Common use of Indian Beneficiaries Clause in Contracts

Indian Beneficiaries. The Contractor shall permit an Indian beneficiary who is eligible to receive services from an Indian health care provider (IHCP) participating as a network provider, to choose that IHCP as his or her provider, as long as that provider has capacity to provide the services. (42 C.F.R. § 438.14(b)(3).) The Contractor shall demonstrate it has sufficient IHCPs participating in its provider network to ensure timely access to services available under the contract from such providers for Indian beneficiaries who are eligible to receive services. (42 C.F.R. § 438.14(b)(1).) Contractor shall document good-faith efforts to contract with all IHCPs in Contractor’s county. If Contractor does not contract with a IHCP in Contractor’s county, Contractor must submit a written explanation to the Department of why it failed to contract with that IHCP, with supporting documentation. The Contractor shall permit Indian beneficiaries to obtain covered services from out- of-network IHCPs if the beneficiaries are otherwise eligible to receive such services. (42 C.F.R. § 438.14(b)(4).) The Contractor shall permit an out-of-network IHCP to refer an Indian beneficiary to a network provider. (42 C.F.R. § 438.14(b)(6).) Exhibit A – Attachment 8 A1 PROVIDER NETWORK

Indian Beneficiaries. The Contractor shall permit an Indian beneficiary who is eligible to receive services from an Indian health care provider (IHCP) participating as a network provider, to choose that IHCP as his or her their provider, as long as that provider has capacity to provide the services. (42 C.F.R. § 438.14(b)(3).) The Contractor shall demonstrate it has sufficient IHCPs participating in its provider network to ensure timely access to services available under the contract from such providers for Indian beneficiaries who are eligible to receive services. (42 C.F.R. § 438.14(b)(1).) The Contractor shall document good-faith efforts to contract with all IHCPs in the Contractor’s county. If the Contractor does not contract with a IHCP in the Contractor’s county, the Contractor must submit a written explanation to the Department of why it failed to contract with that IHCP, with supporting documentationdocumentation as provided for in BHIN 21-023. The Contractor shall permit Indian beneficiaries to obtain covered services from out- out-of-network IHCPs if the beneficiaries are otherwise eligible to receive such services. (42 C.F.R. § 438.14(b)(4).) The Contractor shall permit an out-of-network IHCP to refer an Indian beneficiary to a network provider. (42 C.F.R. § 438.14(b)(6).) Exhibit A – Attachment 8 A1 PROVIDER NETWORK)