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Michael Petruzzelli

, National Council for Mental Wellbeing

CMS Lifts Medicaid Rule, Expanding Access in Tribal Areas

March 31, 2016 | Medicaid | Comments
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Last month, the Centers for Medicare and Medicaid Services (CMS) announced it would be lifting a longtime payment prohibition, allowing Medicaid-eligible individuals who are American Indians and Alaska Natives to receive care through any Medicaid facility. Previous regulations only allowed for this population to receive such benefits through Indian Health Service/Tribal health facilities. This new interpretation will expand access to community-based services for over 2 million Americans who are eligible for Medicaid coverage through IHS.

The Indian Health Services (IHS) is a federal agency within the Department of Health and Human Services. It is responsible for providing comprehensive, culturally-competent health care treatment services for millions of American Indians and Alaska Natives. This new regulation will allow for IHS and Tribal health facilities to enter into care coordination agreements with non-IHS/Tribal providers to furnish specific services for this patient population while receiving the full Medicaid match rate.

 

According to CMS, care coordination would involve, at minimum:

  • The IHS/Tribal facility providing a request for specific services and relevant information about the patient to the non-IHS/Tribal provider;
  • The non-IHS/Tribal provider sending information about the care it provides to the patient, including the results of any screening, diagnostic or treatment procedures, to the IHS/Tribal facility;
  • The IHS/Tribal facility continuing to assume responsibility for the patient’s care by assessing the information and taking appropriate action, including, when necessary, furnishing or requesting additional services; and
  • The IHS/Tribal facility incorporating the patient’s information in the medical record through the Health Information Exchange or other agreed-upon means.

In the announcement, CMS says it intends to release additional guidance for patients and providers over the next few months. Stay tuned to Capitol Connector for more.