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Spotlight
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SAVE THE DATE

All Tribes Consultation Webinar on a
Proposed Tribal Exemption from the Four Walls Requirements

Date: August 8, 2024
3:00-4:00 PM Eastern Time

Registration Link:

https://kauffmaninc.zoom.us/webinar/register/WN_PLbTCYfSR7KACn4Ll8k5mA

 

The Centers for Medicare & Medicaid Services (CMS) Division of Tribal Affairs, in collaboration with the CMS Division of Benefits and Coverage, is holding an All Tribes Consultation Webinar on August 8, 2024 from 3:00-4:00pm Eastern Time on a proposed Tribal exemption from the Medicaid clinic services benefit at 42 CFR 440.90, as published in the Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Proposed Rule - CMS-1809-P.  The proposed rules were published on July 10, 2024, and written comments to the proposed rule are due September 9, 2024 following instructions in the Federal Register notice for submission of comments.

 

Link to PDF: https://public-inspection.federalregister.gov/2024-15087.pdf   starting on page 700.
 

In this rule, CMS is proposing changes to the Medicaid clinic services benefit at 42 CFR 440.90. This benefit requires that services are provided in the clinic, with an exception for furnishing services outside of the clinic to individuals who are unhoused. We refer to this as the “four-walls requirement.” CMS is proposing a mandatory exception from the four walls requirement for IHS and Tribal clinics, which means they can provide clinic benefit services outside the four walls and bill at the facility rate, which would be the All Inclusive Rate for IHS and Tribal clinics. CMS is also proposing optional exceptions to the four walls requirement that would target populations that are served by clinics in rural areas, and behavioral health clinics. 

 

For more information on CMS Tribal outreach materials and resources, visit  https://go.cms.gov/AIAN

A recording of this All Tribes Webinar will be found our Spotlight page at https://go.cms.gov/AIAN

 

SAVE THE DATE

All Tribes Consultation Webinar on Medicare Provisions for IHS and Tribal Facilities in the OPPS Rule (1809-P)

Date: Thursday, July 25, 2024
3:00-4:00 PM Eastern Time

Registration Link: https://kauffmaninc.zoom.us/webinar/register/WN_92m8XwGNQRCJjUrSaZ5lGA

The Centers for Medicare & Medicaid Services (CMS) Division of Tribal Affairs, in collaboration with collaboration with the CMS Center for Medicare, is holding an All Tribes Consultation Webinar on Thursday, July 25, 2024 from 3:00-4:00pm Eastern Time to provide an overview of two important provisions relevant to Indian Health Service and Tribally-operated facilities participating in Medicare. These provisions are proposed in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (CMS-1809-P) published on July 5, 2024. Written comments to the proposed rule are due September 9, 2024 following instructions in the Federal Register notice for submission of comments.

Link to PDF of proposed rule: https://public-inspection.federalregister.gov/2024-15087.pdf

In the CY 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule, CMS is proposing revised payment policies to increase access to certain high-cost drugs for tribally owned and Indian Health Services (IHS) hospitals. CMS is proposing, starting January 1, 2025, to separately pay IHS and tribal hospitals for high-cost drugs furnished in hospital outpatient departments through an add-on payment in addition to the IHS Medicare Outpatient All-Inclusive Rate (AIR) using the authority under which the annual AIR is calculated. CMS is seeking comment on this proposal and related items such as definition of a high-cost drug, payment methodology and implementation plan. See pages 487-495 of the rule.

In addition, CMS is requesting information in order to evaluate a CMS Tribal Technical Advisory Group’s request for CMS to amend its Medicare regulations to make all IHS- and tribally operated outpatient facilities/clinics eligible for payment at the IHS Medicare Outpatient AIR. In the CY 2022 Physician Fee Schedule (PFS) rule, CMS solicited a similar request for information but did not receive specific information on costs or specific types of clinics. In the final CY 2022 PFS rule, CMS committed to continuing to evaluate current Medicare payment policies for IHS and Tribal facilities, CMS is soliciting information in the CY 2025 OPPS rule. See pages 495-498 of the rule for specific information being sought, but in general CMS is interested in knowing the type and number of facilities or clinics and whether the facilities are participating in Medicare as an FQHC or a physician office, etc.

For more information on CMS Tribal outreach materials and resources, visit https://go.cms.gov/AIAN

A recording of this All Tribes Webinar will be found our Spotlight page at https://go.cms.gov/AIAN

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AVAILABLE STAKEHOLDER RESOURCES

Check out our Partner Tools and Toolkits webpage! It includes a wide range of updated materials, including:

  • Virtual Event in a Box (PDF) The box includes instructions and links to Marketplace promotional materials in various languages to use at outreach and educational events.

  • Downloadable Materials: The materials include Marketplace promotional and customizable materials in various languages. Resources available include talking points, reference sheet, social media toolkit, graphics, and other promotional materials.
  • Reference Sheet (PDF): This document highlights resources to share with your partners.
  • Apply to become a Champion for Coverage: Apply to become a Champion for Coverage or encourage other organizations in your area to become Champion for Coverage!
  • Order Free Educational Materials: Order products and have them shipped directly to your organization.

AVAILABLE CONSUMER RESOURCES

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The 2023 – 2024 Calendar New Order is here!

Image of the cover to the 2023-2024 CMS AIAN Calendar

CMS’ Division Tribal Affairs is pleased to announce the release of our 18th month calendar for July 2023 to December 2024. This calendar features health information, website links to excellent resources, planning space for items applicable to your family, and other ways to improve your overall health.

The information in the calendar is intended to assist Tribal families in taking better control of their health, including enrollment in health coverage through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
To order the CMS Tribal 2023 -2024 calendar or any of our outreach materials, please visit the Tribal Products Ordering Page. Please allow 2 weeks for your order to be completed.

We hope you enjoy the calendar!

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Do you or a family member currently have health coverage through Medicaid or the Children’s Health Insurance Program (CHIP)?

Is your mailing address up to date?

If so, you may soon need to take steps to find out if you can continue your coverage. Soon, states will resume Medicaid and CHIP eligibility reviews. This means some people with Medicaid or CHIP could be disenrolled from those programs. However, they may be eligible to buy a health plan through the Health Insurance Marketplace ®, and get help paying for it.


Here are some things you can do to prepare.

  • Make sure your address is up to date.
  • Make sure your state has your current mailing address, phone number, email, or other contact information. This way, they’ll be able to contact you about your Medicaid or CHIP coverage.

Get more information

  • Contact your state Medicaid office or visit Medicaid.gov for more information about Medicaid or CHIP renewal.
  • Call the Marketplace Call Center at 1-800-318-2596 to get details about Marketplace coverage. TTY users can call 1-855-889-4325.
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Help spread the word to promote COVID-19 vaccination so we can reach community immunity.

We Can Do This. We’re working to promote COVID-19 vaccine confidence, encourage prevention, and support our partners’ efforts to reach their communities.

Through strong partnerships with tribes and urban Indian organizations across Indian Country, the Indian Health Service has administered more than 1 million COVID-19 vaccines in Native communities, but there is still more work to do to reach community immunity.

You can help by:

Related Links

Page Last Modified:
07/19/2024 10:35 AM
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