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:
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
Today, 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
Essential Community Provider (ECP) List and Petition for the 2018 Benefit Year
For the Marketplace’s 2018 benefit year, the Centers for Medicare & Medicaid Services (CMS) has released the updated Essential Community Provider (ECP) Petition to collect more complete data from providers who qualify as an ECP and wish to appear on CMS’s ECP list for the 2018 benefit year. The ECP petition is a web-based questionnaire that is available at the following link: https://data.healthcare.gov/cciio/ecp_petition.
CMS releases an updated list of ECPs on an annual basis to assist issuers in complying with the requirements under 45 CFR 156.235. Under that regulation, ECPs are defined as health care providers who serve predominantly low-income, medically underserved individuals. They include health care providers defined in section 340B(a)(4) of the Public Health Service (PHS) Act; entities described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act (SSA); State-owned family planning service sites, governmental family planning service sites, not-for-profit family planning service sites that do not receive Federal funding under special programs, including under Title X of the PHS Act; or Indian health care providers.
The Draft HHS ECP list for the 2018 benefit year is embedded within ECP petition and can be viewed by clicking the button “Check to see if you are on the list” under question 6 of the petition located at https://data.healthcare.gov/cciio/ecp_petition. Providers included on the draft HHS ECP list for the benefit year 2018 reflect those providers who submitted an ECP petition between December 9, 2015 and July 11, 2016 and were approved by CMS for inclusion on the ECP list through the ECP petition review process. CMS has published this draft HHS list of ECPs to provide entities on the list an opportunity through the petition process to notify CMS of any necessary corrections and missing provider data. In addition, CMS solicits providers who do not yet appear on the HHS ECP list but believe they satisfy the ECP inclusion criteria, as outlined in the ECP petition, to petition to be added to the list.
CMS is accepting petitions from qualified providers until 11:59 p.m. ET on October 15, 2016, for data corrections and additions to be considered for the 2018 ECP List.
Providers who need technical assistance with the ECP petition or may have general questions may receive assistance by emailing their question(s) to the following mailbox: EssentialCommunityProviders@cms.hhs.gov. Providers should write in the subject line of the email the following: "Comments on ECP Petition."
We appreciate your interest in partnering with CMS to improve the accuracy of the ECP list.
The CMS ECP policy team
Health Plan Summary of Benefits and Coverage Announcements
On July 13, 2016, CMS released sample completed SBCs for a limited cost sharing plan and a zero cost sharing plan. As with the other SBC documents, these documents will be posted to the CCIIO website and shared with issuers as a reference tool. In particular, we note a number of additions to the sample completed SBC for the limited plan variation. That sample completed SBC shows the cost sharing the consumer would be responsible for at an Indian Health Care Provider (IHCP) or a non-IHCP. The SBC also explains under the limitations, exceptions, and other important information section that if a consumer goes to an out-of-network provider that charges more than the allowed amount the consumer may have to pay the difference (often referred to as balance billing).
Lastly, the instructions to the new SBC template released on April 6, 2016 directs issuers to include language below the coverage examples in the limited cost sharing plan variation SBC to explain that the examples assume that the patient is receiving care from an IHCP provider or with an IHCP referral at a non-IHCP. This language also explains that the consumer’s costs may be higher if care is received from a non-IHCP provider without a referral from an IHCP. In addition, on July 1, 2016 we released the translated SBC and glossary in four additional languages: Chinese, Spanish, Tagalog, and Navajo (oral and written).
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)
NEW CMS Medicaid Estate Recovery Rules and Protections for Indians Brochure
CMS Tribal Affairs is pleased to announce the release of the Medicaid Estate Recovery Rules and Protections for Indians Brochure. Section 5006 of the American Recovery and Reinvestment Act (ARRA) exempts certain Indian income, resources, and property from being subject to Medicaid Estate Recovery. This brochure explains the Medicaid Estate Recovery rules and the exemptions and protections for American Indians and Alaska Natives (AI/ANs). The Medicaid Estate Recovery Rules and Protections for Indians Brochure is now available for downloading at http://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Downloads/MedicaidEstateRecoveryBrochure.pdf
This brochure supports our outreach and education efforts to encourage AI/AN enrollment in CMS programs and was developed with input from the CMS Tribal Technical Advisory Group (TTAG) and our federal partners at Indian Health Service (IHS) and Health & Human Services Intergovernmental and External Affairs (HHS IEA).
For more outreach and education resources for AI/ANs and Indian health providers please visit the CMS AI/AN website: http://go.cms.gov/AIAN-OutreachEducationResources
- DTLL Tribal Consultation 022113 [PDF, 150KB]
- DTLL Tribal Consultation Policy Review 8.2.14 [PDF, 250KB]
- DTLL-2015-Health-Insurance-2-4-14 [PDF, 64KB]
- Navigator DTTL 4_10_2013 [PDF, 36KB]
- ITU Addendum Tribal Leader Letter [PDF, 1MB]
- Tribal Leader Letter 12/5/12 [PDF, 89KB]
- Medicare Part D ITU addendum [PDF, 741KB]
- CMS ICD-10 Industry Email Updates
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- Page last Modified: 06/21/2017 9:33 AM
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