Indian Health Care Providers. For Contractor’s provider contracts entered into on or after January 1, 2015, Contractor shall reference the Centers for Medicare & Medicaid Services “Model QHP Addendum for Indian Health Care Providers” (“Addendum”) available for download here: xxxxx://xxx.xxxxxxxxxxxxxxxx.xxx.xxx/s/Model_QHP_Addendum_Indian_Healt h_Care_Providers.pdf?v=1 Contractor is encouraged to adopt the Addendum whenever it contracts with those Indian health care providers specified in the Addendum. Adoption of the Addendum is not required; it is offered as a resource to assist Contractor in including specified Indian providers in its provider networks.
Indian Health Care Providers. For Contractor’s provider contracts entered into on or after January 1, 2015, Contractor shall reference the Centers for Medicare & Medicaid Services Model QHP Addendum for Indian Health Care Providers (“Addendum”) along with the Overview of the Model QHP Addendum for Indian Health Care Providers (“CMS Overview”) attached hereto as Attachment 12. Contractor is encouraged to adopt the Addendum whenever it contracts with those Indian health care providers specified in the Addendum. Adoption of the Addendum is not required; it is offered as a resource to assist Contractor in including specified Indian providers in its provider networks.
Indian Health Care Providers. (i) DVHA must demonstrate that there are sufficient Indian Health Care Providers (IHCPs) participating in the provider network to ensure timely access to services available under the contract from such providers for Indian beneficiaries who are eligible to receive services.
(ii) DVHA must ensure that IHCPs, whether participating or not, be paid for covered services provided to Indian beneficiaries who are eligible to receive services at a negotiated rate between DVHA and the IHCP or, in the absence of a negotiated rate, at a rate not less than the level and amount of payment DVHA would make for the services to a participating provider that is not an IHCP.
(iii) DVHA must ensure that Indian beneficiaries are permitted to obtain covered services from out-of-network IHCPs from whom the beneficiary is otherwise eligible to receive such services. Conversely, DVHA must permit an out-of-network IHCP to refer an Indian beneficiary to a network provider.
Indian Health Care Providers. 2.7.3.5.1. The STAR+PLUS MMP shall offer Indian Enrollees the option to choose an Indian health care Provider as a PCP if the STAR+PLUS MMP has an Indian PCP in its Network that has capacity to provide such services; in addition, the STAR+PLUS MMP shall permit any Indian who is enrolled in a non-Indian MMP and eligible to receive services from a participating I/T/U Provider to choose to receive Covered Services from that I/T/U Provider.
2.7.3.5.2. The STAR+PLUS MMP shall demonstrate that it has sufficient access to Indian health care Providers to ensure access to Covered Services for Indian Enrollees;
2.7.3.5.3. The STAR+PLUS MMP shall pay both Network and Out-of-Network Indian health care Providers who provide Covered Services to Indian Enrollees a negotiated rate which shall be no lower than the HHSC FFS rate for the same service or, in the absence of a negotiated rate, an amount not less than the amount that the STAR+PLUS MMP would pay for the Covered Service provided by a non-Indian health care Provider;
2.7.3.5.4. The STAR+PLUS MMP shall make prompt payment to Indian health care Providers; and
2.7.3.5.5. The STAR+PLUS MMP shall pay Out-of-Network Indian health care Providers that are FQHCs for the provision of services to an Indian Enrollee at a rate equal to the rate that the STAR+PLUS MMP would pay to a Network FQHC that is not an Indian health care Provider.
2.7.3.5.6. The STAR+PLUS MMP may restrict Enrollment of Indians in the same manner as Indian health programs restrict delivery of services to Indians.
Indian Health Care Providers. Insurer shall maintain sufficient numbers of Indian Health Care Providers (IHCPs) in Insurer’s Provider network to ensure timely access to services from such Providers to those Enrollees eligible to receive such services. Insurer shall provide a quarterly attestation and supporting documentation to FHKC demonstrating compliance with this requirement. Insurer shall allow any Enrollee who is eligible to receive services from a network IHCP to choose the IHCP as his or her PCP so long as the IHCP has the capacity to provide the services. Insurer must also allow any Enrollee who is eligible to receive services from an IHCP to obtain services covered under the Contract from an out-of-network IHCP. Insurer shall allow out-of- network IHCPs to refer Enrollees to a network Provider. Should there be too few IHCPs in the State to ensure timely access to Covered Services, Enrollees who are eligible to receive such services shall be permitted to access out-of-state IHCPs. Insurer shall pay for Covered Services provided to eligible Enrollees by IHCPs, whether participating in the network or not, at either the rate negotiated between Insurer and the IHCP or at a rate not less than the level and amount of payment Insurer would make for services to a non-IHCP network Provider. Insurer shall make all payments to network IHCPs in a timely manner, as required by 42 CFR 447.45 and 447.46. When an IHCP is also an FQHC, but is not a network Provider, Insurer shall pay the IHCP an amount equal to the amount Insurer would pay a participating FQHC that is not an IHCP. When an IHCP is not an FQHC, regardless of network participation status, the IHCP has the right to receive its applicable encounter rate published annually in the Federal Register by the Indian Health Service, or in the absence of such published encounter rate, the amount it would receive if the services were provided by the State’s Medicaid fee for service payment methodology. Insurer shall pay IHCPs the full amount an IHCP is eligible to be paid. No supplemental payments from FHKC will be provided for these payments under any circumstances. Insurer is responsible for the entire amount.
Indian Health Care Providers. To the extent Participating Provider is an Indian Health Care Provider, Participating Provider shall execute and comply with the Medicaid Managed Care Addendum for Indian Health Care Providers. (Section VII, H).
Indian Health Care Providers a. With respect to Indian Health Care Providers (IHCPs), Contractor shall:
(1) Offer contracts to all Medicaid eligible IHCPs in its Service Area, offering reimbursement at the same IHS or PPS encounter rate, as applicable to the specific IHCP, that OHA would pay the IHCP if billed to OHA for a FFS Member;
(2) Provide CCO-enrolled Indian Health Services beneficiaries who have been seen and referred by IHCPs with access to specialty and primary care within Contractor’s Provider Network. The CCO-enrolled Indian Health Services beneficiaries must be provided with such access regardless of whether a referring IHCP is one of Contractor’s Network Providers ;
(3) [RESERVED]
(4) Contractors and IHCPs interested in entering into a contract must reach an agreement on the terms of the contract within six months of expression of interest or initial discussion between Contractor and IHCP, unless an extension is agreed in writing upon by both parties.
(a) If Contractor and IHCP do not reach an agreement on the terms of the contract within six months, the IHCP may request the assistance of a State representative to assist with negotiation of the contract.
(b) The State will use an informal process to facilitate an in-person meeting with Contractor and IHCP to assist with the resolution of issues.
(c) If an informal process does not lead to an agreement, Contractor and IHCP will use the existing dispute resolution process described in OAR 410-141-3560. The informal process shall be used as guidance and will not be binding.
(d) Upon agreement of terms Contractor and IHCP must finalize and approve the contract within ninety (90) days of reaching an agreement.
Indian Health Care Providers a. With respect to Indian Health Care Providers (IHCPs), Contractor shall:
(1) Offer contracts to all Medicaid eligible IHCPs in its Service Area;
(2) Provide CCO-enrolled Indian Health Services beneficiaries who have been seen and UHIHUUHG E\ ,+&3V ZLWK DFFHVV WR VSHFLD Network. The CCO-enrolled Indian Health Services beneficiaries must be provided with
(3) [RESERVED]; and
(4) Contractors and IHCPs interested in entering into a contract must reach an agreement on the terms of the contract within six months of expression of interest or initial discussion between Contractor and an IHCP, unless an extension is agreed to in writing upon by both parties.
(a) If Contractor and an IHCP do not reach an agreement on the terms of the contract within six months, the IHCP may request the assistance of a State representative to assist with negotiation of the contract.
(b) The State will use an informal process to facilitate an in-person meeting with Contractor and the IHCP to assist with the resolution of issues.
(c) If an informal process does not lead to an agreement, Contractor and the IHCP will use the existing dispute resolution process described in OAR 410-141-3560. The informal process shall be used as guidance and will not be binding.
(d) Upon agreement of terms Contractor and the IHCP must finalize and approve the contract within ninety (90) days of reaching an agreement.
