Medicare-Like Rates

2. Medicare-Like Rates

3. Purpose • Introduce the regulation • Discuss covered services • Training opportunities

4. Section 506 of the MMA “Limitation on charges for Inpatient Hospital CHS provided to American Indians and Alaska Natives (AI/AN) by Medicare Participating Hospital” Requires Medicare participating providers to participate in the CHS program and charge no more than the Medicare-based rates to AI/ANs eligible for CHS services Effective Date - July 5th Overview

5. I/T/U’s can now benefit from Medicare’s bargaining power The cost savings will enable the CHS program to purchase much needed health care What Does This Accomplish -Savings

6. Medicare-participating hospitals must accept payment rates as set forth in this regulation as payment in full, which are the Medicare PPS Interim payment rate. Final Regulation

7. CHS payment will be no greater than the MLR No retrospective settlement will be done at year end like Medicare does It is the responsibility of the I/T/Us to calculate the maximum allowable payment rates The actual payment amount is provider specific Final Regulation

8. Medicare participating hospitals and their distinct part units (subunits), excluding physician services (paid under Part B): Acute Care Services (DRGs) Distinct parts of inpatient hospitals Psychiatric Services Rehabilitation facilities Hospital based clinics Psychiatric Hospitals Rehabilitation Hospitals Covered Services

9. Long Term Care Hospitals Skilled Nursing & Swing Beds Critical Access Hospitals Children's Hospitals Cancer Hospitals Covered Services (cont’d)

10. Accept the MLR as a condition of participation in Medicare Providers must submit their claims in accordance with Medicare timely filing guidelines – 18 months Providers cannot bill patients any balance Final Regulation

11. MLR take precedence over contracts except when contracts are lower than the MLR I/T/Us may negotiate rates that are lower than Medicare-based rates Physician contracts need to be pursued Provider Contracts

12. Use the IHS’ FI Contract with regional FIs Download the PC PRICERs from CMS Website – www.cms.gov Purchase PC PRICER commercial software Claims Processing Options

13. Training National Conference Call CHS Conference – July 23rd – 27th Phoenix, AZ CMS Day @ NIHB – September 27th Portland, OR IHS Web site CMS Med Learn website Training

14. We realize how beneficial this regulation is to the I/T/U programs in that it provides savings and the ability to purchase additional health care. Look forward to the training opportunities scheduled. Summary

15. Contacts Brenda Jeanotte-Smith 301-443-2694 301-443-0718 (fax) BJEANOTT@HQE.IHS.GOV

16. Department of Health and Human Services Public Health Service Indian Health Service