Process to develop Recommendations: 1.) AFN reviews previous NIHB exercises, forums, meetings, Action Plan, Chiefs Resolutions over the last 10 years, (etc) 2.) Incorporate the on-line Client Surveys for each benefit area 3.) Regional Engagement Activities (determined by each region) 4.) Community Site Visit reports are reviewed 5.) AFN staff develops draft recommendations based on the above noted review processes 6.) Share the draft recommendations with willing Service Providers for their professional review, feedback and validation 7.) Tables recommendations with the JRSC for review, discussion and negotiation/deliberation 8.) Upon JRSC agreement, a joint implementation plan is developed complete with activities and timelines, responsibilities 9

10 Service Provider Update SERVICE PROVIDER SURVEYS Service Provider Surveys were invited to participate in an online survey for all benefit areas. The Service Provider surveys are all complete and the AFN was accepting written submissions from Service Providers up until October 31, Completed Service Provider Surveys: Pharmacy (273) Dental (245) MS & E (8) MT Drivers (14) MT Coordinators (10) Vision (224) 10

11 Service Provider Update SERVICE PROVIDER FORUM The purpose of the Service Provider Forum was to solicit feedback from a wide range of NIHB specific service providers. The forum also provided an opportunity for service providers to suggest practical changes to policies and systems that will support an improved process for both clients and service providers dealing with NIHB. The AFN shared the current draft benefit recommendations with Service Providers to seek their professional feedback, to ensure recommendations were in-line with industry standards. 11

12 Regional Engagement Process Each region will hold their own regional engagement session, determined by the processes of each individual region. The purpose of these engagement processes is to offer as many opportunities as possible for communities to provide input into the Joint Review, even if they were not selected for a site visit. We anticipate regional engagement sessions to be completed by November 1, 2016 and reports submitted by November 30,

13 Regional Findings KTCL Community Site Visits Federal fiduciary responsibility Perceived lack of communication from FNIHB Payer of last resort policy is an infringement on treaty right to health Disconnect between Federal and Provincial services Perceived lack of trust in local staff, from FNIHB Lack of information on NIHB program 13

14 Dental Findings KTCL Community Site Visits Access - Difficulty with recruiting and retaining Dentists; infrequent visits; group insurance first option; requesting up front payment or co-payment; providers refusing First Nations NIHB clients due to excessive paperwork, coverage rates and burden of administrative processes Coverage - limited children s dental care; things not covered that people believe should be or are not aware; erosion of benefits; dentures; braces; prevention care; align to provincial system Approvals/Pre-determination - issues with delays and paperwork Payments high levels of Band Council subsidizing denied or non-covered claims; issues with delays in reimbursement affecting providers and their decision to serve NIHB clients; issues with the extensive paperwork Denials / Appeals - major issues with the paperwork involved to process these; perception that every appeal denied first forcing people to re-appeal 14

15 Pharmacy Findings KTCL Community Site Visits Access - difficulties for rural/remote/isolated communities; infrequent Doctors visits; Up front payments; After hours access; concerns with prescription drug abuse Coverage - things not covered that people believe should be; erosion of benefits; lack of notification of delisting; overriding physician prescriptions for cheaper options; acknowledgement of traditional healing Approvals - appeals process too long; issues with lengthy delays and paperwork; DEC process burdensome Payments High levels of Band council subsidizing; issues with the extensive paperwork 15

16 Medical Supplies & Equipment KTCL Community Site Visits Findings Access - difficulties for rural/remote/isolated communities; infrequent Doctors visits; storage; 24/7 access (after hours / weekend cover); high levels of un-funded health centre capacity used; largely managed by FN Home and Community Care program in communities Coverage gap in coverage of costs to see specialized health professionals coverage e.g. OTs, PTs, Chiropractors Approvals - issues with lengthy delays and paperwork Payments - Up front payments; high levels of Band council subsidizing equipment (including storage for equipment); issues with the extensive paperwork 16

17 Medical Transportation Findings KTCL Community Site Visits Access - Issues for contribution agreement communities e.g. retaining drivers (rates, hours, insurance); acknowledging local knowledge and information; public transport challenges; out of province challenges Coverage - perceived erosion of services; children priority; escorts policy reviewed; lack of alignment to provincial rates) Approvals - issues with lengthy delays and excessive paperwork; attitude of call centre staff Payments - cumbersome MTRS reporting system; up front payment for travel costs; high level of Band council subsidizing; issues with the extensive paperwork to make claims 17

18 Updates MEDICAL TRANSPORTATION Gathering information and drafting reports; 501 client surveys completed PHARMACY Gathering information and drafting of reports; 424 client surveys completed MEDICAL SUPPLIES & EQUIPMENT Gathering information and drafting of reports; 199 client surveys completed VISION Draft reports complete; 366 client surveys were completed DENTAL Draft Recommendations have been developed and discussed by JRSC, some requiring on-going discussion, with some additional experts; 826 client surveys completed 18

19 Mental Health Update MENTAL HEALTH Review has been completed; 210 client surveys completed Numerous recommendations and a joint implementation plan developed. AFN is currently working with FNIHB-NIHB and the Mental Wellness Continuum Framework Committee to oversee/guide the implementation activities 19

20 Client expectations Key Concerns Low numbers of client surveys On-going commitment for the implementation of recommendations in each benefit area Low numbers of the Medical Transportation Driver and Coordinator surveys 20

21 June 2016 Progress List More than 50 products and medications have been newly added to the NIHB Drug Benefit List as open benefits in 2016, including: Naloxone for treatment of opioid overdose Bisphosphonates for treatment and prevention of osteoporosis and Paget disease (changed from limited use to open benefit) The NIHB Program has increased coverage for partial plastic (acrylic) dentures. NIHB will now review requests for replacement every 5 years (instead of every 8 years). NIHB has revised mental health provider enrollment forms to include information on provider specialties, including trauma informed care, and cultural competency. 21

22 June 2016 Progress List To facilitate client access to oxygen supplies and equipment, NIHB now recognizes licensed practical nurses (LPN) and registered practical nurses (RPN) as home oxygen assessors in provinces and territories where this activity is within their scope of practice. NIHB has revised the approval process for escorts for prenatal clients to ensure consistent adjudication and regard for the advice of medical professionals. NIHB has reduced administration for Vision providers by lifting the requirement for annual re-enrollment. NIHB has made it easier for clients to notify the Program if other health coverage has ended and no longer requires written notification. 22

23 Next Steps Complete the recommendations with the JRSC for the remaining benefit areas Validation sessions to review recommendations 23

24 THANK YOU Please feel free to contact us if you have any questions: Amanda Meawasige Senior Policy Analyst Safe, Secure and Sustainable Communities Assembly of First Nations Phone: (613) ext.108 Toll free: ext.108 Please also send an copy to: 24