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PARTNERSHIP WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES

ISSUE

To further the mission of the Agency, the Indian Health Service (IHS) has developed a close working relationship with the Centers for Medicare and Medicaid Services (CMS).

BACKGROUND

With the passage of the Indian Health Care Improvement Act in 1976, the IHS was given the authority to bill for services provided to American Indians and Alaska Natives who are beneficiaries of CMS programs. The Congress directed that revenue accruing to the IHS was to be used to ensure that IHS facilities met the safety standards, including appropriate equiping, staffing, quality of clinical care, and accreditation of services. This revenue is used to maintain accreditation of all IHS hospitals and clinics through the Joint Commission on Accreditation of Healthcare Organizations or Association of Accredited Ambulatory Health Centers.

SITUATION

As a result of assisting our patients to enroll in available alternate resources, IHS receives in excess of $650 million annually in revenue from CMS for services provided to Medicaid, Medicare, and the State Children’s Health Insurance Program (SCHIP) eligible patients. Enrollment in these programs also provides payments for referral services previously paid for by IHS Contract Health Services. In recent years the IHS and CMS have met regularly at the senior management level to ensure close coordination of policies, foster increased state/tribal innovation, and develop ways to improve access to care for American Indians and Alaska Natives. The American Recovery and Reinvestment Act established the CMS Tribal Technical Advisory Group (TTAG) made up of tribal leaders as an official advisory body on CMS payment and program reforms, policies and regulations for implementation of Medicaid, Medicare, and SCHIP. This past year, the IHS and CMS have worked together to implement outreach and education activities including regional training sessions and training videos addressing IHS and tribal issues for improving access to CMS programs. The videos can be accessed on the National Institutes of Health (NIH) webcast Internet site at http://videocast.nih.gov/PastEvents.asp?c=4.

OPTIONS/PLANS

To increase access to services, the IHS, CMS, National Indian Health Board, and TTAG will continue to collaborate on the fostering of more culturally appropriate, non-institutional services for American Indian and Alaska Native beneficiaries. In collaboration with CMS, the IHS will continue to track Medicaid and Medicare reform proposals, provide outreach eligibility and enrollment training for CMS programs, and evaluate regulatory and payment policy changes that impact on Indian health programs.

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

June 2009