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 by search at: xxxxx://xxx.xxx.xxx/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces . 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”) 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. 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. 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.
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).
