“Health Insurance Premium Tax Credit” (IRS REG-131491-10)

NIHB Supplemental Submission - Definition of IndianAccessible.AI/ANs are required to verify their status as Indians for a variety of purposes. Whenpromulgating the expansive definition of Indian found in 42 C.F.R. § 447.50, CMS explicitlyrecognized that ―administrative simplicity is very important‖ when it noted that for thepurposes of verifying Indian status for Medicaid cost-sharing protections:Documentation that an individual is an Indian could include Tribalenrollment and membership cards, a certificate of degree of Indianblood issued by the Bureau of Indian Affairs, a Tribal censusdocument, or a document issued by a Tribe indicating an individual‘saffiliation with the Tribe. The Indian health care programs and urbanIndian health programs are responsible for determining who is eligibleto receive an item or service furnished by their programs and so amedical record card or similar documentation that specifies anindividual is an Indian as defined above could suffice as appropriatedocumentation. These documents are examples of documents that maybe used, but do not constitute an all-inclusive list of suchdocuments. 101A similar need is present under the ACA and the same kind of solution is appropriateand supported by law. While the most efficient approach would be to use attestation as thebasis for determining who is Indian, NIHB recommends that when documentation of beingIndian is required under any of the definitions, any of the documents referenced for verifyingIndian status for Medicaid cost-sharing should apply equally under the IHCIA, ISDEAA, andIRC definitions. This could be addressed in the rules by setting out such language withregard to each of the special benefits or protections or by setting out an omnibus provisionregarding documentation and applying it uniformly to the others.6. Summary of ArgumentThe plain language of the statutory definitions referred to in the ACA does not limitthe definition of ―Indian‖ to members of Federally-recognized Tribes. HHS has authority toimplement regulations that clarify who is included in the definition of ―Indian‖ for thepurposes of the ACA due to the inherent ambiguity in the statutory drafting. Under theauthority of the Snyder Act, IHCIA and ISDEAA, it is appropriate and legally correct that asingle reconciled definition incorporate each category of individual included in the definitionof Indian found in 42 C.F.R. § 447.50.The objectives of the ACA cannot be achieved, and ambiguity and confusion willresult, if the application for Exchange plans and for Medicaid cannot be streamlined. Astreamlined application for all applicants and efficient and consistent processing for AI/ANs1012010).Medicaid Program; Premiums and Cost Sharing, 75 Fed. Reg. 30, 244, 30,248 (May 28,National Indian Health Board Page 23 of 24 October 31, 2011