NCUIH and Center for Medicaid/Medicare Services Working Group Report about Reimbursement and Potential Legislative Action 12-08-09

Authors: National Council of Urban Indian Health, Center for Medicaid Services
Publication Year: 2009
Last Updated: 2016-04-06 12:54:08
Journal: NCUIH
Keywords: uihp, fmap, urban indian health program, cms, centers for medicaid services, FQHQ, federally qualified health centers, medicaid, reimbursements, all inclusive rate, OMB

Short Abstract:

On January 8th, 2009 NCUIH organized a Urban Indian CMS working group to identify issues and potential solutions involving Medicaid, Medicare and SCHIP. This working group will work to develop NCUIH positions on proposed legislation, policy statements to both Congress and the Transition team, as well as help formulate the NCUIH positions on health care reform measures that impact or otherwise affect CMS policies, procedures, and regulations. Jamie Bartgis and Danielle Delaney will staff this group and help develop and disseminate necessary information.


The Urban Indian CMS working group identified three major issues facing Urban Indian Health Programs: reimbursement rates, eligibility, and consultation/communication. These are issues that NCUIH will bring forward when discussing CMS with the new Administration and Congress. In particular, members noted that the FQHC reimbursement rates for Medicaid and Medicare are substantially lower than the reimbursement rates under the OMB all inclusive rate for Indian health programs. Members advocated either finding an administrative or legislative method for reaching the OMB all inclusive rate, or raising the FQHC reimbursement rates through legislative action. Members also raised the issue of eligibility for Medicaid, noting that many patients who did not fall into one of the categorical or financial eligibility standards for Medicaid were otherwise uninsured. Members suggested that, in addition to increased outreach efforts to enroll patients, that there be efforts to develop an Indian specific eligibility standard at the federal level for the Medicaid program. Differences between State Medicaid programs and the vulnerability of State Medicaid programs concern several members of the working group. Consultation with CMS was raised as a concern as many members have no contact with CMS and are left with unresolved issues as a result. Members also raised the point that without representation on TTAG, UIHP programs and clinics are not included in a number of Administrative policies, including the OMB reimbursement rate and reimbursement for auxiliary services.

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