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Purchased/Referred Care Delivery Area Expansion website. The IHS announced a new website for PRC with the following:
“It includes a status tracker of submitted PRCDA Expansion requests, the PRCDA Listing, and a summary of PRCDA versus Service Delivery Area. A PRCDA refers to the geographic area within which PRC services will be made available by the IHS to members of an identified Indian community who reside in the area, subject to the provisions of 42 C.F.R. Part 136 Subpart C. Tribes may seek PRCDA re-designation or expansion to increase their geographical coverage to include beneficiaries not covered under their existing PRCDA. The PRCDA Expansion webpage will be updated on a routine basis with updated information as needed.”
The website is located here.
The IHS also noted in the March 12, 2024 announcement that:
Section 222 of the Indian Health Care Improvement Act protects IHS beneficiaries with authorized referrals. Vendors are prohibited from billing beneficiaries of the IHS for care provided under the PRC program. In summary, patients are not liable for services that are authorized by PRC, and vendors are prohibited from collecting any payments for these services from the patient, whether directly or through referral to an agent for collection. Patients experiencing this should promptly contact their service unit’s PRC program to resolve the billing issue. Vendors who continue to bill patients despite notification can be reported to Area PRC leadership and IHS attorneys for further action.
SAMHSA Medications for the Treatment of Opioid Use Disorder. SAMHSA revised and released the final rule in February 2024, to make COVID-19 flexibilities permanent, and to expand access to care and treatment for opioid-use disorder. These rules will go into effect in October 2024, allowing time for OTPs to prepare and for states to review their regulations that impact how this rule is implemented.
HRSA Announces Nearly $50 Million Initiative to Support Opioid Treatment and Recovery Services in Rural Communities. On Wednesday, March 6, HRSA Administrator Carole Johnson joined White House Domestic Policy Advisor Neera Tanden and more than 900 rural health stakeholders to announce the Rural Opioid Treatment and Response Initiative. The initiative includes the release of the latest Rural Communities Opioid Response Program notice of funding opportunity, RCORP-Impact. This program aims to increase access to life-saving treatment and help rural individuals achieve long-term, sustained recovery.
IHS Encounter Rate. Indian Health Service (IHS) Announces Calendar Year 2024 Reimbursement Rates and Launch of Associated Webpage: IHS Director Roselyn Tso issued a recent Dear Tribal Leader Letter in which she announced the publication of CY 2024 reimbursement rates in the Federal Register. The rates apply for inpatient and outpatient medical care provided at IHS facilities for Medicare (excluding inpatient Medicare Part A) and Medicaid beneficiaries, beneficiaries of other federal programs, and for recoveries under the Federal Medical Care Recovery Act. Director Tso also announced the launch of a new IHS website focused on all-inclusive rate reimbursement information, such as calculation and source documents. The new website is available here.
Outpatient per Visit Rate (Excluding Medicare)
Calendar Year 2024
Lower 48 States: $719
Outpatient per Visit Rate (Medicare)
Calendar Year 2024
Lower 48 States: $667
White House Tribal Nations Summit. On Dec. 6, 2023, President Biden signed a new Executive Order (EO) to reform how the federal government funds and supports Tribal Nations. The EO requires federal agencies to take action to ensure federal funding for Tribes is accessible, flexible, and equitable, creates a Tribal Access to Capital Clearinghouse for Tribes and Native businesses to find federal funding, requires the federal government to measure chronic funding shortfalls and develop recommendations for what additional funding and programming is necessary, and report annually on these recommendations.
Veterans Affairs Reimbursement Agreement. On Dec. 6, 2023, the Indian Health Service (IHS) and the Department of Veterans Affairs (VA) signed a revised reimbursement agreement. VA will reimburse IHS for purchased/referred care and contracted travel for AI/AN Veterans, in addition to direct care provided for AI/AN Veterans. The DTLL is located here, and the updated agreement is located here.
Indian Health Service Scholarships. The IHS Scholarship Program is accepting applications for scholarship support for the 2024-2025 academic year. The IHS Scholarship Comparison Chart shows a list of eligible degree programs.
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Eligible students are encouraged to apply by February 28, 2024.
White House Releases Playbook to Address Social Determinants of Health. This Playbook lays out an initial set of structural actions federal agencies are undertaking to break down silos and to support equitable health outcomes by improving the social circumstances of individuals and communities. To accompany this Playbook, the Department of Health and Human Services also released a Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework.
Health and Human Services (HHS) Region 10 Tribal Quarterly Call. HHS Region 10 hosted a quarterly call on Thursday, February 29, 2024. The Region X Tribal Consultation will be held in May.
Indian Health Service (IHS) Announces New Electronic Health Record System. IHS has selected General Dynamics Information Technology, Inc. to build, configure, and maintain a new IHS electronic health record system utilizing the Oracle Cerner technology.
CMS Provides Guidance to States on Coverage of Health-Related Social Needs (HRSNs). The CMS guidance provides opportunities available under Medicaid and Children’s Health Insurance Program (CHIP) to cover services and supports that address health-related social needs.
Tribal Protections in Medicaid and CHIP Managed Care Oversight Toolkit. This new toolkit provides resources for states, managed care plans, and Indian Health Care Providers to maximize the benefits of Medicaid and CHIP managed care for American Indian and Alaska Native enrollees consistent with the statutory and regulatory Indian managed care protections.
State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit. This updated toolkit serves as a consolidated and comprehensive compilation of telehealth policies, including related flexibilities and requirements, for states to consider when using telehealth to deliver Medicaid and CHIP benefits and services.
Mandatory Continuous Enrollment for Children in Medicaid and CHIP. Effective January 1, 2024, states are required to provide 12 months of continuous enrollment for children under 19 in Medicaid and CHIP. States may terminate eligibility for children under 19 for the following limited circumstances for children who reach age 19, cease to be state residents, request a voluntary termination of eligibility, or who are deceased, or the agency determines that eligibility was erroneously granted. States are not limited to providing only a 12-month continuous enrollment period for children. Oregon became the first state to receive approval from CMS to maintain eligibility for children from birth to six. Washington has a similar request waiting for approval by CMS.
Medicaid Unwinding Updates. The Consolidated Appropriations Act 2023 set an end date for the Medicaid continuous enrollment condition to March 31, 2023, which included a fourteen (14) month period for states to comply with Medicaid eligibility determination requirements. Since unwinding has commenced, there has been a dramatic loss in Medicaid coverage nationwide. The Tribal Self-Governance Advisory Committee is coordinating a Tribal-specific data survey to share with the Centers for Medicare and Medicaid Services to show the impact on Tribes and Tribal health programs. The Survey is available HERE.
National Institutes of Health (NIH) announces the establishment of the RADx Tribal Data Repository: Data for Indigenous Implementations, Interventions, and Innovations (D4I). After a competitive review, Stanford University, in partnership with the Native BioData Consortium, has been selected to lead this unique NIH-supported effort. The Native BioData Consortium is the first Indigenous-led 501(c)(3) nonprofit research organization and biodata repository within the geographic borders and legal jurisdiction of a Tribal Nation (Cheyenne River Sioux Tribe).
New Health Resources & Services Administration (HRSA) Director of Tribal Affairs, Juliana Blome, Ph.D. She formerly served as Deputy Director of the Tribal Health Research Office at the National Institutes of Health (NIH), where she worked alongside Dr. David Wilson (Navajo Nation). There, she focused on strengthening collaborations between NIH and American Indian and Alaska Native communities, building partnerships based on trust and transparency, and increasing cultural awareness in research that improves health in Tribal communities.
The Veterans Affairs (VA) Department Finalizes Rulemaking on the Pilot Program on Graduate Medical Education and Residency. Effective Dec. 13, 2023, the VA adopts the proposed rule issued on Feb. 4, 2022, as final, with changes, to amend its regulations to include a new pilot program on graduate medical education and residency. The final rule responds to written comments received, including several comments from Tribes and Tribal organizations.
The U.S. Government Accountability Office (GAO) Releases Report on Indian Health Service Federal Facilities. The Report, released in November 2023, found that many federally operated facilities are not in good condition and their medical equipment is aging. The GAO made three recommendations to IHS: to assess the extent of medical equipment data problems across IHS areas implement a plan to correct any problems, and regularly monitor adherence to IHS medical equipment inventory management policy requirements.
Not Invisible Act Commission Releases Final Report. The Report calls upon the federal government to declare a Decade of Action and Healing to address the crisis of missing, murdered, and trafficked American Indian and Alaska Native people. A summary of Key Findings and Recommendations can be found on page 11 of the Report.
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