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Spotlight

CMS Division of Tribal Affairs
Important information for our tribal partners

 

The Role of CMS in Indian Health Care

This video highlights the history of Indian Health Care, CMS Tribal Consultation and the significant impact that CMS programs have in Indian Country.  Click on the link below to view:

https://www.youtube.com/watch?v=I2EnR88gIZM

Federal Funding for Services “Received Through” an IHS/Tribal Facility and Furnished to Medicaid Eligible AI/ANs

On February 26, 2016, the Center for Medicaid and CHIP Services (CMCS) issued a State Health Official letter (SHO) to inform state Medicaid agencies and other state health officials about an update in payment policy affecting federal funding for services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. Under the updated policy, IHS/Tribal facilities may enter into written care coordination agreements with non-IHS/Tribal providers to furnish certain services for their patients who are AI/AN Medicaid beneficiaries. Amounts paid by the state Medicaid program for services requested by facility practitioners in accordance with those agreements are eligible for federal matching funds at the enhanced federal matching rate (FMAP) of 100 percent.

CMS is releasing an FAQ document that addresses common questions related to the provisions at pages 5-6 of the SHO letter relating to Medicaid billing and payments to non-IHS/Tribal providers. Questions related to other provisions of the SHO letter will be addressed in subsequent FAQs.

The FAQs can be found here, https://www.medicaid.gov/federal-policy-guidance/downloads/faq11817.pdf

 

CMS Informational Bulletin on Indian Provisions in the Medicaid Managed Care Rule

The Center for Medicaid and CHIP Services (CMCS) issued an Informational Bulletin on the Indian provisions of the final Medicaid and the Children’s Health Insurance Program (CHIP) managed care regulation. The purpose of this Informational Bulletin is to summarize the relevant provisions into one document, clarify current statute and regulation regarding mandatory enrollment of Indians into managed care, and provide sample language for an Indian Addendum that can be offered to managed care plans on a voluntary basis when executing network provider agreements with Indian health care providers (IHCPs). In addition to the Informational Bulletin, CMCS also released a Model Medicaid and CHIP Managed Care Addendum for IHCPs.2:30-5

The Informational Bulletin and the Addendum can be viewed here: https://www.medicaid.gov/federal-policy-guidance/downloads/cib121416.pdf.

CMS Informational Bulletin on Enrollment

The Center for Medicare & Medicaid Services (CMS) released an Informational Bulletin that provides strategies and helpful information for states, Tribes, Tribal organizations, Indian health care providers, and application assisters to increase enrollment of American Indians and Alaska Natives (AI/ANs) into programs administered by CMS.

The bulletin describes specific strategies for states, such as Tribal Access to State Medicaid Eligibility Portals, out stationing of eligibility workers at Tribal FQHCs, Tribal Medicaid Administrative Match, express lane eligibility for children, presumptive eligibility, and continuous eligibility to increase enrollment of AI/ANs. Specific strategies for Tribes to use are described as best practices and include suggestions such as making personal contact and building trust, holding enrollment events at tribal powwows or other cultural events, and using social media and radio stations to improve outreach and education efforts.

The Informational Bulletin is available on Medicaid.gov at  https://www.medicaid.gov/federal-policy-guidance/downloads/cib112816.pdf

BOOKMARK

CMS recently clarified its policy regarding zero and limited cost sharing plans:
Members of federally recognized tribes with incomes between 100% and 300% FPL can continue to enroll in a zero cost sharing plan, which means they won’t pay any out-of-pocket costs like co-payments, coinsurance, or deductibles for services covered by their Marketplace health plan.   CMS has clarified its policy to enable members of federally recognized tribes with incomes below 100% and above 300% FPL (regardless of income) to enroll in a limited cost sharing plan, which means  they won’t pay any out-of-pocket costs for services received from an Indian health care provider or from another provider if they have a referral from their Indian health care provider. 

CMS has created a bookmark (product #11816-N) that explains this policy clarification that can be distributed as part of your outreach and education efforts.

It is especially important to make sure you order this bookmark (product # 11816-N) when ordering the following materials:
•         Tribal Fact Sheets (product #11643-N)
•         Coverage to Care (product #11813-N)
•         Tribal Glossary (product #11900-N)