Reimbursement rates for health care services authorized under the Indian Health Service contract health service regulations--HRSA. Issuance of statement of policy.
The Indian Health Service (IHS) is issuing this Statement of Policy to inform the public that the IHS will contract to purchase health services for Indian beneficiaries only with those hospitals, physicians and other health care providers which agree to accept, as payment in full, reimbursement at rates no higher than the prevailing Medicare allowable rates (including deductibles and co-payments). This encompasses those rates established for hospitals designated by the Health Care Financing Administration as "sole community providers" or "regional referral centers." Reimbursement rates for services not covered by Medicare allowable rates will be negotiated. In addition, the IHS will refer patients and/or arrange for the transfer of patients to IHS facilities or contract providers, so that non-contract providers will be used only in two situations: In emergency situations for services necessary to stabilize a patient prior to transfer to an IHS facility or to a contract provider, and in situations when the patient's health requires that the services be rendered by a particular provider which may not have a contract with the IHS. The IHS will phase this policy into administration of its contract health services programs. We may, upon further consideration and after consultation with tribal contractors, extend this policy to tribally administered contract health services programs. While tribal contractors are encouraged to adopt cost containment measures, this policy will apply only to contract health services programs administered by the IHS.
D006303:Health Services, Indigenous / Q000191:economics*; D006761:Hospitals; D007198:Indians, North American; D006278:Medicare / Q000331:legislation & jurisprudence*; D014481:United States; D014488:United States Health Resources and Services Administration