Common use of Indian Healthcare Providers Clause in Contracts

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid. An Indian health care provider means a health care program, including providers of contract health services, operated by the Indian Health Service (IHS) or an Indian Tribe, Tribal Organization or Urban Indian Organization (I/T/U) as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). The Contractor shall offer to enter into contracts with Indian health care providers participating in Medicaid and CHIPthat reflect the provisions in this Section 6.2.13. As outlined in In accordance with section 5006(d) of ARRA, the Contractor shall:   Permit any American Indian/ Alaska Native (AI/AN) Indian member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMPPMP (if applicable), to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  service;  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN Indian members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the available. The Contractor will shall be held to these standards.  ;  Reimburse Indian healthcare providers, whether in- in-or out-of-network, for covered services provided to AI/AN Indian members who are eligible to receive services from such providers in accordance with either at 1) a rate negotiated between the requirements set out in Section 1932(hContractor and the Indian healthcare provider, or 2) of if there is no negotiated rate, at a rate not less than the Social Security Act, 42 U.S.C. 1396u-2(h). The rate level and amount of payment shall that would be set at made if the Encounter Rate established services were provided by the IHS on an annual basis and published in the Federal Register.  in-network provider that is not an Indian healthcare provider;  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  8.5.3; and  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN Indian member by the amount of a co-payment copayment or other cost-sharing that would be due from the AI/AN Indian member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) of ARRA requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN Indian members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State state plan, which is the encounter rate determined by IHS in the annual federal register notice. To the extent OMPP FSSA requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 thirty (30) calendar days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  ▪ Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  ▪ Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  ▪ Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  ▪ Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  ▪ Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered EXHIBIT 1.E SCOPE OF WORK – HOOSIER HEALTHWISE services provided to an AI/AN member by the amount of a co-payment or other cost-cost- sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security ActXxxxxxxx Xxx, 42 U.S.C. 1396u-2(h00 X.X.X. 0000x-0(x). The EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-co- payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  ▪ Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  ▪ Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  ▪ Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  ▪ Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  ▪ Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-co- payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  ▪ Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  ▪ Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  ▪ Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  ▪ Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  ▪ Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid. An Indian health care provider means a health care program, including providers of contract health services, operated by the Indian Health Service (IHS) or an Indian Tribe, Tribal Organization or Urban Indian Organization (I/T/U) as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). The Contractor shall offer to enter into contracts with Indian health care providers participating in Medicaid and CHIPthat reflect the provisions in this Section 6.2.13. As outlined in In accordance with section 5006(d) of ARRA, the Contractor shall:   Permit any American Indian/ Alaska Native (AI/AN) Indian member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMPPMP (if applicable), to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  service;  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN Indian members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the available. The Contractor will shall be held to these standards.  ;  Reimburse Indian healthcare providers, whether in- in-or out-of-network, for covered services provided to AI/AN Indian members who are eligible to receive services from such providers in accordance with either at 1) a rate negotiated between the requirements set out in Section 1932(hContractor and the Indian healthcare provider, or 2) of if there is no negotiated rate, at a rate not less than the Social Security Act, 42 U.S.C. 1396u-2(h). The rate level and amount of payment shall that would be set at made if the Encounter Rate established services were provided by the IHS on an annual basis and published in the Federal Register.  in-network provider that is not an Indian healthcare provider;  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  8.5.3; and  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN Indian member by the amount of a co-payment copayment or other cost-sharing that would be due from the AI/AN Indian member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) of ARRA requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN Indian members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State state plan, which is the encounter rate determined by IHS in the annual federal register notice. To the extent OMPP FSSA requires utilization and/or reimbursement data from EXHIBIT 1.M SCOPE OF WORK the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 thirty (30) calendar days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:   Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.   Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.   Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  .  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.311.4.3.   Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid. An Indian health care provider means a health care program, including providers of contract health services, operated by the Indian Health Service (IHS) or an Indian Tribe, Tribal Organization or Urban Indian Organization (I/T/U) as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). The Contractor shall offer to enter into contracts with Indian health care providers participating in Medicaid and CHIPthat reflect the provisions in this Section 6.2.13. As outlined in In accordance with section 5006(d) of ARRA, the Contractor shall:  • Permit any American Indian/ Alaska Native (AI/AN) Indian member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMPPMP (if applicable), to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  service; • Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN Indian members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the available. The Contractor will shall be held to these standards.  ; • Reimburse Indian healthcare providers, whether in- in-or out-of-network, for covered services provided to AI/AN Indian members who are eligible to receive services from such providers in accordance with either at 1) a rate negotiated between the requirements set out in Section 1932(hContractor and the Indian healthcare provider, or 2) of if there is no negotiated rate, at a rate not less than the Social Security Act, 42 U.S.C. 1396u-2(h). The rate level and amount of payment shall that would be set at made if the Encounter Rate established services were provided by the IHS on an annual basis and published in the Federal Register.  in-network provider that is not an Indian healthcare provider; • Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  8.5.3; and • Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN Indian member by the amount of a co-payment copayment or other cost-sharing that would be due from the AI/AN Indian member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) of ARRA requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN Indian members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State state plan, which is the encounter rate determined by IHS in the annual federal register notice. To the extent OMPP FSSA requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 thirty (30) calendar days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  ▪ Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  ▪ Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  ▪ Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security ActXxxxxxxx Xxx, 42 U.S.C. 1396u-2(h00 X.X.X. 0000x-0(x). The EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  ▪ Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  ▪ Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:   Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.   Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.   Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.   Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.   Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.

Indian Healthcare Providers. An Indian health care provider is defined as the Indian Health Service (IHS) or an Indian tribe, tribal organization or urban Indian organization (often referred to as I/T/U). Section 5006 of ARRA provides certain protections for Indian health care providers in Medicaid and CHIP. As outlined in section 5006(d) of ARRA, the Contractor shall:  Permit any American Indian/ Alaska Native (AI/AN) member who is eligible to receive services from a participating Indian healthcare provider to choose to receive covered services from that Indian healthcare provider, and if that Indian healthcare provider participates in the network as a PMP, to choose that Indian healthcare provider as his or her PMP, as long as that Indian healthcare provider has the capacity to provide the services.  Demonstrate that there are sufficient Indian healthcare providers in the Contractor’s network to ensure timely access to services available under the Contract for AI/AN members who are eligible to receive services from such providers. CMS intends to issue regulations regarding sufficiency of Indian healthcare providers in states like Indiana where few Indian healthcare providers are available and the Contractor will be held to these standards.  Reimburse Indian healthcare providers, whether in- or out-of-network, for covered services provided to AI/AN members who are eligible to receive services from such providers in accordance with the requirements set out in Section 1932(h) of the Social Security Act, 42 U.S.C. 1396u-2(h). The rate of payment shall be set at the Encounter Rate established by the IHS on an annual basis and published in the Federal Register.  Make prompt payment to all in-network Indian healthcare providers as set forth in Section 8.4.3.  Not reduce payments to Indian healthcare providers, or other providers of contract health services (CHS) under referral by an Indian healthcare provider, for covered services provided to an AI/AN member by the amount of a co-co- payment or other cost-sharing that would be due from the AI/AN member if not otherwise prohibited under Section 5006(a) of ARRA. Section 5006(d) requires that the State provide a supplemental payment to non- non-FQHC Indian healthcare providers for covered services provided to AI/AN members. The amount of the supplemental payment is the difference, if any, of the rate paid by the Contractor for the services and the rate that applies to the provision of such services under the State plan. To the extent OMPP requires utilization and/or reimbursement data from the Contractor to make a supplemental payment to an Indian healthcare provider, the Contractor shall provide the requested data within 30 days of the request.