Special Rules for American Indians. If applicable, for Indian managed care entities, the Contractor may restrict Enrollment of Indians in the same manner as Indian Health Programs may restrict the delivery of services to Indians. Indians who are enrolled in a non-Indian managed care entities and eligible to receive services from a participating I/T/U Provider, to elect that I/T/U as his or her Primary Care Provider, if that I/T/U participates in the network as a Primary Care Provider and has capacity to provide the services.
Special Rules for American Indians. If applicable, for Indian managed care entities, the Contractor may restrict Enrollment of Indians in the same manner as Indian Health Programs may restrict the delivery of services to Indians. Indians who are enrolled in a non-Indian Contractor and are eligible to receive services from a participating I/T/U provider, may elect that I/T/U as the Member’s Primary Care Provider, if that I/T/U participates in the network as a Primary Care Provider and has capacity to provide the services. Indian Members shall be permitted to obtain services covered under this Contract from Out-of-Network Indian Health Care Providers from whom the Member is otherwise eligible to receive such services. Refer to Section 6.2.10 for more information regarding Indian Health Services.
Special Rules for American Indians. B.7.01. Restricting Enrollment of Indians. Contractor is not an Indian Managed Care Entity. As such, the Contract does not allow Contractor to restrict enrollment of Indians in the same manner as Indian Health Programs may restrict the delivery of services to Indians. See: Section 1932(h)(3) of the Social Security Act; State Medicaid Director Letter (SMDL) 10-001; 42 C.F.R. § 438.14(d); 42 C.F.R. § 457.1209. {From CMSC B.7.01}.
