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28 Final Rule, 77 Fed. Reg. 18346. v.7, 2012‐09‐23a 29 Wording contained in IHCIA § 4(14), ISDEAA § 4(d), and IRC § 45A(c)(6), except that the underlined word (“pueblo”) is only contained in IRC § 45A(c)(6) and the double underlined words (“or group”) are only contained in IHCIA Sec. 4(14). 30 This is the result because pueblos are also considered to be Indian Tribes, nations, organized groups, and communities recognized as eligible for the special programs and services provided by the United States to Indians because of their status of Indians. 31 25 C.F.R. § 900.6 (HHS and Department of the Interior (―DOIǁ) Title I), 25 C.F.R. § 1000.2 (DOI Title IV), 42 C.F.R. § 137.10 (Title V). These regulatory definitions also include ―rancherias and colonies. 32 A significant percentage of American Indians and Alaska Natives that seek an exemption from the tax penalties may not engage an Exchange as the AI/AN individuals may have determined not to pursue health insurance coverage. For these individuals, it is assumed attestations would be made and/or documentation would be provided directly to the IRS. 33 Public Law 105-33. The primary protection established is “A State may not require… the enrollment in a managed care entity of an individual who is an Indian (as defined in section 4(c) of the Indian Health Care Improvement Act of 1977 of 1976 (25 U.S.C. 1603(c)) unless the entity is one of the following [Indian organizations] (and only if such entity is participating under the plan)… ” 34 For purposes implementing the protections afforded AI/AN in the Balanced Budget Act of 1997, see 42 C.F.R. § 438.50(d)(2). 35 In referencing subsection (c) of section 4 of the IHCIA, this definition of Indian is more restrictive than the reference to “Indian” under the IHCIA for purposes of the special monthly enrollment period for AI/ANs enrolled in the individual market through an Exchange (authorized under ACA § 1311(c)(6)(D)). 36 These cost-sharing protections for AI/ANs were established under § 5006 of the American Reinvestment and Recovery Act of 2009, Pub. L. 111-5. 37 See 42 C.F.R. § 447.50, promulgated May 28, 2010. 38 The Snyder Act is the primary statute authorizing the Federal government to provide health care to Indians and implementing the unique Federal obligations to Indians. It directs and authorizes HHS to “direct, supervise, and expend such moneys as Congress may from time to time appropriate, for the benefit, care, and assistance of the Indians throughout the United States” for the “relief of distress and conservation of health.” 25 U.S.C. § 13. 39 Medicaid Program; Premiums and Cost Sharing, 75 Fed. Reg., No. 103, pp. 30, 244, 30,248 (May 28, 2010). 40 Medicaid Program; Premiums and Cost Sharing, 75 Fed. Reg., No. 103, p. 30247. 41 For example, in a recent Section 1115 waiver application from the State of Kansas, a single operational definition of Indian was applied to both sets of Indian-specific Medicaid protections. 42 Federal Register, Vol. 75, No. 148, August 3, 2010, Request for Comments, “Planning and Establishment of State-Level Exchanges,” Section G. Enrollment and eligibility, Office of Consumer Information and Insurance Oversight, HHS, page 45588. 43 ACA § 1311 and 45 C.F.R. § 155.100. 44 ACA § 1413(b) and 45 C.F.R. § 155.405(a). “CHIP” refers to the Children’s Health Insurance Program under title XXI of the Social Security Act. 45 An additional approach to streamlining eligibility across federal programs is the implementation of a common methodology (“modified adjusted gross income”) for determining household income, as authorized by ACA § 1401 / IRC § 36B(d)(2)(B). 46 Conversely, as it appears to occur today under Medicaid, to simplify implementation a state or a subset of Exchange/Medicaid eligibility staff in a state might default to applying one definition for all Indian-specific purposes in a state. AI/ANs applying on one occasion or in one state may be found to be eligible whereas the same AI/ANs would be found to be ineligible on another occasion or in another state, or vice versus. 47 Such as grantees under the Navigator program authorized under ACA § 1311(i) or “in-person assisters”. See 45 C.F.R. § 155.210. Northwest Portland Area Indian Health Board Page 15 of 16
v.7, 2012‐09‐23a 48 Enacted through the passage of the ACA, Congress made the declarations of national Indian health policy in IHCIA § 103. 49 See discussion in the Final Rule at 77 Fed. Reg. 18383; and see 45 C.F.R. § 155.315(h) “Flexibility in information collection and verification” at Final Rule, 77 Fed. Reg. 18455. 50 Final Rule, 77 Fed. Reg. 18383. 51 Final Rule, 77 Fed. Reg. 18383. 52 An additional definition is used for purposes of determining eligibility for services through the Indian Health Service, although this generally aligns with the guidance under 42 C.F.R. § 447.50. 53 Final Rule, 77 Fed. Reg. 18455. 54 NCAI Res. # ABQ-10-080, November 2010, NIHB Res. 10-01, October 2010; TTAG October 2010; TSGAC February 2011; and NPAIHB, October 21, 2010. Northwest Portland Area Indian Health Board Page 16 of 16
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MEDICARE, MEDICAID, & HEALTH REFORM
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GENERAL INFORMATION TABLE OF CONTEN
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Last Updated: November 12, 2012 2.
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Ref. # 2. Task/Issue Person(s) CMS
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Ref. # II. POLICY Task/Issue Person
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IV. OUTREACH AND EDUCATION MMPC: SU
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MMPC October 9, 2012 Teleconference
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Page 77 and 78: Summary T he Indian Health Service
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Page 81 and 82: Introduction Reliable determination
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Indian Health Service, 2012. Federa
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Tribal Consultation Policy HHS 1. P
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defined in Sections 8 and 9 of this
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2. Office of Intergovernmental Affa
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will give equal consideration to th
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provide Indian Tribes with a region
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4. Each Operating Division Head/Dep
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Department’s ability to address i
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17. Sovereignty - The ultimate sour
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1. Selection of workgroup co-chairs
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It is unclear if this was just an o
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November 14 -15, 2012 TTAG FACE TO
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AGENDA: Day 2 Thursday - Nov. 15, 2
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Subpart G--Social Services Block Gr
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organization applying for or receiv
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members of a tribe receiving direct
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is at or below the poverty line. (d
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under this part. Grantees that rece
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income home energy assistance progr
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Need for Uniform Operational Guidan
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Dear Tribal Representatives, Octobe
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There is a strong correlation betwe
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Wed. Nov 14 th : SDPI National Call
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Future MMPC Meetings & Conference C
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Regulation Review and Impact Analys
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64. Policy on Conferring with Urban
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premium tax credit assistance and c
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Access to this benefit is criticall
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community providers for purposes of
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November 12, 2012 Centers for Medic
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_________ American Indian or Alaska
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November 9, 2012 Page 2 We are comm
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Tribal Consultation for Health Insu
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Background Analysis of Tribal Consu
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Analysis of Tribal Consultation Pol
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