The Role of CMS in Indian Health Care



welcome everyone I'm Jennifer doll the CMS tribal affairs office has developed this video to provide an overview of the important role CMS plays in improving the health care of American Indians and Alaskan Natives CMS tribal affairs serves as the primary liaison between CMS and the American Indian and Alaskan Native communities tribal affairs along with designated Native American contacts and each regional office are there to assist and support PMS component and other federal partners on Indian health issues both at the national and regional level there are over five million American Indians and Alaska Natives living in the United States many are eligible for and are enrolled in Medicare Medicaid the Children's Health Insurance Program and the marketplace when American Indians and Alaska Natives enroll in CMS programs they have greater access to health services and tribal communities benefit by enhanced resources to Indian health care providers in their communities American Indians and Alaskan Natives are in ethnically diverse population there are 567 federally recognized tribes and over 250 languages actively spoken American Indians and Alaska Natives call the entire continent home from the Everglades of Florida to the northern reaches of Alaska the federal government entered into nearly 400 treaties with Indian tribes in the 18th and 19th centuries Indian tribes ceded millions of acres of land to the federal government for certain rights and benefits including the provision of health care the US Constitution establishes the basis for the government-to-government relationship and that relationship has been upheld by US Supreme Court decisions federal law and regulations this government-to-government relationship distinguishes American Indians and Alaska Natives from all other ethnic groups in the United States the federal government's responsibility for Indian health care has changed over the years initially the responsibility was in the War Department and then was transferred to the Department of the Interior in 18-49 then in 1954 to the Indian Health Service a sister agency within the Department of Health and Human Services the Indian Health Service is the primary federal agency responsible for providing health care to American Indians and Alaska Natives the indian health service delivery system is comprised of health programs operated by the Indian Health Service tribes and tribal organizations under the Indian self-determination act sometimes called 638 tribes and urban Indian organizations under the title 5 of the Indian Health Care Improvement Act these are referred to as urban Indian clinics the Indian Health Service along with its tribal and urban partners is the comprehensive delivery system that provides culturally appropriate health care to over 2 million American Indians and Alaska Natives in 1976 Congress enacted the Indian Health Care Improvement Act and amended titles 18 and 19 of the social security act to authorize Indian Health Service to receive reimbursement for services provided to Medicare and Medicaid beneficiaries revenues from Medicare and Medicaid are used to meet compliance and accreditation standards to reduce health resource deficiencies and can in most instances represent approximately 25 to 50 percent of local Indian health budgets as you can see CMS plays a key role in fulfilling the federal government's responsibility to provide health care to American Indians and Alaskan Natives and any changes in CMS policies and programs can have a significant impact on Indian health providers and beneficiary access to care executive order one three one seven five consultation and coordination with Indian tribal governments affirm the federal government's commitment to work with tribal governments on a government-to-government basis and required each federal agency to consult with tribal permits subsequent presidential memoranda have reaffirmed this commitment the CMS tribal consultation policy requires the agency to consult on any policy that will significantly impact Indian tribes although determined on a case-by-case basis such issues could arise in any policy area for which CMS has responsibilities such as program eligibility standards changes in provider payment and reimbursement methodologies or changes in service was covered by CMS programs an easy way to determine whether CMS needs to consult is to see if your policy uses the words Indian tribe tribal or Native American however that's not the only time consultation may be required other policies such as those implementing general policies applicable to hospitals clinics and other health providers could significantly impact Indian health providers and may require consultation CMS tribal affairs is available to help you determine whether something you're working on triggers consultation tribal consultation is unique to the government-to-government relationship between Indian tribes and the federal government consultation is defined as an enhanced form of communication that emphasizes trust respect and is intended to be an open and free exchange of information resulting in mutual understanding consultation can be invoked by CMS or the tribes and any stage of policy development or decision-making over the years we have found that many issues can usually be resolved more effectively if consultation occurs in the early stages of policy development a copy of the CMS tribal consultation policy can be found at go CMS gov flesh AI aan scroll down to tribal consultation please also visit this webpage to find more information about CMS tribal affairs and to learn more about Indian Health through other learning opportunities such as webinars all tribes calls PowerPoint presentations and outreach and educational materials CMS tribal affairs wants to thank you for all the work you do every day that has a significant impact on the health and daily lives of all American Indians and Alaskan Natives

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