The Role of CMS in Indian Health Care

Welcome everyone 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 Alaska Natives. CMS Tribal Affairs serves as the primary liaison between CMS and the American Indian and Alaska Native communities. Tribal Affairs, along with designated Native American Contacts in each Regional Office, are there to assist and support CMS components 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 Alaska Natives are an 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 U.S. Constitution establishes the basis for the “government to government relationship” and that relationship has been upheld by U.S. 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 was transferred to the Department of the Interior in 1849, 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 title V 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 a comprehensive delivery system that provides culturally appropriate health care to over 2 million American Indians and Alaska Natives. In 1976, Congress enacted the Indian Healthcare 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 50% 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 Alaska 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 13175 Consultation and Coordination with Indian Tribal Governments, affirmed 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 governments. 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 responsibility, such as program eligibility standards, changes in provider payment and reimbursement methodologies, or changes in services 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 at 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, 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, power point presentations and outreach and educational materials. CMS Tribal Affairs wants to thank you for all of the work you do every day that has a significant impact on the health and daily lives of all American Indians and Alaska Natives.

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