The Indian Health Service (‘IHS’), an agency within the Department of Health and Human Services, oversees and is responsible for providing federal health services to members of federally recognized tribes including American Indians and Alaska Natives (hereafter referred to as “tribal members”).
Many tribal members receive medical care directly from tribal clinics and health facilities near their place of residence. However, some medical services are not available through tribal clinics. A program called Contract Health Services (“CHS”), administered by IHS, was instituted to supplement and complement other health care resources available to eligible Indian people, including care available from tribal clinics and other tribal health facilities. CHS funds are available for use in situations where: (1) no IHS direct care facility exists,(2) the direct care element is incapable of providing the required emergency and/or specialty care, (3) the direct care element has an overflow of medical care workload, and (4) supplementation of alternate resources (i.e., Medicare, private insurance) is required to provide comprehensive care to eligible Indian people.
Self Insured Plans LLC (SIP) is headquartered in Naples, Florida, with its’ National Service Center in Naperville, Illinois and a sales office in Honolulu, HI.
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Population Health Management and Disease Management
The ability to leverage Medicare pricing for tribal medical services under CHS provides significant savings to Tribal Health programs and allows tribal health organizations to extend the “buying” power of their health dollar. As can be seen from this summary of the legislation, there are requirements that must be met before MLR pricing is applicable, but the requirements are reasonable and easy to administer for most Tribal entities, especially with the assistance of SIP.