IHS Implements New Medicare Like Rate Regulation for Tribes
The Indian Health Service (IHS) announced that it will be implementing a new regulation that gives IHS, Tribal, and Urban Indian health programs the ability to cap payment rates at a “Medicare-Like rate” to physician and other non-hospital providers and suppliers who provide services through the Purchase and Referred Care (PRC formally CHS) program.
Background: The PRC budget supports essential health care services from non-IHS or non-Tribal providers and includes inpatient and outpatient care, emergency care, transportation, and medical support services such as diagnostic imaging, physical therapy, laboratory, nutrition, and pharmacy services. PRC programs routinely pay full-billed charges for non-hospital services, including physician services. On average, this would add up to 70% more than would be paid by Medicare. As a result, the PRC program was running out of funds each year.
There was some Tribal concerns on changing this rule because many believed that lowering the rates would cause many providers to stop contracting with I/T/Us. However, implementing rates for non-hospital based providers will more likely increase the volume of services being sought which will result in providers achieving more volume to offset the decrease in rates.
The proposed rule is opt-in and not a requirement. This is in recognition of Tribal sovereignty and self-determination as Tribes have the right to negotiate with providers and determine how best to meet the needs of their community when providing health care.
The IHS announcement and the published rule states that the final rule became effective on March 20, 2016. IHS recognizes that this rule will have significant Tribal implications so in order to ensure that all concerns are taken into account, it will be implemented as a final rule with another 60 days for the public to provide comment on the rule. In addition, IHS will be conducting outreach and education to PRC administrators and participating providers and suppliers so that everyone is on the same page with the rule and there are no adverse impacts on the PRC system.
If you have comments or questions, please contact Eric Jordan, ANHB Policy Analyst at firstname.lastname@example.org.
The WWAMI Rural Health Research Center recently released a new report titled Access to Rural Home Health Services: Views from the Field.
In this report, key informants identified solutions for consideration to address barriers to access to home health services including, payment reforms (e.g. approving new provider types for reimbursement) and increasing telehealth options. Participants also raised concern about the growing burden of administrative requirements associated with reimbursement.
For the full report, click here.
On March 1, 2016 Secretary Burwell announced Mary Smith’s assumption of the IHS Principle Deputy Director position, reporting that Robert McSwain requested to serve in another capacity so as to spend more time with his family. The Alaska Native Health Board congratulates Mary Smith on her new role and expressed our appreciation for Mr. McSwain for his service.
Secretary Sylvia M Burwell’s announcement:
I am pleased to announce that IHS Deputy Director Mary Smith, an enrolled member of the Cherokee Nation, has agreed to serve as the Principal Deputy of the Indian Health Service and will be delegated the responsibilities of the Director, effective today. As such, she will report directly to the Secretary and be responsible for the day to day operations of the IHS as well as our priority IHS initiatives. She will also work directly with Acting Deputy Secretary Mary Wakefield on the Executive Council on Quality focused on our critical work related to the Great Plains Area and making sustainable improvements for direct service tribes throughout Indian country.
Since joining IHS in October 2015, Mary has led a number of key agency priorities including providing leadership on the progress we have made in behavioral health, native youth initiatives, such as Generation Indigenous, and serving as the primary IHS liaison to other federal agencies. She has also made significant contributions to the progress we’ve made on contract support costs as well as in our work on Medicaid in states where expansion will be of particular benefit to Native Americans. Mary has significant management experience from her time working in federal and state government and in the private sector. Mary’s expertise on Native American issues and track record of delivering impact for the tribal community will undoubtedly be great assets to IHS as she assumes this new role. I am very pleased to have Mary serve as Principal Deputy, and look forward to working with her in her new role.
I also want to express my appreciation to Bob McSwain, who has diligently carried out the responsibilities of the Director since February 2015. Bob has requested to serve in another capacity within IHS to allow more time to be with his family. Bob, a member of the North Fork Rancheria of Mono Indians of California, is a long time civil servant who began his federal career with the Indian Health Service in 1976. Bob has been a steward for IHS and committed to its mission of ensuring high quality comprehensive health services are available and accessible to American Indian and Alaska Native people across the United States. I appreciate Bob’s willingness to lead IHS during this important time.
Please join me in thanking Bob for his leadership and congratulating Mary on her new position.
Sylvia M. Burwell